Ayesha Abdullah 19.08.2019

1. & Introduction to the Practice of Ophthalmology Ayesha Abdullah 19.08.2019

6. Plastic Surgery Paediatrics Surgery Neurosurgery Surgery Medicine Obstetrics & Gynaecology Endocrinology Neurology ENT Cognitive Psychology Neuroscience Psychiatry

8. Who are they and what was their contribution Helen Keller Loius Braille Claude Monet Galileo Galile Franklin Delano Roosevelt

11. LEARNING OBJECTIVES By the end of this lecture the students should be able to: Define blindness, visual impairment & low vision according to the WHO- ICD-10 classification Critically evaluate the definition & its implications Describe the global burden of blindness & visual impairment. Identify the major causes of blindness at global and national level. Recognize the impact of blindness on the life of the individual and the society

12. Definition of blindness 1. International Statistical Classification of Diseases & related health problems, 10th revision (ICD-10) Blindness is defined in different ways in different countries according to the purpose of definition i.e legal, social, clinical etc WHO recommends the ICD-101 –based definition In Pakistan we use the same

13. http://apps.who.int/classifications/icd10/browse/2010/en

14. Definitions • There are 4 levels of visual function, according to the International Classification of Diseases -10 • Normal vision • Moderate visual impairment • Severe visual impairment • Blindness “low vision” Visual Impairment

16. Definition of blindness (ICD-10,Visual impairment (VI) categories 3, 4 & 5) Blindness is defined as a visual acuity (VA) of less than 3/60 (20/400) in the better eye with best possible correction Or A visual field in the better eye to less than 100 from fixation Key words?

17. 5 3 6 4 2 1 visual acuity less than 3/60

18. Which one is the better eye? 6/12 1/60 1/60 2/60 in the better eye

19. best possible correction

20. visual field loss Better eye less than 100

25. Let’s examine a few scenarios

26. EPIDEMIOLOGY OF BLINDNESS AND VISUAL IMPAIRMENTMAGNITUDE AND CAUSES

27. MAGNITUDE OF BLINDNESS & VI- 10 important facts • 285 million people are estimated to be visually impaired worldwide: 39 million are blind and 246 have low vision. • About 90% of the world's visually impaired live in low-income settings. • 82% of people living with blindness are aged 50 and above. • Globally, uncorrected refractive errors are the main cause of moderate and severe visual impairment; cataracts remain the leading cause of blindness in middle- and low-income countries. • 80% of all visual impairment can be prevented or cured. http://www.who.int/mediacentre/factsheets/fs282/en/ http://www.who.int/features/factfiles/blindness/blindness_facts/en/index9.html

28. 10 important facts The number of people visually impaired from infectious diseases has reduced in the last 20 years according to global estimates work. Blinding trachoma now affects fewer than 80 million people, compared to 360 million in 1985 Aging populations and lifestyle changes mean that chronic blinding conditions such as diabetic retinopathy & ARMD are likely to rise further Women face a greater risk of vision loss than men  Restorations of sight, and blindness prevention strategies are among the most cost-effective interventions in health care An estimated 19 million children are visually impaired. Of these, 12 million children are visually impaired due to refractive errors, a condition that could be easily diagnosed and corrected. 1.4 million are irreversibly blind for the rest of their lives

29. Global distribution

31. Distribution of causes of blindness

32. “ Avoidable & unavoidable blindness” 4 out of 5 (80%) of the world’s blind are blind of avoidable causes of blindness • Avoidable Blindness • That can be either treated or prevented by known, cost-effective means • Unavoidable blindness • Can you give some examples of each

33. Blindness of the Hearts So have they not traveled through the earth and have hearts by which to reason and ears by which to hear? For indeed, it is not eyes that are blinded, but blinded are the hearts which are within the breasts. Al –Hajj 22:46

34. “And whoever turns away from My remembrance-indeed, he will have a depressed life and We will gather him on the Day of Resurrection blind.”…….. Taha [20:124]

36. Cataract

37. Glaucoma Irreversible Visual Loss Damage to Optic Nerve Raised Intraocular Pressure

39. Glaucoma

44. Corneal opacity

45. Childhood blindnessmortality & morbidity Normal Keratomalacia Vitamin A deficiency

46. Trachoma

47. Age-related macular degeneration Orbit

48. Diabetic Retinopathy