Dr. Anita Ambastha, A08530, Dr.Kumari Preeti, Dr. Gyan Bhaskar, Dr. Rakhi Kusumesh
INTRODUCTION:
Blindness has been recognised as an important public health problem in India, with prevalence of 1% 1.India was the first country in the world to launch a 100% public funded programme for the control of blindness2. For this requisite data has been collected by various nationwide surveys. The last nationwide survey was undertaken in (1999–2001) to document the current situation, trends over the past three decades, and to evaluate the impact of the World Bank supported Cataract Blindness Control Project in the country3,4.
The surveys in the last 10 years have been mostly Rapid Assessments for ages 50 years and older, and national studies for all ages with or without WHO Eye Survey Protocol have been few. As a consequence data could be limited in representation of ages 5 The cost entailed prevents these surveys to be carried out and hence unable to track short term trends and to formulate need based policies. We suggest that by analyzing blindness certification we can get useful and quick information regarding causes of blindness age wise and also note changing trends in time to act with appropriate policy.
This study examined causes by age group of visual impairment by analyzingdata for the period April 2015 to March 2017 from Blindness certifications issued.The aim of this paper is to provideestimates on causes of certifications for blindness and various degrees of visual impairment in Bihar
Material and Method;
Regional Institute of Ophthalmology, Patna, Bihar is notified by the state governmentto issue blindness and visual impairment certificates after recommendation by a certification committee. Visual impairment disability catagories based on severity and proposed disability percentages (Govt. of India)6 was used to certify and give percentage. Category 3 and 4 was defined as BCVA<3/60 or limitation of the field of vision subtending an angle of less than10 degree in the better eye (100% impairment). Category 2 was defined as BCVA<6/60 or limitation of the field of vision subtending an angle of 10- 20 degree (75% impairment). Category 1 was defined as best-corrected visual acuity <6/18 in the better eye (40%).One Eyed persons with BCVA 6/6 in better eye and less than FC 1 ft in worse eye are alloted 30% impairment for certification . People recommendedfor certificationhad irremediable causes of blindness.
Treatable causes like cataract, refractive errors, after cataracts were excluded. Amblyopia post cataract surgery was incuded under complicated cataract surgery.In the application forms for disability certification, BCVA of both eyes noted along with cause of visual impairment. The main cause of visual impairment was ascertained where possible for all certificates completed during April 2015 to March 2017 and tabulated by age group(0-15,16-30,31-45, 46-65,66 and above),aetiology and gender. In this study we used NPCB definition of blindness which is BCVA less then6/60 or Field of vision less than 20 degree in better eye.Hence we included Categories 2 , 3 and 4 (75% to 100% vision impairment) as blind. Category 1(40% visual impairment)was considered as moderate visual impairment. All applicants for certification were given certificates with percentage impairment.
One eyed people were given certificates but were not considered visually impaired as per its definition. For all age grps most common cause of certification and visual impairment were noted, both of which might differ.All patients with BCVA below 40% in better eye including blind were considered as visually impaired for the sake of simplicity of interpretation
RESULTS
AGE WISE DISTRIBUTION OF MOST IMP CAUSES OF CERTIFICATION
AGE WISE DISTRIBUTION OF FIRST AND SECOND MOST COMMON CAUSES OF BLINDNESS
AGE DISTRIBUTION OF CAUSES OF BLINDNESS
| DISEASE | 0-15YRS | 16-30YRS | 31-45YRS | 46-65YRS | >65YRS |
| ONE EYED | 5 | 40 | 10 | 1 | – |
| CORNEAL SCAR BE | 3 | 4 | 2 | ||
| OPTIC ATROPHY | 7 | 9 | 5 | 3 | |
| MACULAR SCAR/DYSTROPHY | 5 | 19 | 6 | 4 | |
| COLOBOMA/CONG RETINAL/GLOBE CONDITIONS | 12 | 5 | 3 | ||
| CONG GLAUCOMA | 2 | ||||
| COMPLICATED PSEUDOPHAKIA | 12 | 14 | 3 | ||
| RETINITIS PIGMENTOSA | 9 | 2 | |||
| GLAUCOMA | 1 | 6 | 1 | ||
| ARMD | 1 | ||||
| CHRONIC UVEITIS | 3 | 2 | |||
| PATH MYOPIA | 2 | 4 | |||
| DIABETIC RETINOPATHY | 2 | ||||
Discussion
Disability certificates like those for blindness offer lot of benefits to the reciepients.. Hence there are many applicants for these certificates. Total number of applicantsof applicants in our study was 203 and certificates were issued to all.
Maximum number of people applying for certification andcertification and diagnosed with VI was between15-45yrs (43%). The most common diagnosis anddiagnosis and cause of certification was amblyopia in this group. Being One Eyed they were given a percentage point of 30% which is not eligible for govt benefits/various concessions as they are not considered visual impaired6. Govt benefits canbenefits canbe availedbe availed from 40%certification onwards. In the BIn age grp 0-15 yrs most common cause of visual impairment andimpairment and certification was Congenital Globe and hereditory retinal and optic nerve problemss at 41% which was in line with other studies. Complicated Aphakia and pseudophakia waspseudophakia was the second most common cause in this age group with26%.
In a population based survey by Dandona et al7.Amblyopia after cataract surgery accounted foraccounted for 8.3% of allof all childhood blindness. Complicated Aphakia/pseudophakia also accountedalso accounted for 16 % of% of all certification between 0-30 age group. and was the second most common cause of visual impairment in this age group too. High incidence of this could be due to few dedicated paediatric units in Bihar in govt sector with trained surgeons andsurgeons and poor followupfollow-up of patients due to high level of illiteracy.Macular scar(20%) was the most common cause of visual impairment inimpairment in 15-30 yearr age group,mostly, mostly HMD. Between age grp 30-45,
Cornealcorneal scar (16%)was) was the most common cause of certification while macular scar was the most common cause of VI. This could because of more incidence of keratitis in this age grp because thisgroup is active in economic activities like farming and also susceptible to trauma. This is in line with other studies8. Between 45-65 yrs, DR(30%) was the most common cause of visual impairment and certification followed by glaucoma(20%) Shailbala Patil9 et al noted in there survey in people above 50 yrs of age that 3.5% had diabetic retinopathyand 0.8% had glaucoma. In patients above 65 yrs of age DR was the most common cause of certification and blindness.
Conclusion:
Estimates: Estimates of vision impairment based on certifications for blindness are likely to be imprecise. They do, however, give some measure of the burden at hospital level of sight impairing eye conditions and changing trends in causes of blindness. There is need to have robust school eye screening programme to treat Amblyopia as most certifications were demanded by this group.
More dedicated paediatricdedicated paediatric units need to be established with better followup of children operated for cataract as complicated catarct surgery has turned out to be an important preventable cause of blindnes in this study. Increasing trend of DR blindness would point to greater need to have early screening and treatment facilities for DR.
References
1.NPCB NEWSLETTER 2017
2.Mohan M. National survey of blindness—India. NPCB-WHO report. New Delhi: Minsitry of Health and Family Welfare, Government of India, 1989.
3.Banthia JK. Census of India 2001: Series 1—India: provisional population totals. New Delhi: Registrar General and Census Commissioner, India, Government of India, 2001:1–311.
4..Dandona L, Dandona R, John RK. Estimation of blindness in India from 2000 through 2020: implications for blindness control policy. Nat Med J India2001;14:327–34.
5.Mohan M. Collaborative study on blindness (1971–1974). A report. New Delhi: Indian Council of Medical Research, 1987:1–65
6.Home: Office of the Chief Commissioner for Persons with Disabilities …https://www.ccdisabilities.nic.in/page.php?p=dop_
7.R Dandona and L Dandona,Childhood blindness in India: a population based perspectiveCornea. 2002 Aug;21(6):555-9.
8. Gopinathan U1, Garg P, Fernandes M, Sharma S, Athmanathan S, Rao GNThe epidemiological features and laboratory results of fungal keratitis: a 10-year review at a referral eye care center in South India.Indian J Ophthalmol. 2014 Feb; 62(2): 240–245
9. Shailbala Patil et al, Prevalence, causes of blindness, visual impairment and cataract surgical services in Sindhudurg district on the western coastal strip of IndiaIndian J Ophthalmol. 2014 Feb; 62(2): 240–245
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