BLINDNESS & ENVIRONTMENTAL RISK OF OPHTHALMOLOGICAL PROBLEMS bydr. Nunuk Maria Ulfah, Sp.M.M.Kes

Blindness Problempatient : time ability work chance -patients relatives:time to care costgoverment :facilities for blinds people

Vision and Blindness

___________________________________________________Criteria Corrected Bilateral Vision___________________________________________________ Minimal Maximal 1 6/60 6/18 2 3/60 6/60 3 1/60 3/60 4 Light perception 1/60 5 No light perception___________________________________________________ Criteria : 3,4,5 : Blindness

THE WORLD BLINDNESS: ( WHO Fact sheet, 2000 )185 million: impaired vision (visus less than 6/18) -45 million : blind * 95% under developed country * 1/3 South East Asia * 80% avoidable( cataract nearly half of the worlds vision loss, and 80% may die before they have a chance for surgery in 1995 low of cataract surgical rate )- 12 peoples blind every minute in the world 4 peoples come from South East Asia

WORLD BLINDNESS CAUSES OF BLINDNESS:Cataract Corneal DiseasesRetinal DiseasesGlaucomaOptic AtrophyTrauma

INDONESIAN BLINDNESS -- CAUSES OF BLINDNESS:CataractGlaucomaRefraction anomalyCorneal diseasesRetinal Diseases

CATARACTMost common caused of blindness in the world 17 million 40 million in 2020majority of cases: old age

CATARACT (continued) - Cataract surgery: efective & efisien the problems of surgical coverage : high cost, lack of trained surgeon, deliver care, facilitiesIndia: blindness from cataract were not operated China & Nepal: 46% - 48% were operated Malawi: 1 between 7 blindness cataract has received surgery

CATARACT (continued) - Risk factors: age mostly old agecigarette smoking USA: 25 % smoker 20% cataract: smokerultra violet exsposuredisease: diabetes, diarrhea, gout, rubellanutritionsteroid usealcohol use

CATARACT (continued) - Prevention: screeningeye health education

OCULAR TRAUMAglobal health eye problemdefinition:mechanical thermal electrical damaged to the eye chemical

OCULAR TRAUMA (continued)caused morbidity, mortality, disability55 million eye injuries / year globally blindness prevalence : 1.6 million & vision impaired: 19 millionUSA: * 1,6 2,4 million eye injured / year 40.000 blind ( 1/3 from sport)* charges US $ 175 200 million for 227.000 eye trauma hospital days.

OCULAR TRAUMA (continued)- Risk factors:agriculture trauma from stick of : rice, sugar cane, bamboo corneal infection / harvesting keratitis corneal scaring blindnessconstruction stones, bricks, mortar, chalk, etcindustry welding, grinding, carpentry, gas explode, etc occupation:

OCULAR TRAUMA (continued)2. home accident:chemical trauma : hair spray , hair dye, insecticide, glue etcthermal: burn while cooking ,etcmechanical: trauma from using knife, scissor, etc

OCULAR TRAUMA (continued)3. sport and games:badminton (malaysia: 2/3 from ocular injury, 50% hyphemas) tennis, boxingguns & air riffle shot , guns toy shot, etc

OCULAR TRAUMA (continued)4. cultural:traditional medicine plant juices, pounded ,etc 5. traffic accident: cranial injuries optic atrophy eye injuries

OCULAR TRAUMA (continued)- Classification:* closed globe injury the eyewall does not have full thickness wound. - contusion - superficial foreign body - lamellar laceration

OCULAR TRAUMA (continued)* open globe injury eye wall has a full thickness wound - rupture from blunt trauma - laceration & penetration - perforation - intraocular foreign body

OCULAR TRAUMA (continued)- Hospital ocular trauma studies:* Tanzania : annual rate injuries per 100.000 : 8.3 caused by: stick (67%) men 60 years and older * Singapore : annual rate per 100.000: 12.6 globe penetration men 20 -29 years old

OCULAR TRAUMA (continued)- Hospital ocular trauma studies:* Melbourne : annual rate per 100.000 : 15.2 pounding metal on metal male outworker * Scotland : annual rate per 100.000: 8.14 home (52%) men 15 34 years old

OCULAR TRAUMA (continued)- Prevention:protective face and eye wear for sport & industrial activitiesseat bealt & helmet legislationsport and games legislationeye health education

TRACHOMAeye infectious disease caused by chlamydia trachomatistransmitted by the hand to eye contact and from face flies contactto cause 15% world blindness 150 million infected and 6 million blind

TRACHOMA (continued)WHO gradingTF ( trachoma follicular): follicels, pannusTI ( trachoma intense) : hipertrophy follicelsTS ( trachoma scarring )TT ( trachomatous trichiasis )CO (corneal opacity )

TRACHOMA (continued)Risk Factors:geographic: poor community without acces to water Sahara Africa, Nepal,Brazil etcenvirontment:fliesclean water

TRACHOMA (continued) Prevention: WHO strategy SAFE:S urgery to correct entropionA ntibiotica: tetracyclin topical & oral, azithromycin oralF ace cleanliness campaignE nvirontmental improvements

MICROBIAL KERATITISattributed to: trachoma, xerophthalmia,measles, neonatal ophthalmia, leprosy agricultural work (ocular trauma ), etcmicrobial keratitis corneal ulceration corneal blindnesscorneal ulceration:caused monocular visioan impaired worldwide second to cataract as the main cause of vision impairmentmost : caused by bacterial str. Pneumoniae fungi fusarium

MICROBIAL KERATITIS (continued)- most: farmer, laborer men more at risk than women productive years

MICROBIAL KERATITIS (continued)- risk factors:geographic: warm & humid fungi montainous bacterialsocial, ethnic: contact lens user corneal trauma farmer, laborer, brick/stoneworker low social economic lack access to health care

MICROBIAL KERATITIS (continued) prevention:eye health educationantibiotic anti fungal topical for corneal trauma

REFRACTIVE ERROR Andhra pradesh, India: 4% had bad vision due to refr err 0.3 % blindessRefractive errorhypermetropimyop responsible for vision loss

REFRACTIVE ERROR (continued)Myop: prevalence: USA 85: 28,5% age 40 & > Taiwan : 11 % age 7-18 India : 3,2 % age < 15 9 % age 16-39 36% age >40

REFRACTIVE ERROR (continued) refractive error correction: spectacles, contact lens, laserrisk factor: genetic: family history social: education level / intelligence, near work low birth weight and prematurityprevention: school & community screening

ONCHOCERCIASISParasitic infection caused by filarial nematode: Onchocerca volvulus spread by vector blackfly: Simulium ( breeds in fast flowing river )Mostly found : africa, latin america

ONCHOCERCIASIS (continued)- Problems: WHO: 17.5 million people infected globally 99% in africa , rest in latin america 500.000 : vision disability120 million live in endemic area are at risk

ONCHOCERCIASIS (continued)- Clinical finding:onchocercal nodules at the bony prominence (rib, knee)palpable lymphe nodes in onchodermatitisonchodermatitis (acute, chronic, lichenified, atrophy, depigmentation)ocular sign microfilaria migrate in to the globe keratitis uveitis chorioretinitis

ONCHOCERCIASIS (continued)- Risk factors:exsposure to bites by infected females black fliesgeographic factors tropic / high temperaturesocial farming, fishing,fetching water

ONCHOCERCIASIS Prevention:screeningprotective clothing vector control insecticide