As the world celebrates the World Sight Day, let us spare a few thoughts on the visually impaired and persons living with low vision (partially sighted) in our country, Nigeria. The following illustration culled from the Community Eye Health Journal(Vol. 21 issue 66) paints an ideal picture of what obtains in most eye clinics and hospitals in Nigeria:
“Mary K, a sixty-five year old widow, had been gradually losing her sight over the past five years. Looking after her three grandchildren had become increasingly difficult. Recently, her neighbour told her about the eye hospital 100km away; the neighbour had heard of older people who came back from the hospital able to see again.
After much convincing, Mary made plans to go to the eye hospital. She sold three bags of maize and gave her radio to the taxi driver so that he would take her to the hospital. The grandchildren cried when they saw her leave but her neighbour agreed to look after them for a few days. All this was worth it; after all she would come back able to see again.
Mary was sick in the taxi and the road took its toll on her old aching body, but she did not mind because the eye doctor would make her see again. After two hours of waiting in the queue at the eye clinic, Mary was seen by the eye doctor. She was very excited. Dr N examined her eyes and after what seemed like forever, he told her that she should go back to the village. He was sorry, but there was nothing he could do for her eyes. Mary protested and told him what her neighbour had said, but he just repeated the same words. “I am sorry, there is nothing I can do for you” Mary walked out of the eye clinic, wondering what to do. No one could help her and no one seemed to care.
Unfortunately, in many parts of the world, the above scenario is all too common in eye clinics. Faced with patients like Mary, eye care practitioners often feel uncomfortable and do not know what to say. Too often therefore, these patients are turned away when in fact much can be done to help them. Patients like Mary who are not completely blind, but whose sight cannot be improved either by treatment (such as cataract surgery) or by the provision of ordinary near or distance spectacles can benefit from low vision assessment and rehabilitation. Sadly, this component of eye care is underdeveloped or completely missing in our eye care system.
The World Health Organisation (WHO) fact sheet on visual impairment (Fact Sheet No 282: updated April 2011) has the following facts:
- 80% of all visual impairment can be avoided or cured
- About 284 million people are visually impaired worldwide: 39 million are blind and 245 million have low vision
- About 90% of the world’s visually impaired people live in developing countries
- Globally, uncorrected refractive errors are the main cause of visual impairment but in middle and low income countries cataracts remains the leading cause
- The number of people visually impaired from infectious diseases has greatly reduced in the last 20 years.
In Nigeria, the National Survey of blindness and low vision estimates that there are 1 million blind Nigerians and 3 million living with low vision. Thus, the majority of visually impaired people have significant residual vision and most may benefit from low vision rehabilitation.
VISION 2020, the Right to Sight, a World Health Organisation (WHO) initiative has provided a new impetus to the concept of comprehensive eye care encompassing eye health promotion and prevention of blindness, treatment of eye diseases and rehabilitation services for people with incurable eye conditions. The hitherto underdeveloped component of low vision, along with services for refractive error, has been identified as priority area for intervention. In view of the VISION 2020 initiative, rehabilitation of low vision patients is now being given attention in different parts of the world and Nigeria must not be left out.
From the earlier illustration, perhaps all that Mary actually needed to go home happy was to be told why her vision could not be restored and that a rehabilitation worker would make a home visit. This person would have demonstrated to Mary what adaptations could be made to her home, allowing her to make the best use of her vision. Mary could also have been helped if someone had informed her of any social welfare benefits she would be entitled to.
If Mary needed to see things near to her, she may have benefitted from getting a simple magnifier to help her take stones out of rice or read (if she where literate). However, being reassured that she would not go completely blind and that help was available is perhaps the greatest service Mary could have received.
In conclusion, we need to act now by including low vision and rehabilitation services in existing eye care systems; create awareness amongst all medical, social, and rehabilitation services to ensure that patients like Mary are not sent home without any promise of help, because tomorrow that person with low vision could be you.
Dr Ogbonna Obiora is an Optometrist at Maxivision Eye Hospital and the of Low Vision Foundation. mainobiora@yahoo.com
