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internationalArticles edition from C ommunity Eye Health CEHJ 77&78 JOURNAVOLUMEL 2 | ISSUE 4 | DecembeR 2012 INDIAN EDITION Low vision: we can all do more Hasan Minto Regional Director for the Eastern Mediterranean, International Centre for Eyecare Education. Dole Kuldeep Clare Gilbert Co-director, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; Clinical Advisor, Sightsavers. Despite all the treatments, operations, and medication at our disposal, there is still a significant number of people whose sight we cannot fully restore. What happens to these patients once they leave our care? Without the neces- sary support, advice, and low vision devices, their remaining vision will not be very good; this can make life a struggle. Low vision assessment. Support may be difficult to find, as low INDIA vision services are often inadequate or inaccessible in many low- and middle- vision interventions once all other treat- Low vision has a significant impact on income countries. Professionals, such as ments the person needs (surgical, medical people’s lives. People with low vision may rehabilitation workers, ophthalmologists, and/or optical) have been given. The struggle to look after themselves without mid-level eye care workers, optometrists/ definition also emphasises the importance help. Having low vision affects their refractionists, and special education of vision for day-to-day functioning. status in the eyes of others and can make teachers, may not know what to do about People who may be able to benefit from social situations difficult. It reduces the people with low vision, leaving them with low vision care will want to do a range of ability of people to pursue an education, to no-one else to turn to. different things. In many low- and middle- look after their children, and to earn Individuals who can only see light or income countries, for example, many an income. People with low vision are also movement of large objects will need people with low vision are aged over at greater risk of falls and death. rehabilitation that focuses on non-visual 50 years and cannot read or write. They With our support, people with low strategies for learning and daily tasks. will have different needs, and require vision can make better use of their sight to However, there are many people who have different services, compared to children do the things they want and need to do. slightly better vision, but are still classified or adults in employment. We hope this issue will show you how. as blind, who have the potential to use their sight. These people could benefit In this issue from low vision care, which may include 1 Low vision: we can do more 14 Making life easier for people with low refraction, provision of magnifiers, and/or Hasan Minto and Clare Gilbert vision environmental modifications. 2 Understanding low vision Clare Gilbert The World Health Organization defines Clare Gilbert 16 Low vision care: who can help? a person who needs to be assessed for 3 Comprehensive low vision services in Karin van Dijk low vision care as someone “who has West Bengal 17 Improving access to low vision services impairment of visual functioning even Subhra Sil Asim Kumar Sil Peggy Pei-Chia Chiang, Jill E Keeffe after treatment and/or standard refractive 6 Low vision: the patient’s perspective 18 CEHJ– promoting improvement in eye correction, and has a visual acuity of less Karin van Dijk health for over 20 years than 6/18 down to and including light 7 When someone has low vision Elmien Wolvaardt Ellison perception, or a visual field of less than Clare Gilbert, Karin van Dijk 19 Improving patient flow through an eye 10 degrees from the point of fixation, but 12 How to predict the near magnification clinic who uses, or is potentially able to use, vision needed Jonathan Pons for the planning and/or execution of task.” 14 Improving our patients’ experience: 20 MEdia’s role in eliminating The important part of this definition is ideas for change avoidable blindness Sally Crook, Boateng Wiafe that people should only be assessed for low M Deshpande, G V Rao, Sridevi S COMMUNITY EYE HEALTH JOURNAL INDIAN EDITION | VOLUME 2 ISSUE 4 1 Community Eye Health LOW VISION SERVICE DELIVERY Understanding Comprehensive low vision services JOURNALINDIAN EDITION Supporting VISION 2020: The Right to Sight low vision in West Bengal Clare Gilbert Subhra Sil DNB, Sil Asim Kumar Co-director, International Centre for Eye Health, Senior Consultant, Netra Niramay Volume 2 | Issue 4|December 2012 London School of Hygiene and Tropical Niketan Vivekananda Mission Ashram, Medicine, Keppel Street, London WC1E 7HT, Chaitanyapur, Purba Medinipur, West Editor International edition UK; Clinical Advisor, Sightsavers. Elmien Wolvaardt Ellison [email protected] Bengal, India Editor Indian edition Who is likely to have low vision? Asim Kumar Sil DNB, MSc, Kuldeep Suhas Dole [email protected] As a rule of thumb, the following people are Medical Director, Netra Niramay Niketan Vivekananda Mission Editorial committee likely to need low vision services and must be Ashram, Chaitanyapur, Purba Nick Astbury referred wherever possible: Figure 1. Blurred vision. People with Medinipur, West Bengal, India Allen Foster blurred vision (right) have difficulty Clare Gilbert • All children who have undergone bilateral Ian Murdoch seeing details, both at distance and GVS Murthy cataract operations, both those with nearby; they often have problems with India has an estimated 280,000 blind Daksha Patel pseudophakia and those with aphakia glare. Printed materials and colours children, which is one of the highest in the Richard Wormald might seem faded. world. According to different studies (1) David Yorston • People with diabetic macular oedema whose Serge Resnikoff vision remains poor despite laser treatment the prevalence of childhood blindness in • People with age-related macular degeneration India varies from 0.62 to 1.06 per 1000 Editorial committee: Indian edition children in 0 – 15 age group as also the GVS Murthy • Children with oculocutaneous albinism Col M Deshpande • People with optic atrophy, whatever the cause causes of blindness. Earlier studies in BR Shamanna • Any person who still has difficulty performing India attributed corneal scars as the Sara Varughese Praveen Vashist their daily activities because of their vision, leading cause of blindness in the country Rohit Khanna even after treatment and refraction. (8). However, subsequent studies found Rajesh Kapse reduction in corneal blindness and globe GV Rao What does low vision look like? abnormalities emerging as the major Consulting editor for Issue 77 Figure 2. Loss of central vision. “Is the Karin van Dijk and Hasan Minto People with low vision are affected in different man sitting down my husband, and is cause. In a study done in the north Consulting editor for Issue 78 ways. They may suffer from some or all of the there a seat for me?” eastern states of India, congenital globe Sally Crook following: abnormalities was found to be the Advisors commonest cause (36%) of blindness Catherine Cross (Infrastructure and Technology) • Severely reduced visual acuity among children (2). And according to Pak Sang Lee (Ophthalmic Equipment) • Blurred vision Low vision assessment in SSA camp Dianne Pickering (Ophthalmic Nursing) Andhra Pradesh Eye Diseases Study • Visual field loss: central or peripheral (APEDS), treatable refractive error caused Editorial assistant Anita Shah education has evolved as the most scale project of identifying children with Copy Editor • Loss of contrast sensitivity 33.3% of the blindness, followed by (Indian Edition) Sridevi Sunderaranjan practical way of educating visually visual impairment and to help them Design Lance Bellers / Omkar Mulgund / Kedar D • Increased light sensitivity. congenital eye anomalies (16.7%) (3). Printing Louts Concepts impaired children. In fact, the concept of through provision of low vision devices It is unfortunate that such a large Many people with low vision suffer from blurred inclusive education developed because and corrective surgeries. Two organisa- Online edition Sally Parsley number of children are suffering from Email [email protected] vision (Figure 1), for example if they have institutional education had some serious tions having the capacity of providing low Figure 3. Loss of peripheral vision. visual impairment and blindness but the Exchange articles scarring on their corneas. drawbacks: vision services were allotted ten educa- “How many other people are there in mechanism of finding them and organ- Kuldeep Suhas Dole [email protected] People with optic atrophy or age-related the room?” Number of institutions was inadequate tional districts each for this extensive ising service for them is a challenge. Website macular degeneration will have loss of central for the total number of persons who work. Our organisation was one of them Different approaches have been tried to Back issues are available at: visual acuity (Figure 2), which means that tasks needed them. and worked among half of the State’s www.cehjournal.org find such children: examining children in requiring good central vision will be difficult. For • Establishment and maintenance of population. special schools, ICDS (Integrated Child Subscriptions and back issues example, reading, writing, threading a needle institutions was expensive. During these two years – 2009 – 11, Development Services), school Community Eye Health Journal, International Centre and sewing, putting on make-up, recognising • Individuals studying were detached 10900 children (6174 (57%) boys and for Eye Health, London School of Hygiene and Tropical screenings are the usual ones in India. people, seeing where their food is on the plate from their families and society. 4726 (43%) girls) were examined in ten Medicine, Keppel Street, London WC1E 7HT, UK. This article depicts the experience of Tel +44 207 612 7964/72 and whether they have finished eating, seeing if • Social and vocational adjustment districts by our team.

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