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World Sight Day: Why over 4.25m adult Nigerians are ‘blind’, by ophthalmologists

World Sight Day - October 14, 2021 - Happy Days 365
Eye

• Cataract, glaucoma, and uncorrected refractive errors are leading causes of blindness
• Nigeria has 700 ophthalmologists to 200m people against WHO’s the ratio of 1:50,000
• Ageing populations, increased prevalence of non-communicable diseases (NCDs), and long gadget use exacerbate eye health issues

Ahead of today’s World Sight Day (WSD), ophthalmologists have raised the alarm that over 4.25 million adults in Nigeria, aged 40 and above, suffer from moderate to severe visual impairment or blindness. WSD is marked every second Thursday of October to raise awareness about retinal diseases and care of the eyes. It is also to support Sightsaver’s work to combat avoidable blindness. The theme of this year’s event is ‘Love Your Eyes’.

The ophthalmologists said cataracts, glaucoma and uncorrected refractive errors are leading causes of blindness. While cataract is the leading cause of blindness (reversible), followed by glaucoma (irreversible), uncorrected refractive errors are the leading cause of visual impairment.

They also decried the situation where Nigeria has 700 ophthalmologists to 200 million people against the World Health Organisation’s (WHO) recommendation of one ophthalmologist for 50,000 people in developing countries.

They warned that the number of people with vision loss is expected to rise from 1.1 billion in 2022 to 1.7 billion by 2050, adding that ageing populations and increased prevalence of non-communicable diseases (NCDs), such as diabetes, could exacerbate eye health issues in years to come. They said natural eye drops clear immature cataracts but are not very effective in patients with uncontrolled diabetes mellitus.

As part of efforts to address the situation, they recommended, among other things, that there is a need for government to prioritise healthcare in Nigeria, improve remuneration for healthcare providers, boost eye-care services in rural communities, scale up awareness at both rural and urban areas and create more revolving funds for the health sector in general.

The experts include a professor of ophthalmology at the College of Medicine, University of Lagos (CMUL)/Lagos University Teaching Hospital (LUTH) Idi-Araba and Chairman, Lagos State Traditional Medicine Board (LSTMB), Adebukola Adefule-Ositelu; and a consultant ophthalmologist and senior lecturer at LUTH, Dr. Olubanke Ilo.

Ilo, in an interview with The Guardian, said: “According to the national blindness and visual impairment study, the latest Nigerian survey did so far (2009), it is estimated that 4.25 million adults, aged 40 years and above, have moderate to severe visual impairment or blindness. Prevalence of blindness was 4.2 per cent and severe visual impairment was 1.5 per cent.”

Ilo said that based on the WHO action plan for the prevention of avoidable blindness and visual impairments from 2014 to 2019, over 80 per cent of global visual impairment is avoidable (that is preventable or treatable).

She said, in spite of this, millions of people remain at risk of vision loss due to a lack of awareness/poor health-seeking attitude.

“The average Nigerian waits until he/she has noticed changes in his/her vision or has pain or itching before he/she goes for an eye check. Unfortunately, one of the leading causes of blindness is glaucoma, a disease that is silent and gives no sign until it is too late.

And by the time the person notices that his/her vision is impaired, it would have gone too far and too late to reverse,” she said. Ilo added that many of the highly skilled eye care workers, particularly ophthalmologists, are leaving Nigeria for other countries, where there is adequate technology and better remuneration.

Ilo said this problem is further compounded by the high cost of health services, poor access to medical facilities, and poor management of the healthcare system, among other challenges facing the practice of medicine and contributing to the paucity of healthcare personnel.

“Nigeria, being the most populous country in Africa with about 214 million people, simply does not have enough healthcare practitioners to serve its population with only about eight ophthalmologists to one million people, compared to Europe with about 71 ophthalmologists to one million population.

“WHO categorises Nigeria as a group of Sub-Saharan countries in Africa where the estimated prevalence of blindness among those over 50 years of age is one of the highest in the world at nine per cent. The high proportion of avoidable blindness, with half attributable to cataracts alone and uncorrected refractive errors, is responsible for 57 per cent of moderate visual impairments, it then means that appropriate and accessible refraction and surgical services need to be provided. If priority attention is not given, the number of blind and severely visually impaired adults was projected to increase by over 40 per cent over the decade,” she said.

On how many optometrists and ophthalmologists, Nigeria has, Ilo said: “Nigeria has over 4,000 optometrists and 700 ophthalmologists.”

The ophthalmologist said for the achievement of universal eye health coverage, emphasis needed to be on developing the human resources sector through effective planning.

On recommendations towards better eye care and preventing blindness in Nigeria, Ilo said: “It starts with awareness! Sight is precious; one cannot assume one can see because you are looking. Common eye diseases in our environment don’t give any sign until they are advanced and by the time one is aware, it is too late. Remember, you can’t see your own eyes, have them checked by experienced personnel, an ophthalmologist.

“Basic eye care training should be provided to relevant human resources such as teachers for school eye health, family physicians, pediatricians, midwives, nurses, immunisation workers and other primary healthcare workers for early detection and referral of eye problems in the community with appropriate linkages developed with specialist eye care units and department that will improve access to eye care services.”

Ilo said with the continuous rise in digital media consumption, especially among the youth, the incidence of ocular problems has also dramatically increased. She said a large portion of the population currently suffers from visual impairment globally and in Nigeria. She said it has been estimated that 49.8 per cent (4.8 billion) and 9.8 per cent (0.9 billion) of the global population will have myopia or high myopia by 2050.

According to a study conducted to determine the level of knowledge and extent of computer vision syndrome (CVS) among computer users at the Securities and Exchange Commission (SEC), Abuja, CVS was common among the employees, with 74 per cent of the respondents experiencing at least one symptom of CVS.

“Headache, transient blurring of vision and eyestrain were the most common symptoms experienced. Longer hours (over four hours/day) spent on smartphone use may increase the likelihood of ocular symptoms, including myopia, asthenopia and ocular surface disease, especially in children. Asthenopia is more commonly known as eyestrain or ocular fatigue. Thus, regulating use time and restricting the prolonged use of smartphones may prevent ocular and visual symptoms,” she said.

She said other risk factors associated with increased prevalence of myopia include longer daily reading hours, lack of physical activity and less time spent outdoors have an impact on myopia development.

“Technological inventions have further compounded the problem; many children currently use display terminals for computer-aided instruction, cellular and smart phones and video games, as well as increased television viewing. It is recommended, therefore, that children spend more time outdoors as this could reduce the prevalence and progression of myopia.”

On why screen breaks are important? Ilo said: “Staring at a screen (phone, computer, laptop, pad, gaming devices) for long stretches without taking breaks can cause symptoms such as eye fatigue, especially where lighting is less than ideal, causing fatigue from squinting.”

For Adefule-Ositelu, eight out of 10 causes of blindness are avoidable. “They are amenable to treatment if only they are presented early enough to experts. We need to stress that not all eye problems emanate from spiritual attacks. We have effective orthodox as well as traditional products for treating eye problems but licensed practitioners must prescribe them. They also must have been subjected to clinical Trial Studies and safely standardised for uses.”

Despite the challenges, Adefule-Ositelu said there is no impending blindness epidemic in Nigeria. She said eye diseases like onchocerciasis (river blindness) have been reduced to the nearest minimum, put under very good and effective control in those affected parts of the country. Onchocerciasis or ‘river blindness’ is a parasitic disease caused by the filarial worm Onchocerca volvulus.

The ophthalmologist said blindness prevention must be addressed through incessant advocacy and sensitisation programmes. “Those with familial eye and or endocrine diseases should inform their families and must ensure early interventions for their family members. The girl child and women must be free and be allowed to seek help from the health facilities as necessary. Prevention can be achieved if school eye health services are included and made compulsory in health screening for pre, junior, senior and tertiary scholars,” she said.

Adefule-Ositelu said those involved in dangerous and violent games should wear protective gear to prevent eye injuries.

She also said parents/guardians should not apply punitive measures on children, targeting their heads and faces; they are to teach junior ones not to play with sharp and heavy objects example brooms, plants, slippers and belts.

The ophthalmologist said Nigerians, especially those with high blood pressure, diabetes, and sickle cell diseases should have health checks as often as necessary as these affect the eyes and can damage the vision. She said balanced diets are essential for good vision maintenance – a great pity, this may be difficult as Nigerians are presently experiencing very severe economic challenges, she lamented.

Adefule-Ositelu said evidence-based medicines for glaucoma control exist in Nigeria. “These are the researches that l championed and carried out in collaboration, in a multi-centre study – carried out in the LUTH in Lagos, Olabisi Onabanjo University (OOU) in Ogun State, National Eye Centre (NEC) in Kaduna and Obafemi Awolowo University (OAU) in Ile Ife. There are nine indexed publications on such discoveries. Globally, glaucoma has no cure yet. To retain vision requires consistency and compliance.”

She said android phones, led TVs and computers, emit lights that can adversely cause problems in the eyes.

“When the light-sensitive layer in the eyes is affected, there may result in damaging effects that will lead to visual impairment and or blindness if not addressed well and on time. One of us just released the use of blue-cut lenses to reduce the progression of myopia from such radiation in children. Generally, protective screen shields and UV-protecting lenses/ sunshades are useful,” Adefule-Ositelu said.

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