Blindness is defined as visual acuity of less then 3/6 (10/200)in the better eye or

a field of vision of less than 20o .

A person has vision of less then 3/60 when he cannot read letters or decipher
symbols at 3m (10 feet) large enough to be read by a normal person at a
distance of 60m (200 feet).
A convience method of diagnosing blindis by asking the person to count fingers
at a distance of 3m . if he cannot he is blind. Successfullcounting od fingers at 3
m is equivalent to a vision 3/60.
Definition of blindness as given above is not satisfactory as it ignores the fact
that different job require different acuity of vision. For intance a pilot or a tailor
needs far greater vision than a physical instructor or a porter. An improved
definition would regard blindness as decrease of visual acuity to such a dgree as
to prevent to pursuit of routine vocational activities. This kind of blindness is
sometimes referred to as economic blindness.
Uniocular blindness is not blindness at all since the loss of vision is in the worse,
not the better, eye.
Causes
The commonest cause of blindness is cataract. It accounts for 50-80% of total
blindness, but for 90% of blindness in a persons over 55 years.
The other notable causes of blindness in the senior citizens is senile macular
degeneration. This disease results from degeneration of the central portion of
retina. In 90% of cases it is of the dry type which gives rise to granual loss of
vision. In the remaining 10%, it is of the wet type due to formation of new blood
vessels behind macula. Their subsequent rupture and bleeding gives rise to rapid
loss of vision.
The common causes of blindness in adults are glaucoma, trauma, diabetic
retinopathy, retina detachment, trachoma, and leukoma.
The three important causes of childhood blindness, retinitis pigmentosa,
retinoblastoma, and retinopathy of prematurity:
retinitis pigmentosa. This is a non-infectious, progressive, degenerative
disease of rods. Pgments are seen over retina. The subject has a very narrow
vision called tunnel vision. He cannot see side object and trips over them.
Retinoblastoma. This is malignant condition of retina seen in children aged 2-5
years. It may be unilateral (which is not a cause of blindness) or bilateral. It may
be non hereditery, or hereditery. Hereditery retinoblastoma is due to a defective
recessive gene on chromosome 13. The condition is diagnosed by demonstrating
yellow light reflex at the pupil.
retinopathy of prematurity (retrolental fibroplasia). This condition results
from the injudicius use of oxygen for perinatal asphyxia in premature babies.

Oxygen causes vasoconstriction of retinal blood vessels. In course of time, retina

gets totally detached.
The others causes of blindness are herpes simplex type 1 eye infection,
congenital cataract, congenital glaucoma, keratoconus, and eye injuries from
crackers.
The uncommon causes of blindness are amourotic idiocy, Eales disease,
anophthalmia, microopthalmia, and optic nerve hypoplasia/ aplasia.
Illiteracy, ignorence, poverty, patronage of road side eye-specialists, use
commons kerchief for wiping eyes, common kajal and eye stick, carelessness, in
exploding crackers, police tortune of suspected criminals, neglience in the use of
protective goggles are some of the social factors in the epidemiology of
blindness.
Prevention
Following package of measures result in the prevention of blindness:

Vitamin A prophylaxis is done for children below 5 years.

Penicillin drops are instilled in the eyes of the newborn babies
High concentration oxygen is avoided in the treatment of perinatal
asphyxia
Trachoma is controlled with SAFE strategy as follows:
S. Surgical treatment of inturned eyelids
A. Antibiotic application to the eyes of everyone. Either tertraciline
ointment or azithromycin suspension is used for this purpose.
F. Facial cleanliness. People are educated to maintain personal hygiene.
E. Environment sanitation. This includes cleanliness of house and its
surroundings and control of eye gnats.
People suffering from diabetes are detected and put on treatment to
ensure they maintain normal blood glucose level.
All cases of cataract, glaucoma, and retinal detactment are treated
Corneal tranplantation is done for benefit of those having leukoma and
other corneal opacities.
Industrial workers are educates to use goggles fitted with shatterproof
glass as protection againts flying splinters.
People are asked to be careful while bursting crackers.
Eye banks are set up and mass publicity is carried out encouraging people
to donate eyes after death

Primary eye care

They educate the people about maintance of good vision

They screen them for eye diseases and visual acuity.
They detect ocular effect of systemic diseases and the systemic effects of
ocular diseases
They treat cases of ophthalmia neonatorum, conjuctivities, and foreign
bodies in eye

They
They
They
They

prescribe spectacles for those with visual defect

reffer patients with major eye diseases to the nearest referral centre.
carry out the follow up treatment of such referred cases
establish cordial relations with other village level health providers.