Vision 2020 & the Practise of Optometry in Nigeria- episode 8

Optom
Prevention of Blindness group in partnership with World Health Organization (WHO) under the umbrella of vision 2020 came up with- Cataract, Trachoma, Onchoceriacis, Childhood blindness, Refractive error/Low Vision, Glaucoma & Diabetes induced blindness- as the most common causes of avoidable causes of blindness that contributes about 80 percent of blindness. It could be avoided or managed effectively when identified early.
Cataract is any opacification of the crystalline lens with a consequent reduction of vision to the point of functional blindness in the affected eye(s). it could be monocular or bilateral depending on the triggering factor(s). such factors as senescense, metabolic, disease, trauma etc can induce cataract formation.
The best treatment of Cataract is surgical extraction of the opacification when the cataract has matured! Though newer technological development has led to earlier (Intumescent stage) removal of the opacification of the crystalline lens. Baring that, Optometrists do manage it @ the intumescent stage, after identifying it with an ophthalmoscope. We use glasses & medications @ this stage, while we ensure that such pre-surgical complications like secondary Glaucoma, itching, tearing, photophobia, pains etc are reduced or even avoided pending cataract surgery.
We refer patients for surgery when the patient's vision is so compromised that either medication or other aids cannot help their vision. Post surgically, the Optometrist ensures that anisometropia is removed, fusion & stereopsis is restored, eye heals properly etc with medications & possibly lenses!
Trachoma & Onchicerciasis ectactically compromises the integrity of the cornea & could ultimately results corneal blindness. Hygiene, therapy & patient education has ultimately proven to effectively check the menace of these oculo-systemic infections. Opthalmologists in conjuntion with Ophthalmic nurses & assistance have used the above method to reduce the incidence & prevalence of these diseases in the Northern & Southern part of Nigeria where Trachoma & Onchocerciasis respectively reigns supreme. But the measure is not complete, especially with the marginal involvement of Optometrists. We could manage corneal complications of these diseases using slit lamps, diagnostic drugs, therapeutic drugs & refering advanced cases for surgery (especially in Trachoma). Post surgically we ensure the lashes maintain aponeurosis & we remove corneal complications as much as medications can.
On Glaucoma and Diabetes induced blindness, the patients are left with retinal blindness in a gradual but steadily chronic fashion. Optometrists are experts in identification of glaucoma, especially during vision screening or routine eye testing. We use medications & glasses to manage Glaucoma; we also encourage patients to go for surgery , when possible. People with Glaucoma frequently show changes in refractive status, just like in ocular manifestations of diabetes.
Ocular manifestation of Diabetes could be in form of glycemic fluctuations of vision in the crystalline lens, cataract, glaucoma (neovascular type, especially), retinopathies & macular degenerations. Maintaining of 'optimum' blood sugar in diabetics can delay these ocular implications & it has proved to have reduced the more serious sequelaes of ocular manifestations of diabetes, especially when accompanied by frequent visit (say ones in a year!) to an eye clinic. Optometrists often use vision check, medications, patient educations & glasses in some cases to help patients with ocular manifestation of diabetes. In cases that require surgery, we prepare the patients & refer them to the specialist Ophthalmologist for surgery. We subsequently co-manage these patients with a resultant 'optimum' vision.
Childhood blindness could be as a result of congenital factors or aquired factors. It manifests in corneal blindness, as in Vit A deficiencies, trauma etc, retinal blindness, as in retinoblastomas, congenital glaucoma etc It could also manifest in crystalline lens opacifications, as in viral infections like measles or pox diseases (this could also affect the cornea). Generally paediatric Optometrists works in partnership with paediatric Ophthalmologists to co-manage these conditions in children. We often use medication pre-surgically & medications and glasses post surgically to induce 'optimization' of the young child's vision!
Finally, Refractive error & low vision which could be primary or a secondary consequence of the other common causes of blindness are expertly managed by the optometrists by removing anisometropia & any form of refractive blur with the use of lenses. apart from blur removal, lenses are also used to restorefusion, stereopsis & other forms of binocularity. We use a retinoscope for this purpose. But most patients blinded by refractive error & low vision cannot access the largely private practise Optometrists, primarily as a result of cost.
It is therefore imperative to build an effective channel to reach an Optometrist in the public sector. Currently, we are very few in public health sector & this should be addressed if Nigeria wants to achieve any meaningful goals of Vision 2020: Right to sight.
Long live Nigeria
Viva Nigerian Optometrist... To be continued...
Dr Ezebuiroh Victor Okwudiri.