optometry.naija: Vision 2020 & the Practise of Optometry in Nigeria...: "Optom Prevention of Blindness group in partnership with World Health Organization (WHO) under the umbrella of vision 2020 came up with- Cat..."
Optom
optometry is discussed here, eye diseases and disabilities are highlighted and management of such ocular conditions enumerated.
Friday, 20 May 2011
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.
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.
Tuesday, 17 May 2011
optometry.naija: Vision 2020 and the role of Optometry Practise in ...
optometry.naija: Vision 2020 and the role of Optometry Practise in ...: "Optom Vision 2020 : Right to sight is all about strategy, about means to an end in itself, though not necessarily an end. Optometry is stra..."
Optom
Optom
Vision 2020 and the role of Optometry Practise in Nigeria- episode 7
Optom
Vision 2020 : Right to sight is all about strategy, about means to an end in itself, though not necessarily an end. Optometry is strategically straddled with a huge responsibility aimed @ blindness prevention and promotion healthy eye sight. Contrary to that believe that our position in the area of Vision 2020 is @ best a fluke, evidence abounds today that the success of Vision 2020 especially in Africa is a function of how effective Optometrists are and their relationship with the Ophthalmologists. In the hierarchy of Vision 2020 development plan the Optometrists, as the Primary eye care practitioner, are positioned in the upper pyramid of blindness prevention cadre. It is obvious to note that the Optometrist, contrary to popular believe, is pivotal in expunging most embarrassing causes of preventable blindness.
Vision 2020 : Right to sight is based on the following objectives:
1) Creating awareness as a viable option for disease prevention and control. (The Optometrist as a Primary Eye care Physician is expected to play a major role in disease control; having in mind the cliche: "Prevention is better than cure", "A stitch in time saves nine", "Early detection of eye anomalies is sine qua non to effective blindness prevention" etc)
2) Capital to facilitate and sustain blindness prevention activities. (Optometrists are largely in private practise in Nigeria. Capital to sustain blindness prevention activities in private eye care practise shouldered by the patients if it should be sustained and this pinches most the vulnerable patients a lot! Unlike in government run health centres where patient's cost of sustaining prevention of blindness activities is highly subsidized by the government. More Optometrists are expected to absorbed by the ministries of healths [Both @ federal and state levels] to compliment the efforts of the Ophthalmologists, who are largely in public practise! It should be noted that Ophthalmic nurses and GPs are not more versed in Eye care than the Optometrist! Again, the government could encourage the rapid development of Private practise in eye care by providing credits and sustainable environment that can develop a sustained prevention of blindness activities.)
3) How to ensure effective planning, development and implementation of Vision 2020 core stategy. These includes-
a) Disease control: It should be noted that Diabetes Mellitus, Onchocerciasis, Chicken Pox, Small pox, HIV, Hypertension, Trachoma, Tuberculosis etc could lead to sight threatening eye conditions. As Primary eye care Practitioner, we are expected to know about these diseases, how they can cause blindness; we need to develop plans aimed @ preventing these diseases, a need to identify the ocular manifestations of these diseases on time and adopting a management approach...
b) Human resource development : I discussed how Optometrists are building on their human resources from the schools of Optometry (3 of those schools are in Nigeria!), doing continuous education aimed @ practise development by Optometrists etc More needs to be done though, like developing residency in Optometry etc.
c) Developing infrastructure and latest technologies: Eye care requires lots of equipment to increase effectiveness. Most of these equipments are concentrated in private practise...consequently, most patients can not access them because of high cost. Unfortunately still, most government hospital Optometrist's section does not have one single modern equipment to facilitate effectiveness in eye care! This seriously needs to be addressed @ length!
To be continued...
Dr Victor Ezebuiroh Okwudiri.
Vision 2020 : Right to sight is all about strategy, about means to an end in itself, though not necessarily an end. Optometry is strategically straddled with a huge responsibility aimed @ blindness prevention and promotion healthy eye sight. Contrary to that believe that our position in the area of Vision 2020 is @ best a fluke, evidence abounds today that the success of Vision 2020 especially in Africa is a function of how effective Optometrists are and their relationship with the Ophthalmologists. In the hierarchy of Vision 2020 development plan the Optometrists, as the Primary eye care practitioner, are positioned in the upper pyramid of blindness prevention cadre. It is obvious to note that the Optometrist, contrary to popular believe, is pivotal in expunging most embarrassing causes of preventable blindness.
Vision 2020 : Right to sight is based on the following objectives:
1) Creating awareness as a viable option for disease prevention and control. (The Optometrist as a Primary Eye care Physician is expected to play a major role in disease control; having in mind the cliche: "Prevention is better than cure", "A stitch in time saves nine", "Early detection of eye anomalies is sine qua non to effective blindness prevention" etc)
2) Capital to facilitate and sustain blindness prevention activities. (Optometrists are largely in private practise in Nigeria. Capital to sustain blindness prevention activities in private eye care practise shouldered by the patients if it should be sustained and this pinches most the vulnerable patients a lot! Unlike in government run health centres where patient's cost of sustaining prevention of blindness activities is highly subsidized by the government. More Optometrists are expected to absorbed by the ministries of healths [Both @ federal and state levels] to compliment the efforts of the Ophthalmologists, who are largely in public practise! It should be noted that Ophthalmic nurses and GPs are not more versed in Eye care than the Optometrist! Again, the government could encourage the rapid development of Private practise in eye care by providing credits and sustainable environment that can develop a sustained prevention of blindness activities.)
3) How to ensure effective planning, development and implementation of Vision 2020 core stategy. These includes-
a) Disease control: It should be noted that Diabetes Mellitus, Onchocerciasis, Chicken Pox, Small pox, HIV, Hypertension, Trachoma, Tuberculosis etc could lead to sight threatening eye conditions. As Primary eye care Practitioner, we are expected to know about these diseases, how they can cause blindness; we need to develop plans aimed @ preventing these diseases, a need to identify the ocular manifestations of these diseases on time and adopting a management approach...
b) Human resource development : I discussed how Optometrists are building on their human resources from the schools of Optometry (3 of those schools are in Nigeria!), doing continuous education aimed @ practise development by Optometrists etc More needs to be done though, like developing residency in Optometry etc.
c) Developing infrastructure and latest technologies: Eye care requires lots of equipment to increase effectiveness. Most of these equipments are concentrated in private practise...consequently, most patients can not access them because of high cost. Unfortunately still, most government hospital Optometrist's section does not have one single modern equipment to facilitate effectiveness in eye care! This seriously needs to be addressed @ length!
To be continued...
Dr Victor Ezebuiroh Okwudiri.
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