1. Managing Ocular Disability In Nigeria Gbemi Oworu FRCSEd, FWACS, MCMI Huddersfield Royal Infirmary Huddersfield

2. Managing Ocular Disability In Nigeria How big is the problem? What are the cause? How do we tackle the problem?

3. What is visual disability? Visual Impairment (VI): Mild VI:<6/12-6/18* Mod VI:<6/18-6/60* Severe VI:<6/60-3/60* Blind: Vision of <3/60* *(in the better eye)

4. Prevalence of blindness & VI Blind 4.2% Severe VI: 1.5% Moderate VI: 5.3% Mild VI: 4.5% 4.25million adults (>40yrs) are either visually impaired or blind The Nigeria national blindness & visual impairment survey 2005-2007 Females : Males (4.4%:4.0%) Illiterate: Literate (5.8%:1.5%) North East: South west (6.1%:2.8%)

5. Causes of visual disability Cataract Glaucoma Corneal scarring from all causes Uncorrected refractive error

6. Causes of visual disability Cataract: - Most common cause of disability - 43% of blindness - 400,000 operable - Increasing by 2020 to 600,000 Glaucoma Corneal scarring Uncorrected refractive error

7. Causes of visual disability Cataract: - Glaucoma - 2 nd commonest cause - 16.7% of blindness Corneal scarring Uncorrected refractive error

8. Causes of visual disability Cataract: - Glaucoma Corneal scarring from all causes:  3 rd commonest cause  7.9% of blindness - trachoma - river blindness Uncorrected refractive error

9. Causes of visual disability Cataract: - Glaucoma Corneal scarring Uncorrected refractive error  Commonest cause of mild (77.9%) to mod(57.1%) VI  2.46 million

10. Managing visual disability - uncorrected refractive error Preschool vision screening (or 1 st year of primary school) Identified during screening for glaucoma and diabetes

11. Managing visual disability - corneal scarring diseases Provision of portable water/good hygiene Health education Prompt treatment of eye infection Prompt surgical treatment Corneal graft surgery Health and safety checks

12. Managing visual disability - glaucoma Education Painless gradual blindness Risk of glaucoma in an African >40 yrs Annual screening by optician or ophthalmologist Prompt effective treatment once diagnosed (eye drops/operation)

13. Managing visual disability - cataract Education Couching is not the answer (46.1%) Affordable safe cataract surgery+ lens implant Subtenon anaesthesia one of the safest local anaesthetic

14. Conclusion 84% of blindness is avoidable or treatable Education Preschool eye test Good hygiene/water Annual eye test for glaucoma Affordable safe cataract surgery The Nigeria national blindness & visual impairment survey 2005- 2007