Eyes are said to be the mirror of the soul. Eyes, considered as part of the brain, are like small windows through which the world is seen. Powerful is the sense of vision but millions of people in Nepal are needlessly being visually impaired. Visual disability has a detrimental impact on education and daily living. Many people in the country are still incognizant of the importance of eye health. This is a crucial public health problem and needs to be effectively addressed so as to raise public awareness to tackle it.
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The number of private hospitals and other health facilities has grown in a substantial number. However, they are located in urban areas and focus on curative services. Our healthcare system is disease-oriented rather than based on primary healthcare. It has been felt that eye health and eye care service is weak due to limited infrastructures and lack of trained eye care personnel. Although there are divisions of sub-health post, health post and primary healthcare centers, no trained eye care service providers are available at any of those levels. There is a shortage of an accessible and an affordable eye care service in the country. More than two decades have passed since the government introduced health policy but eye health has not been incorporated in the health policy.
One out of three persons in Nepal has one or the other eye problem at any given time. The prevalence of blindness in Nepal is 0.39 percent. Nepalis are growing rapidly blind at a rate of at least 125 per day. Three out of 100 people suffer from visual impairment. Cataract, retinal disease, corneal disease, glaucoma, uncorrected refractive error, age-related macular degeneration, and diabetic retinopathy are among the leading causes of blindness and visual impairment in Nepal.According to World Health Organization Global Initiative to Eliminate Avoidable Blindness, 'Vision 2020: The Right to Sight', up to 80 percent of the world's blindness is avoidable. Uncorrected refractive error has emerged as an important cause of visual impairment and ocular morbidity in Nepal. However, eye glasses are not dispensed by all primary eye care centers. These factors call for the tremendous need for eye care services in Nepal and collaborative ways to reduce visual impairment and blindness.
It is observed that the government has been more focused in systemic conditions like TB, malaria, cholera, and diarrhea but has not paid enough interest in eye health. Only some I/NGOs and some private organizations have been involved in improving eye health conditions by providing eye care services and organizing screening camps. The government has failed to conduct free eye screening camps at every community level and remote places.
Although about 75 percent of learning is gained by the sense of vision, there is a poor level of awareness about ocular health among the general population. Many people approach the doctor to get examined only at the late stage. Sedentary lifestyle worsens chronic eye conditions like hypertensive retinopathy and vision loss which can be prevented if treated on time. People have their eyes checked only at the last stage due to lack of adequate eye health education.
Implementing eye healthcare programs, promoting eye health education, and raising awareness on eye disease and ocular trauma can encourage people to have their eyes examined. This can result in early diagnosis, detection and treatment and reduction in visual loss. We should also encourage people to have routine examination of eyes, more importantly those people who suffer from chronic diseases like AIDS, diabetes, hypertension, and TB. Primary eye healthcare workers have to play a major role in counseling people and optometrists should carry out routine eye checks, diagnosis, treatment, counseling and referral of patients.
There should be no disparity in utilization of eye health care services among people all over the country. It is the responsibility of the government and the concerned group to take steps in preventing vision loss from eye diseases. The government should formulate a policy to raise national eye health awareness. It should integrate eye health into existing general health from the primary level. It is imperative that the government provides an affordable, easily accessible and adequate eye health service to each and every citizen. It is recommended that every eye hospital in Nepal should organize eye health screening events in different districts, at least twice a year, to combat eye problems.
We should take proactive measures to reach people of all levels with eye health services. The media's role is important in emphasizing the awareness of eye health. We can initiate discussion programs, air public interest announcements on television and radios, and show documentaries. Raising public awareness of the blinding eye diseases can help vision preservation. Should we be able to spread message about the impact of eye conditions on human's quality of life, a situation will develop when many people themselves become active in caring about their ocular health.
The author is an optometrist and low vision expert at BP Eye Foundation maheshdev2002@gmail.com
