In Nepal, many people with impaired vision or blindness are needlessly deprived of accessing vision rehabilitation services
Close your eyes and you will feel darkness and absence of the world. Light is necessary for vision. Humans cannot see in the dark. Vision loss has a detrimental impact on our education and everyday activities. Availability of vision assistive devices and rehabilitation services has proved to be a boon for people who live with darkness. But in Nepal, many people with impaired vision or blindness are needlessly deprived of accessing and utilizing vision rehabilitation services. Many Nepalis are unaware of accessibility, availability and usefulness of such services. Thus public awareness should be raised about vision assistive devices and rehabilitation services if we are to move such people out of darkness.
Vision is more important than other attributes such as hearing, smelling or touching. Almost 75 percent of learning is gained through vision. But life can be pushed to darkness due to sight loss resulting from either inappropriate eye glasses or several eye diseases like cataract, retinal disease, corneal disease, glaucoma, macular degeneration, and diabetic retinopathy—which are among the leading causes of vision impairment in Nepal. An estimated 0.35 percent people suffer blindness in Nepal, 90 percent of them living in rural areas. People with blindness are increasing at a rate of about 125 per day, and three out of 100 people suffer from visual impairment.
Some of vision losses are reversible and can be avoided, treated or improved, while others are irreversible. In Nepal, 19 percent of blindness is irreversible. Those with blindness or low vision (whose vision cannot be improved even after being provided with the best of glasses and/or medical or surgical treatment) have to live with darkness or some level of visual disability throughout their lives. Thus it is necessary to ensure that these people learn to tackle everyday tasks and perform their daily activities independently.
Losing vision does not loss of independence. Vision loss leads to some limitations, but that does not mean visually challenged people cannot live full and independent life like their sighted peers. It is possible to combat the darkness by using residual vision and making appropriate use of other senses such as hearing and touch for learning and performing activities independently by the help of low vision devices and rehabilitation services. Varieties of low vision devices such as magnifiers, telescopes, large print materials, talking thermometers, scales, watches and calculators, and talking models of blood pressure and blood glucose monitors have been developed. But only some of these are available in few eye hospitals of Nepal. Assistive computer technologies, such as screen readers, screen magnifiers, and speech software that reads text messages and emails, are still not available in Nepal.
Low vision and blindness rehabilitation helps in restoring functional ability and maintaining quality of life and independence of individuals. Visually challenged people can learn how to cook, use computers, travel safely, and tackle home repairs without any need for sight. They use the clock method to feed themselves, in which food items are kept at different hours in the dinner plate. Persons with blindness can read and write with the Braille scripts. Some of them have even achieved PhD degrees.
People without sight have participated in Paralympics Games since the 1976 Summer Paralympics in Canada. Blind cricket for blind and visually impaired players has been organized since 1992. Evidence shows such people have tried outdoor adventures like rafting and rock climbing. In addition, they can cross streets by listening to the flow of traffic. Mobility devices like a cane stick, an electronic cane, a guide dog, and the global positioning system-based navigation system can help them travel safely and independently. Appropriate and proper training for using these devices, arranging appropriate environments for making the home liveable and proper counselling on how best to adapt to society, can make their lives a lot easier. But in Nepal, the government has not been able to make low vision devices and rehabilitation services readily accessible, available and affordable to the needy people.
Vision rehabilitation services are weak in Nepal due to lack of available and affordable vision assistive devices, lack of awareness on the importance and benefit of utilizing low vision rehabilitation services, lack of trained low vision specialists and vision rehabilitation therapists. Moreover, eye health has not been given adequate importance in Nepal’s new health policy though Nepal has taken important stride by passing National Ophthalmic Health Policy (2017) which clearly states that quality of eye care services will be enhanced and the access to education and rehabilitation will be eased for individuals with blindness. This policy must be implemented effectively.
Government should provide affordable, easily accessible, sustainable and comprehensive vision rehabilitation services. People of all levels, geographical locations, gender and races should benefit from these services. Every eye hospital should have low vision and rehabilitation services, eye care human resources like optometrists trained in low vision and rehabilitation therapists. Policymakers should consider expanding coverage for low vision devices. Raising public awareness on importance and usefulness of vision rehabilitation services can help to combat the darkness in the lives due to vision loss. If we can spread the message and provide evidence on usefulness of low vision and rehabilitation services, many people living with darkness will themselves seek services to live a meaningful, and potentially independent, life.
The author is pursuing doctorate degree at School of Optometry and Vision Science, Queensland University of Technology, Australia