Low Vision Services in Nepal: An Overview

Abstract

A person with low vision is someone who has an impairment of visual functioning despite treatment or standard refractive correction. By definition (World Health Organization, 1993), this impairment includes a visual acuity of less than 6/18 (20/60) to light perception or a visual field of less than 10 degrees from the point of fixation in people who are using or are potentially able to use vision for planning or implementing tasks. Globally, of about 314 million people who are visually impaired, 45 million are blind; however, refractive error as a cause of visual impairment is not included in that number, which implies that the actual global magnitude of visual impairment is greater (Siddiqui, Backman, & Awan, 1997). Worldwide, for each person who is blind, an average of 3.4 people have low vision, with country and regional variations ranging from 2.4 to 5.5 (Brilliant et al., 1985). Although low vision does not fall into the category of blindness per se, it has enormous social and economic consequences in terms of productivity losses and dependence. Nearly 87% of the world's people who are blind live in the developing world. More than half live in Asia, and the vast majority of them live in rural communities (Siddiqui et al., 1997). The statistics for Nepal are similar to those of the rest of the developing world: The prevalence of blindness is 0.84 per 100 inhabitants, 92% of the people who are blind live in rural areas, and 80% of the blindness is avoidable (curable or preventable) (Brilliant et al., 1985). In Nepal, the prevalence of low vision is 1% (Nepal Netra Jyoti Sangha, NNJS, 2009). Many reasons have been identified for the rising tide of blindness and low vision. Prominent among them is the increase in the world's elderly population, particularly in developing countries. It is estimated that by 2025, there will be about 1.2 billion older people, almost three-quarters of whom will be living in developing countries (Shamanna, Dandona, & Rao, 1998). Although no nationwide study has been conducted on low vision in Nepal, a report from Lumbini, in the western part of the country, showed that lens-related causes like aphakia, pseudophakia, and cataract are the main causes of low vision (35.55%), followed by refractive errors or amblyopia (19.23%). In addition, retinitis pigmentosa accounted for 7.24%, retinal causes for 6.64%, and other causes (albinism, nystagmus, different syndromes, and so forth) for 10.25% (KC et al., 2007). In a report from Kathmandu, in the central region of the country, Paudel, Khadka, and Sharma (2005) noted that the major cause of low vision was diabetic retinopathy (15.8%), followed by macular diseases (13.2%), age-related macular degeneration (10.5%), retinitis pigmentosa (9.6%), and amblyopia (8.8%). Hence, the distribution of the causes of low vision in Nepal varies significantly from place to place. ACCESS TO LOW VISION SERVICES Nepal is one of the poorest countries in the world, with a per capita income of US$219. It has a low literacy rate of 69.7% for men and 55.9% for women, and this rate is worse in rural communities, where more than 80% of the people live (United Nations Development Programme, 2000). Despite the presence of significant low vision, only 1% of people with low vision in Nepal had access to low vision services before 2005, and such services were available only in Kathmandu, the capital city. The lack of education, high cost of the optical devices, and poor access to the tertiary hospital from rural communities were identified as the major barriers to the receipt of such services. The program Vision 2020: The Right to Sight has recognized that low vision and refraction are important strategic themes for the control of avoidable blindness and recommended good-quality low vision services as an integral part of comprehensive eye care. The leading nongovernmental organization in eye care, NNJS (2009), which was given the mandate by Vision 2020 to develop low vision services as an integral part of comprehensive eye care services, has been implementing a national low vision program since 2005 with financial support from Dark & Light Blind Care of the Netherlands. …