The ppt defines visual impairment in terms of low vision and blindness, enumerate the causes, prevention and treatment modalities .Talks about rehabilitation and Nursing diagnosis, expected outcome and interventions for disturbed Sensory perception: vision.

1. Visual impairment/ blindness
and its management
PRESENTED BY
MRS.SULAKSHA DESSAI
DEPT. OF MEDICAL SURGICAL NURSING ,
INE, BAMBOLIM ,Goa.

2. OBECTIVES FOR THE TOPIC
END OF CLASS OBJECTIVE: Student will be able to identify the problems
faced by people having low vision/ blindness based on their disease process.
Plan and implement care and impart incidental health education to guide
people to prevent visual impairment and help people with Low vision to live an
independent life through adaptation to changes in visual acuity.

3. OBECTIVES FOR THE TOPIC
INSTRUCTIONAL OBJECTIVES: The student will be able to-
1. Review the anatomy and physiology of Eye
2. Define Low vision and Blindness.
3. Classify Low vision and Blindness
4. Describe the etiological factors leading to blindness
5. Discuss about the prevention of blindness.
6. Describe the role of ‘’ National Program for Control of Blindness ‘’ in the management of
blindness in India.
7. Estimate the Goals & Objectives of NPCB in the XII Plan
8.Explain the rehabilitation of a blind person.
9. Enumerate the role of National Association for Blind in Goa.
10. Write the Nursing care plan for the core nursing diagnosis of Blind.

4. Anatomy and physiology

5. Visual impairment/ blindness:
A white cane, the international symbol of blindness

6. Visual impairment and blindness
• KEY NOTES:
• 285 million people are estimated to be visually impaired worldwide: 39 million are
blind and 246 have low vision.
• About 90% of the world's visually impaired live in low-income settings.
• 82% of people living with blindness are aged 50 and above.
• Globally, uncorrected refractive errors are the main cause of moderate and severe
visual impairment; cataracts remain the leading cause of blindness in middle- and
low-income countries.
• The number of people visually impaired from infectious diseases has reduced in the
last 20 years according to global estimates work.
• 80% of all visual impairment can be prevented or cured.

7. Definition
• Low vision:
Low vision is a general term describing visual impairment that requires patients to use
devices and strategies in addition to corrective lenses to perform visual tasks. Low vision is
defined as a best corrected visual acuity(BCVA) OF 20/70 TO 20/200.
Blindness : Blindness is defined as a BCVA that can range from 20/400 to no light
perception.
Absolute blindness: The clinical definition of absolute blindness is the absence of light
perception.
Legal Blindness: Legal blindness is a condition of impaired vision in which a person has
a BCVA that does not exceed 20/200 in the better eye or whose widest visual field
diameter is 20 degrees or less.

8. International Classification of Diseases -10(2010)
Category Presenting distance visual acuity
Worse than: Equal to or better than:
0 Mild or no visual impairment
6/18
20/70
1 Moderate visual impairment
6/18
20/70
6/60
20/200
2 Severe visual impairment
6/60
20/200
3/60
20/400
3 Blindness
3/60
20/400
1/60*
5/300 (20/1200)
4 Blindness
1/60*
5/300 (20/1200)
light perception
5 Blindness No light perception
9 Undetermined or unspecified
* or counts fingers (CF) at 1 metre.

9. CAUSES:
• uncorrected refractive errors (43%), ] Refractive errors include near sighted, far sighted,
presbyopia, and astigmatism
• cataracts(33%),
• glaucoma
• age related macular degeneration,
• diabetic retinopathy,
• corneal clouding,
• childhood blindness, and
• a number of infections.
• cortical visual impairment, Visual impairment can also be caused by problems in the brain
due to stroke, prematurity, or trauma among others

10. PREVENTION AND TREATMENT
• The World Health Organization estimates that 80% of visual loss is either
preventable or curable with treatment of the cause.
• Some of the ophthalmic drugs are listed below

11. OPHTHALMIC DRUGS
1
MITOTICS
I
a
Α-ADRENERGIC BLOCKER-
Dapiprazole
II Β-ADRENERGIC BLOCKER
a Betaxolol
b Timolol
III CHOLINERGIC
a Acetylcholine
b Pilocarpine
IV
a
Α-ADRENERGIC RECEPTOR AGONIST-
BRIMONIDINE
2 ANESTHETIC
a Proparacaine
b Tetracaine

12. OPHTHALMIC DRUGS
3) ANTIBIOTICS
a Chloramphenicol
b Ciproflloxacin
c Gentamycin
d Tobramycin
e Moxifloxacin
4) CARBONIC ANHYDRASE INHIBITORS
a Brinzolamide
b Dorzolamide
c Acetazolamide
5) ANTIVIRAL
a Acyclovir
b Idoxuridine
6) ANTIFUNGAL
a Amphotericin
b Natamycin

13. OPHTHALMIC DRUGS
7) MYDRIATICS AND CYCLOPLEGICS
a Atropine
b Homatropine
c Cyclopentolate
d Tropicamide
e Phenylephrine
8) CORTICOSTEROID
a Dexamethasone
b Hydromethasone

14. OPHTHALMIC DRUGS
9) NSAIDS
a Nepafenac
b Bromfenac
c Flurbiprofen
10) OPHTHALMIC DECONGESTANTS
a Naphazoline
b Lodoxamide
c Oxymetazoline
d Otrivin-o
11)
a
PROSTAGLANDIN ANALOGUES-
LATANOPROST
12) MISCELLANEOUS
a Methyllcellulose
b Hydroxy propyl methyl cellulose
c Ophthacare

15. National Program for Control of Blindness
• National Program for Control of Blindness was launched in the year 1976 as
a 100% Centrally Sponsored scheme with the goal to reduce the prevalence
of blindness from 1.4% to 0.3%. Various activities/initiatives undertaken
during the Five Year Plans under NPCB are targeted towards achieving the
goal of reducing the prevalence of blindness to 0.3% by the year 2020.
• Main causes of blindness are as follows: - Cataract (62.6%) Refractive Error
(19.70%) Corneal Blindness (0.90%), Glaucoma (5.80%), Surgical
Complication (1.20%) Posterior Capsular Opacification (0.90%) Posterior
Segment Disorder (4.70%), Others (4.19%) Estimated National Prevalence
of Childhood Blindness /Low Vision is 0.80 per thousand

16. Goals & Objectives of NPCB in the XII Plan
1. To reduce the backlog of blindness through identification and treatment of blind at
primary, secondary and tertiary levels based on assessment of the overall burden of
visual impairment in the country.
2. Develop and strengthen the strategy of NPCB for “Eye Health” and prevention of
visual impairment; through provision of comprehensive eye care services and quality
service delivery.
3. Strengthening and upgradation of RIOs ( Regional Institute of Ophthalmology) to
become centre of excellence in various sub-specialities of ophthalmology
4. Strengthening the existing and developing additional human resources and
infrastructure facilities for providing high quality comprehensive Eye Care in all
Districts of the country;
5. To enhance community awareness on eye care and lay stress on preventive measures;
6. Increase and expand research for prevention of blindness and visual impairment
7. To secure participation of Voluntary Organizations/Private Practitioners in eye Care

17. REHABILITATION OF BLIND :
EMOTIONAL ACCEPTANCE ;
• Coping with blindness involves three types of adaptation: emotional, physical and social.
• Emotional adjustment of blindness determines the success of physical and social
adjustments of patient.
• Effective coping may not occur until the patient recognizes the permanence of low vision /
blindness.
• A patient and the family members of a low vision/ blind undergo various steps of
Grieving: denial and shock, anger and protest, restitution, loss resolution and acceptance.
• This ultimately influence the rehabilitation of the patient who is blind.

18. REHABILITATION OF BLIND :
EMOTIONAL ACCEPTANCE ;
Most people, once they have been visually impaired for long enough, devise
their own adaptive strategies in all areas of personal and professional
management. Emotional acceptance go a long way to help a person to adapt to
day today activities of life

19. REHABILITATION OF BLIND :
Mobility
Many people with serious visual impairments can travel independently, using a
wide range of tools and techniques.
Orientation and mobility: Becoming familiar with an environment or route can
make it much easier for a blind person to navigate successfully. Orientation and
mobility specialists teach people with visual impairments how to travel safely,
confidently, and independently in the home and the community.

20. REHABILITATION OF BLIND :
AIDS FOR MOBILITY
Tools such as the white cane with a red tip – the international symbol of blindness –
may also be used to improve mobility. A long cane is used to extend the user's range of
touch sensation.
A small number of people employ guide dogs to assist in mobility
Folded long cane A blind man is assisted by a guide dog

21. REHABILITATION OF BLIND :
• GOVERNMENT FACILITIES :
Government actions are sometimes taken to make
public places more accessible to blind people. Public
transportation is freely available to the blind in many
cities. Tactile paving and audible traffic signals
can make it easier and safer for visually impaired
pedestrians to cross streets. In addition to making
rules about who can and cannot use a cane, some
governments mandate the right-of-way be given to
users of white canes or guide dogs.
Financial assistance to start a business is another
example.
Fig. Tactile paving

22. REHABILITATION OF BLIND :
• Most visually impaired people who are not totally blind read print, either of a
regular size or enlarged by magnification devices or by improving the
brightness of the room.
• For the blind, there are books in braille, audio-books, and text-to-speech computer
programs, machines and e-book readers. Low vision people can make use of these
tools as well as large-print reading materials and e-book readers that provide large
font sizes.

23. REHABILITATION OF BLIND :
Reading and magnification
Others read Braille or rely on talking books and readers or reading machines,
which convert printed text to speech or Braille. They use computers with special
hardware such as scanners and refreshable Braille displays as well as software
written specifically for the blind, such as optical character recognition
applications and screen readers
There are also over 100 radio reading services throughout the world that provide
people with vision impairments with readings from periodicals over the radio.
Blind people may use talking equipment such as thermometers, watches, clocks,
scales, calculators, and compasses.

24. Communication
Visual impairment can have profound effects on the development of infant
and child communication due to their inability to see the world around them
Due to delays in a child's communication development, they may appear to be
disinterested in social activity with peers, non-communicative and un-education
on how to communicate with other people. This may cause the child to be
avoided by peers and consequently over protected by family members.
REHABILITATION OF BLIND :

25. Communication
The blind or visually impaired rely largely on their other senses such as hearing,
touch, and smell in order to understand their surroundings.
Sound is one of the most important senses that the blind or visually impaired
use in order to locate objects in their surroundings. A form of echolocation is
used, similar to that of a bat. Echolocation from a person's perspective is when
the person uses sound waves generated from speech or other forms of noise
such as cane tapping, which reflect off of objects and bounce back at the
person giving them a rough idea of where the object is.

26. REHABILITATION OF BLIND :
Communication
Touch is also an important aspect of how blind or visually impaired people perceive
the world. Touch gives immense amount of information in the persons immediate
surrounding. Feeling anything with detail gives off information on shape, size, texture,
temperature, and many other qualities. Touch also helps with communication; braille is
a form of communication in which people use their fingers to feel elevated bumps on
a surface
Certain smells can be associated with specific areas and help a person with vision
problems to remember a familiar area. This way there is a better chance of recognizing
an areas layout in order to navigate themselves through. The same can be said for
people as well.

27. REHABILITATION OF BLIND :
Adjusting attitude
To avoid the rejected feeling of the visually impaired, people need to treat the blind
the same way they would treat anyone else, rather than treating them like they have a
disability, and need special attention.

28. National Association for the Blind
Goa State Branch(St. Cruz)
Activities carried for blind
• Education(Integrated educational Programme)
• Vocational Training
• Multihandicapped projects.
• Sports
• Theatre
• Rehabilitation
• Employment
• Marriage
• Computer training

29. National Association for the Blind
Goa State Branch(St. Cruz)
• Locate & identify the visually handicapped.
• Provide ID cards and medical certificates
• Assist in school admissions
• Provide Educational support
• Facilitate self employment.
• Assist in Bank loans, subsidies, schemes Etc.

30. Nursing Management of Blind
• Disturbed Sensory Perception R/T impaired anatomy and Physiology of eye
• Expected outcome: The client will have improved visual perception as evidenced by an improved visual
acuity nearing 6/6 or adaptation to changes in visual acuity and client performing activities of daily
living.
• Nursing intervention:
• Assess the causes and level of visual impairment.
• Assist in the treatment of cause and prevention of visual impairment.
• Participate in the rehabilitation of visually impaired.
• Talk with the low vision person as you would talk with any other individual, honestly and without pity.
• Identify yourself as you approach the person and before you make physical contact. Also introduce other
people who accompany you if any.
• It is often appropriate to touch the persons hand or arm lightly to indicate that you are about to speak.

31. Nursing Management of Blind
• Nursing intervention:
• When talking, face the person and speak directly to him or her using a normal tone of voice.
• Give spatial orientation of his/her environment to the person to help him in locomotion.
• Be specific when communicating direction. Mention a specific distance or use clock cues
when possible.
• When you offer to assist someone, allow the person to hold on to your arm just above the
elbow and to walk a half step behind you. when offering the person a seat, place the persons
hand on the back or the arm of the seat.
• When you are about to go up or down a flight of stairs, tell the person and place his /her
hand on the banister.
• Make sure that the environment is free of obstacles. Remove obstacles that may be in the
persons pathway,

32. Nursing Management of Blind
• Nursing intervention:
• Offer to read written information, give a live commentary of events whenever
required.
• If you serve food to the person, use clock cues to specify where everything is on
the plate.
• Make sure all objects the person will need are close at hand.
• Identify the location of objects that the person may need.
• Do not change the position of any object in the patients room without his/her
knowledge.
• Place all the assistive devices the person uses close at hand.
• Ask the person, “’How can I help you?’’ Do not offer any help without his
permission.

33. References
• Lyle, T. K. , Cross, A. G., Cook, C. A. G.(1985) May and Worth’s Diseases of the
eye(13th ed.) New Delhi: CBS Publishers & Distributers.
• Chatterjee, B.M. (2004) Handbook of Ophthalmology(6th ed.) New Delhi:CBS
Publishers & Distributers,
• Chintamani, Mani, M., Goyal, H., Sharma, A.,US Editors Lewis, S. L., Heitkemper,
M. M. ,Dirksen, S. R.,et.al.(2011). Lewis’s Medical Surgical Nursing: Assessment and
Management of Clinical Problems; Adapted for South Asian Curriculum. Kundli, Haryana,
India: Replika Press (P) Ltd. 415
• Smeltzer, S. C., Bare, B.G., Hinkle, J. L., Cheever, K. H. (2010). Brunner &
Suddharth’s Textbook of Medical Surgical Nursing. (12TH ed.) Gurgaon: Wolters Kluwer
India Pvt. Ltd. . 1764-1767.
• https://icd.who.int/browse10/2010/en#!H54