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Nigerians risk more blindness from cataract, if…

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By CHIOMA OBINNA

Do you think of cataract as an “old” people’s disease?  Please, think again, according to the confession of 40-year-old Joseph Ogarah – currently battling with cataract in both eyes. It was like a dream recently, when Joseph started having difficulties reading. A bank worker, Joseph often closed from the office very late. He never liked anyone driving him as most executives do by employing drivers to drive them around.

According to him, he feels more comfortable driving himself and had done so for years until he noticed he was finding it difficult seeing very clearly at night.

Wondering what was amiss, he decided to visit an ophthalmologist, who ran some tests on his eyes and discovered Joseph had developed a subcapsular type of cataract.  According to experts, unlike most cataracts, posterior subcapsular cataract can develop rather quickly and affect vision more suddenly than other types of cataract like nuclear or cortical cataract.

Joseph was given a stronger contact lens to improve his vision. Unfortunately, few months later, the contact lens recommended by his ophthalmologist was no longer helpful. The cataract had progressed and opacity vision became cloudy.

Shortly after, Joseph became blind!

Today, Joseph shares in the pains of the estimated 1.3 million Nigerians that are blind as a result of avoidable causes like cataracts.  However, the socioe-conomic impact of blindness which has become a public health concern in Nigeria, does not only lead to the reduction of one’s quality of life but also reduces one’s capabilities and  usefulness in the family, community and the nation at large.

Statistics from the Nigerian National Blindness and Visual Impairment Survey showed that 42 out of every 1,000 adults aged 40 and above are blind and overall, two out of every three Nigerians are blinded by avoidable causes like cataracts.

Specifically, currently 750,000 Nigerians are already blinded by cataract and an additional 200,000 become blind each year, according to the Nigerian National blindness and Visual Impairment Survey.

Cataracts are changes in clarity of the natural lens inside the eye that gradually degrade visual quality. The natural lens sits behind the coloured part of the eye (iris) in the area of the pupil, and cannot be directly seen with the naked eye unless it becomes extremely cloudy. According to medical experts, the lens plays a crucial role in focusing unimpeded light on the retina at the back of the eye. The retina transforms light to a neurologic signal that the brain interprets as vision. Unfortunately, significant cataracts is said to block and distort light passing through the lens, causing visual symptoms and complaints.

Although, cataracts are a treatable disease but poor access to medical facilities, lack of awareness by the public of the impact of the disease and financial constraints have been identified as the major problems facing cataract patients in the country.

Currently, the Nigerian National Blindness and Visual Impairment Survey showed that there are estimated 486,000 adults in the country who are in immediate need of cataract surgery.

But, if nothing is done to save the vision of these Nigerians and many others, a recent study by the Nigeria National Blindness and Visual Impairment Study Group had predicted that by 2020, 1.4 millionNigerians over age 40 will lose their sights, and a majority of the causes will be either preventable or treatable if appropriate and accessible refraction and surgical services needed to be provided are not put in place.

According to experts, “If priority attention is not given, the number    of blind and severely visually impaired adults in Nigeria will increase by greater than 40 per cent over the next decade.”

The study also noted that groups that had less access to health care were particularly vulnerable to preventable visual impairment.

According to the study, “The difference in the prevalence of vision loss due to cataracts between men and women, urban and rural areas, and levels of education in Nigeria almost certainly reflect access to services.” The authors recommended vision care plans that target women, rural residents and the less educated.

One obvious leading pointer to the rise in preventable blindness has remained cataract. For instance, the latest extrapolation of a prevalence rate for cataracts to countries and regions revealed that Nigeria has an estimated prevalence rate of 12,5750,3562  for cataracts.

The National President of Nigerian Optometric Association, (NOA), Dr. Ikechukwu Nwakuche, who regretted that cataract has blinded not a few Nigerians, said there was need for a campaign against the disease and other eye problems in the country which, he added, are contributing enormously to the number of carnage on the country’s highways.

According to him, to tackle the high prevalence of avoidable blindness in the country, there is need to begin a compulsory eye check right from the time a Nigerian child is entering primary school.

Nwakuche advised that once an individual notices any changes in his or her vision, that individual go early to the hospital for an eye check.  He called for the use of  eye protections such as sunglasses or hats that will help prevent ultraviolet rays from getting to the eyes as part of measures to slow down the rate at which cataract causes blindness.

Overview

Cataracts are changes in clarity of the natural lens inside the eye that gradually degrade visual quality. The natural lens sits behind the coloured part of the eye (iris) in the area of the pupil, and cannot be directly seen with the naked eye unless it becomes extremely cloudy. The lens plays a crucial role in focusing unimpeded light on the retina at the back of the eye. The retina transforms light to a neurologic signal that the brain interprets as vision. Significant cataracts block and distort light passing through the lens, causing visual symptoms and complaints.

Cataract development is usually a very gradual process of normal aging but can occasionally occur rapidly. Many people are, in fact, unaware that they have cataracts because the changes in their vision have been so gradual. Cataracts commonly affect both eyes, but it is not uncommon for cataracts in one eye to advance more rapidly. Cataracts are very common, affecting roughly 60 per cent of people over the age of 60.

When people develop cataracts, they begin to have difficulty doing activities they need to do for daily living or for enjoyment. Some of the most common complaints include difficulty driving at night,reading, participating in sports such as golfing, or travelling to unfamiliar areas; these are all activities for which clear vision is essential.

Causes
The lens is made mostly of water and protein. Specific proteins within the lens are responsible for maintaining its clarity. Over many years, the structures of these lens proteins are altered, ultimately leading to a gradual clouding of the lens. Rarely, cataracts can be present at birth or in early childhood as a result of hereditary enzyme defects, and severe trauma to the eye, eye surgery, or intraocular inflammation can also cause cataracts to occur earlier in life. Other factors that may lead to development of cataracts at an earlier age include excessive ultraviolet-light exposure, diabetes, smoking, or the use of certain medications, such as oral, topical, or inhaled steroids.

Symptoms
Cataracts may cause a variety of complaints and visual changes, including blurred vision, difficulty with glare (often with bright sun or automobile headlights while driving at night), dulled colour vision, increased near-sightedness accompanied by frequent changes in eyeglass prescription, and occasionally double vision in one eye. Some people notice a phenomenon called “second sight” in which one’s reading vision improves as a result of their increased near-sightedness from swelling of the cataract.

Exams and tests
To detect a cataract, the eye-care provider examines your lens. A comprehensive eye examination usually includes the following:

* Visual acuity test: An eye chart test is used to measure your reading and distance vision.

* Refraction: Your eye doctor should determine if glasses would improve your vision.

* Glare testing: Vision may be significantly altered in certain lighting conditions and normal in others; in these

circumstances, your doctor may check your glare symptoms with a variety of different potential lighting sources.

* Potential acuity testing: This helps the ophthalmologist get an idea of what your vision would be like after the removal of the cataract. Think of this as the eye’s vision potential if the cataract was not present.

* Contrast sensitivity testing: This checks for your ability to differentiate different shades of gray, which is often  limited by cataracts.

* Tonometry: a standard test to measure fluid pressure inside the eye (Increased pressure may be a sign of glaucoma.)

* Pupil dilation: The pupil is enlarged with eye drops so that the ophthalmologist can further examine the lens and retina. This is important to determine if there are other conditions which may ultimately limit your vision besides cataracts.

Treatment
Surgery: There are three basic techniques for cataract surgery: The most common and modern form of cataract surgery today is a process called phacoemulsification. In this most modern method, cataract surgery can usually be performed in less than 30 minutes and usually requires only minimal sedation and numbing drops, no stitches to close the wound, and no eye patch after surgery.

* Extracapsular cataract surgery: This procedure is used mainly for very advanced cataracts where the lens is too dense to dissolve into fragments (phacoemulsify) or in facilities that do not have phacoemulsification technology.

* Intracapsular cataract surgery: This surgical technique requires an even larger wound than extracapsular surgery, and the surgeon removes the entire lens and the surrounding capsule together

Prevention
At present, there is no real effective way to prevent the formation of cataracts, so secondary prevention involves controlling other eye diseases that can cause cataracts and minimising exposure to factors that promote cataracts.

* Wearing sunglasses outside during the day.

* No vitamins,  topical or oral medications or supplements are proven to decrease the chance of developing cataracts.

* A healthy lifestyle might help, just as a healthy lifestyle helps prevent other diseases in the body. Eat a proper diet, get regular exercise and rest, and do not smoke.

* If you have diabetes, tight blood-sugar control can delay the otherwise accelerated development of cataracts.

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