Coordinated approach needed to eliminate avoidable blindness

There are many reasons why hundreds of thousands of people across the country become blind. The unfortunate tale is that the majority of them suffer from either preventable or easily curable blindness. Proper intervention or surgery can help them to regain the precious gift of sight. Dr M A Muhit, an eminent Bangladeshi ophthalmologist, who is currently working as the clinical research fellow at the University of London’s International Centre for Eye Health has shared his views with Star Health on blindness issues in Bangladesh.

Dr Muhit is the lead researcher who has conducted the first national study on childhood blindness in our country. He has been awarded the Distinguished Service Award by Asia Pacific Academy of Ophthalmology for his leadership role in the development of research, programmes and policies for prevention of blindness in children — both in Bangladesh and at international level to ensure the rights of the blind children. He is the founder president of Child Sight Foundation (CSF) and also the medical advisor of Muslim Aid, UK.

Star Health: What are the reasons behind blindness in our country?

Dr Muhit: The main reason of blindness in our country is cataract where the lens of eye gradually becomes hard and opaque. It accounts 79.6 percent of all causes of blindness. Other causes include age related macular degeneration, uncorrected aphakia, optic atrophy, diabetic retinopathy, refractive error, glaucoma, hypertensive retinopathy, chorioretinitis etc. Most ironical fact is people are becoming unnecessarily blind from cataract which could be treated surgically.

Star Health: What are the difficulties you faced during your research in the country?

Dr Muhit: During conducting the national study on childhood blindness, I faced many difficulties to find out blind children. A child with blindness often stays at home as parents are unaware that the child is in a treatable condition. Again, after finding a blind baby who needs surgery in both eyes, parents are reluctant to let their babies go through surgery thinking that the risks are too high. Without appropriate counselling, many parents do not accept referral for surgery even when surgery is offered free of cost. Many of us do not know that the treatments available for prevention and cure for blindness are one of the cheapest and most cost effective healthcare interventions, especially when measured against the cost in lost productivity lifelong that is associated with the loss of sight.

Star Health: What are the barriers of blindness prevention?

Dr Muhit: Proper eye care facilities have not yet been established. We have shortage of skilled ophthalmologists. We have mostly medical ophthalmologists, not trained in micro-ophthalmology who can correct the diseases causing blindness. We need to increase the number badly. We have lacking in coordination between government and NGO sector which is extremely needed for a successful programme. We can learn a lesson from success story of other countries where integrated approach helped lessen blindness rate to a significant level very rapidly. We have poor setup and lack of some sophisticated instrument for micro-surgery. Primary eye care programme is almost non-existing through which we can prevent a significant number of population from being blind unnecessarily.

Star Health: How can we strengthen current prevention programme?

Dr Muhit: Many people accept blindness as fate and most of them do not know that blindness in our country is largely treatable or preventable. This is why, raising awareness level is one of the key factors that can help reduce the intensity. By involving mass media more strongly, continually providing updated information to doctors and most importantly linking the key informants of the society like school teachers, imams, chairmen, local leaders to current programme can accelerate the process extensively to reach our goal. We have good national policy but it is not working properly. Programmes should be effective and sustainable.

Star Health: How can we improve the condition of the people who are already blind?

Dr Muhit: In our country, blindness carries a big stigma. It deprives them of being an active member of the community. It often excludes them from education or for some, it provides special education through a different system called Braille. But it is seen that they need integrated education instead of special school education. It is more important because it allows students to be closer to their home and friends and make them an active member of a society quickly. We should implement integrated education system and community rehabilitation for them.

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