ELIMINATING blindness in Nigeria may be a mirage if Nigeria continues to rely on its 14-year-old National Blindness and Visual Impairment Survey, which was carried out in 2007, to plan for eye care services in 2021 despite the increase in the nation’s population by over 66 million.
Worldometer elaboration of the United Nations data estimates Nigeria’s population in 2007 and 2021 as 146.3 million and 212.7 million respectively.
From 2005 to 2007, the “National Blindness and Visual Impairment Survey” was conducted to measure eyesight in Nigeria.
This first survey, meant to calculate vision data of individuals over 40 in the country, estimated that about 0.78 per cent of Nigerians are blind and over 80 per cent of this blindness is avoidable.
In people aged 40 years and above, the prevalence of blindness is 4.2 per cent; and many people’s vision could be improved with spectacles.
In addition, it calculated that approximately 1.13 million individuals aged 40 years are currently blind; while 4.25 million adults are visually impaired or blind, with 2.7 million having a moderate visual impairment and an additional 400,000 adults severely visually impaired.
Also, blindness is associated with increasing age, more than doubling in those aged 60 years plus.
The number of blind people varies across the six geopolitical zones (GPZ) with the North-West harbouring the largest proportion at 29 per cent due to the high prevalence and large population.
Refractive errors, cataracts and glaucoma are the leading avoidable causes of vision loss.
The main causes of childhood blindness include cataracts, congenital glaucoma, harmful eye medication (traditional and non-traditional) and the interplay between measles and Vitamin A deficiency.
Nigeria’s Minister of Health, Dr Osagie Ehanire, in commemorating the 2021 World Sight Day, putting the prevalence of blindness in Nigeria at 0.78 per cent, said that the government planned to make comprehensive eye care more accessible to the majority of Nigerians to reduce the burden of blindness.
Ehanire, in a remark through the Permanent Secretary, Ministry of Health, Mr Mamuda Mamman, said, “Fortunately, the ministry has taken this as a priority through steps aimed at integrating Primary Eye Care into the Primary Health Care thus increasing accessibility to eye care and encouraging preventive eye health especially in the rural areas that the PHC serves.”
Group Medical Director, Eleta Eye Institute, Dr Gboyega Ajayi, stated that but for international agencies funding the survey, Nigeria might not have any data on the prevalence of blindness and visual impairment and already the country is overdue for another survey to support eye care service planning.
“I am particularly worried about glaucoma. Unlike the educated, so long as many educated people, businessmen and professionals are seeing and able to do their work, they do not take time to check their eye until they are almost blind.”
In a study of 1881 patients screened at 24 outreaches in South-West Nigeria, among which 120 glaucoma cases/suspects were identified, 56 (46.7 per cent) of the glaucoma patients were aware of glaucoma and only 39 (32.5 per cent) patients could answer at least one knowledge question correctly.
In addition, the study said that health workers interviewed named cost and poor knowledge as the main reasons glaucoma patients frequently attended free screening outreach events rather than seeking definitive care.
Dr Ajayi said the future of eye care service in Nigeria is gloomy because it is very costly to be blind in Nigeria and there are few doctors interested in training to become eye specialists in Nigeria.
“What they lost in terms of not being able to go to work and the cost of a chaperon to accompany them to the clinic for care, who would also be out of work at the period, is sometimes a lot more than the cost of accessing eye care service.
“The situation is getting worse because we are not even having enough doctors for training in ophthalmology. For instance, at the Eleta complex, we needed 10 new doctors to train in ophthalmology and we got only two.
“Some of those we trained have left for greener pastures and that means that the ophthalmology training programme in Nigeria may collapse very soon because we don’t have new people to train. It is gloomy for medical care generally, but particularly in eye care. If others need three people and they have one, they can cope, but the case is not so with ophthalmology,” he said.
While many times, people equate brain drain in medical care to money, Dr Ajayi said its cause is deeper than money.
According to him, issues of brain drain in ophthalmology is linked to the unduly prolonged length of time of training, the poor reward system in the workplace and substandard facilities in hospitals.
Professor Folasade Akinsola, consultant ophthalmology at the Lagos University Teaching Hospital (LUTH), remarked in the 21st annual faculty lecture of the National Postgraduate Medical College of Nigeria, Faculty of Ophthalmology in Lagos, that the burden of visual impairment and avoidable blindness is heavier on low and middle-income countries like Nigeria and specifically on rural communities as well as older people.
According to her, the country should not be having a prevalence of blindness, just as she called for more work on public education, government involvement, and training of specialists.
Mrs Abosede Akinola, a nurse at the Centre for Eye Health, Ibadan, however, said the response to eye outreach services in the community is low because often people are sceptical about facilities the free eye outreach would offer.
According to her, “some of them know that they have eye problems, but they will want to go to their place of work before coming. They only start to come in when someone probably left the venue of the outreach with free glasses or medications. When you are expecting about 160 people to come from a community, you might only see 60.”
Dr Friday Oke, an optometrist said Nigeria is barely doing enough for people with eye problems, adding, “Nigeria has less than 10,000 personnel to cater to its population that is over 200 million. It is grossly inadequate although we are asking that people should have their eyes screened once in a year.”
Past president of Ophthalmologist Society of Nigeria, Dr Bade Ogundipe stated that as individuals get older, the chances of having sight problem increases because of increased possibility they could have developed diseases such as diabetes, cataract and macular degeneration that affects sight as well as physiological changes in the eyes.
He declared, “If an individual, for example, was shortsighted as a child, he may not use reading glasses when others are using glasses. But the general rule is that it may come to a point in life that one may need glasses.
“When it is the physiological one, you will need to wear glasses only for reading. It is not a disease per se whereas the other ones can be looked at as if they are diseases.”
Moreover, Dr Ogundipe said whether a person will wear glasses will also be dependent on the individual’s occupation, adding that a farmer may not see the need for glasses, but a professor that reads often will certainly seek help early.
While some people do not seek eye care early because they are careless with their eyes, he declared that others cannot afford the cost of seeking eye care and some due to myths and misconceptions on eyeglasses and surgery would refrain from going to the hospital.
According to him, “Some will say don’t bother going to the hospital, they will only give glasses. But there are some that will need eye surgery. There are different types of surgery. For example, after cataract surgery, you will see well. Glaucoma surgery is also straightforward, but it is not going to improve visions but help to reduce pressure in the eye.
“But people will say don’t let them operate on you, when they operated on me, I didn’t see better whereas they had glaucoma. So a lot of negative reporting affects the disposition of people to seeking help when they have eye problems.”
Howbeit, Dr Ogundipe urged Nigerians to love their eyes, have regular eye checks and not wait till they notice any signs or symptoms.
He declared that by the time there is a drop in vision in some instances, the individual is almost blind.
“Cataract may increase inability to see, but still go to the hospital. You don’t wait until there is a disaster. If for example, it is due to glaucoma by the time there is loss of some vision, at least 70 per cent of the optic nerves would have been damaged and this is irreversible. So, it is better to be proactive; have your eyes regularly checked before you notice any symptom,” he cautioned.
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