Eye Care in Developing Nations PDF

Preface

Millions of blind people live in our world. They do not go blind by the millions, as the visionary Sir John Wilson, blind himself, once said. If you have ever known a blind person, then you are likely aware of the enormous physical, social, psychological, and economic toll that blindness inflicts. But millions? Is it really possible to comprehend the magnitude of this silent catastrophe?

The numbers are staggering: 37 million people blind and another 124 million with low vision. A total of 161 million are visually impaired. One person goes blind every five seconds, on average, and one child goes blind every minute.

At least 75% of all blindness is either reversible, in the case of cataract, or preventable, as with trachoma and external eye infections, for example. Ninety percent of all new blindness occurs in the developing world. Most of those people are impoverished and have limited access to eye care. Most are adults, but millions are children. Who among us can condone the tragedy of childhood blindness that could have been prevented?

Should the international health care community, public health specialists, administrators, political leaders, and concerned citizens forge a social contract with those who are blind and people who are at high risk of blindness? I believe they should. Many of us already have, as evidenced by the non-governmental organizations and international agencies described in the resource appendices of this edition. I believe it is an ethical and moral imperative that everything that can be done to prevent blindness and restore sight should be done.

The intent of this book is simple and clear. Eye Care in Developing Nations was first published in 1987 for medical assistants, clinical officers, and nurses training and working in eye care in Africa. Two subsequent English editions followed in 1990 and 1999. The title has been translated into Chinese, French, Tibetan, and Vietnamese editions.

This fourth edition has been expanded and updated. New text, treatment algorithms, and diagnostic criteria have been added. This is the first edition in which color plates have been published. The varied photographs in this edition depict both common and rare ocular conditions. Suggestions of colleagues and co-workers have been taken into consideration in revising and expanding the text and illustrations.

Somewhere today on the Gangetic Plain of northern India and southern Nepal, a child, blind from corneal scarring secondary to vitamin A deficiency and measles, will perish from starvation. A teenager in Indochina will detonate a landmine with her innocent footfall while walking to school, taking her legs and her eyesight. An African elder, his hair white with the dignity of age and his pupils white with mature cataracts, will die, his sight-restoring surgery never performed because he did not have access to eye care. An indigenous Latin American, severely sub-sighted, will forego a trip to the eye specialist for treatment of her glaucoma for lack of bus fare as she is slowly blinded by her disease.

There is simultaneous tragedy and hope in these human snapshots. There is tragedy because preventable blindness persists in a bountiful world, one of unequal resource distribution. Hope, because in each instance, blindness could have been prevented.

It is in the spirit of hope that this book can assist the international efforts and local action in preventing blindness and restoring sight in disadvantaged populations.