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The Causes of Blindness in Special Education School

The Causes of Blindness in Special Education School Oji –River Lga of Enugu State

Introduction

Blindness is defined as decreased ability to see to a degree that causes problems not fixable by usual means, such as glasses (WHO,2015).Some also include those who have a decreased ability to see because they do not have access to glasses or contact lens. The term blindness is used for complete or nearly complete vision loss (Maberley,et.al, 2006).Visual impairment may cause people difficulties with normal daily activities such as driving, reading, socializing and walking. The most common causes of visual impairments globally are uncorrected refractive error (43%), cataract (33%), and glaucoma(2%).Refract errors include near sighted, farsighted ,presbyopia, and astigmatism. Cataract are the most common causes of blindness .Other disorders that may cause visual problems include  age related macular degeneration, diabetic retinopathy, corneal clouding, childhood blindness, and a number of infections.

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(WHO,2012).As of 2012 there were 285 million people who were visually impaired of which 246 million had low vision and 39million were blind. In Nigeria, 84% of all causes of blindness are either preventable or treatable. This is comparable to other reports in Nigeria (Adegbehingbe,et.al, 2007) and other countries in Africa such as Rwanda, Ghana, Sudan, Tunisia, Niger, Ethiopia, India etc.(John et.al,2008).Vision 2020 emphasizes the need to strengthen both services if the elimination of avoidable blindness is to become a reality(Thylefor,2000).With 80% of blindness being avoidable and the success of approaches like cataract surgery being established, effective implementation of vision 2020 may contribute toward development and economic productivity. Special efforts are needed to target persons living in areas most often over looked and persons who are poorly educated or exposed. Variations need to be addressed so that priority attention are given to those region/zones that have high magnitude and lack adequate surgical or optical services within a system that delivers comprehensive eye care to populations. Blindness has always been a public health problem in Nigeria and there is urgent need to implement comprehensive blindness prevention programs. However, an obstacle to proper planning and successful implementation is the lack for reliable data on blindness in many underserved regions such as Oji River in Anambra State. There for more work should be done in other to estimate the causes of blindness .This data can therefore be used by various organizations in planning, implementing, and monitoring eye care programs in similar geo-economics areas.

Blindness is the inability to see anything, even light. If you are partially blind, you have limited vision. Complete blindness means that you cannot see at all and are in total darkness. Legal blindness refers to vision that is highly compromised. What a person with healthy eyes can see from 200feet away, a legally blind person can see only from 20feet away. By 10 revision of the WHO international stastical classification of diseases, injuries and causes of death, blindness is defined as visual acuity of less than 20/400(6/120), or a corresponding visual field loss of less than 10 degrees, in the better eye with best possible correction. Blind people with undamaged eyes may still register light non-visually for the purpose of circadian entrainment to the 24 hours light/dark cycle. Light signals for this purpose travel through the retinohypothalamic tract and are not effective by optic nerve damage beyond where the retinohypothalamic tract exists. Apart from the standard definitions of blindness and general perception of it, there are some other different forms of blindness; they include:

Color blindness is the ability to perceive differences in various shades of colors, particularly green and red, that others can distinguish. It is most often inherited (genetic) and affects about 8% of males and under1% of women. People who are color blind usually have normal vision other wise and can function well visually. This is actually not true blindness.

Night blindness is a difficulty in seeing under situations of decreased illumination. It can be genetic or acquired.Thes majority of people who have night vision difficulties function well under normal lighting conditions; this is not a state of sightlessness.

Snow blindness is loss of vision after exposure of the eyes to large amounts of ultraviolet light. Snow blindness is usually temporary and is due to swelling of cells of the corneal surface. Even in the most severe of cases of snow blindness, the individual is still able to see shapes and movement. Anyone who has access to glasses and sees well with the glasses cannot be termed blind.

SIGNS AND SYMPTOMS

All people who are blind or have visual impairment have the common symptoms of difficulty in seeing. People with similar levels of visual loss may have different responses to that symptom. If one is born blind, there is much less adjustment to a non-seeing world than there is for people who lose their vision late in life, where there may be limited ability to cope with that visual loss. Support systems available to individual and their physiological makeup will also modify the symptoms of lack of sight. People who lose their vision suddenly, rather than over a period of years, also can have more difficulty adjusting to their visual loss.

Associated symptoms, such as discomfort in the eyes, awareness of the eyes, foreign body sensation and pain in the eyes or discharge from the eyes may be present or absent, depending on the underlying causes of the blindness.

A blind person may have no visible signs of any abnormalities when sitting in a chair and resting. However, when blindness is a result of infection of the cornea (the dome in front of the eyes),the normally transparent cornea may become white, making it difficult to view the colored part of the eye. In blindness from cataract, the normally black pupil may appear white. Depending on the degree of blindness, the affected individual will exhibit signs of visual loss when attempting to ambulate. Some blind people have learned to look directly at the person they are speaking with, so it is not obvious they are blind. The department of health identifies three groups of people who may be classified as severely visually impaired.

  1. Those below 3/60(equivalent to 20/400 in US notation) snellen (most people below 3/60 are severely sight impaired).
  2. Those better than 3/60 but below 6/60 snellen (people who have a very contracted field of vision only)
  • Those 6/60 snellen or above (people in this group who have a contracted field of vision especially if the contraction is in the lower part of the field). Other countries such as Kuwait share the 6/60 criteria (Al-merjan et.al, 2005).
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PRIMARY CAUSES OF BLINDNESS THROUGHOUT THE WORLD.

World health organization (WHO) data, based on the 2002 global population survey, shows that blindness resulting from infectious diseases is decreasing. However, blindness from conditions relating to ageing is increasing. According to WHO an estimate, the most common causes of blindness (excluding refractive errors) around the world includes;

GLAUCOMA

Glaucoma damages the eyes optic nerve and is a leading cause of blindness. It usually happens when the fluid pressure inside the eyes slowly rises, damaging the optic nerve. Often there are no symptoms at first, but a comprehensive eye exam can detect it. About 2.3 million American’s suffer from glaucoma. It estimated that an additional 2 million have the disease but don’t know it. Glaucoma is a leading cause of blindness among African Americans and Hispanics. Africans Americans experiences glaucoma at a rate three times that of whites. They suffer blindness four times more frequently. Between the ages of 45 and 64, glaucoma is 15 times more likely to cause blindness in African Americans than in whites.

People at risks should get eye exams at least every two years, especially:

  • African Americans over age 40
  • People over age 60,especially Hispanics
  • People with a family history of glaucoma

Treatment usually includes prescription eye drop and surgery. There is no cure for glaucoma. Early diagnosis and treatment can control glaucoma before vision loss or blindness occurs. New research is focusing not only on lowering pressure inside the eye, but also exploring medications to protect and preserve the optic nerve from the damage that causes vision loss. There has been progress in understanding the genetics of glaucoma in the last few years, including the discovery of genes found to be associated with many forms of glaucoma.

MACULAR DEGENERATION

Macular degeneration, often called age-related macular degeneration (ARMD), is a leading cause of vision loss in Americans 60 and older. It is a disease that destroys the sharp, central vision needed to see objects clearly. This affects the ability to read, drive, watch television, and do routine daily tasks.

Age related macular degeneration affects the macula, the part of the eye that allows you to see fine detail. It does not hurt, but causes cells in the macula to die. In some cases, age related macular degeneration advances so slowly that people notice little change in vision.in others, the disease progresses faster and may lead to vision loss in both eyes. There two kinds of age related macular degeneration-wet and dry. Wet age related macular degeneration occurs when abnormal blood vessels behind the retina start to grow under the macula. Dry age related macular degeneration occurs when the light-sensitive cells in the macula slowly break down, gradually blurring central vision in the affected eye.

Treatment: Although there is no cure for age related macular degeneration at this time, regular eye exams can detect the disease so treatment can be most effective. Findings from the nei-supported age-related eye disease study (areds) show that a specific combination of vitamins and minerals can help slow the progression of advanced age related macular degeneration. Treatment for wet age related macular degeneration include laser surgery, photodynamic therapy and drugs injected into the eye, are lucentis (rabibizumab)and avastin(bevacizumab).nei is also supporting areds2 to learn whether a modified combination of vitamins and minerals can further help people with age related macular degeneration.

DIABETIC RETINOPATHY

Diabetic retinopathy is caused by diabetes. It affects the retina, the light-sensitive tissue at the back of the eye and causes the most blindness in U.S. adults. It affects the vision of more than half of 18million people diagnosed with diabetes age 18 or older. People with diabetes should have a complete eye exam through dilated pupils at least once a year.

Treatment: Diabetic retinopathy is treated with surgery or laser surgery. With timely treatment; adequate control of blood sugar, blood pressure, and cholesterol levels and regular follow up, 90 percent of all cases of blindness from diabetes can be prevented.

HEAD INJURY

Injuries to the brain, skull, or scalp are all types of head injury. A head injury may be mild or severe depending on what caused it. Some injuries produce bleeding within your skull. Others cause damage on the outside of your head. These injuries may be inform of lacerations, bumps, or bruises.

Symptoms of head injury

  • Inability to stand or balance
  • Confusion
  • Small cuts or bumps
  • Headache
  • Nausea
  • Temporary memory loss
  • Ringing in the ear

RETINAL DETACHMENT

The retina is a light-sensitive membrane located at the back of the eye. When light passes through the eye, then lens focuses an image on the retina. The retina converts the image to signals that is sends to the brain via the optic nerve. The retina works with the cornea, lens, and other part of the eye and the brain to produce normal vision.

Retinal detachment occurs when the retina separates from the back of the eye. This causes loss of vision that can be partial or total, depending on how much of the retina is detached. Retinal detachment is a medical emergency. When your retina becomes detached, its cells may be deprived of oxygen.

Symptoms of retinal detachment

  • Blurred vision
  • Partial vision loss
  • Flashes of light when looking to the side
  • Areas of darkness in your field of vision
  • Suddenly seeing many floaters.

OPTIC NEURITIS

Optic neuritis (ON) is a condition in which your optic nerve becomes inflamed. Inflammation causes vision loss-although usually in only one eye. As you recover and the inflammation goes away, your vision mat return. ON can flare up suddenly from an infection or nerve disease.

Those with ON suffer vision loss, which can be accompanied by pain. There are other conditions with symptoms that resemble the symptoms of ON .Physicians may use optical coherence tomography (OCT) or magnetic resonance imaging (MRI) to help reach the correct diagnosis.

CAUSES OF OPTIC NEURITIS

The cause of optic neuritis is not well understood. Most cases are idiopathic, which means they have no apparent cause. In other cases, the most common causes is multiple sclerosis. Infact, ON is often the first symptom of MS. Less commonly, ON is caused by infection or an inflammatory immune system response.

Nerve diseases that can cause ON include:

  • Multiple sclerosis
  • Neuromyelitis
  • Shilders disease

Infections that may cause ON include:

  • Mumps
  • Measles
  • Tuberculosis
  • Lyme disease

CORNEAL OPACITIES:

Corneal opacities are eye problems that can lead to scarring or clouding of the cornea, which decreases vision. This includes xerophthalmia which is estimated to affect 5 million children each year.50, 000 develop actual corneal involvement and half of those go blind. Xerophthalmia is the blinding complication of vitamin A deficiency, is seen most often in malnourished children. Globally an estimated 750 million have vitamin A deficiency an estimated 2.7 million, mostly children are blind of whom 60% will die. Prevention through nutrition, education, promotion of home gardens and providing vitamin A supplement can prevent xerophthalmia, save life and prevent early death. Corneal ulcer is a significant cause of monocular blindness every year in Indian sub-continent alone.

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TRACHOMA

This is a bacterial infection that affects your eyes. The bacterium that causes trachoma spread through direct contact with the eyes, eyelids, and nose or throat secretions of infected people. Trachoma very contagious and almost always affects both eyes. Signs and symptoms of trachoma begin with mild itching and irritation of your eyes and eyelids and lead to blurred vision and eye pain. Untreated trachoma can lead to blindness.

The WHO estimates that there are 84 million people infected with trachoma of whomn1.3 million are blind although this estimation has dropped in the past 10 years from 6 million, this highly infectious disease is caused by the organism chlamydia trachomatis and is found primarily in 55 countries in Africa, the middle east, central Asia, India and South-East Asia. Rates are being slowly reduced due to improved asses to unpolluted water, good hygiene and antibiotic treatments (Mahmoud et al., 2005).

ONCHOCERCIASIS

Onchocerciasis also known as River blindness, is one of the main causes of blindness affecting poorer countries and is the second most frequent infectious cause of blindness after Trachoma.

Onchocerciasis is a disease in which a parasitic infection with a worm called onchocerca volvulus causes inflammation with the eye leading to severe inflammation, damaging to critical structures and frequently to permanent blindness.

Infection with this worm also causes severe skin disease with terrible itching, rashes, skin nodules and other secondary skin changes and deformities. In the countries where it occurs, at least 80million people are known to be at risk of Onchocerciasis. There are probably about 15million people who are infected with onchocerca volvulus and of this, studies suggest that about 300,000 people are blinded by it.

It is one of the main causes of blindness affecting poorer countries and is the second most frequent infectious cause of blindness after trachoma.

CHILDHOOD BLINDNESS

It has been estimated that there are 1.4 million blind children in the world, 1 million of which live in Asia and 300,000 in Africa.

GENERAL CAUSES OF BLINDNESS

Genetic defects

Poisoning

Willful actions

 MANAGEMENT

Mobility: Many people with serious visual impairment and blindness can travel independently, using a wide range of tools and techniques. Orientation and mobility specialists are professionals who are specifically trained to teach people with visual impairments how to travel safely, confidently, and independently in the home and the community. These professionals can also help blind people to practice traveling on specific routes which they may use often, such as the route from one’s house to a convenience store. Becoming familiar with an environment or route can make it much easier for a blind person to navigate successfully. 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. It is usually swung in a low sweeping motion, across the intended path of travel, to detect obstacles. However, techniques for cane travel can vary depending on the user and/or the situation. Some visually impaired person do not carry these kinds of canes, opting instead for shorter, lighter identification cane (ID), still others require a support cane.

The choice depends on the individual’s vision, motivation, and other factors. A small number of people employ guide dogs to assist in mobility. These dogs are trained to navigate around various obstacles, and to indicate when it becomes necessary to go up or down a step. However, the helpfulness of guide dog is limited by inability of the dogs to understand complex directions. Some blind people use GPS for the visually impaired as a mobility aid. Such software can assist blind people with orientation and navigation, but it is not a replacement for traditional tools such as white canes and guide dogs. Technology to allow blind people to drive motor vehicles is currently being developed. 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 driven to user of white canes or guide dogs.

Reading and Magnification: Most visually impaired people who are not totally blind read prints, either of a regular size or enlarged by magnification devices. Many also read large print which is easier for them to read without such devices. A variety of magnifying glasses some hand held, and some on desktops, can make reading easier for them. Other read Braille (or the infrequently used moon types), or rely on talking books and readers or reading machines, which convert printed text to speech or Braille. They use computer 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. Closed circuits to televisions, equipment that enlarges and contrasts textual items are more high tech alternative to additional magnification devices. There are also over 100 radio reading services throughout the world that provide people with vision impairments with reading from periodicals over the radio. Access technology such as screen magnifiers and refreshable Braille displays enable the blind to use mainstream computer applications and mobile phones. The availability of assistive technology is increasing, accompanied by concerted efforts to ensure the accessibility of information technology to all potential users, including the blind. Later version of Microsoft windows include on accessibility wizard and magnifier for those with partial vision, and Microsoft Narrator, a simple screen reader, Linux Distribution (as live CDS) for the blind include Oralux and Adriane Knoppix, the latter developed in part by Adriane Knopper who has a visual impairment. Mac OS also comes with a built in screen reader, called Voice over. The movement toward greater web accessibility is opening inviting place for visually impaired suffers who want to remain informed. Experimental approaches in sensory substitution are beginning to provide access to arbitrary live views from a camera. Modified visual output that includes large print and/or clear simple graphic can be of benefit to users with some residual vision (Gregor et al., 2002)

Other Aids and techniques: Blind people may use talking thermometers, watches and clocks, scales, calculators and compasses. They may also enlarge or mark dials on devices such as ovens and thermostats to make them unstable. Other techniques used by blind people to assist them in daily activities include”

  • Adaptation of coins and bank notes so that the value can be determined by touch. For example in some currencies such as the euro, the pound sterling and the Indian rupee, the size of a note increases with its value; some currencies’ banknotes have a tactile feature to indicate denomination like the Canadian currency tactile feature which is a system of raised dots in one corner, based on Braille cells but not standard Braille.
  • Labeling and tagging clothing and other personal items.s
  • Placing different types of food at different positions on a dinner table
  • Marking controls of household appliances
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Sports: Blind and partially sighted people participate in sports such as swimming, snow skiing and athletics. Some sports have been invented or adapted for blind such a goal ball, association football, cricket, golf, and tennis. The worldwide authority on sports for the blind is the international Blind sports federation (Lin, 2012). People with vision impairment have participated in the Paralympics games since the 1976 Toronto summer Paralympics.

1.1 STATEMENT OF PROBLEM

According to Kehinde and Ogwurike (2005) in their work on pattern of blindness in institution for the blind in Kaduna, Nigeria’’, blindness is not just only a personal tragedy, it is also an economic nightmare. The global initiative vision 2020: The right to sight has a mission to eliminate the main causes of avoidable blindness in other to give all the people of the world,   particularly the millions of needlessly blind, the right to sight in the year 2020. To achieve this, there must be appropriate definition of blindness and reliable statistics on the number of blind persons, the population at risk, and importantly the causes of blindness in special education school Oji –River LGA of Enugu state.

1.2 PURPOSE OF STUDY

This study is aimed at:

  • Determining the major causes of blindness among students in special Education school Oji-River.

1.3 RESEARCH HYPOTHESIS

Null Hypothesis (Ho):

There is no relationship between gender and causes of blindness in Special Education School Oji-River.

  • Alternate Hypothesis (Ha):

There is relationship between gender and causes of blindness in Special Education School Oji-River

1.4 RESEARCH QUESTION

  • What are the common causes of blindness among student in Special Education School Oji- River?
  • Is there any significance difference between gender and causes of blindness?
  • Is there a relationship between gender and age?
  • What is the laterality of blindness?

1.5 OBJECTIVES

  • Determining the frequency and distribution of existing causes of blindness among people of various age and gender.
  • Determining if there is any relationship between age, gender and environment or location in causing blindness
  • Recommending ways by which the causes of blindness can be prevented or managed and documenting information gotten from further use.
    • SIGNIFICANCE OF STUDY
  1. From past studies and observations, it is imperative to bring to the open the major causes of blindness especially if some of these causes can be prevented.
  2. It is therefore hoped that this study is a form of creating awareness and also a challenge to optometrist, public health workers and other eye care personals to take a step against eye threatening disorder.
  3. It can also help the masses become aware and conscious that some disease and conditions predispose them and their children to blindness.
  4. This study serves as a reference to other researcher in the future and to the global initiative vision 2020.

1.7 DELIMITATION

This includes all students who presented with visual acuity less than 3/60 in the better eye even with the best optical correction, whose records were found in the school.

1.8 LIMITATIONS OF STUDY

  • Records of exact number of the students who are admitted in the school were not found due to misplacement while filing and loss.
  • Some information needed including final diagnosis in some cases were not completely recorded

1.9 DEFINITION OF TERMS

1.9.1 Conceptual

Blindness: Visual acuity of less than 3/60 or its equivalent

Corneal opacity: Loss of normal transparency of cornea due to scarring

Diabetic retinopathy: It refers to retinal changes seen in patient with diabetic mellitus

Glaucoma: Is a group of eye disease causing optic nerve damage.

Macular degeneration: Is a bilateral disease of persons over 50 years of age

Measles: Is a viral infection that mainly affects children, but can occur at any age.

Onchocerciasis: Is an eye and skin disease caused by a worm (filaria) it is transmitted to humans through the bite of a blackfly.

Retinal detachment: Is the separation of neuro sensory retina proper from the pigment epithelium.

1.9.2: OPERATIONAL

Blindness: Inability to see; Absence or severe loss of vision so as to be unable to perform any work for which eyesight is essential. It is synonymous to the terms ablepsia; ablepsy; alexia.

Corneal Opacity: Are eye problem that can lead to scarring or clouding of the cornea, which decreases vision.

Diabetic retinopathy: Is a condition occurring in persons with diabetes, which causes progressive damage to the retina.

Glaucoma: Is a group of diseases that damage the eyes optic nerve and can result in vision loss and blindness.

Macular degeneration: Is a medical condition usually affects older adults and results in a loss of vision in the center of the visual field because of damage to the retina.

Measles: Is a viral infection of the respiratory system.

Onchocerciasis: Is an eye and skin disease caused by a worm (filaria).It is transmitted to humans through the bite of a blackfly.

Retinal detachment: Is a disorder of the eye in which the retina peels away from its underlying layer of support tissue.

The Causes of Blindness in Special Education School Oji –River Lga of Enugu State

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