Need for vision rehabilitation in India

Vision impairment and blindness describes functional vision loss that cannot be corrected to within the normal range with spectacles, contact lenses or medical interventions such as surgery. Vision rehabilitation can potentially benefit people with vision impairment & there is an urgent need to act upon immediately to overcome the barriers to rehabilitation.

Dr. Beula Christy, Associate Director, Head of Services - Institute for Vision Rehabilitation, LVPEI, Hyderabad

Vision impairment and blindness describes functional vision loss that cannot be corrected to within the normal range with spectacles, contact lenses or medical interventions such as surgery and that interferes with normal everyday function. Globally, there are an estimated 253 million people with vision impairment (4% of world’s population), and more than 90% are from developing countries, such as India. The number of children in need of low vision care worldwide is 6 million, of these children; 4.8 million live in low and middle income countries. In India, there are an estimated 56 million people with vision impairment including the 8 million with blindness. From this an estimated 800,000 are children with low vision or blindness. Of all visual impairment 20% cannot be corrected to normal by conventional spectacles, contact lenses or surgery and requires rehabilitation intervention.

Individuals with vision loss confront challenges related to their physical well-being and mental health. Vision impairment imposes several functional implications in performing daily activities such as reading & writing, watching television, seeing faces, leisure activities, preparing meals, money management, personal grooming etc., Restricted mobility and orientation skills particularly in elderly make them more vulnerable to falls and associated complications. In addition to the functional disability associated with vision loss, it is evident that the psycho-social impact of visual impairment such as individuals feeling irritable fatigued and disinterested as well as sadness, tearfulness and depression is also substantial. The economic impact of visual impairment and associated disabilities is also an important consideration. The costs associated with vision loss at an individual level include direct costs of treatment, the loss of personal income for those in their employable years, associated costs such as social security disability benefits and the lost productivity of those caring for or assisting persons with visual impairment. The combination of social, functional, and psychological and economical limitations results in an overall reduction in quality of life.

Vision loss in children adversely affects their overall development in their early childhood.

They may have delay in milestones because when vision is impaired, a child does not have the ability to observe how others behave or care for their own needs. Children with vision loss will also have difficulty in social inclusion, particularly in terms of acceptability by sighted children, which may lead to emotional and behavioral difficulties. Play is another facet of social skills that is often overlooked. Participation in mainstream schooling is an important concern as globally 90% of children with vision impairment do not get access to education.

Vision rehabilitation services have a key role to play in mitigating the negative consequences of vision impairment and enabling people - children and adults with visual impairment to meet their full potential. The goal of vision rehabilitation is to empower people with incurable vision impairment to enhance their quality of life and live a life as independent as possible. The key components of intervention include Psychological support to vision loss, Low vision care – assessment, training, & prescription of devices, Special skills training such as Independent living skills & mobility, Assistive software training to use computers, Early intervention for children below 5 years of age with developmental problem, Guidance & placement services for economic independence, Self help meets & Peer support programs, Advocacy and Support services.

Thus, vision rehabilitation can potentially benefit people with vision impairment, however, except for a small number of high income countries, in most countries less than 10% of people with low vision have access to specialist services; in many it is less than 5%. India is one of these countries where coverage and access to services is attainable by very few people. Rates of rehabilitation service uptake are influenced by a mix of factors, including the lack of prioritization; the lack of policies and plans; high costs and non-existent or inadequate funding mechanisms; insufficient numbers of appropriately trained professionals, absence of facilities and equipment; and ineffective service models and lack of integration and decentralization of services such as rehabilitation care within primary and secondary health care settings. Unmet rehabilitation needs can limit activities, restrict participation, cause deterioration in health, increase dependency on others for assistance, and decrease quality of life. These negative outcomes can have broad social and financial implications for individuals, families, and communities. Owing to rapid increase in global population and aging threat, a massive increase in the number of people with blindness and moderate to severe visual impairment is expected as an estimated 276 million by 2020 and 703 million by 2050.

Hence there is an urgent need to act upon immediately to overcome the barriers to rehabilitation service through a series of actions, including: reforming policies on service delivery systems, developing funding mechanisms to address barriers related to financing of rehabilitation, increasing human resources for rehabilitation, increasing the use and affordability of technology and assistive devices, expanding research programs, improving information and access to good practice guidelines.

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