Monday, 18 December 2017
Refractive errors, the cause of 44% of all forms of visual impairment in Ghana

Refractive errors, the cause of 44% of all forms of visual impairment in Ghana

By Dr Kwame Oben-Nyarko (Optometrist), Third Eyecare and Vision Centre

Introduction
Kojo Mensah is a 7-year-old class 2 pupil in a school in Teleku Bukazo in the Western Region of Ghana.

He is a very tall child so his teacher has placed him at the back of the class so that he does not obstruct the view of other pupils in the class who are shorter than him.
He constantly makes mistakes when copying from the board.
Mr Owusu-Amanfo is Kojo Mensah’s teacher. He recently attended a training seminar sponsored by Adamus Resources Limited and facilitated by Third Eyecare and Vision Centre on ‘Red Alerts among Pupils with Eye Conditions’.
The seminar trained teachers on how to identify eye conditions among pupils by observing their behaviour and signs that can be seen of pupils with eye conditions.
It also taught Mr Owusu-Amanfo how to measure visual acuity with the snellen chart.
Mr Owusu-Amanfo, armed with the knowledge and skills acquired from the training, decided to probe further into why Kojo Mensah could not write correctly from the board.
First of all, he asked him if he could see well, and Kojo Mensah answered in the affirmative.
The teacher, still being curious, decided to move him to the front row for a week and observe what the outcomes would be regarding his output on copying from the board.
To his utter surprise, Kojo started copying more correctly from the board. He also decided to run a simple visual acuity test with test types printed on an A4 sheet.
It was there that he realised that Kojo Mensah could not see well, and advised the parent’s to go and see Dr Kwame Oben-Nyarko, who was in the district organising free eye examinations for pupils within the district and supplying them with free glasses with the help of Adamus Resources Limited.
It was there that it was discovered that Kojo Mensah had a very high REFRACTIVE ERROR, for which he needed to correct immediately with glasses.
Failing to wear the glasses could have led to his eyes getting permanently blurred or lazy even with spectacles correction later in life.
What is refractive error?
Refractive error can simply be defined as the eyes’ inability to focus all the light entering it to one point on the retina such that images become blurred.
It can either be caused by the eyeball being shorter or longer than it is actually supposed to be, or the power of the eye being either stronger or weaker than it is actually supposed to be, or the curvature of the eyeball being irregular than it is actually supposed to be.
There are three main types of refractive errors; namely, myopia (shortsightedness), hyperopia (farsightedness) and astigmatism.
There are other complex forms of refractive errors and these could come in the form of myopia being combined with astigmatism, or hyperopia being combined with astigmatism.
All of these forms of refractive errors are characterised by blurriness of vision at either far (long) distances or near (short) distances.
Refractive errors could lead to pain the eyes as well as severe headaches that do not resolve with pain killers.
Some patients of refractive errors also tend to strain or squint the eyes a lot and could also complain of seeing shadows around objects that they are looking at.
This condition is simply managed by the use of spectacles or contact lenses or laser surgery.
It is never too early to wear glasses as failing to do so could lead to permanent visual impairment.
This is a condition that affects people of all ages and it is very worrying for children in school to have it because it tends to affect their performance due to their inability to see well and appreciate detail.
A lot of the time, if this condition is not diagnosed and managed early, it could lead to the eyes being permanently unable to see well even with spectacles.
Globally, it is estimated that 2.3 billion people have refractive errors; out of this number, 670 million have visual impairment due to uncorrected refractive errors (Naidoo and Jaggernath, 2012).
In Ghana, it is estimated that 44% of all forms of visual impairment is caused by refractive errors (Operation Eyesight Universal, 2017).
This estimate is expected to rise if government does not invest in training and engaging the services of more optometrists, as well as making lenses and frames more affordable by taking taxes off them.
Conclusion
Kojo Mensah, after receiving and wearing his glasses, began to improve his copying from the board. He could also sit anywhere in class and still see clearly on the board.
Had it not been Mr Owusu-Amanfo who discovered this based on the knowledge he had acquired, Kojo Mensah could have struggled through school and become visually impaired and eventually a burden on society. Now, Kojo Mensah is more productive in class and learning has become easier thanks Mr Owusu-Amanfo, Adamus Resources Limited and Third Eyecare and Vision Centre.
The menace of uncorrected refractive errors is not one to be toyed with. It requires a collective effort from government, eye care providers, teachers, parents and corporate organisations to fight it.
Government should ensure the training, engagement and equitable distribution of more optometrists to fight refractive errors.
Government should also make policies that make annual eye examinations for pupils and workers mandatory as this helps identify people with eye conditions so that the needed management is given to avert visual impairment.
Government must also, as a matter of policy, reduce or totally remove taxes on lenses and spectacles frames so that they become more affordable.
Optometrists should also continue to volunteer their time, energy and resources in the fight against visual impairment from refractive errors by doing more free community and school eye care projects.
Parents and teachers should be very observant of their children as most of the signs of refractive errors can be picked simply by observation.
A lot more corporate bodies should support eye care organisations in the fight to reduce the incidence of visual impairment in Ghana.
Together, we shall win the fight again avoidable blindness and visual impairment. #LET VISION COUNT…

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