Health Wikipedia

Irrespective of gender and age, everyone has the equal right to see the beauty of this world. But access to eye care services for women and girls is not equal to that of men and boys. Only 35 percent of eye care services are received by women and girls who are blind and remaining 65 percent services are received by their male counterparts.

Experts identified gender discrimination, customary social attitude, lack of women empowerment, lack of education and awareness, fissure in national policy for eye health are the barriers to equal access to eye care services.

Nearly two-thirds of blind people worldwide are women and girls. Less access to eye care services than men is one important fact behind the huge number of blind women and girls. Moreover, certain eye conditions like trachoma and cataract affect women more than men contributing the rising number.

The theme of World Sight Day 2009 that was being observed on October 8 was “Gender and eye health — equal access to care”. It was dedicated to ensure gender equality in the access of eye care services, which is unfortunately not the case in Bangladesh.

There is urgent need to step up focus on women and girls who unnecessarily have already become blind or becoming blind where simple interventions can prevent blindness and help them get back their precious sight.

Women and girls face the discrimination in receiving proper eye care services due to certain factors that should be eliminated.

“We have common social attitude that women should always get less priority not only in getting eye care but also in all social services. Male people of the family hold the decision making power and they are reluctant to bring women and girls under eye care services as they are not earning members of the families”, said renowned ophthalmologist Dr M A Muhit, Clinical Research Fellow of International Centre of Eye Health, London.

“Women are also not aware of the fact that they have equal right to access eye care as male. Moreover, many women have accepted the condition as their fate; rather they prefer treatment of their husbands or children. But very few of them know that 80 per cent of the blindness can be prevented with early intervention and sight restoring surgery”, Dr Muhit added.

Although female gender are more in number and deprived more, there is no gender analysis or gender sensitive issue in the national plan for eye health in Bangladesh. Health authorities in the national level need to recognise the existing gender differences in access to eye care services. This could be an important step to reducing the disparity in eye care treatment for women.

Dr Muhit opined that the existing programmes to eradicate avoidable blindness and improve eye health in Bangladesh must give emphasis on counselling, education, awareness and empowering women. Along with women, men as they are considered decision makers, must be motivated and make aware about the significance of sight restoring operations or treatment for women to help them get back their sight.

Blind women cannot contribute to the well-being of the family with ease. Motivating men and women together can have the tremendous impact on community mobilisation. With access to timely treatment of women with impaired vision or avoidable blindness can bounce back and lead more fulfilling lives, Dr Muhit suggested.

Women need better access to eye care services. Without ensuring equal access to eye care for them, we cannot meet the target to eradicate avoidable blindness within 2020. Let’s make a cumulative move to reach the goal.

A most common primary intraocular (inside the eyes) malignancy of childhood arises from primitive retinal cells of the eye. About 90% cases are diagnosed less than 3 years of age.

A common presentation is white pupillary reflex, some with squint and some with inflammation of the eye. In our country, most of the patients present with advance stage when the tumor extends externally.

In advance stage though the chance of saving eye is less but when other eye is examined and if a small lesion is detected, can be treated by focal therapy (Photocoagulation with Laser). Early detected is very important in that respect.

When treating retinoblastoma, it is first and foremost important to understand that it is a malignancy. When the disease is contained within the eye, survival rates exceed 95% in the western world.

However with extra ocular spread survival rates decreases to under 50%. Therefore, in deciding on a treatment strategy, the first goal must be preservation of life then preservation of eye and finally preservation of vision.

The modern management of intraocular retinoblastoma currently incorporates a combination of different treatment modalities including chemotherapy, photocoagulation with Laser, cryotherapy, radiation therapy and surgery like enucleation (removal of globe).

Metastatic disease is managed with intensive chemotherapy, radiation and bone marrow transplantation. Among all of this treatment options — the best, cheap and less hazardous option is photo-coagulation with Diode Laser if tumor is detected in early stage with a very small lesion. If laser is applied, eye can be saved, even useful vision can be preserved.

The treatment of children with retinoblastoma requires a team approach including an ocular oncologist, pediatric ophthalmologist, pediatric oncologist and radiation oncologist.

The chemo, radiation therapies are very expensive. Comparing all modalities, the photocoagulation therapy with Diode Laser is cheaper. This facility is available at the government set-up in Sylhet MAG Osmani Medical College Hospital. The facility is available on courtesy of WHO. Expert manpower is available there and moreover the service is offered at free of cost.

The facility of laser photocoagulation can save valuable life of a child and also rescue a family from a danger point. Children with intraocular retinoblastoma who have access to modern medical care have a very good prognosis for survival.

The eyes are amazing windows through which we observe the world. It is responsible for majority of all the information our brain receives and usually we rely on our eye-vision more than any other sense. For a strong vision we need antioxidants, nerve supporters, pigment protectors, cell membrane components, vasodilators and cofactors.

Scientists at the Cleveland Clinic judge that antioxidants like beta-carotene and vitamin C can reduce vision loss in patients with age-related vision impairment called Age-Related Macular Degeneration (ARMD). These vitamins can protect our eyes from vision-altering free radical damage.

Harvard scientists have found that antioxidant ‘zeaxanthin’ can protect our eyes against ARMD by absorbing blue light which is a part of sunlight. This terrible light is capable of damaging our retinas. Fruits and vegetables contain vitamin A, C, E and Beta-carotene. The yellow vegetables are important for daytime vision.

According to some researchers, green tea has 10 times more antioxidants than fruits and vegetables. Green tea contains flavonoid antioxidants that fight free radicals and also prevent age related skin problems.

Garlic and onions are rich in sulfur, which is necessary for the production of glutathione, an important antioxidant for the lens of the eye, and the whole body. Small Fishes and fishes rich with Omega 3 (especially DHA or docosahexaenoic acid) are good for eyes. DHA provides structural support to cell membranes, and is recommended for dry eyes, treatment for macular degeneration, and sight preservation.

Spinach and green leafy vegetables are rich in carotenoids, especially lutein and zeaxathin. Lutein, a yellow pigment, protects the macula from sun damage and from blue light.

Eggs are rich in cysteine, sulfur, lecithin, amino acids and lutein. Sulfur-containing compounds protect the lens of the eye from cataract formation. Vitamin B Complex is (especially Vitamin B-12) necessary for nerve function. The retinal receptor cells send all their messages through nerve fibers into the optic nerve, and into the brain. These vitamins keep up nerve and general body activities. One of the most common deficiencies in elderly individuals is B12. According to ‘eye specialists’ vitamin B-12 (under the tongue or sublingually) is recommended everyday for people with optic nerve disease or glaucoma.

These days we must be selective in terms of the foods we eat when the soil is contaminated with pesticides and chemicals. And sometimes modern-day diet cannot provide all the answers. We need to be able to add extra constituents to our dietary in order to restore what may have been lost.

Today, there are lots of people who are organised to take care of our eyes. They are ophthalmologist, optometrist and opticians. It depends what kind of eye care we need.

Ophthalmologist is an expert treating medical diseases of the eye. If you are concerned about your glasses – an optometrist is the right person. They are specialists in glasses, contacts, and primary eye care. An optician is somebody who specialises in fitting glasses to our eyes- making lenses, fitting the frames, adjusting the nose pieces.

In developed countries opticians can also be involved in dispensing contact lenses, but they do not prescribe glasses or contacts, and they do not measure or examine eyes.

Dr Rubaiul Murshed…