Blindness is a major public health problem in African because of the sheer number of people so afflicted. Economic survival is a struggle for the average, non-handicapped person in a developing country. The burden of blindness is therefore a major added frustration to the individual’s economic independence and social development.
Eye care delivery has not received much attention in many African countries. Although the need for eye care cannot be denied, it is competing for scarce resources with more compelling problems like high maternal and infant mortality and acute medical and surgical problems.c Ophthalmologists are few and tality and acute medical and surgical problems. Ophthamologists are few and the traditional hospital-based curative ophthalmic practice is expensive to run.
By and large, ophthalmologists, optometrists and hospitals are situated in big cities and towns while more than 80% of the population lives in rural areas and villages.The majority of the population is therefore underserved or not served at all. For every patient who attends the hospital, there are probably 4-5 needy patients who have not visited the doctor because they are too poor, too far from the hospital or just ignorant of what can be done. Besides, taboos and sociocultural attitudes often discourage patients from using existing modern facilities. Consequently, diseases are usually seen at an advanced stage. These factors, contributing to late presentation, together with inadequate facilities lead to a pool of curably blind as is seen in the cataract backlog in Africa.
The eye diseases seen in Africa are often no different from those encountered in Europe; most of them are treatable or preventable, but their neglect has a devastating effect on vision.
Cataracts are very commonly seen in Africa, accounting for approximately 50% of all cases of blindness. They may be congenital in origin; often due to intrauterine infection like rubella, or metabolic diseases in the child like galactosaemia. Cataracts may also complicate injuries to the eye; but more commonly they are seen in the elderly.
Senile cataracts are known to occur at an earlier age in the tropics, and recent work suggests that severe diarrheoal diseases early in life may be a contributory factor. It will be interesting to see in a few year’s time the effect of oral rehydration therapy on the prevalence of cataracts. The surgical treatment of cataracts is very rewarding, but advantage of this fact is often not taken, due mainly to inadequate facilities and ignorance. Mobile eye units being operated by various non-governmental organizations are now unable to afford the cost of corrective glasses, as is often the case, the improvement in vision is often adequate to enable him to look after himself and move around, thereby ceasing to be a burden on family and friends. Although more cataract operations are now being done, contact lenses and intraocular lens implantations, which have become routine in developed countries, are not usually available in Africa.
Infections of the external eye are very common, notably among which are trachoma, conjuctivitis of the newborn, epidemic haemorrhagic keratocon-junctivitis, corneal ulcers, measles, Keratoconjunctivitis and leprosy. The infection may spread to the inner eye and lead to loss of the eyre. Eye infections may be responsible for up to 25% of all cases of blindness in Africa.