Corneal blindness

The number of cornea blind Filipinos probably number half a million. This number may be low compared to the number of people blind because of cataracts but the rate corneal blindness is being addressed is far less at less than one percent per year.

Unlike cataract patients where cataract affects people in their 60s or 70s, cornea patients are usually affecting patients in their 20s and 30s.

The cornea is the front crystal part of the eye, just before the lens, iris and pupils. It is likened to the crystal part of your wristwatch. Any condition which affects the clarity of the cornea will lead to blurred or diminished vision of that eye.

Sadly, in our country the most affected are individuals in their 20s due to infection, trauma and malnutrition. The cornea is a unique tissue of the eye because when it is injured or compromised, it tries to heal itself. The downside is when it heals and reconstructs itself, leading to scarring. It is precisely this scarring that eventually blurs the vision of the individual.

Any scarring affecting the central part of the cornea will blur the vision. Depending on how dense the scar is, it may manifest as blurred or diminished near and far vision to sometimes legal blindness.

Legal blindness

Legal blindness is a state where a person has been prescribed with glasses or contact lenses to correct his vision but still unable to read or recognize the big E in the standard eye chart. The Big E is the first letter a person is asked to read on a routine eye check-up. Legal blindness can be caused by cataract, glaucoma, diabetes, other retinal problems, or corneal scars.

The impact of corneal blindness on these individuals is that their future productive potential is compromised because these individuals cannot effectively compete with their binocular counterparts. Some occupations require binocularity or stereoscopic vision or plain vision in both eyes such as the military, police, some branches of engineering or any job that requires good vision in both eyes. There are other causes of blindness: cataracts, glaucoma, retina or optic nerve conditions.

The good thing is cornea blind people can be effectively treated here in our country. Filipino surgeons probably do only about 500 to 700 corneal transplants a year. Even if we do 2,000 surgeries a year, it will still take us 50 years to catch up with the backlog of cases. Even if you do a beautiful graft (transplant), there is the problem of rejection. People think it is just like cataract surgery, once it is done you forget about it. Not with corneal transplants – once a transplant patient, always a transplant patient. Anti-rejection medicines are not that expensive. However, patients and some general ophthalmologists sometimes cannot tell that there is a rejection going on.

Prevention

One thing that can diminish the number of cornea blind individuals is prevention. At the first sign of possible corneal infection after injury, see your eye doctor. Ordinary eye infections like sore eyes or conjunctivitis have the usual red eye; corneal infections are usually accompanied by more intense red eyes, intense eye pain, diminished or blurred vision, photophobia or light sensitivity. Sometimes a "white spot" may appear on the black part of the eye, meaning the cornea. Industrial accidents on welders, construction workers and the like can be prevented by wearing appropriate eye protection devices. There should be legislation passed to penalize owners who do not provide safety glasses or goggles.

Contact lens wearers should likewise be warned regarding the risk of prolonged wearing of contact lenses. Most contact lens wearers get their lenses from non-ophthalmologists and sometimes, instructions on proper lens hygiene and overall eye care are omitted which makes this population at high risk. The bacteria that affect contact lens wearers are also more damaging that non-contact lens wearers’.

General practitioners should be informed on how to recognize, treat and when appropriate, refer without delay people with sight-threatening infections. The local herbolario should likewise be discouraged in trying to treat these eye conditions with folk medicine or worse, with steroid-containing eye medications.

Corneal blindness can be prevented. Sometimes the infection is so overwhelming, a few hours or days lost due to indecision may cost the individual his sight and worse, his eye!