Vision

What is blindness to you? Exercise: Write down your own definition of blindness. Name other problems that people might have with their eyes.   In pairs share your answers. Notes for teacher: Teacher starts the Fred Hollows pack by discussing with students what vision and vision loss means. Do any students wear glasses? Do any students have grandparents with cataracts or another eye condition?

Definitions BLINDNESS: When a person is unable to see because of injury, disease, or a condition at birth. AVOIDABLE BLINDNESS: Blindness which could be either treated or prevented, also referred to as NEEDLESSLY BLIND. VISUAL IMPAIRMENT: Full or part loss of vision.

What is avoidable blindness? Exercise: All students to stand up Any students with glasses sit down Any students who have parents who wear glasses sit down Any students whose grandparents have had an eye operation sit down   Notes for teacher: Conclusion: Teacher to discuss with students that all those people who sat down represent people with avoidable blindness – which is all the conditions that could be treated or prevented.

The Fred Hollows Foundation NZ Fred Hollows NZ is a charitable organisation that works in the Pacific to eliminate avoidable blindness. In these areas 4 out of 5 people who are blind don’t need to be. In many cases, a short 20-minute operation can restore sight or a dose of antibiotics can prevent blindness. Notes for teacher: Teacher can now ask 5 students to stand up. Teacher tells the 5 students they are blind One by one four students are told to sit down Teacher explains that their blindness was curable with an operation. The remaining student represents the person whose blindness was not preventable or curable

How is sight tested? Vision charts are one way to assess how well a person can see. If they cannot see well, the medical term for this is ‘refractive error’ (for example - they are short-sighted or long-sighted). Vision charts might have lines of letters, or E shapes for people who cannot read or don’t use the English alphabet Notes for teachers: A short-sighted person can only clearly see objects that are close to them - objects which are further away cannot be seen clearly. A person who is long-sighted can only clearly see objects that are far away – objects which are close to them cannot be seen clearly.

Using a vision chart, what result is considered being blind? A person is considered blind if their vision is worse than 3/60. This means a person who is blind will not be able to see the top E on this chart when standing 3 metres away whereas a healthy human eye could read the top ‘E’ at 60 metres away.

You can use a vision chart to compare your eye sight with your school mates. This will only give you an approximate idea of your vision. Your optometrist has much more precise tools to measure exactly how well you can see. Try it out! Exercise Notes to give the students for how to test vision – chart found in Teacher resource 1a: The vision chart is a three metre conversion of the standard six metre chart. Tape the eye chart to a wall. Stand three metres away from the chart and begin reading each line from the top down. If you have chosen the E chart you will need to use your hand to indicate which way the E is pointing. Each line of the chart is labelled on the left side. The second to last line is 6/6. Have a class mate watch to see that you are reading each letter correctly. The last line that you are able to read will give you an approximate idea of your vision. If you can read the very bottom line, your vision is 6/5 (20/10)! Now try covering one eye and just testing the other one. Is one eye better than the other? Compare your vision with your classmates. Do some of you have better vision than others? If you wear glasses, what is your vision with them on and what is it without them?

THE WORLD 36 253 7.3 BILLION MILLION PEOPLE ARE BLIND POPULATION 7.3 BILLION 36 MILLION PEOPLE ARE BLIND 253 MILLION PEOPLE ARE VISUALLY IMPAIRED OF THESE Note: Go to IPAB.org for the latest statistics on blindness. These statistics are current as at June 2018.

Anatomy and function of the eye

Watch the short film on eyes and then test yourself! Find out about eyes Notes for teacher: Watch the short film explaining the anatomy and function of the eyes. Then print out the diagrams below for students to label what they have learned. Answers below (these can be played in a slide show).

Which parts of the eye do you know? Eyelids Pupil Iris Eyelashes Notes for teacher: Print out and ask students to label

Inside the eye Cornea Retina Lens Optic nerve Print out and ask students to label Optic nerve

Around the eye Eyebrows Eyelids Eyelashes Eyebrows and eyelashes keep sweat and dust out of the eyes. Eyelids protect the front of the eye and allow us to sleep. Slide show on eyes starts here. Eyelashes

Iris Pupil The coloured part of the eye responsible for controlling the size of the pupil. The pupil is a hole located in the centre of the iris and controls how much light enters the eye

Cornea Lens The transparent layer forming the front of the eye. Sits inside the eye behind the pupil and iris. The lens changes shape, getting fatter to focus close objects and thinner for distant objects.

Retina

There are many causes of blindness and visual impairment There are many causes of blindness and visual impairment. Three most common causes are: Cataract Refractive Error Diabetic Retinopathy (DR) CAUSES

In the Pacific, cataract accounts for 80% of avoidable blindness When someone suffers from cataract, the lens of the eye becomes cloudy. Cataract can affect one or both eyes. The normally clear (black) pupil area becomes grey, as a milky cloudiness of the lens progresses until the cataract is mature. Cataract is the leading global cause of blindness. Cataract blindness can be treated with a short 20 minute operation.

REFRACTIVE ERROR Globally, uncorrected refractive error is the main cause of visual impairment. Most people can see again with a correctly-prescribed pair of glasses. Refractive error is a very common eye problem. It occurs when the eye cannot clearly focus the images from the outside world. It causes blurred vision - conditions such as long and short sightedness. Causes can vary from genetics to environmental factors.

DIABETIC RETINOPATHY (DR) Diabetes causes a person's blood sugar to become too high. It is a lifelong condition. Diabetic retinopathy is a complication of diabetes and is the world’s leading cause of blindness in the working age population.   When someone has high blood sugar levels, the blood vessels in the retina can become damaged – this cannot be reversed.  

Who is affected by blindness and visual impairment? Almost 90% of people with visual impairment live in developing countries. Globally, around half a million children become blind each year. 55% of visually impaired people are women Notes for teacher: Check Fred Hollows Website for updated statistics. As of December 2017: In the South Pacific, where The Fred Hollows Foundation NZ works, over 39,500 people are blind and around 175,000 are visually impaired. Since The Foundation NZ began we have distributed over 150,000 spectacles. Source of slide: World Bank Organisation.

Exercise What does poverty mean to you? What do you think basic needs are? What do you think the link is between poverty & blindness? Discuss why you think the percentage of visual impairment is higher in women than men. Notes for teacher: Teacher could set these questions as group tasks to answer. Answers: 1&2: Answered on next slide 3: Generally there are three main reasons. Firstly, there are some behavioural and biological differences between men and women that cause a slightly higher risk of developing certain eye diseases. For example, women have a slightly higher risk of developing cataract than men, irrespective of age. Secondly, in developing countries, women often have less access to healthcare due to social, cultural and economic norms. For example, it may be considered more important for a male family member to get treatment, or a mother may prioritise the family’s needs over her own. Thirdly, visual impairment increases with age and, in most countries, women live longer than men.  

Poverty and Blindness Poverty is not having enough money to meet basic needs. These basic needs are essential for healthy eyes. They include: Proper healthcare Adequate shelter Nutritious food Basic hygiene facilities Clean water People affected by blindness in developing countries usually fall further into poverty. Notes for teacher: Teacher to discuss with students why a blind person is likely to fall further into poverty. Some answers: They can no longer work, so their income is limited or stops. There is usually no welfare system to financially help the person and their family. Someone from their family will need to stay with the blind person during the day to help with basic tasks such as using the toilet and eating. The person staying at home might have to stop working to care for the blind person. The child of the blind person might have to stay home from school to care for their parent. Their education is lost, they are not able to get a well paid job when they are older.

Storyboard activity Draw images to go along with the following story to create your own storyboard Notes for teacher: The following slides tell a story. The teacher should read out the slides one at a time and give the students 4 minutes to draw an image to accompany that part of the story. A Word storyboard template has been provided in teacher resources 1b to print out and give to the students. At the end of the story the students will have a completed story board. For the teacher’s information, the Fred Hollows storyboard has been included as a comparison and can be found in resource 1c.

Take a man in the Pacific with a bright future Take a man in the Pacific with a bright future. He works hard and is able to provide for his family and contribute to the wider community.   His life is full and enjoyable; his wife works and his daughter goes to the local school. Storyboard number: 1

But then darkness sets in - over time, his sight starts to deteriorate. Suddenly, he can no longer work and his daughter now needs to stay home from school to look after her father, keeping her from her education.   Storyboard number: 2

Now, his wife is the sole earner for the household Now, his wife is the sole earner for the household. She has to work to support the whole family. Money is tight because there is now only one person working.   Storyboard number: 3

What impact do you think this is having on his family/relationships? What impact do you think not going to school will have on his daughter and her future? HIT PAUSE! Teacher to stop half way through and ask the class to answers these questions.

The family hear that The Fred Hollows Foundation’s Pacific Outreach team are visiting his country and they are able to perform a 20-minute sight-restoring operation.   He is able to return the next day to have his bandages removed. He opens his eyes and light comes streaming in. He can now see the faces of his family again. Storyboard number: 4

He has his life restored - he returns to work, independent and proud once more. Able to provide for his family, pay his bills and contribute to his community again. Storyboard number: 5

His future looks bright, and so does his daughter’s future, now she is able to return to full-time schooling. She dreams of becoming an eye doctor to help people like her father. Storyboard number: 6

The economic impact of restoring sight is significant Notes for teacher: Teacher should have a class discussion about the above statement. Some answers: When sight is restored to a person who is blind they are able to go back to work and earn money They pay tax on the money which goes back into the economy The carer is released from their duties and able to return to work and earn money The child who was caring for their parent is able to return to school, get an education and get a good job

Exit activity In your own words write down how you think blindness impacts the person, their whanau and the wider community. Notes to teacher: Print out slide and ask students to write in their own words how blindness impacts the person affected, their whanau and the community.