A SIGHT TO BEHOLD
The third national survey on blindness provides proof to the steady decline of blindness in the country
By JIN PAUL DE GUZMAN
Associate Editor
In 15 years, the number of Filipinos who go blind has gone down by 46 percent.
When the first national survey was undertaken in 1987, blindness in the country was considered a public-health problem. The national prevalence of blindness was 1.07 percent--seven-hundredths of a point higher than the World Health Organization-assigned cutoff. Cataracts ran away as the leading cause of blindness that could otherwise be prevented. Almost nine out of every 10 (87.18 percent) Pinoys who were blind went blind due to cataracts.
By 1995, blindness stopped being by definition a public-health problem--but it remained an important public-health concern--when the second national survey revealed a blindness prevalence of 0.7 percent. Cataracts remained the top cause of blindness, taking 77 percent of all cases.
With the release of the results of the third national prevalence of blindness survey in late October, the numbers went lower still. Covering 2002, the survey revealed a prevalence of 0.58 percent; cataract-related cases of blindness now took only six out of every 10 cases.
Supported by the Department of Health, the survey was conducted by the Institute of Ophthalmology of the University of the Philippines-National Institutes of Health. Dr. Evangeline Olivar-Santos served as national coordinator for both the 1995 and 2002 surveys.
A CLEARER PICTURE
In keeping with the Department of Health's Vision 2020--which is what
public-health officials call the goal to eliminate preventable blindness by
the year 2020--the survey aimed to give a clearer picture of the national
blindness situation. Like the two earlier surveys, this study investigated not only blindness and its causes but also low vision and its causes. Where the third survey differed is that it also took a special look at the prevalence and causes of blindness among children. In addition, this survey went as far as looking at the prevalence and causes of blindness on the regional level--not just a national picture.
In a way of looking, the absolute number of blind Filipinos hasn't achieved that dramatic a change; it is the number of blind Filipinos in proportion to the national population which has significantly gone down. There were 578,000 blind Filipinos in 1987; 478,968 in 1995; and 461,121 in 2002. This amounts to a decrease of only about 117,000 in the absolute number. However, the active interventions instituted by health-care professionals and institutions have helped prevent the pre-valence of blindness from rising with the national population.
SIGNIFICANT STRIDES
The report of the survey results attributes the decrease in blindness prevalence to the "significant strides" made after the second survey's results came out. One of these, said the report, was the establishment of the National Committee for Sight Preservation, which "coordinated [the] blindness-prevention activities of its member agencies," as well as "monitored the cataract surgical rate in the country." This was followed by the launching of Vision 2020 in 2000, a project that is a "part of the WHO global initiative to eliminate avoidable blindness by increasing cataract surgeries, providing refractive services, and planning national programs for childhood blindness."
Another initiative that contributed to the decline in cases of blindness is the Modified Residency Training Program (MRTP) of the University of the Philippines Manila, Department of Health, and Christoffel Blindenmission. This program aimed to make ophthalmic services available to provinces that had gone without access to eye care. Ophthalmologists-in-training no longer have to go through the traditional residency training in medical centers in big cities. Instead, they are immersed in their respective communities, getting down to work by aggressively conducting cataract missions under the supervision of consultants, and regularly receiving additional educational materials (books, journals, and others) through the mail. This way, the distribution problem of specialists is addressed, and patients have a better chance of getting eye problems diagnosed earlier.
QUICK FACTS
Here are the study's other findings:
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The number of Filipinos with any form of visual impairment is 3.67 million, or 4.62 percent of the national population.
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Pinoys with low vision reach 1.59 million (two percent), while those with monocular visual impairment reach 1.62 million (2.04 percent).
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There are about three to 19 bilaterally blind people in each region. The region with the highest prevalence of blindness is Southern Mindanao, with a mean prevalence of 1.08 percent; regions with the lowest prevalence are Ilocos, National Capital Region, Cordillera Autonomous Region, and Caraga (mean prevalence: 0.26 percent).
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After cataract, other major causes of blindness are errors of refraction (10.3 percent of all cases), glaucoma (eight percent), and retinopathy and maculopathy (four percent each). As for low vision, the major causes are errors of refraction (53 percent), cataracts (40.8 percent) maculopathy (2.2 percent), and retinopathy (two percent).
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156,926, or 0.43 percent of all children in the country suffer from some form of visual impairment. Cases of bilateral blindness are pegged at 0.06 percent (22,418).
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The most common reasons behind visual impairment in children are errors in refraction (33.9 percent of all cases), cataract (16.1 percent), phthisis bulbi (12.5 percent), and corneal opacity (10.7 percent).
Olivar-Santos Wins
Dangal ng Bayan Award
Dr. Evangeline Olivar-Santos, researcher for the Institute of Ophthalmology of the National Institutes of Health and its assistant director from 1986 to 1988, was recently named one of the
Dangal ng Bayan awardees by the Professional Regulations Commission (PRC). The PRC acknowledged Olivar-Santos's "commitment to service," as well as her "personal but successful crusade" in lowering the prevalence of blindness in the country.
Well known for being the leader of the massive national surveys of blindness in 1995 and 2002, Olivar-Santos is able to witness the decline in cases of preventable blindness. But aside from helping in monitoring this decline, she also helped institute ways to actually bring down the prevalence of blindness.
The Modified Residency Training Program (MRTP) in ophthalmology, one of her biggest undertakings, has helped address unequal distribution of ophthalmologists in the country. Although the MRTP was widely criticized in its early years, it was able to prove how valuable it is. Today, 90 percent of the country's provinces have resident ophthalmologists. Together with the MRTP's continuous eye-health missions (particularly cataract surgeries), this has contributed significantly to the nation's eye health.
A 1965 graduate of the University of the Philippines-College of Medicine, she is the recipient of numerous national and international awards. She was named outstanding researcher by the NIH earlier this year, and was honored by Asia-Pacific Academy of Ophthalmology in for 2003 outstanding service in the prevention of blindness throughout the Asia-Pacific region.
Although nearing retirement age, Olivar-Santos said she is not really going to "retire." She still sees herself continuing on to inspire younger ophthalmologists to persevere and continue to serve the country, the way the late Dr. Geminiano de Ocampo inspired her to get involved in research and service. She also plans to pursue her love of painting more actively, and write her autobiography.
Institute of Ophthalmology
Vision Is Our Mission
One of the pioneering health-research institutions in the country, the Institute of Ophthalmology of the National Institutes of Health (NIH) aims to contribute to "the conservation, promotion, and restoration of visual health and the control of blindness."
Established in 1965 via Republic Act 4593 as the Philippine Eye Research Institute, it was an autonomous unit of the University of the Philippines and affiliated with the College of Medicine and the Philippine General Hospital. It aimed to be "the center of ophthalmologic research activities and repository of recorded literature and information about eye research in the country," with Dr. Geminiano de Ocampo serving as the first director.
With the PERI being renamed the Institute of Ophthalmology in 1978, its research-only function was broadened to cover tertiary eye care and postresidency training. However, the Institute reverted to its "original mission of being the national center for ophthalmic research through clinical, applied, and epidemiological investigations" in 1988. It became a part of the NIH with the latter's establishment in 1998.
Now nearing its 40th anniversary, the Institute of Ophthalmology has contributed significantly to the understanding of eye health in the country through research. It has four major research programs: one on the anterior segment of the eye, the posterior segment, and the external eye, and also one on preventive or public-health ophthalmology. It offers extensive laboratory support facilities, and boasts of its sections in ocular pathology and ocular microbiology, which may be considered pioneering efforts in the country.
Its current director is Dr. Manuel Agulto.
Research Forum Tackles Infectious Diseases
Two infectious diseases--one still rampant, the other of uncertain prevalence--took center stage at a research forum organized and attended by the research faculty of the University of the Philippines-National Institutes of Health. Held on October 12, this particular forum was the first of a series of forums held during the academic year.
The forum is one of the NIH's ways of encouraging the members of its research faculty and staff to undertake studies that will be of great significance to the health of Filipinos. Dr. Eva Cutiongco, research-faculty member from the Institute of Human Genetics, introduced the presentations and moderated the event.
TB AND THE LIVER
Pediatric hepatologist Germana Gregorio presented the results of a study on the use of polymerase-chain-reaction assay in detecting Mycobacterium tuberculosis in pediatric liver specimens. The study, which examined specimens from 80 subjects who were younger than 18 years, was coauthored by Drs. Josie Grace Causing, Alicia Cornista, Jose Maria Avila, Francisco Narciso, and Filipinas Natividad.
The fact that tuberculosis continues to infect and kill a large number of Filipinos is well known. Although BCG vaccination is an important part of the expanded program for immunization of the Department of Health, it has been proved by a number of studies that its benefits are limited, especially when it comes to extrapulmonary TB.
Hepatic TB has been reported to occur in 10 to 50 percent of adult cases of extra-pulmonary TB. As for children, Gregorio said that diagnosing hepatic TB remains "a dilemma." This is why they decided to examine the sensitivity and specificity of the PCR assay in detecting hepatic TB.
INFECTIOUS MONONUCLEOSIS
Dr. Teresa Luisa Gloria-Cruz of the Ear Institute raised the possibility that infectious mononucleosis may not be as uncommon in the country as previously believed. Her presentation, coauthored by Drs. Carmen Nievera and Josefino Hernandez, focused on the management of three cases of infectious mononucleosis that had been seen at the Ear Institute in a span of five months.
Infectious mononucleosis, an illness caused by the Eppstein-Barr virus, is not a rare occurrence among Caucasians; every year, between 50 and 100 cases are seen in every 100,000 people.
The condition is believed to be rare in the country, an idea that is reinforced by the absence of national prevalence and incidence data on the illness. In effect, physicians may not always come equipped to manage such cases when faced with one. In addition, infectious mononucleosis may be mistaken for a more common disease such as streptococcal throat infection, or even such problems as diphtheria and human-immunodeficiency-virus infection.
After Gloria-Cruz's presentation, pediatric-infectious-disease specialist Anna Ong-Lim expounded on the clinical recognition, laboratory diagnosis, and management of infectious mononucleosis. Both of them stressed the importance of raising the awareness of doctors on the condition.
Strengthening the NIH Mission and Vision
After holding their first strategic planning/workshop at the Tagaytay International Convention Center in July, the National Institutes of Health presented a portion of the Strategic Plan 2005-2009 at the 25th University of the Philippines Manila Research Council Meeting. Held at the College of Nursing Auditorium on September 21, the meeting gathered together the different constituent units of UP Manila to discuss directions for health-science and social-science research.
Dr. Vicente Belizario Jr., NIH deputy director, presented the vision, mission, objectives, and target areas for results identified in the strategic planning/workshop.
The NIH vision is to be "the recognized authority on health research and development that is the key source of critical health information for national development in the Philippines and the Southeast Asian region." Meanwhile, their mission is to be "a major resource center for health research and capacity building, in pursuit of excellence and in the service of the Filipino people."
The NIH objectives focus on seven specific areas: legislation and policy development; health research and development for health organizations; training of medical practitioners and other health-care professionals; capacity building for institutions and individuals interested in health research; health awareness and health-seeking behavior among Filipinos; leadership in national research undertakings; formulation of the national health-research agenda; and preeminence in the area of health research and development.
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