Dr Anderson Chimeziri, the President, Nigerian Optometric Association (NOA) has expressed concern that long gadget use is exacerbating eye health issues, especially among children, including media professionals. In this interview with Nkechi Onyedika-Ugoeze, he suggests that employing optometrists in primary health centres will boost eye care at the grassroots.
 
What is responsible for the rising eye problems, especially among children in the country?
Lack of awareness about proper eye care practices, inadequate access to eye care services, environmental factors such as pollution and poor lighting conditions, and lack of emphasis on preventive eye care measures in healthcare systems have contributed to increased eye problems.
  
The level of visual demand among children has increased and influenced by various factors, including early childhood learning and exposure to educational materials and video games on visual display units prolonged use of digital mobile communications, outdoor pollution negatively affecting environmental health poor hygiene practices in schools, inadequate nutrition, with a preference for starchy foods over fruits and vegetables.
   
Other factors include nutritional deficiencies during gestation, particularly prevalent in Sub-Saharan Africa, the eye’s nature as a tissue, subject to feeding, growth, fatigue, and aging, changing case definitions, requiring more efficient vision for various tasks such as reading small prints and electronic images in low light conditions, increased exposure to harmful UV rays and blue light from digital devices due to environmental degradation.
  
Additional factors could include socioeconomic disparities affecting access to eye care, cultural attitudes towards vision health, and educational policies promoting more screen time and outdoor activities.

How does poor outdoor and prolonged work activities contribute to eye problems?
The eye works with memory, in fact, studies have shown and reported that the brain is an extension of the eyes. So, the more a child sees objects, the likelihood that he or she will recognise them (visual perception). Sight is not about seeing but believing that what you saw is what it is. What you do not know may not make meaning to you or may be wrongly interpreted as another thing.
   
So, outdoor activities help the child become acquainted with the environment, develop colour perceptions and depth of focus, to form basic visual data for further development. On the other hand, prolonged work activities increase the visual demand of a child even before maturity of vision. This may affect eye muscle coordination and single binocular vision contributing to the eyes getting tired easily.

   
Some children who have a pre-existing deficit in refractive status may develop eye strain, accomodation anomaly and inability to synchronise the coordination of eye rotations and visual acuity.

In contemporary society, there is a notable shift towards indoor-centric lifestyles for many children, which has implications for their visual development.
  
With limited exposure to diverse visual stimuli beyond screens, such as TVs, classroom blackboards, and digital devices, children’s ocular capacities may be confined and fail to undergo the robust development witnessed in previous generations. This departure from historical norms, where outdoor activities played a significant role in visual maturation, underscores the need for proactive measures to mitigate the potential consequences of prolonged indoor engagements on children’s eye health and visual acuity.

A lot of Nigerians working in the ICT including the media use gadgets, such as computers, phones and tablets to carry out most of their jobs on a daily basis. How can these people effectively do their jobs without jeopardising their eyes?
 Increased dependence on digital media has its toll on the eyes. Before now, we used white and black print media, which elicited a response from the part of the eye called the rods. Also, print media are stationary and do not need to cascade movement or your attention moving from one place to the other, contrary to this, electronic or digital media require much more. It needs colour components, movement, depth perception and higher resolution time.
   
The blinking rate with digital media is lowered and the eye surface is more prone to dryness due to prolonged exposure. These constitute some symptoms which are termed, Computer Vision Syndrome (CVS). CVS is the emerging epidemic in the eye care industry that is very prevalent in our modern communities. There should be a break of about 20 seconds and relaxation of the eyes by looking at distant objects after about 20 minutes of near work.

What is the projected number of vision loss associated with this?
There may not be an available record of vision loss due to CVS, but it serves as confounder to cause co-morbid eye conditions that may complicate pre-existing eye problems. The symptoms of CVS on its own are so worrisome that it will be difficult for one to attain good functionality from available vision.

What role can parents play in ensuring that their children participate in healthier outdoor activities?
 Outdoor activities should be early morning time not later than 10am due to harmful UV rays that emit from the sun when it is closer to the earth at noon time. Evening time from 5 pm is another good time.

Children can wear anti UV sunglasses where it is necessary to work outdoors.  Parents should be encouraged “to allow their children to participate in healthier out-door activities and to reduce prolonged near work like use of mobile phones, laptops, eye pads, and sitting close to the TV.

What other factors are responsible for visual impairment?
Many other causes include cataract, damage to the eye lens, glaucoma, damage to the optic nerve head, ocular injuries, Chronic health states, Diabetes, hypertension, infections arthritis poor nutrition, trachoma, onchocerciasis or river blindness, Apollo or red eye conditions, use of harmful eye medications or substances, self-medication, poor eye surgery or surgery done by untrained personnel and harmful traditional practices among others.

What is the impact of vision loss on national productivity and how can we promote preventive eye care?
This is what our association has been working on and is still working on. We are setting up Vision centres across the country through a donor support programme in partnership with One-Site Essilor-Luxottica Foundations. These centres are to be cited in underserved areas in Nigeria. We recently carried out the most elaborate Eye Health awareness campaign during the last observed World Sight Day event.

All over Nigeria, Optometrists have been flooding the social media with health tips on eye care; we release promotional and preventive materials to the community on eye health care. We are advocating for inclusion of eye care as an integral programme in primary health care (PHC) programmes of Nigeria.

How many optometrists are needed to cater for the over 200 million population in the country?
The Register of The Optometrists and Dispensing Opticians Registration Board of Nigeria (ODORBN), we have about 6000+ Optometrists bearing in mind that many are not practicing and a huge number have left the country to go overseas.

 
 But alarmingly, we have only 400 optometrists in the employ of the Federal Ministry of Health as obtained from Federal payroll. Some states do not have even one while others have just few. This means that the battle against blindness and visual impairment is fought mainly by those in the private sector who see most of the optometric patients.
  
This situation needs to be addressed and the Federal Ministry of Health needs to replicate this number for more impact. Secondly, the State governments need to open up employment opportunities for Doctors of Optometry and focus more on preventive instead of curative eye care.

What is the role of the government in ensuring full implementation of the national eye health policy?
The Federal Ministry of Health has set up a unit for Eye Health program under the Department or Directorate of Public Health. Most eye care programmes are run by the unit, however, we need greater involvement of Optometrists who are core Primary Eye Care providers at the unit.
  
We believe that if the unit harnesses all the potentials from all cadres of eye workers and synergizes ideas and these potentials fairly and objectively well, we shall make a good impact on addressing the burden of blindness and visual impairment in Nigeria.
  
The employment of optometrists, who are primary eye care providers across primary health centres in the country, will boost eye care at the grassroots. The various tiers of government have a role to play in this regard to ensure enhanced eye care delivery in the country and ensure that forms of avoidable blindness is curbed.