**Author details**

Diagnosis of irreversible (legal) blindness should be made by medical or eye care professionals qualified to make such pronouncements, and the same should be validated by objective methodology as far as is possible. There are legal ramifications to unfavorable visual diagnoses with socio-economic, emotional, vocational, relational, and psychological consequences. Pronouncements should be made in the presence of a legal support system, as well as the full

Case in point: Macular holes are common, and when greater than 600 microns, have a poorer prognosis for repair and vision rehabilitation. This, until recently with the advent of autologous blood as an adjunct to macular hole surgery. Research continues to change the prognoses for vision rehabilitation in many cases traditionally considered end-stage. Informed second opinion should be a part of due process in the management of patients with unfavorable

The prognosis of conditions like glaucoma, retinitis pigmentosa and macular degeneration, to name a few are largely subjective. Advice on prognosis and related patient counseling needs to be collaborative, involving psychologist, ophthalmologist, patient, care-givers, and key opinion leaders who can use latest investigative and therapeutic tools to alter the course of progression where possible. Acceptance of a diagnosis and prognosis had a large cultural and socio-economic component that differs significantly according to the cultural milieu [11]. Second opinion in many cases may involve the use of tele-medicine, research, and profes-

It is a well-established fact that physical activities including sports, build self-esteem and self-acceptance, as well as enhance physical, mental, and emotional health [12]. This has been known to medicine as far back as B.C. 460 (alluded to by Hippocrates). The International Blind Sports Association (IBSA) is the arm of the Paralympic Movement governing professional and competitive sports for the visually impaired. British athletics in schools was used as an inspiration for developing Paralympic sports, Para (parallel) – lympics (running just after the regular Olympic program) [11]. The running, jumping, and throwing activities were found to boost not only physical wellbeing, but brought inclusion and equality to persons

*'The fundamental principle guiding the Paralympics movement is that elite level athletes with physical disabilities should have opportunities and experiences equivalent to those afforded elite athletes without disabilities…Competitive sports have proven to be an effective vehicle to promote equality, inclusion, accessibility and awareness about the capabilities of those with physical disability…and dispel the* 

Wanderi [12] looked at the role of sports in the lives of Kenyans in educational institutions and communities on a whole. The Government of Kenya in 1988 outlined a decade plan for the integration of education to the tertiary and post graduate level, where both physically challenged and those desirous of working with the disabled would receive equal training in the universities, a program which spread across academic and sports departments. The 2006–2011

otherwise marginalized due to disabilities. Quoting from the Paralympics manual:

*stigma surrounding disability and illuminate the realm of possibility…"* [13]*.*

visual prognoses that can negatively affect their quality of life [9, 10].

cadre of relevant eye care professionals.

90 Causes and Coping with Visual Impairment and Blindness

sional exchanges across borders.

**6. Role of sports as a coping mechanism**

Maynard McIntosh

Address all correspondence to: ophthalmicsuites@gmail.com

Ophthalmic Suites and Caribbean Lasik Vision Centre (CLVC), Kingston, Jamaica
