How Family Life and Status Affect Visual Problems in Impoverished Communities

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William Hess
Mrs. Martin
Critical Discourse
06 November 2017
How Family Life and Status Affect Visual Problems in Impoverished Communities
When it comes to vision development and management, family is one of the most
important factors when it comes to making sure everything is passed okay from generation to
generation. There are vision disorders that we cant control, and there are those that we can
control. But, even when we can control them, there are certain aspects in everyday life that we
either cant control or lack any motivation to do anything about them. Such aspects include
education quality, family life, social status, and struggle within and against other communities.
In this essay, family issues come to the forefront with four primary issues of impoverished
family life: inbreeding rates, genetic defect rates, how inbreeding leads to genetic defects, and
family income.
Inbreeding is a large issue within most communities worldwide. But, in impoverished
communities where populations are small, the thought of inbreeding is not an unreal possibility.
In fact, it is astonishingly common in third-world areas and impoverished areas. In an article
about consanguineous marriages, the first figure shows different consanguineous marriage rates
worldwide. Regions that are considered first-world regions, such as the United States, Canada,
and China have rates at less than 5%, whereas third-world/impoverished regions, such as the
2
Middle East, Northern Africa, and West Asia, have rates ranging from 20% to greater than 50%1.
This means that, in most third-world areas, roughly half the population is reproducing via those
who are second cousins or closer. In these countries, first cousin marriages account for roughly
of all marriages2. But why is this type of practice happening so frequently?
Most areas where consanguineous marriage is common actually comes from the social
acceptance of such practice. Sociological studies of these areas show that there is the possibility
of stability in a couple due to higher compatibility between the pair because they share similar
social relationships before and after marriage3. But, we also need to look at potential health
effects associated with consanguineous marriages, which are potentially observed as genetic
defects.
Genetic defects are caused by many factors, including environmental/economic stability,
radiation, and relational combination. Looking at environmental/economic stability, its effects on
defects can all link back to one thing: geographical location. In well-populated, modernized
areas(such as the United States), birth defects occur in only 1 out of 33 children, and they cause
20% of infant deaths4. With vision-specific birth defects, such as microphthalmia(shrinking of
1
Hamamy, Hanan. Consanguineous Marriages: Preconception Consultation in Primary Health Care
Settings. Journal of Community Genetics, Springer-Verlag, July 2012,
www.ncbi.nlm.nih.gov/pmc/articles/PMC3419292/.
2
3
4
CDC. Birth Defects. Centers for Disease Control and Prevention, Centers for Disease Control and
Prevention, 21 Sept. 2016, www.cdc.gov/ncbddd/birthdefects/data.html.
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eyes during development) or anophthalmia(absence of one or both eyes), the rate in the U.S is 1
in 5,3495.
Looking at the difference of race and ethnicity in terms of birth defects, a study of 39% of
U.S live births show that babies born to non-Hispanic black or Hispanic mothers have higher
mortality rates within the 28 day to 1 year mark than babies born to non-Hispanic white
mothers6. One other disease that can lead to genetic mutation, which can lead to visual defects, is
HIV/AIDS, a disease that weakens the immune system drastically. Approximately 42 million
people live with this, with its main targets being women, African Americans, and Hispanics7.
One of the studies that has occurred with a lasting impact on social behavior and genetic
problems is the adverse childhood experiences(ACEs) study. Led by doctors Robert F. Anda and
Vincent J. Felitti, this study discovered the effect of adverse childhood experiences on social
development problems after reaching adulthood. As a result of the study, the two concluded that
a high ACE score(scale of 0-10) linked with a higher prevalence of cancer, chronic lung disease,
smoking, alcohol abuse, depression, anxiety, teen pregnancy, and higher stress levels, among a
list of diseases 8.
Now, how does a study that has nothing to do with visual defects have any relevance to
visual defects? To answer this, we need to look at the various health problems associated with
adverse childhood experiences. In terms of smoking, smoking while pregnant increases the risk
5
6
7
WHO. Genes and Human Disease. WHO, World Health Organization, 2017,
www.who.int/genomics/public/geneticdiseases/en/index4.html.
8
Anda, Robert F, et al. Building a Framework for Global Surveillance of the Public Health Implications
of Adverse Childhood Experiences. Theannainstitute.org, Theannainstitute.org, July 2010,
www.theannainstitute.org/ACE%20folder%20for%20website/2BFGS.pdf.
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of eye diseases that can lead to blindness9. This is something that has been known for a while,
but anything that can affect a developing baby, especially with vision problems, is something
that is considered a threat to a good quality of life. When looking at the rates of people who quit
smoking, finding seems a little strange. Although smoking addictions are caused by nicotine
addiction, people who have depression are more likely to smoke and less likely to break the urge
than those who arent depressed10.
Alcohol abuse is another major issue with visual problems. One of the main effects of
alcoholism is alcoholic neuropathy, a type of nerve damage caused by heavy drinking11.
Considering how much the visual sense relies on the nerves, this neuropathy can be seen as a
harm to visual health, and may allude to more pressing visual disorders, including glaucoma, low
vision, and the formation of cataracts. Fortunately, scientists from 5 different medical centers
have discovered the gene believed to be responsible for alcoholism: gene GABRG3 on
chromosome 1512. This gene is associated with receptor in neurons responsible for the transport
of gamma-aminobutyric acid(GABA), a major inhibiting chemical in the central nervous
system13. This inhibition leads to a stronger volume of alcohol to restore brain circuits to a
normal state versus a nonalcoholic.
9
Various Authors. News Moms Need. News Moms Need RSS, 12 July 2011,
newsmomsneed.marchofdimes.org/?p=9738.
10
Anda, Robert F, et al. Building a Framework for Global Surveillance of the Public Health Implications
of Adverse Childhood Experiences. Theannainstitute.org, Theannainstitute.org, July 2010,
www.theannainstitute.org/ACE%20folder%20for%20website/2BFGS.pdf.
11
Palermo, DO Joseph. Alcohol Abuse: 12 Health Risks of Chronic Heavy Drinking. OnHealth,
WebMD, 27 July 2016, www.onhealth.com/content/1/heavy_drinking_alcohol_abuse.
12
13
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What exactly is alcohols effect on the eyes? According to a source explaining short and
long term effects of alcohol on vision, its effects include slower pupil reaction, decreased
contrast sensitivity, eye twitching, increased dryness, increased formation of cataracts and
AMD(age-related macular degeneration), decreased vision due to vitamin deficiency, tobacco-
alcohol amblyopia, and prenatal vision problems14. Lets break these down in order to
understand them a little better.
Slower pupil reaction is self-explanatory, as alcohol causes the iris to contract and dilate
at a much slower speed than normal15. This is what makes drunk driving particularly dangerous
as it inhibits reaction time to oncoming headlights. Another thing that makes drunk driving,
especially at night, so dangerous is decreased contrast sensitivity(the ability for the eye to
distinguish between objects based on lightness and darkness). A study from Western University
supports this claim, showing that alcohol reduces the ability to adjust vision for contrast and
brightness by 30%16.
Myokymia, or eye twitching, is merely the eyelid twitching, which can be triggered by
the excess intake of alcohol. A study from Hallym University College of Medicine in relation to
dry eye shows that alcohol can increase and exasperate the symptoms of dry eye 17. This can
harden the inner parts of the eye and lead to other eye problems.
14
Various Authors. What Is the Effect of Alcohol on the Eye? CooperVision, CooperVision, 2017,
coopervision.com/blog/what-effect-alcohol-eye.
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16
17
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In addition to the short-term effects explained above, a string of long-term effects can
seriously affect eye health and vision quality. Cataracts, for example, are cloudy spots on the lens
of the eye that cause blurred vision18. Alcohol-caused cataracts, compounded with the influence
of alcohol, can make for a deadly situation on the road.
The AOA also sees alcohol consumption as a major factor in developing something
known as age-related macular degeneration, or AMD for short. AMD is caused when the
macula(the central portion of the retina responsible for sharp, clear vision) degenerates over the
course of human life, causing loss of central vision over time19. A family history of alcoholism
can contribute to this, as a history of AMD is a sign for developing AMD in your life.
Severe cases of alcoholism can cause damage to the liver, leaving it unable to absorb
vitamins, which in turn leads to vitamin deficiencies. Two vitamin deficiencies relating to the
eye include vitamin B1 and vitamin A. A deficiency in vitamin B1 can cause weakness or
paralysis in the muscles of the eye20. A deficiency in vitamin A can cause a series of problems,
including night blindness, corneal thinning, corneal perforation, dryness, and blindness21.
Another risk of alcohol consumption to vision quality is tobacco-alcohol amblyopia, a
condition that causes painless vision loss over time22. Fetal Alcohol Syndrome also affects
18
AOA. Cataract. American Optometric Association, American Optometric Association,
2017,www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/cataract.
19
AOA. Nutrition and Age-Related Macular Degeneration. American Optometric Association, American
Optometric Association, 2017, www.aoa.org/patients-and-public/caring-for-your-vision/nutrition/nutrition-and-age-
related-macular-degeneration.
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21
22
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vision, especially in developing infants. Some of the impacts seen include underdevelopment of
the optic nerve, difficulty with eye coordination, and the tendency of eyelids to droop23.
Readdressing the issue of inbreeding and genetic defects, inbreeding itself doesnt cause
genetic defects, contrary to public opinion. Inbreeding merely causes lack of genetic variation in
a chain of a population, which leads to an increased risk of disease transferability. Another big
issue yet to be discussed on this topic is economic stability, which, believe it or not, has a major
role in family life.
First off, as addressed in the early portions of this essay, areas in the Middle East,
Northern Africa, or West Asia have the highest consanguineous marriage rates in the world.
Does this potentially relate to economic status in comparison to the world? Looking at graphs of
economic stability and growth, the Middle East and Northern African region had a GDP of
$2.748 trillion in 201024, while the GDP of the United States at this time was $14.964 trillion25.
With this data, there is a clear correlation between GDP and consanguineous marriage rates, with
a lower GDP corresponding to higher consanguineous marriage rates. This also means that there
is likely a worse state of living and lower ability to find new people in these economically
limited regions, leading to relational marriages.
23
24
The World Bank. Middle East & North Africa . Middle East & North Africa | Data, The World Bank
Group, 2017, data.worldbank.org/region/middle-east-and-north-africa.
25
The World Bank. United States . United States | Data, The World Bank Group, 2017,
data.worldbank.org/region/united-states.
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The average family monthly income in the UAE in 2009 was $4968.44, with around 60%
of this being spent on general expenses26. This is much lower than the average in th United
States, which has a family monthly income of ~$610027. Although this difference is small,
looking at just two different economic statistics with the same general trend gives a lot of insight
on what the world outside of the U.S sees on a daily basis.
All of these statistics and information add up to one major conclusion: family life has a
massive influence on the potential of vision defects in a population. From general birth statistics
to the effects of alcohol on the eye, there is an obvious effect of impoverishment on the quality
of vision. The question now is, What can we do to help provide education and eyecare to these
areas that need it the most? One of the biggest potholes in this situation is ourselves. We need to
just gain the courage and the knowledge to be able to share the dangers of different eye diseases
and different negative influences within communities, which will be the final step of this journey
into providing affordable eyecare to impoverished communities.
26
Bundhun, Rebecca. UAE Monthly Household Income Revealed. ArabianBusiness.com,
ArabianBusiness.com, 3 Feb. 2009, www.arabianbusiness.com/uae-monthly-household-income-revealed-
80418.html.
27
Frankel, Matthew. Here's the Average American Household Income: How Do You Compare?USA
Today, Gannett Satellite Information Network, 24 Nov. 2016,
www.usatoday.com/story/money/personalfinance/2016/11/24/average-american-household-income/93002252/.

How Family Life and Status Affect Visual Problems in Impoverished Communities

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Inbreeding is a large issue within most communities worldwide. But, in impoverished

In fact, it is astonishingly common in third-world areas and impoverished areas. In an article

of all marriages2. But why is this type of practice happening so frequently?

Genetic defects are caused by many factors, including environmental/economic stability,

radiation, and relational combination. Looking at environmental/economic stability, its effects on

20% of infant deaths4. With vision-specific birth defects, such as microphthalmia(shrinking of

than those who arent depressed10.

alcoholism is alcoholic neuropathy, a type of nerve damage caused by heavy drinking11.

of gamma-aminobutyric acid(GABA), a major inhibiting chemical in the central nervous

normal state versus a nonalcoholic.

AMD(age-related macular degeneration), decreased vision due to vitamin deficiency, tobacco-

understand them a little better.

of alcohol, can make for a deadly situation on the road.

Another risk of alcohol consumption to vision quality is tobacco-alcohol amblyopia, a

role in family life.

limited regions, leading to relational marriages.

on what the world outside of the U.S sees on a daily basis.

into providing affordable eyecare to impoverished communities.

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