Community Ophthalmology – I

Dr.Swathi.NOphthalmology

• Blindness• Vision 2020

Approach to eye related problems

Clinical : Remedial measures targeting individuals

Community : Remedial measures directed towards

whole community

“Community Ophthalmology can be defined as the use of full scope of ophthalmic and public health knowledge ,skills and services to promote the ocular health status of groups of people, particularly at the community level, thereby directly improving the quality of life of individuals, families and communities.”

Multidisciplinary approach

Rehabilitation of blind people

Reduce the ocular ill-health

Promote the quality of life

Objectives: Treat and improve the eye health of the entire

community

Information needed: Data on the magnitude of the eye problems in

the community, available eye health services etc.

Diagnosis: Community diagnosis, eye problems and

needs

Action: Community based eye care programmes

Evaluation: Impact of interventions on overall ocular health

status of populations including reduction of blindness

BlindnessDevastating physical condition

Emotional ,social and economic implications.

Affects the individual, the family and the community

Prevention :

• Definition

• Magnitude

• Etiology

• Control

WHO Definition

Category of visual impairment BCVA in the better eye

0 Normal 6/6 -6/18 (can see 6/18 or better) 1 Visual impairment <6/18 -6/60 (cannot see 6/18,can see 6/60)2 Severe visual impairment <6/60-3/60 (cannot see 6/60,can see 3/60) (Economic Blindness)3 Blind (Social blindness) <3/60-1/60 (cannot see 3/60,can see 1/60)4 Blind (Legal blindness) <1/60-only PL (cannot see 1/60,can see light)5 Blind (Complete/total) No PL (cannot see light)9 Undetermined / Unspecified

Visual field loss:

3 <10 ° but > 5° around central fixation4 <5° around central fixation even if V/A is not impaired.

Global Magnitude of Blindness• 45 million – blind

• 35 million - visually disabled

• 60% of global blindness in Sub Saharan Africa, China and India

• 9/10 blind individuals in the world live in Developing countries

PrevalenceBlindness Prevalence Rate: > 1% in general population

Significant Public Health Problem

WHO Recommendations:• National Blindness Rate <0.5%• Individual Communities <1%

Etiology

• Cataract (47.8%)• Glaucoma (12.3%) 68.8% of global blindness• ARMD (8.7%)• Corneal opacity (5.1%)• Diabetic Retinopathy (4.8%)• Childhood blindness (3.9%)• Trachoma (3.6%)• Onchocerciasis (0.8%) • Others (13.0%)

• Developed countries: ARMD Glaucoma Diabetic Retinopathy Cataract

• Developing Countries: Cataract Trachoma Vit A deficiency Onchocerciasis Glaucoma

Control of Blindness

Based on:

• Strategy • Disease oriented approach• Services oriented approach • Community approach

Strategies

• Primary Prevention: Prevention of disease

• Secondary Prevention: Prevention of visual loss

• Tertiary Prevention: Restoration of sight

Disease-oriented approach

Cataract – surgery

Vitamin A – supplementation

Trachoma control

Screening of school children

Onchocerciasis - Distribution of Ivermectin

Services oriented approach

Primary care services:

- Promotive and preventive, also curative measures

- Education and community participation

- Community based

- Training of health workers.

Secondary eye care:

Management of common blinding conditions Training and supervision of health personnel Hospital based Adequate infrastructure to handle common

blinding conditions incl correction of refractive errors, cataract, entropion and trichiasis, corneal ulcers endophthalmitis, ocular trauma and PACG.

Screening for POAG and Diabetic Retinopathy

Tertiary eye care:

Management of conditions which require highly specialized staff and sophisticated equipments

Specialized treatments like corneal grafting, Paed cataract surgery, RD surgery, Ocular malignancies

Expert technical leadership, Training of personnel involved at secondary level

Research activities

Community approach

Specific blindness control measures directed towards population at risk

Increase awareness, assessment, assistance and reduction of disability

VISION 2020: The Right to Sight

Trends & Projections in Global Blindness

VISION 2020 Partnership

WHOVISION

2020

NGDOsProfessions

Corporations

NATIONALVISION 2020

BODIES

IAPB

Ministries of

Health

DISTRICT VISION 2020 SERVICE UNITS

District Level Implementation

Eye Care Team

Equipment & Supplies

Community-Patients

Service Delivery Model for VISION 2020

Advanced Tertiary

Tertiary

Secondary

Primary

Principles

Integrated

Sustainable

Equitable

Excellent

International Agency for the Prevention of Blindness

Founded in 1975 it now has 108 members:

n International NGOs

n Professional Bodies

n Universities

n Corporate Companies

Governed by a Board of Trustees and Council of Members Head office in London, UK

VISIONA world in which no one is needlessly blind or visually impaired and where those with unavoidable vision loss can achieve their full potential.

MISSIONPromotes the global initiative VISION 2020: The Right to Sight- to eliminate the

main causes of avoidable blindness by the year 2020.

-brings together governments and non-governmental agencies

- to facilitate the planning, development and implementation of sustainable national eye care programmes

- based on the three core strategies of disease control, human resource development and infrastructure development,

-incorporating the principles of primary health care.

Diseases covered in vision 2020

• Cataract

• Trachoma

• Onchocerciasis

• Childhood blindness

• Refractive errors & low vision

• Write a note on Vision 2020• Give the WHO definition of blindness• Name the diseases that are covered under

Vision 2020 in India.• Give 4 causes of preventable blindness• Write a note on school eye screening• Name 4 causes for childhood blindness

Symposium on 22.09.16

• Vision 2020

• NPCB

• DBCS

• Childhood blindness

Thank you