Npcb by pushkar dhir

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NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS VISION 2020 & RURAL EYE CAMPS Presenter – Dr.Pushkar Moderator- Dr. Jayeeta Bose

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Transcript of Npcb by pushkar dhir

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NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS VISION

2020 & RURAL EYE CAMPS

Presenter – Dr.PushkarModerator- Dr. Jayeeta Bose

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INTRODUCTION• NPCB launched in the year 1976 ,Centrally Sponsored

scheme .

• Goal to reduce the prevalence of blindness to 0.3% by 2020.

• To achieve this target min. of 21 million cataract operations are to be performed.

• Survey on Avoidable Blindness conducted under NPCB during 2006-07 showed reduction in the prevalence rate of blindness from 1.1% (2001-02) to 1% (2006-07).

• 230 crore approved by empowered programme committee (EPC) for 2013-14 for NPCB.

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THE ORGANISATION

CENTRAL• Ophthalmology Section,

DGHS,MOHFW• Procurement of goods• Grant –in Aid to NGOs• Organizing central level

trainning courses• Monitoring & evaluation• Procurement of

consultancy &services

STATE• State opthalmic cell, Directorate

of health services, State health societies

• Coordinate and monitor with all the District Health Society

• Procure equipment and drugs which required in GOI facilities

• Receive and monitor use of funds, equipments and material from the Government

• Promote eye donation & monitor the districts for collection and utilization of eyes collected by eye donation centres and eye banks.

DISTRICT• District blindness control

society• Organize screening camps

for identifying those requiring cataract surgery and other blinding disorders

• Organize screening of school children.

• To plan and organize training• Procure drugs and

consumables• Promote eye donation • Regular screening for and

other diseases in the out reach camps

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Service Delivery & Referral Systems

Tertiary level(Regional Institute of

Ophthalmology/ Centres of Excellence in Eye care &

Medical colleges

Secondary Level

(District Hospital & NGO Eye hospital)

Primary Level

(Sub district level hospitals/CHC/Mobile

Ophthalmic units, PHC /Panchayats)

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Definition of Blind under NPCB

• Inability of a person to count fingers from a distance of 6 meters or 20 feet Technical Definition

• Vision 6/60 or less with the best possible spectacle correction

• Diminution of field vision to 20° or less in better eye

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Main causes of Blindness in India are

63%

20%

1%

6%

1%

1%

5% 4%Cataract

Refractive Error

Corneal Blindness

Glaucoma

Surgical Complication

Posterior Capsular Opacification

Posterior Segment Disorder

Others

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Objectives of the Programme are

•To reduce the backlog of blindness through identification and treatment of blind.

•To develop Eye Care facilities for every 5 lac population

•To develop human resources for providing Eye Care Services.

•To improve quality of service delivery by establishing Regional institute of •ophthal , up gradation of medical colleges & district hospital.

•To secure participation of Voluntary Organizations in eye care.

•To enhance community awareness on eye care

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INFRASTRUCTURE DEVELOPMENT UNDER NPCB

At RP centre and 10 other Regional

Institutes of Ophthal, a

National institute of Ophthal has

been established for manpower

develop, research and

referral services.Medical colleges are upgraded

under NPCB & at certain med

institutes & paramedical ophthalmic

assistants are trained.

Eye banks have been

developed in govt and non-govt sectors.

>500 Dist hospitals have been equipped

with ophthalmic equipments

and requisite manpower is

posted.

DBCS was started as pilot

project in 5 districts and

now over a 500 centres under

the chairmanship

of DC/Dep Com have been set

up.

Prevalance of Blindness being

acute in rural areas, NPCB has tried to expand the

accessibility to these areas by the means of PHC, mobile

eye units

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DANIDA:Man power development Establishment & development of monitoring and evaluation system at state levelTraining Preparation of health education material, teaching & information aids.

WHO:40 intra country fellowship in Institutes of excellenceSurvey on childhood blindness in East Delhi to estimate prevalence & causes of blindness in children <15 yr.Study on refractive errors in school drop outs.Establishing National Surveillance Unit.Launch work shop on vision 2020.

BOOST UP FOR NPCB

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Performance of Cataract Surgery: 1985-2003

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Revised Strategy of NPCB

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Construction of dedicated Eye Wards and Eye Operation theaters in DistrictsAppointment of Ophthalmic Surgeons and Ophthalmic Assistants in new districts

Appointment of Ophthalmic Assistants in PHCs/ Vision Centers where there are none (at present ophthalmic assistants are available in block level PHCs only)

Appointment of Eye Donation CounselorsGrant-in-aid for NGOs for management of other Eye diseases other than Cataract like Dr, Glaucoma

Management, Laser Techniques, Corneal Transplantation, VR Surgery

Treatment of childhood blindness etc of Rs. 750 per case for Cataract/IOL Implantation Surgery and Rs.1000 per case of other major Eye Diseases .For North-Eastern States, Hilly and Desert Areas Rs. 850

for Cataract and Rs.1100 for other major Eye Care Management is proposed.

Special attention to clear Cataract Backlog and take care of other Eye Health Care Centers from NE States.

Telemedicine in Ophthalmology {Eye Care Management Information and Communication Network}

Involvement of Private Practitioners.

A provision of Rs.1550 crore has been proposed for implementation of NPCB during 11th Five Year Plan.

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A COMBINED EFFORT OF WORLD HEALTH ORGANIZATION & NGOS

Launched in Geneva on Feb 18, 1999, to combat problem of avoidable blindness in the world.

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Helen Keller Worldwide

FOUNDING MEMBERS OF VISION 2020 WHO IAPB ChristoffelBlind mission. Helen Keller Worldwide. SightSavers International. ORBIS International

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Al Noor Foundation. American Academy of Ophthalmology. Asian Foundation for the Prevention of Blindness. The Canadian National Institute for the Blind. The Carter Centre. Foundation Dark and Light Blind Care. The Fred Hollows Foundation.

IMPACT – EMRO

International Centre for Eye Care Education.

IFOS

International Trachoma.

Internazionale per la prevensione della Cecita.

Lighthouse International.

Lions Club International Foundation.

Operation Eye sight Universal.

Royal National Institute for the Blind.

SEVA Foundation.

Vision 2020 Australia.

Vision 2020 UK.

World Council of Optometry.

SUPPORTING MEMBERS

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• Present estimation:– 45 million people blind

+– 135 million visually disabled

Present situation Worldwide

LowVision

Blind

< 6/18 - 3/60Or less than 20 deg

Visual field< 3/60

Best corrected VA

International classification ignores the burden of uncorrected refractive error

WHO defination

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Global Distribution of Blindness by Cause

Cataract42 %

Trachoma15 %

Glaucoma14%

Oncho.1 %

Other28 %

Macular degeneration

Diabetic retinopathy

+Refractive errors

(uncorrected)

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Without intervention the number of people with blindness might reach 76 million by 2020.

Global ageing of populations makes world blindness increase by about 2 million annually.

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AIM OF THIS INITIATIVE• To INTENSIFY AND ACCELERATE present prevention of blindness

activities so as to achieve the goal of eliminating avoidable blindness by the year 2020.

• Globally 5 conditions have been identified: Cataract Trachoma Onchocerciasis Childhood blindness Refractive errors and Low Vision.

Chosen on basis of contribution to burden of blindness and feasibility&affordability of interventions to control them.

Over the period 1995-2002, glaucoma and DR have been included

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Group 2 : FOCAL IN

DISTRIBUTION ( POORCOMMUNI

TIES) – vit a def, trachoma, onchocer.

Group 3 : INCREASING IN

MAGNITUDE, DIAGNOSTIC AND MGT STRATEGIES ARE NOT WELL DEFINED AND NOT COST EFFECTIVE –

Glaucoma , DR

Group 1: UNIVERSAL

CONDITIONS WHICH CAN BE SUCCESSFULLY TREATED and hence cost-

effective- cataract and R errors.

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Cataract Trachoma Onchocerciasis Childhood blindness

Refractive Errors and Low

vision50% global incidence 146 million people

worldwide17 million people

affected 1.5 million

children are blind

Backlog 20 million unoperated cases

cataract surgery performance rate- 10

million annually

Targets projected : 4000/million

population/year = 32 million cataract sxy by

year 2020

10.6 million adults have

sequele( trichiasis,entropion).

More in Africa, China, Middle-east.

SAFE strategy adopted

Targets : eliminating trichiasis/entropion

and reducing prevalance of

trachoma to 5%.

0.3-0.6 million are blind.

African and Latin- American

countries

Target : establish National programmes after

effective surveillance such

as by 2020 no new cases are

reported.

1.3 million in Asia & Africa.

Targets :To eliminate vit a def diseases and

achieve nil incidence in all

countries.

Services developed for treatable dis :

cataract, glaucoma, ROP

Refraction and evaluation

for pt`s requirement of

corrective devices.

Manufacture of proper devices

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Vision 2020 in India:Launched in 2001.Inculcated in 2002 with NPCB for future planning for control of

blindness.

Target diseases : Cataract, Childhood blindness, Ref Errors & Low Vision, Corneal blindness, DR, glaucoma, Trachoma (focal basis).

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Strategies for corneal blindness

• Major obstacle in tackling corneal blindness is the wide gap b/`w the requirement and availability of donor corneas for which recommendations include:-

o Strengthening of hospital corneal retrieval systems.

o Assessment of persons needing corneal grafting.

o For vit a def related diseases: focus on eco backward classes is needed

Strategies for glaucoma and DR

• Immediate term :

training ophthalmologists to handle these conditions. Comprehensive eye evaluation via better clinical practice in slit lamp biomicroscopy, AT, disc and retinal evaluation and gonioscopy.

• Intermediate term:o Residency training prog in med colleges.o Training of MLOP in handling these

conditions in peripheries.o Training non ophthalmic physicians on

clinical profile of these conditions.o Public education

• Long term:o To provide high quality eye care at all

levels

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Global trends :

• Over 1995 – 2002, constant factors – ageing, population growth and underdevelopment.

• Chronic diseases as glaucoma and DR have shown an increase incidence due to change in life expectancy and life-styles.

• Strategy is to bring about awareness of these conditions and also about the compliance and adherence to Rx schedules.

• Need an effective Public health approach

• This can happen with HRD & Infrastructure appropriate technology.

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COST EFFECTIVENESS OF VISION 2020

• Frick and Foster calculated $ 102 billion of economic gain if VISION 2020 is successful.

Benefits of vision 2020: Blindness alleviation to 50

million. Enhanced ophthalmic training. Paramedical training. Creation and upgradation of

facilities. Access to modern technology.

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Rural eye camps

Camps – effective modality for medical service delivery on a mass scale and it is cost effective.

In ophthalmology – effective strategy to combat illness at

grassroots level.

Over the years, Ophthalmic camps have become cataract centered.

Other eye camps – One day screening camps: Glaucoma, DR,School screening or refraction camps

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Rural eye camps

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In last few years, surgical camps are being phased out by the govt. because –

Certain surgical camps as 1986 Khurja and Muradabad camps have shown disastrous results. These have led to a decrease in credibility of the surgical eye camps.

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Protocol of a surgical camp OT installation protocol and procedure

1. Planning : informing organizer about camp methodology and requirements like generators, adequate OT facility and location.

2. Camp site feasibility study

3. Surgical team : surgeons, optometrists, OT technicians, camp coordinator.

1. Advisable to get a running OT in a govt. setup or private hospital freshly whitewashed or painted.

2.Cleaning with detergent and disinfectants.

3. All openings and cracks are sealed.

4. AC and other electrical appliances installed.

5. Furniture and microscopes cleaned and installed.

6.Fumigation for 36-48 hrs & after every day of surgery.

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PREOP TREATMENT

POST OPERATIVE CARE

CONCLUSION

1. Broad spectrum topical a/b.

2. Topical povidone iodine.

3. Local hygeine.

4. Continuation of systemic med.

5. Pt`s personal hygeine and cleanliness

1. Daily exam in the postop period.

2. Topical and sysytemic med

3. Complications recognized and managed at

the earliest

4. At discharge: VA ( PH). First follow up date notified

5. Follow ups at 6th and 8th wks.

• Surgical camps though being phased out are an effective way to reach distant rural and tribal population and also an effective means to control cataract blindness – backlog + new cases.

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