Control of blindness


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Control of blindness

  2. 2. ©abhilash pm 2
  3. 3. Blindness??? WHO define “ visual acuity of less than 3/60 (snellen) or its equivalent. ” Or Inability to count fingers in day light at a distance of 3 metres ©abhilash pm 3
  4. 4. ICD classification of visual impairement cata Visual acuity gory Max less than Mini equal to or better than 0 6/18Low vision 1 6/18 6/60 2 6/60 3/60blindness 3 3/60 1/60 4 1/60 Light perception 5 No light perception ©abhilash pm 4
  5. 5. Problem statement world- 180million visually disabled 45 million blind Prevalence .2-1% 80% avoidable blindness SEAR 60 million 45 million visually disabled;15 million blind& .7million blind children 95% avoidable blindness ©abhilash pm 5
  6. 6.  INDIA Annual incidence of cataract induced blindness 2million;~3million people need cataract surgery Prevalence; gen population 1.1% >50 yrs 8.5% 6-7% children have vision problem ©abhilash pm 6
  7. 7. Causes of blindnesscataract 62.6%Refractive error 19.7%glaucoma 5.8%Posterior segment pathology 4.7%Corneal opacity 0.9%Other causes 6.2% ©abhilash pm 7
  8. 8. Epidemiological determinants AGE SEX MALNUTRITION OCCUPATION SOCIAL CLASS SOCIAL FACTORS ©abhilash pm 8
  9. 9. CHANGING CONCEPTS IN EYEHEALTHCAREAcute intervention comprehensive eye healthcare1. Primary eye care2. Epidemiological approach3. Team concept4. Establishment of national programmes ©abhilash pm 9
  10. 10. Primary eye care Inclusion of an eye care component in primary healthcare system Promotion and protection of eye health together with on the spot treatment are it’s cornerstones Final objectives-increase the coverage and quality of eye healthcare through PHC, improve the utilization of existing resourcesEpidemiological approach Measurement of incidence, prevalence of disease and their risk factors ©abhilash pm 10
  11. 11. Team concept One eye specialist + auxiliary health personnelEstablishment of national programs Started by voluntary agencies Focused on single disease eye camps eg: national trachoma control National blindness control program ©abhilash pm 11
  12. 12. PREVENTION OF BLINDNESS Concept of avoidable blindness Components of action1. INITIAL ASSESSMENT2. METHODS OF INTERVENTION Primary eye care Trained primary health workers 1 village health guide for 1000 populn&2 MPWs for 5000 popln Provided essential drugs Refer cases Promotion of personal hygiene ©abhilash pm 12
  13. 13.  Secondary care• Definitive management of common blinding condn• PHCs &district hospital& mobile eye clinics• Cataract surgery; gen health surveys ©abhilash pm 13
  14. 14. Tertiary careEstablished @ national & regional capitalAsso with Med clg& Institute of medRetinal detachment sur; corneal grafting etcEye bankRehabilitation of blind ©abhilash pm 14
  15. 15.  Specific programmes1. Trachoma control prog2. School eye health services3. Vitamin A prophylaxis4. Occupational eye health services3.LONG TERM MEASURES Control of infn Improving the quality of life& modifying the risk factors Health education4. EVALUATION ©abhilash pm 15
  16. 16. ©abhilash pm 16
  17. 17. NATIONAL PROGRAMME FORTHE CONTROL OF BLINDNESS 1976 Goal reduce prevalence of blindness from1 to .3 ©abhilash pm 17
  18. 18. REVISED STRATEGIES 1) To make NPCB more comprehensive by by strengthening services for other causes of blindness 2) shift frm eye camp approach to fixed facility surg approach;conventional surg to IOL 3) to expand world bank project 4) strengthen participation of voluntary organization 5) enhance the coverage of eye care services in tribal& other under served areas ©abhilash pm 18
  19. 19. OBJECTIVES 1. Reduce the backlog of blindness 2. develop eye care facilities in every district 3. develop human resources for providing eye care services 4. to improve quality of service delivery 5 .to secure participation of voluntary organizations in eye care ©abhilash pm 19
  20. 20. DEVELOPMENT OFINFRASTRUCTURE FOR EYE CARE Strengthening of PHCs Central mobile units Strengthening of Dist hosp Upgrading of Dpts of Ophthalmology in Med clgs Establishment of regional institutes Ophthalmic asst training centres Dist mobile units State ophthalmic cell Estb of DCBSs Eye banks Paramedical ophthalmic assistants posted ©abhilash pm 20
  21. 21. ORGANIZATIONAL STRUCTUREfor NPCBADMINISTRATIONCentral: ophth section Directorate General of health services, ministry of H& FW Delhi state: state ophthalmic cell ,Dir of Health services,State health societies District:DBCS ©abhilash pm 21
  22. 22. Service delivery & referral system Tertiary level : RIO& centres of excellence in eye care Secondary level: Dist hospital& NGO eye hospital Primary level: Sub dist level hosp/ CHC;mob ophth units;upgraded PHCs;link workers;panchayats ©abhilash pm 22
  23. 23. NEW INITIATIVES PROPOSEDUNDER NPCB Construction of dedicated eye wards& eye op theatre in dist hosp of NE state, j&k ,bihar etc Appointment of ophth surgeons &assist in new district hosp Appointment of ophth assistants in PHCs/vision centres Appointment of eye donation counsellors on contract basis in eye banks under govt& NGO sector Grant in aid for NGO for other eye d/s Special attention to clear cataract backlog & take care of other eye care centres frm NE states Telemedicine in ophthalmology Involvement of private practitioners A provision of RS 1550 crore has been proposed for implementation NPCB in 11 five yrs plan Vit A supplement &MMR vaccination via DBCS to prevent childhood blindness Setting up of 5 centres of excellencefor eye care services ©abhilash pm 23
  24. 24.  Community health education is a built in component at all levels of NPCB implementation School eye screening programme Collection & utilization of donated eyes ©abhilash pm 24
  25. 25. Externally aided projects World bank assisted cataract blindness control project Danish assistance to NPCB WHO assistance for prevention of blindness ©abhilash pm 25
  26. 26. VISION 2020/ THE RIGHT TO SIGHT Global initiative to reduce “AVOIDABLE BLINDNESS” by the yr 2020 Target d/s are cataract, childhood blindness,corneal blindness,glaucoma,diabetic retinopathy. Human resource development as well as infrastructure& tech devpt@ various levels of health system ©abhilash pm 26
  27. 27. structure Centres of excellence 20 ry rtia Te Training centres 200 ary Service centres nd 2000 co Se ary Vision centres 20000 imPr ©abhilash pm 27
  28. 28. ©abhilash pm 28