BLINDNESS PREVENTION IS REQUIRED IN TODAYS WORLD

1. BLINDNESS
BY
K.N.VIKAS NAIDU

2. STRATEGIES INCLUDE
 APPROACH TO PLANNING AND IMPLEMENTATION OF
BLINDNESS CONTROL MEASURES IS BASED ON
STRATEGY
DISEASE
SERVICES
COMMUNITY

3. DISEASE ORRIENTED
APPROACH
 PROVISION OF SERVICES FOR CATARACT
SURGERY
 VITAMIN A SUPPLEMENTATION
 CONTROL OF TRACHOMA
 SCREENING OF SCHOOL CHILDREN FOR
REFRACTIVE ERRORS
 DIST OF IVERMECTIN FOR
ONCHOCERCHIASIS

4. SERVICE ORIENTED APPROACH
 PRIMARY CARE SERVICES
AT COMMUNITY LEVEL
 SECONDARY CARE SERVICES
AT EYE CLINIC LEVEL
 TERTIARY CARE SERVICES
AT TRAINING OR REFERRAL CENTRE LEVEL
(INCLUDES ALL EYE SPECIALISTS)

5. COMMUNITY LEVEL APPROACH
 IT IS DIRECTED AT TARGET
POPULATION AT RISK

6. SPECIFIC BLINDING
DISORDERS &
THE APPROACH TO
PREVENTION

7. CATARACT

8. AT PRIMARY LEVEL
 HAELTH WORKER
SCREENS AND
REPORTS THOSE
WITH VISION <3/60
OR <6/60 FOR
SURGERY
 HE/SHE COUNSELS
&MOTIVATES THOSE
AFFECTED TO
UNDERGO SURGERY
Cortical cataract
Congenital cataract

9. AT SECONDARY LEVEL
 CATARACT SURGERY
SHOULD BE
PERFORMED WITH
EQUAL EMPHASIS ON
QUALITY AND
QUATITY OF
SURGERY Lens implantation in cataract surgery

10. AT TERTIARY LEVEL
 PROVISIN OF
FACILITIES FOR
COMPLICATED CASES
OF CATARACT LIKE
 CONGENITAL
CATARACT Congenital cataract

11.  SUBLUXATED LENS
 CATARACT
ASSOSCIATED WITH
SYSTEMIC
DISORDERS ( LIKE
DIABETES) Total opacification of lens

12. GLAUCOMA

13. TREATMENT
 THERE IS NO CURE FOR GLAUCOMA BUT CAN BE
CONTROLLED BY
MEDICATION
 MIOTICS- PILOCARPINE,CARBACHOL
-WHICH HELP OPEN DRAINAGE CHANNELS AND
INCREASE FLOW OF AQ HUMOUR OUT OF EYE.
 EPINEPHRINE COMPOUNDS-DIPIVEFRIN,EPIFRIN
-WHICH LOWERS THE I.O.P

14. A baby with congenital glaucoma

15.  BETA BLOCKERS- DECREASEE THE RATE AT WHICH
AQUEOUS HUMOUR FLOWS INTO EYE
(BETAXOLOL,TIMOLOL)
 CARBONIC ANHYDRASE INHIBITORS
HELPS REDUCE FLOW OF AQUEOUS HUMOUR INTO
EYE (METHAZOLAMIDE,CHLORPROPMIDE)
 ALFA ADRENERGICS-RADUCE AQ HUMOUR
PRODUCTION AND INCREASE ITS OUTFLOW
(BRIMONIDINE,APRACLONIDINE)
 PROSTAGLANDIN ANALOGUES-INCREASES
UVEOSCLERAL OUTFLOW (LANTAPROST)

16. Other photos of
congenital glaucoma

17. PREVENTION
 WHILE GLAUCOMA CANNOT BE PREVENTED THE EARLIER IT IS
DIAGNOSED THE BETTER
 RECOM,DATIONS FOR EARLIER DETECTION
 HAVE A TONOMETRY TEST EVERY 2 TO 4 YEARS IF U R B/W 40 TO
65 YRS
 HAVE A TEST EVERY 1 OR 2 YEARS IF U
 ARE 65 YRS OR OLDER
 HAVE A FAMILY HISTORY OF GLAUCOMA
 ARE OF BLACK OR ASIAN ANCESTARY
 HAVE DIBETES OR ANY OTHER CHRONIC INFL DISEASE
 HAVE HAD PREVIOUS EYE INJURY
 ARE TAKING STEROIDS

18. TRACHOMA

19. METHODS OF INTERVENTION
 THE S - SURGERY
A - ANTIBIOTICS
F - FACE WASHING
E - ENVIRONMENT
STRATEGY IS DIRECTED AT ELIMINATING
TRACHOMA BY REDUCING BLINDNESS
COMPLICATIONS IN SHORT TERM.

20.  SURGICAL
CORRECTION OF
ENTROPION
ANDTRICHIASIS HAS
AN IMMEDIATE
EFFECT IN
PREVENTING
BLINDNESS
PROVIDED IT IS
DONE BEFORE
IRREVERSIBLE
CORNEAL SCARRING
Importance of face
washing in trachoma

21.  ANTIUBIOTIC
TREATMENT AIMS
AT
1. TO REDUCE
SEVERITY OF
INFLAMMATION
2. TO DECREASE
DISEASE
TRANSMISSION
3. TO REDUCE
POTTENTIAL FOR
SCARRING

22.  ANTIBIOTICS USED MOST COMMONLY
ARE
TETRACYCLINE
ERYTHROMYCIN
SULPHONAMIDES
RIFAMPICIN

23. DIABETIC
RETINOPATHY

24. INTERVENTIONS FOR
PREVENTION AND TREATMENT
 LIKE GLAUCOMA LOST VISION CANNOT BE
RECOVERED.
 TREATMENT BY PHOTOCOAGULATION IS
AT BEST EFFECTIVE AND SHOWN TO
REDUCE BY 60 TO 95%.
 PRIMARY PREVENTION: BY CHANGES IN
THE LIFE STYLE OF INDIVIDUALS.

25.  SECONDARY
PREVENTION:SHOULD
BE DONE BY EARLY
DIAGNOSIS OF TYPE
2 DIABETES WITH
INITIAL BASELINE
FUNDUS
EXAMINATION.
 TERTIARY LEVEL:
TERTIARY LEVEL
ACTION IN
RESTORATION OF
SIGHT BLIND
DIABETICS.
Retina of a
diabetic
retinopathy
patient

26. IF POSSIBLE IN
SELECTED PATIENTS
WITH VITREOUS
HAEMORRHAGEOR
TRACTIONAL RETINAL
DETACHMENT USING
SOPHISTICATED
MODERN
VITREORETINAL
SURGICAL
EQUIPMENT.

27. BLINDNESS PREVENTION
PROGRAMMES

28. NATIONAL PROGRAMME FOR
CONTROL OF BLINDNESS
 WHO HAS DEFINED BLINDNESS AS “
VISUAL ACUITY LESS THAN 3/60 OR
INABILITY TO COUNT FINGERS IN
DAYLIGHT AT A DISTANCE OF 3 METRES.
 INDIA HAS 6 MILLION OUT OF 38 MILLION
BLIND PRESENT IN THE WORLD.

29. ABOUT PROGRAMME
 THE PROGRAMME WAS STARTED IN 1976
AS Q 100% CENTRALLY SPONSORED
PROGRAMME.
 IT ALSO INCORPORATES EARLIER
TRACHOMA CONTROL PROGRAMME
STARTED IN 1963.

30. GOALS
 TO REDUCE THE PREVALENCE OF
BLINDNESS FROM 1.49% (1986-89) TO
LESS THAN 0.3%.
 TO ESTABLISH INFRASTRUCTURE AND
EFFICIENT LEVELS IN THE PROGRAMME
TO BE ABLE TO CATER NEW BLINDNESS
EACH YEAR AND PREVENT BACKLOGS.

31. OBJECTIVES
 TO ESTABLISH EYE CARE FACILITIES FOR
EVERY 5 LAKH POPULATION.
 TO DEVELOP HUMAN RESOURCES FOR
EYE CARE SERVICES AT ALL LEVELS OF
P.H.C, SUB CENTRES ETC.
 TO IMPROVE QUALITY OF SERVICE
DELIVERY.
 TO SECURE PARTICIPATION OFCIVIL
SOCIETY AND PRIVATE SECTOR.

32. STRATEGIES
THE 4 PRONGED STRATEGIES ARE:
 STRENGTHENING SERVICE DELIVERY.
 DEVELOPING HUMAN RESOURSES FOR
EYE CARE.
 PROMOTING OUTREACH ACTIVITIES AND
PUBLIC AWARENESS.
 DEVELOPING INSTITUIONAL CAPACITY.

33. ACTIVITIES
 CATARACT OPERATION: TO SRENGTHEN EYE
CARE SERVICES BY ADDITIONAL INPUT. IOL
IMPLANTATION HAS INCREASED AT MANY
STATES WITH THW ASSISTANCE OF WORLD
BANK.
 INVOLVEMENT OF N.G.O’S: FOR THIS THE
VOLUNTARY ORGANIZATIONS ARE
ENCOURAGED TO ORGANIZE EYE CAMPS IN
REMOYE RURAL AND URBAN AREAS. N.G.O’S
PLAY AN IMP ROLE IN CATARACT SURGERIES.

34.  CIVIL WORKS: CONSTRUCTION OF EYE WARDS,
OPERATION THEATRES AND DARK ROOMS WERE
UNDERTAKEN IN 7 STATES UNDER WORLD
BANK ASSISTED PROJECT.
 TRAINING: IMPARTING TRAINING TO EYE
SURGEONS BOTH AS TRAINERS AND AS
SURGEONS WHO WILL BE IMPLEMENTING I.O.L
 COMMODITY ASSISTANT: COMMODITY’S LIKE
SUTURES AND IOL’S, INDIRECT
OPHTHALMOSCOPES, SLIT LAMPS,
KERATOMETRES, YAG LASERS ARE PROCURED
CENTRALLY AND DISTRIBUTED TO STATES.

35.  INFORMATION EDUCATION AND
COMMUNICATION: POSTERS, VIDEO SPOTS ,
RADIO JINGLES, ETC IN ALL REGIONAL
LANGUAGES.
 MANAGEMENT INFORMATION SYSTEMS: A
SOFTWARE IS DEVELOPED TO FACILITATE DATA
COMPLETION AT 25 SENTINEL SURVEILANCE
UNITS IN MEDICAL COLLEGES.
 MONITORING AND EVALUATION: RAPID
ASSESEMENT SURVEY, FACILITY SURVEY, AND
BENEFICIARY ASSESEMENT SURVEY IN 1997-99
AND VISUAL OUTCOME SURVEY 1999-00.