National Programmes in eye care

1. COMMUNITY
OPHTHALMOLOGY

2. AIM
 Prevention of ocular diseases and visual impairment
 Reduction of ocular disability
 Promotion of ocular health and quality of life and
efficiency of a group of people at the community level.

3. BLINDNESS
 WHO Defn of blindness
 Visual acuity of less than 3/60(snellen) or its
equivalent
 Screening of visual acuity by non-specialised
persons – Inability to count fingers in broad daylight at a
distance of 3 meters

4. AVOIDABLE BLINDNESS
 Preventable blindness - prevented by
attacking the causative factor at an
appropriate time
Eg : corneal blindness due to Vit A def
and trachoma
 Curable blindness - Vision can be restored by
timely intervention.
Eg : cataract blindness can be cured by
surgical treatment.

5. MAGNITUDE OF BLINDNESS
 Globally 253 million people have visual impairment of
whom nearly 36 million are blind
 80% of visual impairment is avoidable
 IN India - 8 million blind people (2001-2002 survey
NPCB )
 Prevalence of blindness is 1.1% NPCB(2001-2002)

6. CAUSES OF GLOBAL
BLINDNESS
 UNOPERATED CATARACT(35%)
 UNCORRECTED REFRACTIVE ERRORS (21%)
 GLAUCOMA
 OTHERS

7. CAUSES OF GLOBAL VISUAL
IMPAIRMENT
 Uncorrected refractive errors (53%)
 Un-operated cataract
 ARMD
 Glaucoma
 Diabetic retinopathy
 Others

8. IN INDIA (NPCB survey 2001-
2002)- major causes of
blindness
CATARACT
REFRACTIVE ERRORS
GLAUCOMA
POSTERIOR SEGMENT DISORDERS
SURGICAL COMPLICATIONS
CORNEAL BLINDNESS

9. Global Initiatives For
Prevention Of Blindness
 Prevention of Blindness Programme (PBP)- WHO 1978
 Vision 2020 – The right to sight
 Vision for the future VFTF (2001)
 Universal Eye Health: Global Action Plan

10. National Programme For
Control Of Blindness
 India was the first country in the in the world to launch
the NPCB in the year 1976 as a 100% centrally sponsored
programme
 It incoporated the earlier Trachoma control programme
and Vitamin A prophylaxis programme

11. OBJECTIVES
 To provide comprehensive eye care
facilities for primary , secondary & tertiary
levels of eye health care
 To reduce the prevalence of blindness in
population from 1.38% to 0.31% by 2000

12. PLAN OF ACTION &
ACTVITIES
 (A) EXTENTION OF EYE CARE
SERVICES
 through eye camps and mobile eye units

13.  (B) Establishment of permanent
infrastructure
 Primary eye care at peripheral level
 Secondary eye care at intermediate level
 Tertiary eye care at central level
 Center of excellence at apex level

14. (1) Establishment of peripheral sector for primary
eye care
 A wide number of eye conditions can be
treated/prevented at the grass-root level by locally
trained primary health workers who are the first to
make contact with the community
 PHC strengthened by
- providing necessary equipment
- posting a paramedical ophthalmic assistant
- organising refresher courses for doctors &
and other staff of PHC on prevention of
blindness

15.  Establishment of intermediate sector for
Secondary eye care
Development of Diagnostic & Treatment facilities at
district & subdivisional levels under the charge of an
eye specialist

16.  Establishment of central level for tertiary eye care
 Sophisticated eye care
 Upgradation of eye departments of state medical
colleges & by establishments of RIO

17.  (4) Establishment of an Apex National Institute Of
Ophthalmology
 - at Dr Rajendra Prasad Centre for Ophthalmic
Sciences,New Delhi
 - provides overall leadership , supervision & guidance
in technical matters to all services and institutions

18. (C) Intensification of eye health education
Important long term measure in order to create
community awareness of the problem
Done through mass communication – TV talks , radio
talks , films , seminars & books
school teachers, social workers , community leaders

19. PROGRAMME
ORGANISATION
1) Central level
Responsibility of National Programme Management cell
Located in the office of Director of General health
services
Dept of health, Govt of India
2) State level
NPCB is implemented through State Ophthalmic Cell
State Programme Officer is in charge of NPCB

20.  3) District Blindness Control Society
To plan , implement & monitor the blindness control
activities comprehensively at the district level
under overall guidance of the NPCB

21.  DBCS was established because
 1) District can be designated as a unit for implementing
various development activities
 2) To simplify administration & financial procedures
 3) To enhance participation of the community & the
private sector

22. DBCS
 Maximum 20 members
 Chairman
 Vice chairman
 Member secretary: District Programme Manager (DPM)
 Advisor of the society is State Programme Manager
 Technical guidance is provided by the Chief Ophthalmic
Surgeon/ Head of the Ophthalmology Department of
Medical College

23. VISION 2020 : The Right to
Sight
 Global initiative launched by WHO on Feb 18 , 1999 in
Geneva in broad coalition with a
Task Force of International Non-Governmental
Organisations (NGOs)
OBJECTIVE
Eliminate Avoidable Blindness by the year 2020 and to
reduce the global burden of blindness

24.  VISION 2020 will be implemented through four phases
of five year plans , the first started in 2000
 WHO has identified five major blinding eye conditions
for immediate action which are
 Cataract , Childhood Blindness , Trachoma , Refractive
Errors and Low Vision & Onchocerciasis

25. CATARACT
 Aim is to decrease the number of cataract blinds
in the world
 Strategy is to increase the Cataract Surgery Rate
(CSR) i.e. number of cataract surgeries per million
population per year

26. CHILDHOOD BLINDNESS
 Considered a priority because of the number of
years of blindness that ensues
 Prevalence 0.5 – 1 per 1000 children aged 0 – 15
years
 Globally there are 1.4 million blind children
 Causes
– Vitamin A def
- Measles
- Conjunctivitis
- Ophthalmia neonatorum
- Congenital cataract
- Retinopathy of prematurity(ROP)

27. STRATERGIES AND ACTIVITIES
 1)Elimination of preventable blindness by
 - Measles immunisation
 - Vit A supplementation
 - Monitoring use of oxygen in
premature newborn
 -Promoting school screening programmes
for diagnosis and management of
refractive errors and trachoma
 - Promoting eye health education in
schools

28.  2) Management of surgically avoidable causes of
childhood blindness such as cataract , glaucoma & ROP

29. TRACHOMA
 Effective interventions have been demonstrated
using SAFE stratergy:
 Surgery to correct lid deformity and prevent
blindness
 Antibiotics for acute infections and community
control
 Facial hygiene
 Environmental change including improved access
to water and sanitation and health education

30. REFRACTIVE ERRORS AND
LOW VISION
 Screening to identify individuals with poor vision which
can be improved by spectacles or other optical devices
 Refraction services to those identified with significant
refractive errors
 Ensure optical services to provide affordable spectacles
 Low vision services and low vision aids to be provided
for all those in need

31. ONCHOCERCIASIS
 0.3 million people blind due to onchocerciases world
wide
 About 95% of infected persons reside in Africa
 Target – to develop National Onchocerciasis Control
Programme with satisfactory coverage in all the 37
countries where the disease is endemic
 Stratergy – to introduce community directed treatment
with annual doses of Ivermectin

32. ROLE OF EYE CAMPS
 2 types of eye camps
Comprehensive eye care camps
Screening eye camps
 Patients are provided comprehensive eye care services
including refraction, cataract surgery

33. EYE BANKING
 Eye bank is an organization which deals with the collection,
storage and distribution of cornea for the purpose of
corneal grafting
 Functions
 Increase awareness about eye donation
 Registration of the pledger for eye donation
 Collection of donated eyes
 Receiving and processing of donor eyes
 Preservation of the tissue
 Distribution of the donor tissues to corneal surgeons
 Research activities

34. Eye bank personnel
 Eye bank in charge- qualified ophthalmologist
 Eye bank technician
 Clerk cum store keeper
 Medical social worker or Public Relation Officer
 Driver cum projectionist

35. Eye collection centres
 Peripheral satellites of an eye bank for better
functioning
 About 4-5 eye collection centres are attached with each
eye bank
 Functions
• Local publicity of ye donation
• Registration of donors
• Arrangement for collection of eyes
• Initial processing, packing and transportation of eyes to
eye bank

36. Rehabilitation of the blind
 Medical rehabilitation- Low vision aids
 Training and psychosocial rehabilitation
Mobility training, training in daily living skills
 Educational rehabilitation- blind schools
 Vocational rehabilitation