Community Ophthalmology

1. COMMUNITY
OPHTHALMOLOGY
Guided By-
Dr. Mohanakumari
Professor & HOD
Dept. of Shalakya Tantra
GAMC Mysuru
Presented By-
Prajesh Jadhav
Final Year BAMS
GAMC Mysuru

2. COMMUNITY OPHTHALMOLOGY
 Community ophthalmology – use of appropriate
strategies and methods to reduce the burden of eye
diseases in a community.
 Basic principles –
 The practice of community ophthalmology involves –
1. An assessment of the extent of the problem of eye
diseases and socio economic impact of blindness on
the community.
2. Finding and applying the most appropriate eye care
solutions for the specific community.

3.  These solutions comprise of –
a. Preventive activities for control of communicable and
non-communicable eye diseases and environmental
health hazards.
b. Promotive activities concerned with improved
nutrition, intensive eye health education and
improved life style.
c. Curative programs addressing the common eye
conditions like refractive errors , trachoma, cataract,
xerophthalmia etc.

4. BLINDNESS
 W.H.O – accepts a cut off of V.A<3/60 in the
better eye, with best possible correction to
define blindness.
 N.P.C.B – V.A<6/60 in the better eye with best
possible correction to define blindness.

5. BLINDNESS
 ECONOMIC BLINDNESS – that level of blindness which prevents
an individual from earning his wages.
 Presenting vision <6/60 in the better eye.
 Since this level of visual impairment hinders a person from earning
– also referred as WORK VISION
 LEGAL BLINDNESS – The level of blindness that necessitates
welfare measure and legal protection.
 Vision less than 6/60 or 20/200 or less in the better eye , with
correction, and/or a visual field less than 10 degrees.
 This definition is used in USA.

6. BLINDNESS
 SOCIAL BLINDNESS – the degree of disability that hampers an
individual from socially interacting with the family and peer groups
in a satisfactory manner.
 The inability to count fingers at a distance of 3m (with the better
eye) with best correction.
 Since this level of visual impairment curtails the day to day
movement of an individual – also referred as WALK VISION.
 MANIFEST BLINDNESS – V.A < 1/60 .
 Seriously constraints the accomplishment of tasks for daily living .
Also impairs mobility. Used as service indicator – as most of the
cataract blind in the developing world are operated at this stage.

7. BLINDNESS
 ABSOLUTE BLINDNESS – the inability to perceive light in any eye.
 CURABLE BLINDNESS – that stage of blindness where damage is
reversible by prompt management. E.g cataract
 PREVENTABLE BLINDNESS- the loss of blindness that could have
been completely prevented by institution of effective preventive or
prophylactic measures .e.g xerophthalmia, trachoma, glaucoma
 AVOIDABLE BLINDNESS – the sum total of curable blindness. In
India, 85-90% of all blindness is avoidable.
 INCURABLE BLINDNESS – the state of blindness which is beyond
redemption. 5-10%

8. N.P.C.B
 THE NATIONAL PROGRAMME FOR CONTROL OF
BLINDNESS
- Was launched in 1976.
- Being implemented as 100% centrally sponsored
program since its inception.
- In 1982, it was implemented in the prime minister’s 20
point socio economic program.

9. OBJECTIVES
- Provision of comprehensive eye care
facilities at primary, secondary and
tertiary health care level.
- To achieve a substantial reduction in the
prevalence of eye diseases in general and
the overall reduction in the prevalence of
blindness to 0.3% by 2000 AD

10. COMPONENT ACTIVITIES UNDER N.P.C.B
- Creating an infrastructure for cataract surgical and
support services.
- School eye screening and refraction services.
- Strengthening eye health education activities
- Control of corneal blindness including establishment of
eye banks.

11.  As per Survey in 2001-02, prevalence of blindness is
estimated to be 1.1%.
 Rapid Survey on Avoidable Blindness conducted under
NPCB during 2006-07 showed reduction in the
prevalence of blindness from 1.1% (2001-02) to 1%
(2006-07).
 Various activities/initiatives undertaken during the Five
Year Plans under NPCB are targeted towards achieving
the goal of reducing the prevalence of blindness to
0.3% by the year 2020

12.  Cataract (62.6%)
 Refractive Error (19.70%)
 Corneal Blindness (0.90%)
 Glaucoma (5.80%)
 Surgical Complication (1.20%)
 Posterior Capsular Opacification (0.90%)
 Posterior Segment Disorder (4.70%)
 Others (4.19%)
 Estimated National Prevalence of Childhood Blindness /Low
Vision is 0.80 per thousand
Main causes of blindness

13. GOALS & OBJECTIVES OF NPCB IN THE XII PLAN
 · To reduce the backlog of blindness through
identification and treatment of blind at primary,
secondary and tertiary levels based on assessment of
the overall burden of visual impairment in the country.
 · Develop and strengthen the strategy of NPCB for
“Eye Health” and prevention of visual impairment;
through provision of comprehensive eye care services
and quality service delivery.
 · Strengthening and upgradation of RIOs to become
centre of excellence in various sub-specialities of
ophthalmology

14.  . Strengthening the existing and developing additional
human resources and infrastructure facilities for
providing high quality comprehensive Eye Care in all
Districts of the country;
 · To enhance community awareness on eye care and
lay stress on preventive measures;
 · Increase and expand research for prevention of
blindness and visual impairment
 · To secure participation of Voluntary
Organizations/Private Practitioners in eye Care

15.  Three major types of refractive corrective which is to
be provided to the population –
- Myopic correction for school children
- Presbyopic correction to the above 40 years segment
- Aphakic correction to operated cataract patients.
- INTENSIVE HEALTH EDUCATION ACTIVITIES – are
central to the success of the N.P.C.B
- Information, education and communication activities
have recently been augmented.

16.  CORNEAL BLINDNESS AND EYE DONATION – for this purpose
N.P.C.B supports the establishment of eye collection centres and
eye banks both in the government and the NGO sector.
 WORLD BANK ASSISTED CATARACT CONTROL PROJECT –
- Was initiated in 1994
- Covers 7 states where the prevalence of blindness and the backlog
of operable cataracts was the highest in the country – U.P,
Rajasthan, M.P, Maharashtra, A.P, Orissa and Tamil Nadu.
- In these states over a period of 7 years (1994-2001) augmentation
of cataract services was attempted.
- 11 million cataract surgeries were planned to be done.

17. ORGANIZATION OF NPCB
 1.National programme management cell
 2. State programme management cell
 3. District blindness control
a. District hospital ( Medical Superintendent)
 i. Ophthalmic surgeon
 ii. District mobile unit
 b. District health officer(C.M.O)
 i. Community health officer – medical officer – MPW
 ii. Primary health officer – medical officer - MPW

18. VISION 2020: THE RIGHT TO SIGHT
- Global initiative launched by the World Health Organization
and a Task Force of International Non-governmental
Organizations.
 To combat the gigantic problem of blindness in the world.
- It was launched in Geneva on February 18, 1999 by the then
Director General of the World Health Organization, Dr. Gro
Harlem Brundtland.

19.  - envisages collaboration between
governments, World Health Organization,
International Agency for -
 Prevention of Blindness, funding agencies,
international, nongovernmental and private
organizations that collaborate with the World
Health Organization in the prevention and
control of blindness.

20. GLOBALLY, FIVE CONDITIONS HAVE BEEN IDENTIFIED
FOR IMMEDIATE ATTENTION FOR ACHIEVING THE
GOALS OF VISION 2020
 They are-.
 - Cataract
 - Trachoma
 - Onchocerciasis
 - Childhood blindness
 - Refractive Errors and Low Vision

21.  These conditions have been chosen on the basis of-
1. their contribution to the burden of blindness
2. the feasibility and affordability of interventions to
control them.
 Each country will decide on its priorities based on the
magnitude of specific blinding conditions in that
country.

22. FIVE BASIC STRATEGIES TO COMBAT BLINDNESS
 1. Disease prevention and control
 2. Training of personnel
 3. Strengthening the existing eye care
infrastructure
 4. Use of appropriate and affordable
technology
 5. Mobilization of resources

23. CATARACT
- Major cause of blindness in the world
- An estimated 16-20 million people are
bilaterally blind from cataract and the
number is increasing.

24. TRACHOMA
 An estimated 146 million people have the
active infection with the
 microorganism Chlamydia trachomatis, for
which antibiotic treatment is indicated.
 - There are approximately 10.6 million adults
with in turned eyelashes (trichiasis/entropion),
for which eyelid surgery is needed to prevent
blindness.

25.  - An estimated 5.9 million adults are blind from
corneal scarring due to trachoma.
 - Trachoma is the second cause of blindness in
 sub-Saharan Africa, China and the Middle-Eastern
countries.
 - Trachoma is to be controlled through the
implementation of the SAFE strategy integrated within
primary health care in all communities identified as
having blinding trachoma within a country.

26. ONCHOCERCIASIS
 - An estimated 17 million people are infected with
onchocerciasis. - Approximately 0.3-0.6 million are
blind from the disease.
 - Endemic in 30 countries of Africa and occurs in a few
foci in six Latin American countries and in Yemen.

27. CHILDHOOD BLINDNESS
 - Estimated 1.5 million blind children in the world, of
whom
 1 million live in Asia and 3,00,000 in Africa.
 - Prevalence = 0.5 - 1 per 1,000 children aged 0-15
years.
 - An estimated 5,00,000 children going blind each year
(one per minute).
 - Many of these children die in childhood.
 - It is estimated that childhood blindness causes 75
million blind

28. REFRACTIVE ERRORS AND LOW VISION
 - Spectacles are an essential part of the treatment of
many eye patients.
 - Their provision is therefore an integral part of eye
care delivery.
 The steps in the provision of refraction services and
low vision care for patients are as follows-.
 i) Screening - Identification of individuals with poor
vision which can be improved by spectacles or other
optical devices.
 ii) Refraction - Evaluation of the patient to determine
what spectacles or device may be required.

29.  iii) Manufacture - Manufacture of the spectacles or an
appropriate device, both of which may be
manufactured locally, purchased externally or donated.
 iv) Dispensing - Issuing of the spectacles or device,
ensuring a good fit of the correct prescription.
 v) Follow-up - Repair of spectacles/devices or repeat
dispensing.

30. HUMAN RESOURCE DEVELOPMENT
 Community Level
 Primary Health Care (PHC) is a fundamental concept of
the World Health Organization for improvement in
health.
 All the elements of primary health care can contribute
to the prevention of blindness.
 PHC worker - important role to play in the control of
blindness -
 i) Identification - PHC workers are ideally placed to
identify blind and visually disabled children and adults
in their own home.

31.  ii) Assessment and diagnosis - PHC workers can be
taught to assess those individuals who could be helped
by the services of a specialist, for example identifying
cataract for referral to an ophthalmologist.
 iii) Referral for management and treatment - PHC
workers can encourage individuals to go for treatment
and can provide the referral system that will promote
this.
 iv) Follow-up and evaluation - After treatment, the PHC
worker can follow up the patient at home to help with
visual rehabilitation (the patient after cataract surgery,
for example), give advice on any treatment and make
sure that spectacles are available.

32.  Secondary and Tertiary Levels
 Ophthalmologists –
Target 2000 2010 2020
Ophthalmologis
ts per
population
Sub-Saharan
Africa
500000 1:400000 1:250000
Asia 1:200000 1:100000 1:50000

33. VISION 2020: THE RIGHT TO SIGHT IN INDIA
 - India was the first country in the world to launch the
National Programme for Control of Blindness in 1976
with the goal of reducing the prevalence of blindness.
 - Of the total estimated 45 million blind persons (best
corrected visual acuity < 3/60) in the world, 7 million
are in India
 India is committed to reduce the burden of avoidable
blindness by the year 2020 by adopting strategies
advocated for Vision 2020- The Right to Sight.

34. ACHIEVEMENTS
 - All surveys indicated cataract as the single largest
cause of blindness in India.
 - Controlling cataract blindness- given priority in
India.
 - Funds were mobilized from the World Bank during
1994-2002. - - Assistance was provided to seven major
states, estimated to contribute 70% of the country’s
cataract blind.

35.  307 dedicated eye operation theatres and eye wards
constructed in district level hospitals
 Supply of ophthalmic equipment for diagnosis and
treatment of common eye disorders, particularly for
intra-ocular lens (IOL) implantation at all district
hospitals
 More than 800 eye surgeons trained in IOL surgery
 30 non-governmental organizations (NGOS) assisted
for setting up/ expanding eye care facilities

36.  Volume of cataract surgery has steadily increased
since 1993. Cataract Surgery Rate is 3800 per million
population (2003-04). There has been a significant
increase in proportion of cataract surgeries with IOL
implantation from <5% in 1994 to 85% in 2003-04.
 - There has also been an increase in coverage of eye
care services
 - A Rapid Assessment survey carried out in 14
districts in 1998 indicated coverage of 70% persons
having access to eye care services.

37. DECENTRALIZED APPROACH
 India is a vast country having 28 States and 7 Union
Territories with 593 districts, with an average
population of nearly two million per district.
 The programme implementation has been
decentralized upto the district level where District
Blindness Control Societies (DBCS) have been set up as
the nodal agencies.
 Members of the DBCS include officials from District
Administration, Health, Education and Social Welfare
Departments, media, community leaders and
NGOs/Private Sectors involved in eye care.

38. THANK YOU