Community ophthalmology aims to provide comprehensive eye health care through public health approaches like epidemiology, health promotion, and primary eye care. It focuses on preventive, curative, and promotive community-based activities. Key aspects include epidemiological studies of eye diseases, policy and planning, management information systems, monitoring and evaluation, environmental eye health, economics of eye care, behavioral sciences, biostatistics, and project management. Community ophthalmology specialists employ public health approaches and work in community settings to address the epidemic of preventable blindness.

1. Current Concept and Practices of
Community Ophthalmology
Dr. Suraj Senjam
Faculty of Community Ophthalmology
Dr. R P Centre AIIMS New Delhi

2. Questions
 What do you understand by Community Ophthalmology?
 Why do we need to have such discipline ?
 What should be the curriculum for this discipline?
 What are spectrum of activities ?
 Who are going to provide this ?

3. Community ophthalmology
 Initial viewed: Ophthalmology services should be solely provided
through tertiary health centers by Ophthalmologists
 Epidemic of preventable blindness and visual impairment
 Many eye problems are within the purview of public health concerned
 First proposed by Dr. Patricia E. Bath in 1978
 Relatively new in the Biomedical Sciences
 Very few Institutions has this discipline

4. Community ophthalmology
 Public Health Ophthalmology
 Community Eye Health
 Preventive Ophthalmology
 Focus: Three community based activities:
 preventive,
 curative,
 promotive.
British Journal of Ophthalmology, 1987, 71, 116-117

5. Community Ophthalmology
 21st Century
 The perspective of Public Health Discipline is growing, so as
too Community Ophthalmology
 Applied all public health sub-dimensions

6. Community Ophthalmology
 An important branch of community medicine that aims at
comprehensive eye health care in the community setting employing
the knowledge of public health and social & preventive medicine to a
large extent, viz. epidemiology, health promotion, health economics,
heath management, environmental health, public health policy &
planning, social sciences & behavioral health, medical biostatistics
and primary health care.

7. Community Ophthalmology Vs. Community eye care services
 Community eye care services
I. Promotive-Eye Health
Promotion
II. Preventive-screening
III. Curative
IV. Referral
V. Rehabilitation-visual
E.g. Eye Camp, School screening
 People think these are the activities
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 Community Ophthalmology
1) Community eye care services
2) Epidemiology of eye Diseases
3) Epidemiological studies
4) Policy & Planning of Eye health
5) Management Iinformation System (MIS) on
eye health
6) Monitoring and evaluation
7) Environmental eye health
8) Eye Health economics
9) Behavioral & Social Sciences on eye care
10) Biostatistics
11) Managing and Presenting Public Health
Data
12) Project Cycle Management

8. Community Ophthalmology: Promotive-Eye
Health Promotion
 Educational or IEC materials for each important problems
 Pamphlets, posters, banner, hoarding flip chart etc
 Small booklets like what a patient should know about glaucoma/ DR etc
 Booklets on low vision information
 Improving personal hygiene, sanitation, environment modifications, diet habit
 Various Media:
 Audiovisual and folk song, skit drama etc
 Eye health talk or Mela

9. Community Ophthalmology: Preventive
measures
1. Etiological preventive measures
 Nutritional blindness secondary to Vit. A deficiency
 Clean face and good hygiene and sanitation
 Onchocerciasis spread by black flies
2. Prevention from Blind and visual impairment
 Surgical intervention of angle closure Glaucoma, DR,
3. Prevention from further loss of quality of life, deterioration of
livelihood
 Visual rehabilitation and vision aids

10. Community Ophthalmology
 Curative
 Surgical removal of cataract
 LASIK
 Treatment of conjunctivitis
 Rehabilitation
 Mobility and orientation training
 Training on Daily Living Activities
 Community Based Rehabilitation

11. Epidemiology of eye Diseases
1. Non-infective
 Example: Cataract, Refractive errors, Glaucoma
2. Infective
Example: Trachoma, Conjunctivitis, Onchocerciasis
Cataract
Classification, Prevalence, incidence, risk factors, trends, ecological study
finding, Sign and symptoms , morbidity, economical impact, prevention and
screening and briefly about management
Trachoma
Problems statement, epidemiological determinants-agent factors, Host factors
environmental factors, mode of transmission, Sign and symptoms, control
measures

12. Epidemiological studies
 Study of the distribution, frequency and determinants of health
related events or diseases in a defined population and application of
this study to the control of health problems
 Distribution: what ? Who? Where ? When?
 Frequency: Incidence, prevalence,
 Determinants: probable risk factors, protective factors

13. Epidemiological study
A. Descriptive studies
 Individuals
I. Case reports
II. Case series
III. Cross-sectional
 Population or ecological studies
B. Analytical studies
I. Case control
II. Cohort
III. Trials
DR. RPC AIIMS 13
In Community Ophthalmology

14. Cross Sectional Survey
1. Ideal Epidemiological survey
 Sample –representative
 Result-generalizable
 Time consuming
 Need more resources
 Need epidemiologist
 Suitable for high income
countries
DR. RPC AIIMS 14
2. Rapid Assessment survey
 Not representative
 Not generalizable
 Less time consuming
 Need less resources
 Simplified sampling methods
 Suitable for low-middle income
countries

15. Rapid Assessment Survey
 Rapid Assessment of Avoidable Blindness (RAAB)
 Rapid Assessment of Visual Impairments (RAVI)
 Rapid Assessment Refractive Error (RARE)
 Trachoma Rapid Assessment (TRA)
 Rapid Assessment of Cataract Surgical Services (RACSS)
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16. Scientific study: Protocol
 Sample size
 Sampling techniques
 Data collection
 Data management
 Data analysis and dissemination

17. Policy & Planning for Eye Health
 Better health policy is a driving force for better life
 Policy making based on sound scientific knowledge
 Health research-evidence based decision making
 National Blindness Survey (RAAB) in India
 Program reform with special emphasis on structural and implementation
 Financing eye health care-insurance, user fees
 Public-Private partnerships in the services delivery

18. Management Information System
 Better the information system, better the health care
delivery, management and outcome
 Designing good MIS
 Information on human resources, infrastructures, equipment,
activity related
 Geographical information on hospital facilities
 Computerize information system
 Monitoring and evaluation
 MIS use for different management level

19. Program Monitoring and evaluation
 Cataract surgical program
 School vision screening program

20. Environmental and eye health
 Population changes (demography)
 Effect on life expectancy on eye health
 Migration effect
 Physical environment
 Temperature, UV, air pollution, humidity, wind, soil, chemicals
 Urban housing, lighting system
 Biotic environment
 Infectious agents, vectors, forestry etc
 Domestics environment
 Water supply, sanitation, smoking, diet, lifestyle etc.
 Work habits
 Politico-cultural environments
 Conceptual or cultural practices, equity of health accessibility, national priority
 Socio-economic environment
 poverty

21. Eye Health Economics
 Economics is the sciences of choice
 Government
Hospital eye health care or
Public health ophthalmic program
 Allocative efficiency
Some of amount resources  where to allocate (program
competes each other for resources allocation)
How many of the resources to allocate to each program
One program gains at the expense of other
 This will by addressed by Cost-Benefit Analysis

22. Eye Health economics
 Technical efficiency
 Best way to achieve the given objective
 The patient will be treated, but question is how
 Comparison of options with the same goal
 Day care cataract surgery vs. inpatient stay surgery for cataract
 Day care LASIK vs, inpatient stay
 This will be addressed by Cos-Effective Analysis

23. Behavioral & Social Sciences on eye health
 Socio-cultural Belief (harmful or beneficial effect)
 Social norm
 Human behavior towards eye problems
 Factors influencing on decision to seek eye care
 QOL after treatment
 Individual behavior to treatment adherence
 Example: Urban people not willing to spend on glasses, rather prefer
spend on smart phone, mobile

24. Theories to change individual behavior
 Health belief model
 Originally developed to explain why individuals participate in
health screening and immunization program
 Models explain the likelihood of an individual taking action
against a given health problem
 It can be applied in eye health
 Why few individuals still not corrected their refractive error or
not undergone cataract surgery

25. Biostatistics
 Software packages for analysis
 Analysis of quantitative data
 Analysis of qualitative data
 Multivariate analysis

26. Managing and Presenting Public Health Data
 When the data is large enough
 Develop data management plan for use in ophthalmic health
 Roles-primary investigator, coordinator, data manager
 Coding system
 Consistency checking
 Double entry technique
 Labels and file organization

27. Summarizing and presenting data
Adage: A picture is worth a thousand words
Keeping in mind the primary purpose is to communicate the information
 Tables
 Graphs
 Charts

28. Project Cycle Management
 Pre-project analysis
 Planning
 Budgeting
 Implementation
 Monitoring and evaluation

29. Take home message

30. Eye Care Services
RecommendationCurrent Status
• Ophthalmology
• Community Ophthalmology
Eye Care Services