This document discusses control of blindness globally and in India. It defines blindness and provides classifications of visual impairment. Around 180 million people worldwide are visually disabled, with 80% of cases being avoidable. In India, the major causes of blindness are cataract, refractive error, and glaucoma. Prevention strategies include primary, secondary, and tertiary eye care as well as specific programs and long-term measures. The National Programme for Control of Blindness was established in 1976 with the goal of reducing blindness prevalence. It focuses on developing eye care infrastructure, human resources, and participation of voluntary organizations. The program's objectives are to reduce the backlog of blindness cases and improve service quality.

1. CONTROL OF
BLINDNESS

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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
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4. ICD classification of visual impairement
cata Visual acuity
gory
Max less than Mini equal to or
better than
0 6/18
Low vision 1 6/18 6/60
2 6/60 3/60
blindness 3 3/60 1/60
4 1/60 Light perception
5 No light
perception
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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
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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
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7. Causes of blindness
cataract 62.6%
Refractive error 19.7%
glaucoma 5.8%
Posterior segment pathology 4.7%
Corneal opacity 0.9%
Other causes 6.2%
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8. Epidemiological determinants
 AGE
 SEX
 MALNUTRITION
 OCCUPATION
 SOCIAL CLASS
 SOCIAL FACTORS
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9. CHANGING CONCEPTS IN EYE
HEALTHCARE
Acute intervention comprehensive eye healthcare
1. Primary eye care
2. Epidemiological approach
3. Team concept
4. Establishment of national programmes
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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 resources
Epidemiological approach
 Measurement of incidence, prevalence of disease and
their risk factors
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11. Team concept
 One eye specialist + auxiliary health personnel
Establishment of national programs
 Started by voluntary agencies
 Focused on single disease eye camps eg: national
trachoma control
 National blindness control program
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12. PREVENTION OF BLINDNESS
 Concept of avoidable blindness
 Components of action
1. INITIAL ASSESSMENT
2. 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
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13.  Secondary care
• Definitive management of common
blinding condn
• PHCs &district hospital& mobile eye
clinics
• Cataract surgery; gen health surveys
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14. Tertiary care
Established @ national & regional capital
Asso with Med clg& Institute of med
Retinal detachment sur; corneal grafting etc
Eye bank
Rehabilitation of blind
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15.  Specific programmes
1. Trachoma control prog
2. School eye health services
3. Vitamin A prophylaxis
4. Occupational eye health services
3.LONG TERM MEASURES
 Control of infn
 Improving the quality of life&
modifying the risk factors
 Health education
4. EVALUATION
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17. NATIONAL PROGRAMME FOR
THE CONTROL OF BLINDNESS
 1976
 Goal reduce prevalence of blindness
from1 to .3
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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
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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
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20. DEVELOPMENT OF
INFRASTRUCTURE 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
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21. ORGANIZATIONAL STRUCTURE
for NPCB
ADMINISTRATION
Central: 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
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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
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23. NEW INITIATIVES PROPOSED
UNDER 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
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24.  Community health education is a built in component at
all levels of NPCB implementation
 School eye screening programme
 Collection & utilization of donated eyes
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25. Externally aided projects
 World bank assisted cataract blindness
control project
 Danish assistance to NPCB
 WHO assistance for prevention of
blindness
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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
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27. structure Centres of
excellence
20
ry
rtia
Te
Training
centres 200
ary
Service centres
nd
2000
co
Se
ary
Vision centres 20000
im
Pr
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