The document discusses the National Programme for Control of Blindness Vision 2020 in India. It aims to reduce blindness prevalence to 0.3% by 2020 by performing over 21 million cataract surgeries. The programme is implemented through a three-tier structure at the central, state, and district levels. It focuses on reducing backlogs and increasing access to eye care in rural areas through activities like rural eye camps, infrastructure development, and human resource training. The document also provides strategies and protocols for conducting effective rural eye camps and cataract surgeries to reduce blindness in remote populations.

1. NATIONAL PROGRAMME FOR
CONTROL OF BLINDNESS VISION
2020 & RURAL EYE CAMPS

2. INTRODUCTION
• NPCB  launched in the year 1976 ,Centrally Sponsored
scheme .
• Goal to reduce the prevalence of blindness to 0.3% by
2020.
• To achieve this target min. of 21 million cataract
operations are to be performed.
• Survey on Avoidable Blindness conducted under NPCB
during 2006-07 showed reduction in the prevalence rate
of blindness from 1.1% (2001-02) to 1% (2006-07).
• 230 crore approved by empowered programme
committee (EPC) for 2013-14 for NPCB.

3. THE ORGANISATION
CENTRAL
• Ophthalmology Section,
DGHS,MOHFW
• Procurement of goods
• Grant –in Aid to NGOs
• Organizing central level
trainning courses
• Monitoring &
evaluation
• Procurement of
consultancy &services
STATE
• State opthalmic cell, DHS, State
health societies
• Coordinate and monitor with all
the District Health Society
• Procure equipment and drugs
which required in GOI facilities
• Receive and monitor use of funds,
equipments and material from the
Government
• Promote eye donation & monitor
the districts for collection and
utilization of eyes collected by
eye donation centres and eye
banks.
DISTRICT
• District blindness control
society
• Organize screening camps for
identifying those requiring
cataract surgery and other
blinding disorders
• Organize screening of school
children.
• Procure drugs and
consumables
• Promote eye donation
• Regular screening for cataract
and other diseases in the out

4. Service Delivery & Referral Systems
Tertiary level
(Regional Institute of
Ophthalmology/ Centres of
Excellence in Eye care &
Medical colleges
Secondary Level
(District Hospital &
NGO Eye hospital)
Primary Level
(Sub district level
hospitals/CHC/Mobile
Ophthalmic units, PHC
/Panchayats)

6. Definition of Blind under NPCB
• Inability of a person to count fingers from a
distance of 6 meters or 20 feet Technical
Definition
• Vision 6/60 or less with the best possible
spectacle correction
• Diminution of field vision to 20° or less in
better eye

7. Main causes of Blindness in India are
62%
20%
1% 6%
1% 1%
5%
4%
Cataract
Refractive Error
Corneal Blindness
Glaucoma
Surgical Complication
Posterior Capsular Opacification
Posterior Segment Disorder
Others

8. Objectives of the Programme are
• To reduce the backlog of blindness through identification and treatment of blind.
• To develop Eye Care facilities for every 5 lac population
• To develop human resources for providing Eye Care Services.
• To improve quality of service delivery by establishing Regional institute of
• ophthal , up gradation of medical colleges & district hospital.
• To secure participation of Voluntary Organizations in eye care.
• To enhance community awareness on eye care

9. INFRASTRUCTURE
DEVELOPMENT UNDER
NPCB
At RP centre and 10 other
Regional Institutes of
Ophthal, a National institute
of Ophthal has been
established for manpower
develop, research and
referral services.
Medical colleges are
upgraded under NPCB &
at certain med institutes
& paramedical
ophthalmic assistants
are trained.
Eye banks have been
developed in govt and
non-govt sectors.
>500 Dist hospitals have
been equipped with
ophthalmic equipments
and requisite manpower
is posted.
DBCS was started as pilot
project in 5 districts and
now over a 500 centres
under the chairmanship
of DC/Dep Com have
been set up.
Prevalance of
Blindness being
acute in rural areas,
NPCB has tried to
expand the
accessibility to these
areas by the means
of PHC, mobile eye
units

10. Inclusion of NPCB in Prime Minister 20 point
programme in 1982.
World Bank:1994-95 to 2002
Expanding coverage in rural and tribal areas
Training of ophthalmic manpower.
Improvement of management system
Providing IOL implants
DANIDA:
Man power development
Establishment & development of monitoring and
evaluation system at state level
Training
Preparation of health education material, teaching
& information aids.
WHO:
40 intra country fellowship in Institutes of
excellence
Survey on childhood blindness in East Delhi to
estimate prevalence & causes of blindness in
children <15 yr.
Study on refractive errors in school drop outs.
Establishing National Surveillance Unit.
Launch work shop on vision 2020.
BOOST UP FOR
NPCB

11. Performance of Cataract Surgery: 1985-
2003

12. Revised Strategy of
NPCB

13. Construction of dedicated Eye Wards and Eye Operation theaters in Districts
Appointment of Ophthalmic Surgeons and Ophthalmic Assistants in new districts
Appointment of Ophthalmic Assistants in PHCs/ Vision Centers where there are none (at present
ophthalmic assistants are available in block level PHCs only)
Appointment of Eye Donation Counselors
Grant-in-aid for NGOs for management of other Eye diseases other than Cataract like DR, Glaucoma
Management, Laser Techniques, Corneal Transplantation, VR Surgery
Treatment of childhood blindness etc of Rs. 750 per case for Cataract/IOL Implantation Surgery and
Rs.1000 per case of other major Eye Diseases .For North-Eastern States, Hilly and Desert Areas Rs.
850 for Cataract and Rs.1100 for other major Eye Care Management is proposed.
Special attention to clear Cataract Backlog and take care of other Eye Health Care Centers from NE
States.
Telemedicine in Ophthalmology {Eye Care Management Information and Communication Network}
Involvement of Private Practitioners.

15. A COMBINED EFFORT OF WORLD
HEALTH ORGANIZATION & NGOS
Launched in Geneva on Feb 18, 1999, to combat problem of avoidable
blindness in the world.

16. Helen Keller Worldwide
FOUNDING MEMBERS OF VISION 2020
 WHO
 IAPB
 ChristoffelBlind mission.
 Helen Keller Worldwide.
 SightSavers International.
 ORBIS International

17.  Al Noor Foundation.
 American Academy of Ophthalmology.
 Asian Foundation for the Prevention of Blindness.
 The Canadian National Institute for the Blind.
 The Carter Centre.
 Foundation Dark and Light Blind Care.
 The Fred Hollows Foundation.
 IMPACT – EMRO
 International Centre for Eye Care Education.
 IFOS
 International Trachoma.
 Internazionale per la prevensione della Cecita.
 Lighthouse International.
 Lions Club International Foundation.
 Operation Eye sight Universal.
 Royal National Institute for the Blind.
 SEVA Foundation.
 Vision 2020 Australia.
 Vision 2020 UK.
 World Council of Optometry.
SUPPORTING MEMBERS

18. • Present estimation:
– 45 million people blind
+
– 135 million visually disabled
Present situation Worldwide
Low
Vision
Blind
< 6/18 - 3/60
Or less than 20 deg
Visual field
< 3/60
Best corrected VA
International classification ignores the burden of uncorrected refractive error
WHO defination

19. Global Distribution of Blindness by Cause
Cataract
42 %
Trachoma
15 %
Glaucoma
14%
Oncho.
1 %
Other
28 %
Macular degeneration
Diabetic retinopathy
+
Refractive errors
(uncorrected)

20.  Without intervention the number of people with blindness
might reach 76 million by 2020.
 Global ageing of populations makes world blindness increase
by about 2 million annually.

21. AIM OF THIS INITIATIVE
• To INTENSIFY AND ACCELERATE present prevention of blindness
activities so as to achieve the goal of eliminating avoidable blindness by the
year 2020.
• Globally 5 conditions have been identified:
 Cataract
 Trachoma
 Onchocerciasis
 Childhood blindness
 Refractive errors and Low Vision.
Chosen on basis of contribution to burden of blindness and
feasibility&affordability of interventions to control them.
Over the period 1995-2002, glaucoma and DR have been included

22. Group 2 :
FOCAL IN
DISTRIBUTION (
POORCOMMUNITIES
) – vit a def,
trachoma, onchocer.
Group 3 :
INCREASING IN MAGNITUDE,
DIAGNOSTIC AND MGT STRATEGIES
ARE NOT WELL DEFINED AND NOT
COST EFFECTIVE – Glaucoma , DR
Group 1:
UNIVERSAL
CONDITIONS
WHICH CAN BE
SUCCESSFULLY
TREATED and hence
cost-effective-
cataract and R
errors.

23. Cataract Trachoma Onchocerciasis Childhood
blindness
Refractive
Errors and Low
vision
50% global incidence 146 million people
worldwide
17 million people
affected
1.5 million
children are blind
Backlog 20 million
unoperated cases
cataract surgery
performance rate- 10
million annually
Targets projected :
4000/million
population/year = 32
million cataract sxy by
year 2020
10.6 million adults
have sequele(
trichiasis,entropion).
More in Africa,
China, Middle-east.
SAFE strategy
adopted
Targets : eliminating
trichiasis/entropion
and reducing
prevalance of
trachoma to 5%.
0.3-0.6 million
are blind.
African and
Latin- American
countries
Target :
establish National
programmes after
effective
surveillance such
as by 2020 no
new cases are
reported.
1.3 million in
Asia & Africa.
Targets :
To eliminate vit a
def diseases and
achieve nil
incidence in all
countries.
Services
developed for
treatable dis :
cataract,
glaucoma, ROP
Refraction
and evaluation
for pt`s
requirement of
corrective
devices.
Manufacture
of proper
devices

24. Vision 2020 in India:
Launched in 2001.
Inculcated in 2002 with NPCB for future planning for control of
blindness.
Target diseases :
 Cataract,
 Childhood blindness,
 Ref Errors & Low Vision,
 Corneal blindness,
 DR, glaucoma,
 Trachoma (focal basis).

25. Strategies for corneal blindness
• Major obstacle in tackling corneal
blindness is the wide gap b/`w the
requirement and availability of
donor corneas for which
recommendations include:-
o Strengthening of hospital corneal
retrieval systems.
o Assessment of persons needing
corneal grafting.
o For vit a def related diseases:
focus on eco backward classes is
needed
Strategies for glaucoma and DR
• Immediate term :
training ophthalmologists to handle
these conditions. Comprehensive eye
evaluation via better clinical practice
in slit lamp biomicroscopy, AT, disc
and retinal evaluation and gonioscopy.
• Intermediate term:
o Residency training prog in med
colleges.
o Training of MLOP in handling these
conditions in peripheries.
o Training non ophthalmic physicians on
clinical profile of these conditions.
o Public education
• Long term:
o To provide high quality eye care at all
levels

26. Global trends :
• Over 1995 – 2002, constant factors – ageing, population growth
and underdevelopment.
• Chronic diseases as glaucoma and DR have shown an increase
incidence due to change in life expectancy and life-styles.
• Strategy is to bring about awareness of these conditions and
also about the compliance and adherence to Rx schedules.
• Need an effective Public health approach
• This can happen with HRD & Infrastructure appropriate
technology.

27. COST EFFECTIVENESS
OF VISION 2020
• Frick and Foster calculated $
102 billion of economic gain
if VISION 2020 is
successful.
Benefits of vision 2020:
 Blindness alleviation to 50
million.
 Enhanced ophthalmic training.
 Paramedical training.
 Creation and upgradation of
facilities.
 Access to modern technology.

28. Rural eye camps
 Camps – effective modality for medical service delivery on
a mass scale and it is cost effective.
 In ophthalmology – effective strategy to combat illness at
grassroots level.
 Over the years, Ophthalmic camps have become cataract
centered.
 Other eye camps –
 One day screening camps:
 Glaucoma, DR,School screening or refraction camps

29. Rural eye camps

30. In last few years, surgical camps are being phased out by the govt.
because –
Certain surgical camps as 1986 Khurja and Muradabad camps have
shown disastrous results. These have led to a decrease in credibility
of the surgical eye camps.

31. Protocol of a surgical camp
OT installation protocol and
procedure
1. Planning : informing
organizer about camp
methodology and
requirements like
generators, adequate OT
facility and location.
2. Camp site feasibility study
3. Surgical team : surgeons,
optometrists, OT
technicians, camp
coordinator.
1. Advisable to get a
running OT in a govt.
setup or private hospital
freshly whitewashed or
painted.
2.Cleaning with detergent
and disinfectants.
3. All openings and cracks
are sealed.
4. AC and other electrical
appliances installed.
5. Furniture and
microscopes cleaned and
installed.
6.Fumigation for 36-48 hrs
& after every day of
surgery.

32. PREOP
TREATMENT
POST OPERATIVE
CARE
CONCLUSION
1. Broad
spectrum
topical a/b.
2. Topical
povidone
iodine.
3. Local hygeine.
4. Continuation
of systemic
med.
5. Pt`s personal
hygeine and
cleanliness
1. Daily exam in
the postop
period.
2. Topical and
sysytemic med
3. Complications
recognized and
managed at
the earliest
4. At discharge:
VA ( PH).
First follow up
date notified
5. Follow ups at 6th
and 8th wks.
• Surgical camps
though being
phased out are
an effective way
to reach distant
rural and tribal
population and
also an effective
means to control
cataract
blindness –
backlog + new
cases.