13. npcb,eye camps,eye banking, eye prosthesis

npcb,eye camps,eye banking, eye prosthesis

1. MEDICAL SURGICAL NURSING- II UNIT – II NURSING MANAGEMENT OF PATIENTS WITH DISORDERS OF EYE TOPIC : NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS, EYE CAMPS , EYE BANKING AND EYE PROSTHESIS PRESENTED BY Mrs. SOUMYA SUBRAMANI, M.Sc.(N) LECTURER, MSN DEPARTMENT CON- SRIPMS, COIMBATORE.

2. NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS 2

3. 10 I N T R ODUCTION India was the first country in the world to launch National Level Blindness Control Programme . NPCB was launched in 1976 as a 100% centrally sponsored programme . In 1994-95 programme decentralized with formation of District Blindness Control Society in each district. Goal - to reduce the prevalence of blindness from 1.4 to 0.3% by 2020.

4. 4 Obje c ti v es o f NPCB To continue 3 ongoing signature activities i.e., performance of 66 lacs cataracts operations per year; school eye screening & distribution of 9 lacs free spectacles per year for refractive errors; and collection of 50 thousand donated eyes per year for keratoplasty . To reduce the backlog of avoidable blindness through identification and treatment at primary, secondary and tertiary levels.

5. 5 Co n t d ……. To develop comprehensive universal eye care services and quality service delivery. Strengthening and upgradation of Regional Institutes of Ophthalmology to Centre of Excellance in various sub- specialities . Strengthening of existing infrastructure facilities and to develop additional human resources for providing eye care in all districts.

6. 6 Co n t d …….. To enhance community awareness on eye care . To increase and expand research for prevention of blindness and visual impairment. To secure participation of voluntary organizations/private practitioners in delivering eye care.

7. S TR A T E G Y O F P R OGRAMME: St r en g then i n g se r vice de l i v e r y D e v el op i n g h u man r esou r ce f o r e y e c a r e P r omot i n g ou t- r each activi t ies & pub lic a w a r eness D e v el op i n g i n s t i tuti o n a l c apaci t y T o e st abl i s h e y e c a r e f acil i t i es f o r e v e r y 5 l ac pe r sons.

8. REVISED S TR A T E GI E S: Mo r e c o m p r ehens i v e b y s t r en g theni n g se r vices f o r other c auses o f b li ndness T o sh i ft f r om e y e c amp app r oach t o f i x ed f acili t y su r gi c al app r oac h and f r o m c o n v e n ti onal su r g e r y t o I OL imp l a n t a ti on. T o e xpan d W or ld ban k p r ojec t li k e bu il d i n g e y e c a r e i n f r a s tru c tu r e all o v er c ou n t r y T o s t r en g then the par t ici p a ti o n o f V o l u n t a r y o r g ani z a ti on in p r og r am m e and t o ea r mark g eog r aph i c al a r eas t o NGOs. T o enhance c o v e r a g e o f e y e c a r e se r vices in t r i ba l and othe r unde r se r v ed a r eas

9. O R GA N I Z A TIO N AL S TRUCTUR E F O R N PCB

10. 10 Activities under NPCB P r og r amme C a t a r act o pe r a ti ons I n v o l v eme n t o f N GOs I E C activities Mana g eme n t I n f orm a ti o n S y st em S c ho o l E y e S c r een in g P r og r amme Co llect io n and ut i l i z a ti o n o f d o n a t ed E y es Co n t r o l o f V i t amin A d e f i ciency Mon i t or i n g and E v al u a ti o n b y su r v e y

11. SCHOO L EY E SC R E E NING P R OGRAMME 6 -7 % c h i l d r en a g e t o 10-14 y ea r s – E y e s i g h t p r ob lem Ch i l d r en – sc r eened b y sc h oo l t eache r s. Suspec t ed r e f r acti v e er r o r a r e see n b y op h tha l m i c as s i s t a n ts & spec t acles a r e p r escr i be d f r ee o f c o s t.

12. C OLL E C T ION & UTILI Z A TIO N O F DON A TE D EYE 40, 00 don a t ed e y es e v e r y y ear Hosp i t al r e tr ie v al p r og r amm e - major s t r a t egy f o r c o llec t i o n o f e y es. E y e don a t i o n f ortni g h t- 25 th Aug t o 8 th Sept

13. Collecti on and Util i z ati o n of E ye dona t ion Corneal blindness accounts for 1 % of all cases of blindness. It mainly occurs among children and young adults. Common causes include vitamin A deficiency, eye infections and injuries. Donated eyes need to be removed within 6 hours of death of the individual. It is to be preserved in specific solutions in eye banks and utilized for transplantation within 72 hours. Eye donation fortnight is organized from 25th August to 8th September every year to promote eye donation/eye banking. During 2011-12 target for eye donation was surpassed as against a target of 50,000 eyes; 53,543 eyes were do n at ed. 22

14. V i s i o n 2020: Th e R ig h t t o S ig h t G l oba l i n i t i a t i v e t o r educe a v o i dab le (P r e v e n t able and cu r able) b l i nd n ess b y t he y ear 20 2 0. Main f e a tu r es: T a r g e t D i seases Huma n r esou r ce d e v el o p me n t and i n f r a s tructu r e and t echno log y d e v el o p me n t.

15. P R OPOSE D S TRU C TUR E F O R V I SIO N 2020: TH E R I GHT T O SIGHT

16. 16 Development of infrastructure : Construction of eye wards, operation theatres and dark rooms was taken up during ninth plan, mainly in the states covered under the World Bank Assisted Cataract Blindness Control Project to enhance capacity for eye care in the public sector.

17. N e w in i ti a ti v e s of the p r og r am in 1 2 th Five Year Plan 17 Distribution of free spectacles for near work to old persons suffering from Presbyopia. Telemedicine in ophthalmology department Provision of multipurpose District Mobile Ophthalmic Units in all districts all over the country.

18. R E A C H – OUT A P P R O A CH R E A C H – IN A P P R O A CH EY E C AMPS C OMPREHENSIVE EY E CAR E C AMPS SCR E ENIN G EYE CAMPS

19. C O M P R E H E N S I V E E Y E C A R E C A M P S : PRE P AR A T O R Y PHASE INTENSIVE P H ASE C O N SOLI D A T I O N PHASE CULMI N A T I O N AND RE T R I E V AL P HASE F OL L O W - UP P H ASE SCREENIN G EY E CAM PS: r eac h -in ap p r oach base- hos p i t al app r oa c h

20. EYE BANKING

21. Why do we need an Eye Bank ?

22. EYE B ANK: It is a non-profit community organization which deals with collection, storage and distribution of cornea for the purpose of corneal grafting, research and supply of other eye tissues for other purposes.

23. 1 9 6 : E dm u n d z i r m - 1 s t suc c es s fu l c ornea l t r ans p la n t a t i on 19 3 7: V P F il a t o w - f a ther o f m oder n e y e bank i ng 1949 - 1 s t e y e ban k in Ind i a (D r . Mut h ai h )- Chen n ai 1 9 6 1 : E y e ban k as s oc i a t i o n o f A m eri c a. 1974 - Mc k a r e y and K au f fma n (MK ) medi um. History

24. Structure of Eye Bank Medical section : Medical Director ( A qualified Corneal Surgeon), Trained technicians Administrative Section : Eye Donation Counsellor / Social Worker / Health Educator / Clerk

25. Functions of the Administrative Section The administrative section is responsible for - Public awareness programmes - Liaison with government, local voluntary and other health care agencies - Fund raising

26. Functions of the Medical Section Medical section deals with the entire technical operation of the eye bank: -Tissue harvesting, evaluation, preservation and distribution. (maintaining medical quality of highest standard).

27. Functions of the Eye Bank Networking of eye banks under the umbrella of a national organisation ( e.g. Eye Bank Association of India) allows -Public education programmes - Institution of newer eye banking procedures - T raining programmes and development of uniform medical standards

28. Eye Banking System

29. Eye Banking System Eye Donation Center ( EDC) ( 1) public and professional awareness about eye donation (2) co-ordinate with donor families and hospitals to motivate eye donation (3) to harvest corneal tissue and collect blood for serology (4) to ensure safe transportation of tissue to the parent eye bank.

30. Eye Bank (EB ) Provide a round-the-clock public response system over the telephone and conduct public awareness programs on eye donation. Co-ordinate with donor families and hospitals to motivate eye donation/Hospital Cornea Retrieval Programs – (HCRP) To harvest corneal tissue To process, preserve and evaluate the collected tissue To distribute tissue in an equitable manner for Keratoplasty To ensure safe transportation of tissue Eye Bank Training Centre (EBTC) All of the eye bank functions plus training for all levels of personnel in eye banking and research.

31. How It Works ?

32. EYE B ANK PE R SONNEL: E y e b ank i n cha r g e Ey e ban k t echn i cian Cl er k - cum s t o r e k eeper M S W o r P R O D r i v er cum p r oject ion i s t

33. F A C T S ABOUT EYE DON A TION W i th i n 6hou r s o f de a th Ca r e o f e y es t o b e t a k en af t er de a th It t a k es 15 - 20mi n t o c o ll e ct E y e d on a ti o n o f a pe r so n- gi v es s ig h t t o 2 bl i n d pe r sons E a c h c orne a - c an b e uti l i z ed i n 5 c ases. N e v er boug h t/ so ld N e v er r e fused Ca n t b e r em o v ed f r o m l iv in g pe r so n i n sp i t e o f their c onse n t

34. Tissue Retrieval Contraindications: Systemic: AIDS Rabies Active viral hepatitis Creutzfeldt-Jakob disease SSPE Reye’s syndrome Death from unknown causes Congenital Rubella Active septicemia Leukemia (blast form) Lymphoma/ lymphosarcoma Ocular: Intrinsic eye diseases Retinoblastoma Active conjuctivitis,iritis,uveitis,vitritis,retinitis Congenital abnormalities ( keratoconus ) Central opacities,pterygium Prior refractive procedures (radial keratotomy)

35. P r o c ed u r e o f e y e d on a ti o n : Tissue retrieval-- Enucleation / insitu corneo -scleral excision Donor blood sample-- HIV ,HBV,HCV,HTLV-I &II, Syphilis. corneal evaluation---EXCELLENT , VERY GOOD, GOOD, FAIR,POOR Storage--- Short term Intermediate Long term Very long term

36. Storage of donor tissue

37. Preservation of cornea Long term Organ Culture storage system MEM media(minimum essential media) Developed by Harry Eagle. 34 degree C Incubated at room temperature in nutrient medium Storage period : 30 days Advantage : Enables HLA matching Very long time preservation: Cryopreservation 1year

38. F amous pe r sona l ities in Ind i a wh o o p t e d f or e y e don a tion

39. MARCH IS NATIONAL EYE DONOR MONTH EYE DONAION FORTNIGHT- 25 th AUGUST TO 8 th SEPTEMBER WORLD SIGHT DAY- 13 th OCTOBER(2 nd thursday)

40. LEGAL ASPECTS IN INDIA Under the Transplantation of Human Organs Act, 1994 (THOA) The qualification of doctors permitted to perform enucleation (surgical eye removal) has been reduced from MS ( Ophth .) to MBBS. Eye donation in India is always decided by the donor’s surviving relatives and not by the actual donor. Enucleating doctors always have to legally obtain a written consent from the relatives of the deceased before they actually remove the eyes.

41. EYE Prosthesis

42. Int r oducti o n This ocular prosthesis is nothing but a artificial eye which is used to increase the aesthetic appearance of an individual who lost their eye due to some accidents Note: It clearly mentions that, this artificial eye does not regain the vision

43. What is o cular p r osthe s is? An ocular prosthesis or artificial eye is a type of craniofacial prosthesis that replaces an absent natural eye following an enucleation , evisceration, or orbital exenteration . The prosthesis fits over an orbital implant and under the eyelids.

44. Ocula r p r o s thesis

45. Th r ee T ypes of Eye Removal EVISCER A TIO N - EN U C L E A TI O N - EX E N T ER A TION

46. Eye implants Ba s i c a ll y , T h ere ar e two types o f i m p l a n ts: Non- integrated i m p l a n t Integrated i m p l a n t

47. R a w M a t erials f or manu f ac t uring p r o s thesis P l a s tic W ax p l a s t er o f P ar is Al gina t e P a i n ts an d othe r de c or ati n g ma t er i a ls

48. Possible Condition s Leading to an Artificia l Eye E N U C LE A TION BLIND, P AINF U L E Y E OC U LAR MELANOMA TRAUMA RUPT U RED GLO B E PEN E TR A TING E Y E INJU R Y PEFO R A TING E Y E INJU R Y C A T A R A C T INFE C TION VITRE O U S HEM OR R HAGE EN D OPHT H ALMITIS

49. Ad v a n t a g es : Inherent biocompactibility and proclivity to become fibrovascularity integrated with resiudual muscle and tissue. It also minimize the fear of the bacterial infection

50. D i sad v a n t a g es Extended operative time required to locate and attach the extraocular muscle to the motility sphere. Cost effective.

51. Conclusi o n The art of replacing missing eye with a prosthesis has been carried out many years and these can be stock or custom made. The use of an ocular prosthesis of appropriate size, contour can prove aesthetical value. It promotes physical and psychological healing for the patient and improve social acceptance.

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