Community Ophthalmology focusses on eye health

Community ophthalmology

1. Community Ophthalmology

2. Community Ophthalmology

3. “ aaaahhhh ”

4. Is there a way out?

5. Community Ophthalmology Curative ophthalmology can make a perceptible impact in the society only in conjunction with community ophthalmology. According to WHO criteria, global estimate predict that there are 314 million people with visual impairment [45 million Blind (visual acuity <3/60) and 269 million due to Low Vision (visual acuity <6/18) due to eye diseases and refractive errors].

6. Community Ophthalmology Over the last 20 years, causes of blindness has changed both in proportion and actual numbers; however, cataract has still remained the major cause of blindness globally and more so in Asia. Globally, major causes are 17.6 million cataract [39%], 8 million refractive errors [18%], 4.5 million glaucoma [10%], 3.2 million age-related macular degeneration [7%], 1.9 million corneal scar [4%], 1.8 million diabetic retinopathy [4%], 1.3 million childhood blind [3%], 1.3 million trachoma [3%], 0.3 million onchocerciasis [0.7%] and 4.8 million due to other causes [11%].( 2 )

7. Community Ophthalmology Available Indian estimates suggest that there are more than 12 million bilaterally blind persons in the country with visual acuity [VA] <6/60 in the better eye, of which nearly 7 million are with VA <3/60 in the better eye.

8. Community Ophthalmology Main causes of blindness in the surveyed population indicated cataract [62.6%] refractive errors [19.7%], corneal blindness [0.9%], glaucoma [5.8%], surgical complication [1.2%], posterior capsular opacification [0.9%], posterior segment disorder [4.7%] and other causes [4.19%].

9. What are the major differences in curative & preventive medicine ? Goals Target Diagnosis Therapy Results Treatment & cure Single patient Physical examination. Drugs / Surgery Limited to individuals Prevention of disease Population/community Health survey (Community Diagnosis) Health education improved sanitation, Hygiene, Immunization etc Prevention of disease Improvement of quality of life in community Curative Preventive

10. Public health principles Applied to ophthalmology Activities in community Prevent Blindness Reduce the disability caused by poor vision Main Aims of Community Ophthalmology Summary of Activities

11. Therefore community ophthalmology can be explained as a discipline where “The traditional care applied to an individual patient is diverted to a population with a prominence placed on preventive aspects”

12. Community Ophthalmology Community ophthalmology may be defined as the science and art of promoting well being by preventing ocular disease, decreasing ocular morbidity and promoting ocular health by organized community effort.

13. BLINDNESS Blindness refers to a condition where a person suffers from any of the following conditions, namely: Total absence of sight; or Visual acuity not exceeding 6/60 or 20/200 ( Snellen ) in the better eye even with correction lenses; or Limitation of the field of vision subtending an angle of 20 degree or worse

14. LOW VISION “Low vision are those who suffer visual acuity between 20/200 to 70/200 (Snellen) or 6/18 to 6/60 in the better eye after the best possible correction or a Field of Vision between 20 to 30degrees”.

15. NPCB DEFENITION What is the definition of blindness under NPCB   Blindness is defined under following headings: ·         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

16. Social blindness: Vision 3/60 or diminution of field of vision to 10  Manifest blindness: Vision 1/60 to just perception of light Absolute blindness: No perception of light Curable blindness: That stage of blindness where the 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, and glaucoma  Avoidable blindness: The sum total of preventable or curable blindness is often referred to as avoidable blindness.

17. CAUSES Main causes of blindness are as follows: - 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 

18. GLOBAL INITIATIVES FOR BLINDNESS PREVENTION WHO – prevention of blindness program(1978) VISION 2020 – the right to sight (1999) Vision for the future VFTF (2001)

19. What is VISION 2020: The Right to Sight? VISION 2020: The Right to Sight, is a global initiative to eliminate avoidable blindness. The programme is a partnership between the World Health Organization (WHO), and the International Agency for Prevention of Blindness (IAPB) and nongovernmental organizations (NGOs) involved in eye-care.

20. What is VISION 2020: The Right to Sight

21. What is VISION 2020? Aim The aim of VISION 2020 is to eliminate avoidable blindness by the year 2020.

22. prime mandate of VISION 2020 . 75% of blindness and visual impairment occurs in the poor and very poor communities of the world, and that 75% of blindness and visual impairment is a result of five preventable or treatable conditions (cataract, refractive errors and low vision, trachoma, onchocerciasis , and a specific group of causes of childhood blindness). For each of these conditions a cost-effective intervention exists

23. prime mandate of VISION 2020 If priority is given at the global level to improving eye-care services for neglected communities and to targeting these five diseases , it is calculated that instead of 76 million blind people in 2020, there will be 24 million. This is the prime mandate of VISION 2020 .

24. Programme strategy The concept of VISION 2020 The Right to Sight, is built upon the foundation of community participation three essential components of the VISION 2020 programme are cost-effective disease control interventions human resource development (training and motivation) infrastructure development (facilities, appropriate technology/consumables, funds

25. The VISION 2020 concept

26. FIVE STRATEGIES Under this initiative , five basic strategies to combat blindness are-. Disease prevention and control Training of personnel Strengthening the existing eye care infrastructure Use of appropriate and affordable technology Mobilization of resources

27. 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

28. CATARACT Cataract Cataract is the major cause of blindness in the world. An estimated 16-20 million people are bilaterally blind from cataract The cataract surgical rate is a quantifiable measure of the delivery of cataract services. It is the number of cataract operations per million population per year. Aim Elimination of cataract blindness (person with vision less than 3/60 in both eyes)

29. 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). An estimated 5.9 million adults are blind from corneal scarring due to trachoma.

30. Trachoma 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. This includes the following

31. SAFE STRATEGY Delivery of community-based trichiasis Surgery by trained paramedical staff (S of SAFE). Antibiotic treatment (either tetracycline eye ointment or oral azithromycin ) for children with active disease (A of SAFE). Promotion of Facial cleanliness (F of SAFE) and Environmental improvement (E of SAFE), including personal hygiene and communitysanitation as part of primary health care.

32. Onchocerciasis An estimated 17 million people are infected with onchocerciasis. Approximately 0.3-0.6 million are bli nd. TARGET- to develop national onchocerciasis control program in endemic areas STRATERGY- treatment with annual dose of ivermectin

33. CHILDHOOD BLINDNESS PREVALENCE World wide – 1.4 million asia – 1 million africa – 3 lakhs AIM – eliminate avoidable cause of childhood blindness by 2020

34. CHILDHOOD BLINDNESS ACTIVITES .elimination of preventable blindness by measles immunisation vit a supplementation monitoring oxygen use in premature new born avoiding traditional practice Management of surgically avoidable causes such as cataract ROP

35. REFRACTIVE ERRORS AND LOW VISION AIM – to eliminate visual impairment and blindness due to refractive error and other causes of low vision STRATEGIES 1.Create awareness 2.Screening to identify individuals with low vision 3.Refraction services 4. Low vision services and low vision aids

36. 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 in the world, 7 million are in India . Due to the large population base and increased life expectancy, the number of blind particularly due to age-related disorders like cataract, is expected to increase. India is committed to reduce the burden of avoidable blindness bythe year 2020 by adopting strategies advocated for Vision 2020- The Right to sight.

37. Thank you for your patient listening

38. Bye** bye*** ***one more class in community ophthalmology is there tomorrow. ** good news it would be shorter than today’s.