COMMUNITY OPHTHALMOLOGY.pptx

Community Ophthalmology is a new discipline in Medicine which promotes eye health and blindness prevention through various programs like Vision 2020, National blindness control programme, etc. It covers important causes like Cataract, Childhood blindness, Trachoma, Refractive Errors & low vision, Onchocerciasis. Includes, Eye camps, Eye banking and Rehabilitation of the blind.

1. COMMUNITY OPHTHALMOLOGY PRESENTATION BY, DR. SEEMA M NINGAPPANAVAR BAMS, (MD)PANCHAKARMA

2. CONTENTS DEFINTION & GOALS OF COMMUNITY OPHTHALMOLOGY BLINDNESS-DEFINITIONS,MAGNITUDE & CAUSES DISEASES CAUSING BLINDNESS Cataract Childhood Blindness Trachoma Refractive Errors & Low Vision Onchocerciasis ROLE OF EYE CAMPS EYE BANKING REHABILITATION OF BLIND CONCLUSION

3. DEFINITION OF COMMUNITY OPHTHALMOLOGY The Branch of Science that utilizes appropriate strategies & methods to promote Ocular Health & prevent Blindness at the Community level.

4. Goals Prevention of Ocular diseases & Visual impairment Reduction of Ocular disability Promotion of Ocular Health, Quality of Life & Efficiency of group of people at Community level

5. BLINDNESS A. DEFINITION OF BLINDNESS ACC TO WHO: “ Inability to count fingers in day-light at a distance of 3 metres ” which indicates vision less than 3/60 or its equivalent . B. OTHER DEFINITIONS OF BLINDNESS: Economic blindness : Vision in better eye <6/60 to 3/60 Social blindness : Vision in better eye <3/60 to 1/60 Legal blindness : Vision in better eye <1/60 to perception of light Total blindness : No light perception (PL – ve )

6. 5)Avoidable Blindness Preventable blindness is that which can be easily prevented by attacking the causative factor at an appropriate time. For ex, Corneal blindness due to Vit A deficiency can be prevented by timely measures. Curable blindness is that in which vision can be restored by timely intervention. For ex, Cataract blindness can be cured by surgical treatment.

7. Categories Of Visual Impairment In the ninth revision (1977) of International Classification of Diseases (ICD), the visual impairment has been divided into 5 categories

8. Magnitude of blindness in India While the problem of Blindness is global, its magnitude is much higher in India. Of the estimated 45 million, India alone has 8.9 million blind people,(2001-2002 survey, NPCB), which comes to about 1/5 th of the total in the world Factors for higher prevalence of Blindness in India are: Gross inadequacy of Ophthalmic personnel Lack of availability of services near by area Under-utilization of available manpower Rural/urban imbalance in availability of services Lack of knowledge & concern, malnutrition, lack of eye care, superstitions & ignorance Prevalence of infections Man-made blindness due to quack practice & home remedies

9. CAUSES OF BLINDNESS Cataract 19 M Glaucoma 6.4m Trachoma 5.6m Childhood Blindness Including >1.5m Xerophthalmia Onchocerciasis 0.29m Others 10m

10. GLOBAL INITIATIVES FOR PREVENTION OF BLINDNESS National Blindness Control Programme Vision 2020-’the right to sight’ Vision for the future

11. CATARACT Cataract remains the single largest cause of Blindness Aim - under ‘Vision 2020’ is to eliminate avoidable blindness due to Cataract i.e., to decrease the number of Cataract blinds in the world from 19 million to zero by the year 2020 Strategy -to increase the Cataract Surgery Rate(CSR ) Emphasis; High success rates in terms of restored vision & quality of life outcome Affordable & accessible services Measures to overcome barriers & increased use of services

12. CHILDHOOD BLINDNESS Causes - main causes include : Vit A deficiency, Measles, Conjunctivitis, Ophthalmia neonatorum , Congenital Cataract & Retinopathy of Prematurity(ROP) Aim - is to eliminate avoidable causes of childhood blindness by the year 2020 Strategies -under Vision 2020; Elimination of preventable blindness by- Measles Immunisation, monitoring oxygen in the premature new born , promoting school screening programmes for refractive errors , etc. Management of surgically avoidable causes of childhood blindness such as cataract, glaucoma, ROP

13. TRACHOMA BLINDNESS Trachoma is a leading cause of preventable blindness worldwide with an estimated 5.9 million persons blind are at immediate risk because of Trichiasis The disease accounts for nearly one –sixth of the Global burden of Blindness SAFE Strategy ; S urgery to correct lid deformity & prevent blindness A ntibiotics for acute infection & community control F acial hygiene E nvironmental change including improved access to water & sanitation & health education Elimination of Blindness due to trachoma is considered feasible but not the eradiation of Trachoma because of lack of preventive measures So to overcome this W.H.O has organised an Alliance for Global Elimination of Trachoma by the year 2020(GET2020)

14. REFRACTIVE ERRORS AND LOW VISION Aim –to eliminate visual impairment(visual acuity less than 6/18) & blindness due to refractive errors Strategies recommended under ‘Vision 2020’ initiative include – Screening to identify individuals with poor vision which can be improved by spectacles or other optical devices Refraction services to be made available to individuals identified with significant refractive errors Ensure optical services to provide affordable spectacles for individuals with significant errors Low vision services & low vision aids to be provided for all those in need

15. ONCHOCERCIASIS Onchocerciasis (River Blindness) is known to be endemic in 37 countries An estimated 17 million people are infected with onchocerciasis 95% of infected persons reside in Africa Aim - is to eliminate blindness due to onchocerciasis by the year 2020 Target - to develop ‘National Onchocerciasis Control Programme’ with satisfactory coverage in all the 37 countries where disease is endemic Strategy - to introduce community directed treatment with annual doses of Mectizan ( ivermectin )

16. ROLE OF EYE CAMPS IN PREVENTION OF BLINDNESS Objectives - Eye camp approach for prevention of blindness still plays a vital role in the developing countries where infrastructure is not fully established 62.6% of blindness in India is due to cataract which can be very well cured in eye camp Organisation of an eye camp - Presently 2 types of eye camp are held Comprehensive eye care camps with ‘Reach-out approach’ Screening eye camps (Reach-in approach with comprehensive eye care) Documentation, M onitoring & Evaluation - A complete and meticulous record of the patients treated in the eye camp along with the post operative complications noted & managed should be kept

17. EYE BANKING Definition - Eye bank is an organisation which deals with the collection, storage & distribution of cornea for the purpose of corneal grafting, research & supply of the eye tissue for other Ophthalmic purposes Eye collection centres- these are the peripheral satellites of an eye bank for better functioning Functions of eye collection centres- Local publicity for eye donation Registration of voluntary donors Arrangement for collection of eyes after death Initial processing, packing & transportation of collected eyes to the attached eye bank

18. LEGAL ASPECT The collection & use of donated eyes come under the purview of ‘The Transplantation of Human Organs Act,1994’ Facts about eye donation: Almost anyone at any age can pledge to donate eyes after death; all that is needed is a clear healthy cornea The eyes have to be removed within six hours of death Eye donation gives sight to two blind persons as one eye is transplanted to one blind person The eyes can be pledged to an eye bank & can be actually donated to any nearest eye bank at the time of death The donated eyes are never bought or sold Eye donation is never refused The eyes cannot be removed from a living human being inspite of his/her consent & wish

19. REHABILITATION OF BLIND Medical rehabilitation - by low vision aids(LVA) Training & psychosocial rehabilitation ; Mobility training with help of stick Training in daily living skills like washing, clothing , etc,. Educational rehabilitation -education in blind schools with the facility of Braille system of education Vocational rehabilitation -training in making handicrafts, book binding , candle & chalk making , etc,.

20. CONCLUSION It should never be forgotten that , one of the human right is right to see, the strategies must ensure that ; No citizens goes blind needlessly due to preventable causes All avenues are exhausted to restore the best possible vision to curable blinds Blinds not amenable to curable measures receive comprehensive rehabilitation

21. Thank You