National programme for control of blindness

Blindness and national programme

1. NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS SANTOSH KR SOREN JRA I DEPT OF PSM RIMS, RANCHI 1 Venue-Seminar Hall Time-30 min.(22/08/2017)

2. OUTLINE Definition of Blindness Types of Blindness Burden Introduction of NPCB Objectives Strategies Organizational Structure Activities of NPCB New Initiatives Vision 2020 Universal Eye Health 2

3. Definition of Blindness under NPCB Inability of a person to count fingers from a distance of 6 meters or 20 feet. Vision 6/60 ( Snellens ) or less with the best possible spectacle correction. WHO definition…..Vision 3/60 or less. Main causes of Blindness are Cataract(62%), Refractive error(20%), Glaucoma(6%),Posterior Segment Disorder(5%), Post Capsular Opacification (1%), Corneal Blindness(1%), Surgical Complications(1%) and Others(4%). 3

4. Snellen’s chart 4

5. TYPES OF BLINDNESS Economic blindness Social blindness Manifest blindness Absolute blindness Curable blindness Preventable blindness Avoidable blindness Visual Acuity:- – Sharpness of vision, measured as maximum distance a person can see a certain object, divided by the maximum distance at which a person with normal sight can see the same object. 5

6. Comparison of WHO and NPCB definitions 6 WHO-ICD VISUAL ACUITY NPCB LOW VISION Category (1) <6/18 - 6/60 Low vision Category (2) <6/60 - 3/60 Economic/Legal blindness BLINDNESS Category (3) <3/60 – 1/60 Social blindness Category (4) <1/60-perception of light Manifest blindness Category (5) No perception of light Absolute blindness

7. GLOBAL BURDEN OF BLINDNESS As per WHO Statistics:- 285 million people visually impaired worldwide 39 million are blind & 246 million have low vision 82 % of people living with blindness are aged 50 & above. Globally uncorrected refractive errors are the main cause of visual impairment. Cataract remain the leading cause of blindness in middle & low income countries. 7

8. 80 % of all visual impairment can be prevented or cured. Prevalence is highest in Africa (1.2%) followed by Asia (0.75%) and Latin America (0.5%). 8

9. NATIONAL BURDEN OF BLINDNESS Out of 39 million blind people across globe India has 8 million blind person. As per 2006-07 survey the prevalence of blindness was 1%. Prevalence of blindness- 1) > 50 years was 8.5 %. 2) Childhood blindness is 0.8 /1000. 3) Children 5-15 yrs the visual impairment is 6.4%. 9

10. Introduction 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. 10

11. Objectives of NPCB 1)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. 2)To reduce the backlog of avoidable blindness through identification and treatment at primary, secondary and tertiary levels. 11

12. Contd ……. 3) To develop comprehensive universal eye care services and quality service delivery. 4) Strengthening and upgradation of Regional Institutes of Ophthalmology to Centre of Excellance in various sub- specialities . 5) Strengthening of existing infrastructure facilities and to develop additional human resources for providing eye care in all districts. 12

13. Contd …….. 6) To enhance community awareness on eye care. 7) To increase and expand research for prevention of blindness and visual impairment. 8)To secure participation of voluntary organizations/private practitioners in delivering eye care. 13

14. Stratagies of Programme 14 Continued emphasis on Free Cataract surgery through govt. health care system and through NGOs & private sectors. Making the program ‘ Comprehensive’ by including diseases other than cataract too- Diabetic Retinopathy; Glaucoma; Corneal Blindness; Vitreo -Retinal surgery; Childhood Blindness etc. Active screening of population >50 yrs for cataract (reducing backlog).

15. Screening of children for refractive errors & provision of free glasses to the needy. Coverage of underserved areas Capacity building of eye care providers IEC activities for creating awareness on eye care in the community RIOs, Centre of Excellence and Medical Colleges to be improved & strengthened . 15

16. District hospitals also to be strengthened by upgrading infrastructure and contractual staff & funds. Emphasis on primary eye care and establish vision centers on all PHCs. Creating multipurpose district mobile ophthalmic units for improving coverage. 16

17. Organizational Structure 17

18. Activities under NPCB Programme Cataract operations Involvement of NGOs IEC activities Management Information System School Eye Screening Programme Collection and utilization of donated Eyes Control of Vitamin A deficiency Monitoring and Evaluation by survey 18

19. Cataract surgery by IOL implantation : Steps to control cataract blindness 1. Identify the blind and list them in the village registers 2. Organise screening camps for confirming the cataract blind for referral 3. Transport the cataract blind to the base hospital 4. Follow up of the operated cases, carrying out refraction and providing best corrective spectacles. . 19

20. Cataract operations have substantially increased from 16 lakh in 1992-93 to almost 63.03 lakhs in 2012-13 (target was 66 lakhs ). Cataract surgery rate of 400 operations per lakh population is required to enable states to clear backlog of cataract blindness. The states of Gujarat, Punjab, Tamil Nadu, Andhra Pradesh, Maharashtra, Delhi and UTs of Pondicherry and Chandigarh have achieved this norm . Bihar and Assam are the lowest performing states having cataract surgery rate of < 200/ lakh . The percentage of IOL surgeries has increased from 20% in 1997-98 to 95% in 2013-14. 20

21. School Eye Screening Programme 5%-7% of children aged 10-14 years have problems with their eyesight affecting their learning at school. Teachers have been trained to screen the children. Screening is to be done on an annual basis. After confirmation by Ophthalmic Assistants, glasses are prescribed or provided free of cost to the poor. During 2012-13, 7,08,861 school age children have been provided free spectacles against a target of 10,00,000 . 21

22. Collection and Utilization of Eye donation 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 donated. 22

23. 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. 23

24. IEC Activities : IEC activities are taken up at central, state and district level. Special compaigns for mass awareness are taken up during eye donation fortnight (25th August to 8 th september ) and world sight day (2nd Thursday of October). At the central level, the IEC prototype material is produced and disseminated to states. A quarterly newsletter has been started since july 2002. Support to voluntary organisations : Voluntary Organisations play an important role in implementing various activities under the programme . For expansion/ upgradation of eye care units in tribal and backward rural areas a grant in aid of Rs 25 lakhs is provided through State Blindness Control Societies . 24

25. Management Information System : To facilitate monitoring of trends in performance and analyzing epidemiological situation on blindness, a computerized information system has been set up in the form of 25 Sentinel Surveillance Units located in PSM departments of medical colleges. The cataract surgery data is stratified for gender, social status, type and place of surgery. 25

26. New initiatives of the program in 12 th Five Year Plan . 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. 26

27. VISION 2020: Right to Sight Global initiative to reduce avoidable blindness (preventable and curable) by the year 2020. Target Diseases: Cataract Refractive errors Childhood blindness Corneal blindness(trachoma) Glaucoma Diabetic retinopathy 27

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29. Universal Eye Health : a global action plan 2014-19 The vision of this action plan is a world in which - nobody is needlessly visually impaired - where those with unavoidable vision loss can achieve their full potential and - where there is universal access to comprehensive eye care services. WHO estimates that if only two major causes can be controlled, 2/3 of visually impaired can regain good sight. 29

30. These two measures are: - providing refractive services - cataract surgery The basis of reduction of ‘avoidable blindness’ depends not only on specific eye care services but also on other sectors like- -RCH: immunization against ( rubella,measles ), nutrition, prematurity - Safe water and basic sanitation. 30

31. Also eye health is influenced by control by: Non-communicable diseases e.g DM,HTN Communicable diseases e.g trachoma Geriatric health care problems (cataract) Hence eye health services can be strengthened by integrating into primary health care. WHO has suggested 3 indicators for helping the countries to assess if the universal eye health is adequate or not: 1) Prevalence and causes of visual impairment - target has been set as ‘reduction of avoidable blindness by 25% by 2019 from the 2010 level. 31

32. 2) the number of eye care personnel 3) Cataract surgical service delivery: - No of surgeries performed per million population in an year = “cataract surgical rate” - No of individuals with bilateral cataract induced impairment, who have received cataract surgery on at least one eye= “cataract surgical coverage”. 32

33. Externally Aided Projects 33 -WHO -WORLD BANK -DANIDA

34. World Bank assisted cataract blindness control project (1994‐2002): Implemented in 8 states. 15.35 million operations had been done against 11 million target. IOL implantation had been increased from 3% in 1993 to 75% in 2002. Danish assistance to NPCB (1998‐2003) : Funds were utilized for the training , development of MIS, supply of equipment. 34

35. References K.Park text book of Preventive and Social Medicine, M/s Bhanot Publishers 24th edition 2017 Jugal Kishore , text book for National health programmes , 9th edition 2011 Govt.of India,National Programme for Control of Blindness in India, Ministry of Health and Family Welfare, New Delhi 35

36. 36 THANK YOU