The document summarizes the National Programme for Control of Blindness in India. It discusses the objectives of reducing blindness prevalence to 0.3% by 2020 through initiatives like free cataract surgeries, school eye screening, and collection of donated eyes. The program aims to make eye care comprehensive and universal by addressing other causes beyond cataract. It operates through a decentralized structure with district blindness control societies and utilizes strategies like capacity building, awareness campaigns, and strengthening infrastructure. New initiatives under the 12th five year plan include distribution of free spectacles for the elderly and telemedicine in ophthalmology.

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
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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%).
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4. Snellen’s chart
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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
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• 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.
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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%).
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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%.
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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.
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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.
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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.
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14. Stratagies of Programme
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• 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.
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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.
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17. Organizational Structure
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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
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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.
• .
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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.
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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.
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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.
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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 8th 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 .
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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.
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26. New initiatives of the program in 12th
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.
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27. VISION 2020: Right to Sight
• Global initiative to reduce avoidable blindness
(preventable and curable) by the year 2020.
• Target Diseases:
1. Cataract
2. Refractive errors
3. Childhood blindness
4. Corneal blindness(trachoma)
5. Glaucoma
6. Diabetic retinopathy
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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.
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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.
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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”.
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33. Externally Aided Projects
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-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.
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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
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