overview of Community ophthalmology

1. COMMUNITY OPHTHALMOLOGY

2. A discipline where
“The traditional care applied to an
individual patient is diverted to a
population with a prominence placed on
preventive aspects”

3. WHAT ARE THE MAJOR DIFFERENCES IN CURATIVE
& PREVENTIVE MEDICINE ?
Goals
Target
Diagnosis
Therapy
Results
Curative Preventive
Treatment & cure
Single patient
Physical examination.
Drugs / Surgery
Limited to individuals
Prevention of disease
Population/community
Health survey (Community
Diagnosis)
Also include Health education
improved sanitation,
Hygiene, Immunization etc
Prevention of disease
Improvement of quality of life in
community

4. NEED ?
 285 million visually impaired, 39 million blind
 90 % in developing countries
 80 % preventable or curable
 Blindness – cataract, glaucoma, trachoma,
childhood blindness etc.
 Visual impairment - uncorrected refractive errors
(myopia, hyperopia or astigmatism) 43 % cataract
33%, glaucoma, 2%.
 Large portion remain blind due to lack of access to
affordable eye care

5. SOUTH-EAST ASIA
 1/3 of worlds blind & 50 % of blind children come
from this region
 Prevalence of blindness 0.8 %
 90 % preventable or curable
 Cataract, refractive error, childhood blindness,
glaucoma are the major causes of blindness.
 Cataract surgery rate remains low & back load
keeps on accumulating.

6. INDIA
 8.5% blindness in 50 & above
 1.1 % in general population
 Annual incidence of cataract induced blindness is 2
million
 Approx 3 million need corneal transplant
 6 – 7 % of children aged 10 -14 yrs have problem
with vision
 Causes - cataract 62.6%
R E 19 %
glaucoma 5.8%

7. EPIDEMIOLOGICAL DETERMINANTS
Age
Malnutrition
Occupation
Social class
Social factors

8. CONCEPTS
Primary eye care
Epidemiological approach
Team concept
National programmes

10. WHO GUIDELINES FOR PRIMARY EYE CARE
1. Conditions to be recognized and treated by
a trained primary eye care worker
☞ Conjunctivitis and lid infections
- Acute conjunctivitis
- Ophthalmia neonatorum
- Trachoma
- Allergic & Irritative conjunctivitis
- Lid lesions – chalazion
☞ Trauma
- Sub conjunctival hemorrhages
- Superficial FB
- Blunt trauma
☞ Blinding Malnutrition

11. 2. Conditions to be recognized and referred after
treatment has been initiated.
☞ Corneal ulcers
☞ Lacerating or perforating injuries of the eye ball
☞ Lid lacerations
☞ Entropion / Trichiasis
☞ Burns - Chemical
- Thermal

12. 3. Conditions that should be recognized and referred
for treatment.
☞ Painful red eye with visual loss
☞ Cataract
☞ Ptergium
☞ Visual loss < 6/18 in either eye

13. COMPONENTS OF PREVENTION
 Initial assessment
 Methods of intervention
- Primary eye care
- Secondary care(mobile)
- Tertiary eye care
- Specific programmes
- Trachoma
- School
- - Vitamin A
- Occupational
 Long term measures
 Evaluation

14. VISION 2020
 WHO – feb 1999
 To eliminate avoidable blindness by 2020
 Right to Sight
 Target diseases are cataract, refractive error,
childhood blindness, corneal blindness, glaucoma,
diabetic retinopathy.
 HR, infrastructure & technological development.
 20 centres of excellance, 200 training centres, 2000
service centres & 20,000 vision centres.