Community ophthalmology

COMMUNITY OPHTHALMOLOGY

A discipline where

“The traditional care applied to an

individual patient is diverted to a

population with a prominence placed on

preventive aspects”

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)

Also include Health education

improved sanitation,

Hygiene, Immunization etc

Prevention of disease

Improvement of quality of life in

community

Curative Preventive

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

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.

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%

EPIDEMIOLOGICAL DETERMINANTS

Age

Malnutrition

Occupation

Social class

Social factors

CONCEPTS

Primary eye care

Epidemiological approach

Team concept

National programmes

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

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

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

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

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.