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Background and Rationale:• EstimatesfromInternationalAgencyforPreventionofBlindnessshowsthatin2015

therewerearound253millionpeopleworldwidelivingwithvisionimpairment,ofwhich36millionwereblind.Thevastmajorityofvisuallyimpairedliveinlowincomesettings,and over 80% are aged 50 years or above. Globally, uncorrected refractive errorsandcataractarethemajorcausesofblindnessandvisualimpairmentandcollectivelyresponsible formore thanhalf of blindness and three- fourthof visual impairment.Morethan80%ofallvisualimpairmentcanbepreventedorcured.

• In many middle-income and industrialized countries, other eye conditions haveemergedaspotentialthreatstothestatusofsightoftheirpopulations.TheincreaseofDiabetesMellitusamongmanypopulationgroupshascauseddiabeticretinopathy,while glaucoma, an eye disease known for centuries, remains on the public healthagenda due to difficulty in early diagnosis and the necessity for life-long treatment.Age-relatedMacularDegeneration(AMD)ranksthirdamongtheglobalcausesofvisualimpairment.

• ‘Vision2020RighttoSight’isaglobalinitiativebyWorldHealthOrganization(WHO)andIAPB(InternationalAgencyforPreventionofBlindness)launchedin1999withagoalofeliminatingavoidableblindnessbyyear2020.

WHO’s global EyeHealth Action Plan, aims to focus on reducing avoidable visualimpairmentasaglobalpublichealthproblemand to secureaccess to rehabilitationservices for the visually impaired. The target of the programme is to reduce theprevalence of avoidable visual impairment which is feasible only if comprehensiveservicesareavailable forallatall levelsofcare i.e.primary,secondaryandtertiarylevel.

• Indiacontributesto20.5%and21.9%ofworld’sblindandvisuallyimpairedpopulation/patientsrespectively1.Themaincausesofblindnessare-Cataract(62.6%)RefractiveError(19.70%)CornealBlindness(0.90%),Glaucoma(5.80%),SurgicalComplication(1.20%)PosteriorCapsularOpacification(0.90%)PosteriorSegmentDisorder(4.70%),Others (4.19%) EstimatedNational Prevalence of ChildhoodBlindness is 0.80 perthousand2.

• The National Programme for Control of Blindness (NPCB) was launched in 1976as a 100% centrally sponsored scheme (now 60:40 in all states and 90:10 in NEStates)withthegoalofreducingtheprevalenceofblindnessto0.3%by20203.Theprogrammehasbeenrenamedintheyear2017asNationalProgrammeforControl

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ofBlindnessandVisualImpairment(NPCB&VI).RapidSurveyonAvoidableBlindnessconducted under NPCB during 2006-07 showed reduction in the prevalence ofblindnessfrom1.1%(2001-02)to1%(2006-07).Apartfromcataractsurgeries,nowthefocusoftheprogrammeisontreatmentandmanagementofothereyediseaseslikeglaucoma,diabeticretinopathy,Vitreoretinaldiseases,cornealblindness,lowvisionandchildhoodblindness.Theprogrammeisnowgearedtotakecareofallcategoriesofvisualimpairment.

• TheseOperationalGuidelinesareintendedforStateandDistrictprogrammanagersandserviceprovidertostrengthenintegratedprimaryeyecareservices.OthercompaniondocumentsincludetrainingmanualsandStandardTreatmentGuidelinesthatwouldbeupdatedanddisseminatedonaperiodicbasis.

• InIndia,HealthandWellnessCentres(HWC)nowprovideanopportunitytoprovideprimaryeyecare,andstrengthenreferralnetworks toeliminateavoidableblindness.The guidelines are intended to complement and supplement existing interventionsundertheNPCB&VI.

1Globalestimatesofvisualimpairment:2010,https://bjo.bmj.com/content/96/5/614

2NationalprogramforControlofBlindnessandVisualImpairmenthttp://npcb.nic.in/index1.asp?linkid=29&langid=1

3NationalprogramforControlofBlindnessandVisualImpairmenthttp://npcb.nic.in/index1.asp?linkid=29&langid=1

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Service Delivery Framework:ServicesforPrimaryeyecarewillbeprovidedatthreelevels:Communitylevel,HealthandWellnessCentres-SubHealthCentresandPrimaryHealthCentres/UrbanPrimaryHealthCentresandVisionCentre levelsorother referral facilitiesdependinguponstatecontext.Primary eye care services span community level awareness building, undertaking activescreening forblindnessandrefractiveerrors,managementofbasiceyeconditions,enablereferralandundertakefollowup.

Individual/Family/Community level:

Screening,preventivecareactivities,promotionofeyecare,andhomebasedfollowupareexpectedtobeundertakenbytheASHAandMultipurposeWorkers,supportedandsupervisedbytheCommunityHealthOfficers(CHO).DetailsofservicestobeprovidedatcommunityaredetailedinTable1.

Health and Wellness Centres-Sub Health Centre/Primary Health Centre/ Urban PHC level:

AttheHWC-SHC,thePrimaryHealthCareteam,ledbyaCommunityHealthOfficer(CHO)wouldensuresthatregulareyescreeningisundertaken,coordinateswiththeRashtiryaBalSwasthyaKaryakram(RBSK)Teamforscreeningchildrenofagegroup0-18yearsintheAnganwadiandschools,managethereferralofthoserequiringsurgeryandtreatmentofrefractiveerrors,ensureaccesstofreespectacles, andwould also undertake home and community based follow upvisits.

TheMedical Officer (MBBS) at the HWC-PHC/UPHCwould be responsibleforensuring thateyecareservicesaredelivered throughallHWCs inher/hisareaandthroughthePHCitself.Table2detailstheservicestobeprovidedatHWC.

Whereavailable,servicesoftheVisionCentres,atthelevelof50,000populationwouldbeutilizedsoastoleveragetheservicesoftheoptometrist/ParaMedicalOphthalmicAssistants(PMOA).Currently,theplanistoestablishVisionCentresatthelevelofCommunityHealthCentres(secondarylevelhealthcentres)laterscalinguptothePrimaryHealthCentrelevel.

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Table 1: List of services to be provided at Community level

Community Level Responsibilities

Services Preventive and Curative care

CommunitybasedservicesforeyecareandCounsellingandsupportforcareseekingforblindness,othereyedisorders

• Awareness generation on common eye disorders andthe need for early care seeking through VHSNC/MAS,VHND/UHNDandothercommunitylevelmeetings

• Clarifying misconceptions related to eye care and eyedisorders,includingdiscouragingtheuseoftraditionaleyemedicationor leftovereyedrops.Providing Informationabout availability of services related of eye treatment atdifferentlevelsofhealthcare.

• To ensure Vitamin A prophylaxis routinely for childrenunderage6monthsto5Years

• Identification/Mobilization of patient with identified eyedisease(ofknowndiabetic,identifiedpatients)

• Referralandfollowupforavailabilityofeyecareservicesatreferralcentre.

• Follow up of post-operative cataract patients anddistributionofspectaclestothem.

• To ensure regular use of spectacles and follow-up bi-annuallyinchildrenwithrefractiveerror.

• ToenabletheelderlyandthosewithPresbyopiatogetfreespectacles.

ASHA/AF

ScreeningforblindnessandRefractiveerrors

• By ASHA: Screening of Visual Impairment: Less than6/18inanyeye.ReferAnnexure-1

• Screening of population above 30 years of age andidentificationof thosewithPresbyopia (Poornearvisionrelated to ageing), symptomatic person with visualimpairment, Known Diabetic patient and person withsubnormalvision,redeyeandanyothereyecomplaint.

• Impartinghealtheducationformotivatingpeoplewhoareatriskofvisualimpairment.

• UndertheRBSK,allchildrenarescreenedforvisualacuityatschoolandAnganwadilevels.

• Record keeping: maintaining a list of referrals fromcommunitywhocannotreadby6/18vision.Tomaintainalistofvisualimpairedandblindindividualsinthecommunity.

• UndertakeRehabilitationandcounselling

PrimaryHealthCareteam.(in

coordinationwithRBSKteam,where

needed)

Communityscreeningforcongenitaldisordersreferral

• Encourage eye examination for all children who werepreterm (less than 32 weeks) or low birth weight (lessthan2kg)within30daysof theirbirth throughRBSK,facilitatedbyASHA/AF.

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Table 2: List of services to be provided at Health & Wellness Centre

Health & Wellness Centre Responsibilities

Services Preventive and Curative care

Screeningforblindnessandrefractiveerrors

• Visual Acuity by using Snellen’s Chart and near Vision card(Annexure2).

• CaseidentificationforCataract,Presbyopia,TrachomaandCornealdisease.

• ScreeningforvisualacuityinDiabeticpatients.

• DispensingofmedicinesforConjunctivitis,Dryeye,Trachomaandfollowupmedicinesforchroniceyedisease(e.g.Cataract,GlaucomaandDiabetes)treatedatreferralcentre.

CHO/ANM/MPW

Conjunctivitis,AcuteredeyeandEyeallergy

• TocreateawarenessaboutthesecontagiouseyediseasesthroughIECtoavoidspreadoftheseconditionsusingappropriatemeasures.

CHO

Trachoma • Awarenessgenerationoncommoneyediseasesandneedofseekingearlyeyecareserviceswheneverrequired.

• Awarenessgenerationoneyedonation.

• Educate community regarding personal hygiene, facial cleannessandcleanlinessofenvironmenttopreventspreadofTrachoma.

• Referpatientstohighercentrefortreatment.

• SurveillanceofTT/TIcasesandtheirreferraltoeyespecialistwhereneeded.

• MaintenanceofrecordasperNPCBVIguidelines.

CHO

Xeropthalmia • ToidentifyVitaminAdeficiencyandBitot’sspot

• ToassureVitaminAprophylaxis

CHO/ANM/MPW

Firstaidforforeignbody,eyeinjuries,stabilizationandthenreferral

• Washeyeswithcleanandrunningwater.

• Donotrubtheeyeincaseofforeignbody.

• Attempt to remove only superficial foreign body especially thoselocatedintheconjunctivalsacoftheeye.

• Don’tattempttoremoveforeignbodyfromcornea.

• Stabilizationandpatch theaffectedeyewithstabilizedgauzepadandrefertonearestfacilityhavinganOphthalmologist.

CHO

Acid/Alkali/Chemicalexposure

• Washwithcleanwaterbyavoidingspillingoveronunaffectedfacialareaandimmediatereferraltoanophthalmologist.

CHO/MPW/ANM

IECActivities • Avoidtouchingfaceandeyeduringeyeinfections

• CHO/ANM/MPWwillprovideeyedropsagainstprescription

CHO/MPW/ANM

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Table 3: List of services to be provided at Referral centre/Vision centre

Referral centre /Vision Centre

Conditions Management/Treatment Responsibilities

Acuteandchroniceyeproblems

• Diagnosisandregulartreatmentforcommoneyeconditions MO

Surgicalcareforeye

• Followupcareforoperatedpatients. PMOA(whereavailable)Careatvisioncentre/

referralsite–PHC/CHC/DH

Refractiveerror

• Diagnosisforrefractiveerrorsandtoprovidefreespectaclestopatientsdiagnosedwithpresbyopiaandschoolchildrenwithrefractiveerrors

• To collaborate with RBSK team to provide spectacles tochildrenwithrefractiveerrors.

PMOA(whereavailable).Careatvisioncentre/

referralsite–PHC/CHC/DH

Cataract • Identificationofoperablecataractandreferforsurgery. PMOA(whereavailable).Careatvisioncentre/

referralsite–PHC/CHC/DH

Glaucoma • ScreeningforGlaucomaandreferforsurgery MO/PMOA(whereavailable).

Diabeticretinopathy

Screening fordiabetic retinopathyand facilitatingconsultationwitheyespecialistearlystage.

• Annualexaminationofeyeismustforadiabeticpatient

• The facility of fundus photography using non mydriaticfunduscamera

• Referralforfurthertreatment

MO/PMOA(whereavailable).

Cornealblindness

• Referforadvicetoeyespecialistandfollowinstructionsgivenbythespecialist.

MO/PMOA(whereavailable).

Removalofforeignbodyineye

• Referral toophthalmology forcorneal/deep foreignbodiesineye.

PMOA

Trachoma • SurveillanceofTT/TIcasesandtheirreferraltoeyespecialistwhereneeded.

• MaintenanceofrecordsasperNPCBVIguidelines

MO/PMOA

Eyescreeningcamp

• Toassistdistrictteamduringeyescreening/outreachcamps

• To collaborate with RBSK team for distribution of freespectaclestochildrenhavingrefractiveerrors.

• MaintenanceofrecordasperNPCBVIguidelines

PMOA

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Referral and Treatment: Ensuring Continuity of Care:

• Effective linkages to be developed from peripheral level to district level withthehelpoffunctionariesandfrontlineworkers,includingPRIs/ULBs,PrimaryHealth Care team at HWC, Public Health Nurses, School teachers, Schoolhealthdoctorsandsensitizedparents,PrivateOphthalmologistsandDistrictlevelofficials.

• AllpatientsidentifiedwitheyerelatedproblemthatrequiressurgeryoremergencycarewillbereferredtotheOphthalmologistatthesecondarylevel.

• ComplicatedcasesthatcannotbeadequatelyhandledattheDistricthospitalwillbefurtherreferredtotheStateMedicalCollegeforexperttreatment.

• Foridentifiedcases,thefollowupfortreatmentcomplianceandcontinuumofcarehastobeplannedatthelevelofHWC/SC/PHC/UPHCitself.

• Theloopbetweentheprimarycaremedicalproviderandthespecialistmustbeclosed.Thiscanbeachievedwhenthespecialistsatdistrictfacilityorhigherareable tocommunicate to themedicalofficerof theadequacyof treatment,anychangeintreatmentplans,andfurtherreferralaction.

• Inorder toexpandaccess to services, and reach remotepopulations,MobileMedicalUnitswouldenableanexpansionofservicedeliveryandservetheroleofenablingtheprovisionofcareandservingtoestablishContinuumofcare.

• Medical colleges with existingOphthalmic set up will act as tertiary referralcentre.

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Health Promotion including the use of IEC for Behavior Change Communication:

Health Promotion through IEC

• Keymessagestoincludegeneraleyecare,eyehygiene,causesandprevention,ofcommoneyeproblems,counselingofpatientsandfamilymemberswitheyeproblems.

• Usingcommunity-basedplatformslikeVHSNC/MAStoeducatecommunityonpracticinghealthyhabitsrelatedtoeye,andearlyidentificationofcommoneyeproblems.

• EducatingschoolteachersandAWWaboutcausesandpreventionofcommoneye problem, identification of visual impairment among children and specialneedsofchildrenwitheyeproblems,includingblindchildren.

• Motivationforeyedonation

• Special activities duringWorldGlaucomaweek, EyeDonation Fortnight andWorldSightDay

Suggested Key Messages

• EatadietrichinVitaminA(papaya,mango,eggyolketc.),seasonalvegetables,especiallydarkgreenleafyvegetablessuchasspinach,broccoli,fruits(Watermelonetc.),fishthatarehighinOmega-3fattyacids.

• Dofollowthe20-20-20ruleofeyecarewhenusingacomputer,tablet,oranydigitalscreen.Every20minutes,refocusyoureyesfor20secondstoanobjectlocatedatleast20feetaway.

• Avoidtheglare.Donotstareatthesunandotherbrightobjects

• Neverwalkoutinthesunwithoutsunglasses

• Never share eye drops, eye make-up with anyone – it can cause crosscontamination

• Removealleyemakeupatnightbeforesleeping

• Washhandstoavoideyeinfections

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• Donotworkinpoorlight.Readinginpoorlightcanstraineyes.

• Patientwitheyeinfectionavoidgoinginswimmingpoolandpublicplaces.

• Donotusehomeremediesforeyemedication

In case of any eye related problem please contact your nearest vision centers.

IEC: Suggested Media Tools for all common eye diseases

• Counsellinginfamilies,socialgroups,villagePanchayat,urbanslumandnon-slumareas.

• Folkart,Theatre,Puppetshows,Drumbeating.

• Schoolchildrenandschoolteachers.

• Talkbyreligiousleaders.

• Communityradiomedia

• Otherlocaltraditionalmedia.

• FlipChart/Posters.

• ProductionofpictorialillustrativeguideonChildEyecareforASHA.

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Medicines and Diagnostics:The followingmedicinesandconsumablesshouldbeavailableatCommunity,HealthandWellnessCentres-SHC/PHC/UPHCandReferralCentre.

Community Level Health & Wellness centre -Sub centre

• VitaminAprophylaxis Essential :

• EyedropsMethylcellulose

• EyedropsSodiumCromoglycate2%

Desirable:(tobedispensedonlyonprescriptionofaregisteredMedicalPractitioner)

• EyedropsCiprofloxacin0.3%

• EyedropsTropicamide1%

Note: Do not use / store eye drops containing steroids

Health & Wellness centre-PHC/UPHC Referral Centre/Vision Centre

• EyedropsMethylcellulose*

• EyedropsSodiumcromoglycate2%

• EyedropsLignocaine4%

• EyedropsCiprofloxacin0.3%**

• EyedropsTropicamide1%**

• AllmedicinesasperEssentialMedicineList

• TabAcetazolamide250mg

• EyedropLignocaine4%

• EyedropTropicamide1%

• EyedropPilocarpine2%and4%

• EyedropAtropine1%,OintmentAtropine1%

• EyedropCyclopentolate1%*Do not use / store eye drops containing steroids

**To be dispensed only on prescription of a registered Medical Practitioner

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List of EquipmentThefollowingequipmentshouldbeavailableatCommunity,Health&WellnesscentreandReferralCentre:

Community Level Health and Wellness Centre Referral Centre/ Vision Centre

ASHA kit:VisionScreeningcardfor6/18vision,measuringtape(6metre),recordingformat,readingmodule,referralcards.

School Teacher kit: VisionScreeningcardof6/9vision,Measuringtape,recordingformat,readingmodule,referralcards.

Instruments:

• Coveredstainlesssteeltraywithsterilecottons/swabs/gloves

Equipment –

• IlluminatedVisionchart(near&distance)

• Torch(withbatteries)

• Data entry - mechanism (e.g.Registers/tablets/PCs

• IECmaterials(Flipcharts,Posters& Brochures for common eyeconditions)

• Access to electronic learningmaterial; can be developedby reviewing various existingmodels from the institution/NGOs.

Essential Equipment:

• Trialset

• Trialframe(adultandchild)

• Tonometer(Schiotz)

• DirectOphthalmoscope

• IlluminatedVisionTestingDrum

• Planemirrorforretinoscopy

• StreakRetinoscope

• Snellen&NearVisionCharts

• Binomag/magnifyingloupe

• Torch(withbatteries)

• Lidspeculum

• Furnishing&fixtures

• Slitlamp(optional)

• Epilationforceps

• Foreignbodyspudandneedle

Desirable equipment’s:

• Non-mydriaticfunduscamera

• Non-contacttonometer

• Autorefractionmeter

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Requirements for operating tele-ophthalmology services at HWC-PHC/UPHC and CHC levels

Basic requirements:

• Health personnel should be well versed to use basic eye equipment and digitalinstruments.

• Inordertotransmitavideo:Availabilityofinternetconnectionwithminimumbandwidthof2Mbpsandrangeof100-500meters.

Instruments Required:

Digital ophthalmic instruments: Non-digital ophthalmic instruments:

• NonmydriaticFunduscamera

• Slitlamp

• Directandindirectophthalmoscope

• TrialBox

• Visionchart

• Visiondrum

Software:EMR(ElectronicMedicalRecord)assuggestedbytheMOHFW.

Hardware:Server,Laptop,Webcam,SoundBoxandRouter.

Diagnosis :FundusPhotography:Fundusphotographyinadultsandcooperativechildrenispossiblewithafunduscameraorbyusingaslitlamp-mounteddigitalcamera.

Human Resource and Capacity Building Plan:

ThemainobjectiveistoimplementPrimaryEyeCareatcommunitylevel,HealthandWellnessCentre(H&WC)andvisioncentrelevel.ConcernedNodalofficerwillmonitorandcoordinateimplementationofprimaryeyecareactivities.

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ASHA

Roles and Responsibilities• Awareness generation for prevention of eye disease: Refractive error, Cataract, Trachoma, Diabetic

Retinopathy,Childhoodblindness

• Awarenessregardingmaintenanceforpersonalhygieneandenvironmentalandlifestylemodificationsandavoidmythsandmisconception.

• AwarenessgenerationandmobilizingchildrenforVitaminAprophylaxisandmeaslesimmunization.

• Toutilizecommunitybasedplatformsforhealthtalkfixedforeyecare.

• Changeinhealthseekingbehaviorofpatientsandcaregiversthroughawarenessandfacilitation.

• ScreeningforBlindness,VisualImpairmentandNearVision.

• Referraltovisioncentreandreferrallinkage.

• Ensure followupof patients requiring long termmedication for diseases likeGlaucoma, and diabeticretinopathy.

• Ensuringfollow-upforpost-operativepatients.

• Rehabilitation by counselling people about role of family in supporting visually impaired and blindindividual.

Skills and TrainingSkills:VisionScreening,Knowledge,Communicationandcounsellingskills,Recordkeepingskills

ASHA Facilitators/MPW/ANM

Roles and Responsibilities• SupportivesupervisionandMonitoring

• Creating awareness regarding maintenance for personal hygiene and environmental cleanliness andlifestylemodificationsusingcommunitybasedplatforms.

• Communitybasedrehabilitation,socialacceptanceandVocationaltrainingandinclusiveeducationforlowvisionpatients.

Skills and Training• Trainingonskillsrelatedtotheirrolesandresponsibilities.

Community Based volunteers-

VillageHealth&SanitationCommittee/MahilaArogyaSamitis:Awarenessregardingmaintenanceforpersonalhygieneandenvironmentalcleanlinessandlifestylemodifications.Communitybasedrehabilitation,socialacceptanceandVocationaltraining,Inclusiveeducation.

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Community Health Officer (CHO)

Roles and Responsibilities• MaintenanceofBlindandVisualImpairmentregister

• CompilationandvalidationofdatacollectedbyASHA(listofeyedisorders).

• MonthlymeetingwithASHAs/ANM/MPW

• Screeningoftargetpopulationforvisiontesting(distanceandnearboth)

• Screeningoftargetpopulationforcommoneyeconditionslikecataract,presbyopia,trachoma&cornealdisease.

• HealthPromotionwithspecialfocusoneyecare

• Counsellingof the identifiedpatients forcataractsurgery,wearingspectaclesregularly,complianceforglaucoma,fundusexaminationfordiabetics.

• RegularmonitoringofBloodpressureandBloodsugar

Skills and Training• Communicationskill

• Screeningofvision,BloodPressuresandBloodsugar.

• Removalofsuperficialforeignbodyineye

• Howtouseeye-drops

• ManagementofdatacollectedbyANM/MPW/ASHA

Para-Medical Ophthalmic Assistant (PMOA)–at vision centers

Roles and Responsibilities • Testvisualacuity,refractionandprescriptionofglasses.

• Screeningand identificationof eyediseases like cataract, glaucoma, childhoodblindness,uncorrectedrefractiveerrors,squint,trachoma,cornealopacity,Uveitis,diabeticretinopathy

• Screeningforcolorvision(notforissuingcertificate)

• Dispensingofspectacles

• HealthEducationandtrainingofprimarylevelfunctionariesandvolunteers

• Enucleationoftheeyesincaseofcornealdonationafterdeath(afterrequisitetrainingonly)

• Organization and management of documentation, counselling, screening camps, school eye health,community health education sessions, coordination with other departments, teleophthalmology andepidemics

• DutiesundersupervisionofMedicalOfficersorEyeSpecialists

• Providingprimaryeyecare including treatment foreyediseases like trachoma,conjunctivitis,allergiesofeyelidsandconjunctiva,dryeye,vitaminAdeficiency,lachrymalsystemdisorder,superficialcornealabrasion.

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• Ocularemergencies:Identify,initiateprimarymedicaltreatment(FirstAidaspertheprotocol)andurgentreferraltoanOphthalmologist,anyemergencycaseslikechemicalburns,perforatinginjuriesofeyeballorlids,cornealUlcers.

• Minorsurgicalprocedureslikeepilation,removalofconjunctivalforeignbodies.

• Followupofpost-operativecasesaspertheinstructionoftheoperatingsurgeons.

Training1-weektrainingforVT/OA/Optometrist

• Thevisiontechnicianmustbetrainedforacomprehensiveeyeexamination,Schiotztonometry,refractionandgoodknowledgeofcommoneyediseases.

• History taking,refraction,slit lampexamination, Intraocularpressuremeasurement,Lacrimalpatencytesting,fundusexam(non-mydriatic)&images,superficialForeignbodyremoval,epilation,visualacuityassessment,essentialeyecaredatamanagement,basichealthworkertrainingcapacity.

Medical Officer (MO)

Roles and Responsibilities • Diagnostic and treatment of commoneye conditions/infections, primary eye care for trauma, referral of

more complex cases,medical fitness for cataract surgery, disability certification, initial readingof Fundusimages, act asNodalofficer forVisionCentreoperations,outreachactivities (planning,monitorwellnessclinics/communityworkersandco-ordinationwithdistricthospitals),qualityassuranceofASHA&PMOAactivities.

Training1-daytrainingforskillbuilding

Monitoring and Supervision:At Community Level At Health &

Wellness CentreAt Vision Centre

• NumberofASHAtrained

• Populationscreened

• Visuallyimpairedineithereyeidentified

• Cataractsurgeriesconductedinthecatchmentarea.

• NumberofTeachersTrained

• Numberofchildrenscreenedinschool

• NumberofchildrenidentifiedwithVA<6/12inanyeye.

• NumberofchildrendiagnosedwithRefractiveError

• NumberofChildrenPrescribedwithspectacles.

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• Proportion of blind and Visually impaired identified (Number of blind and Visuallyimpairedidentified/catchmentpopulationofHWCX100)

• Percentage of blind and Visually impaired referred (Number of blind and Visuallyimpaired referred/total number of individuals identified as being blind and VisuallyimpairedX100)

• Percentageofcataractidentifiedandreferred.(Numberofcaseswithcataractidentifiedandreferred/totalnumberofhomevisitsX100)

• PercentageofDiabeticRetinopathyidentifiedandreferred(NumberofOPDcaseswithdiabeticretinopathyidentifiedandreferred/totalnumberofOPDX100)

• Percentage of eye injuries identified and referred (Number ofOPD caseswith eyeinjuriesidentifiedandreferred/totalnumberofOPDX100)

• Numberofcataractsurgeriesconductedinthecatchmentarea

• Numberofrefraction/glassesprescribedattheOPDoftheunit/centre

• NumberofspectaclesdistributedattheOPDoftheunit/centre

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SCREENING TOOL TO BE USED AT VARIOUS LEVELSAnnexure -1VisionchartatCommunityLevel

(ForASHA:6/18VisionChart)

*Note:AllVisiontestingchartsattachedhereforreference.Forscreeningpurposepleaseusetheactualprintedcharts.

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Annexure -2HealthandWellnessCentre&ReferralCentre/VisionCentre

1. Snellen’schart

*Note:AllVisiontestingchartsattachedhereforreference.Forscreeningpurposepleaseusetheactualprintedcharts.

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2. Nearvisionchart

*Note:AllVisiontestingchartsattachedhereforreferenceforscreeningpurposepleaseusetheactualprintedcharts

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Annexure -3ListofContributors

1 Dr.PraveenVashisht Professor&Head,CommunityOphthalmology,Dr.R.P.CentreOphthalmicSciences,AIIMS

2 Dr.PromilaGupta DDG, DGHS, MoHFW

3 Dr.R.D.Ravindaran Arvind Eye Care System, Madurai

4 Dr.AsimKumarSil MD,VivekanandMissionAshram,Haldia,WestBengal

5 Dr.B.K.Jain Director, Sadguru Netra Chikitsalya, Chitrakoot

6 Dr.GauravGupta WHO representative

7 Dr.TabaKhanna State Program Officer (NPCB), Arunachal Pradesh

8 Dr.UtpalJani State Program Officer (NPCB) & Joint Director (Ophthalmic), DHS, Gujarat

9 Dr.MohamadIqbalBharti Joint Director (NPCB), DHS, Rajasthan

10 Dr.SrinivasMarmamula Associate Director - Primary Eye Care, Community Eye Health Education and Research

11 Dr.RohanChariwala Ophthalmologist & Public Health Consultant, Divyajyoti Trust, Gujarat

12 Dr.PallaviShukla Community Ophthalmology, Dr. R. P. Centre Ophthalmic Sciences, AIIMS

NHSRC TEAM

1 Dr.RajaniR.Ved Executive Director, NHSRC

2 Dr.J.N.Srivastava Advisor-QI, NHSRC

3 Dr.ParminderGautam Senior Consultant-QI, NHSRC

4 Dr.NikhilPrakash Senior Consultant-QI, NHSRC

5 Dr.NehaDumka Senior Consultant-CPHC, NHSRC

6 Dr.SujeetKr.Sinha Consultant-QI, NHSRC

7 Dr.TanviBansal Consultant-QI, NHSRC

8 DrArpitaAgrawal Consultant-QI, NHSRC

9 Dr.KanikaJain Short Term Consultant-QI, NHSRC