3. Blindness??? WHO define visual acuity of less than 3/60
(snellen) or its equivalent. Or Inability to count fingers in day
light at a distance of 3 metres abhilash pm 3
4. ICD classification of visual impairement cata Visual acuity
gory Max less than Mini equal to or better than 0 6/18Low vision 1
6/18 6/60 2 6/60 3/60blindness 3 3/60 1/60 4 1/60 Light perception
5 No light perception abhilash pm 4
5. Problem statement world- 180million visually disabled 45
million blind Prevalence .2-1% 80% avoidable blindness SEAR 60
million 45 million visually disabled;15 million blind&
.7million blind children 95% avoidable blindness abhilash pm 5
6. INDIA Annual incidence of cataract induced blindness
2million;~3million people need cataract surgery Prevalence; gen
population 1.1% >50 yrs 8.5% 6-7% children have vision problem
abhilash pm 6
8. Epidemiological determinants AGE SEX MALNUTRITION OCCUPATION
SOCIAL CLASS SOCIAL FACTORS abhilash pm 8
9. CHANGING CONCEPTS IN EYEHEALTHCAREAcute intervention
comprehensive eye healthcare1. Primary eye care2. Epidemiological
approach3. Team concept4. Establishment of national programmes
abhilash pm 9
10. Primary eye care Inclusion of an eye care component in
primary healthcare system Promotion and protection of eye health
together with on the spot treatment are its cornerstones Final
objectives-increase the coverage and quality of eye healthcare
through PHC, improve the utilization of existing
resourcesEpidemiological approach Measurement of incidence,
prevalence of disease and their risk factors abhilash pm 10
11. Team concept One eye specialist + auxiliary health
personnelEstablishment of national programs Started by voluntary
agencies Focused on single disease eye camps eg: national trachoma
control National blindness control program abhilash pm 11
12. PREVENTION OF BLINDNESS Concept of avoidable blindness
Components of action1. INITIAL ASSESSMENT2. METHODS OF INTERVENTION
Primary eye care Trained primary health workers 1 village health
guide for 1000 populn&2 MPWs for 5000 popln Provided essential
drugs Refer cases Promotion of personal hygiene abhilash pm 12
13. Secondary care Definitive management of common blinding
condn PHCs &district hospital& mobile eye clinics Cataract
surgery; gen health surveys abhilash pm 13
14. Tertiary careEstablished @ national & regional
capitalAsso with Med clg& Institute of medRetinal detachment
sur; corneal grafting etcEye bankRehabilitation of blind abhilash
pm 14
15. Specific programmes1. Trachoma control prog2. School eye
health services3. Vitamin A prophylaxis4. Occupational eye health
services3.LONG TERM MEASURES Control of infn Improving the quality
of life& modifying the risk factors Health education4.
EVALUATION abhilash pm 15
16. abhilash pm 16
17. NATIONAL PROGRAMME FORTHE CONTROL OF BLINDNESS 1976 Goal
reduce prevalence of blindness from1 to .3 abhilash pm 17
18. REVISED STRATEGIES 1) To make NPCB more comprehensive by by
strengthening services for other causes of blindness 2) shift frm
eye camp approach to fixed facility surg approach;conventional surg
to IOL 3) to expand world bank project 4) strengthen participation
of voluntary organization 5) enhance the coverage of eye care
services in tribal& other under served areas abhilash pm
18
19. OBJECTIVES 1. Reduce the backlog of blindness 2. develop
eye care facilities in every district 3. develop human resources
for providing eye care services 4. to improve quality of service
delivery 5 .to secure participation of voluntary organizations in
eye care abhilash pm 19
20. DEVELOPMENT OFINFRASTRUCTURE FOR EYE CARE Strengthening of
PHCs Central mobile units Strengthening of Dist hosp Upgrading of
Dpts of Ophthalmology in Med clgs Establishment of regional
institutes Ophthalmic asst training centres Dist mobile units State
ophthalmic cell Estb of DCBSs Eye banks Paramedical ophthalmic
assistants posted abhilash pm 20
21. ORGANIZATIONAL STRUCTUREfor NPCBADMINISTRATIONCentral:
ophth section Directorate General of health services, ministry of
H& FW Delhi state: state ophthalmic cell ,Dir of Health
services,State health societies District:DBCS abhilash pm 21
22. Service delivery & referral system Tertiary level :
RIO& centres of excellence in eye care Secondary level: Dist
hospital& NGO eye hospital Primary level: Sub dist level hosp/
CHC;mob ophth units;upgraded PHCs;link workers;panchayats abhilash
pm 22
23. NEW INITIATIVES PROPOSEDUNDER NPCB Construction of
dedicated eye wards& eye op theatre in dist hosp of NE state,
j&k ,bihar etc Appointment of ophth surgeons &assist in new
district hosp Appointment of ophth assistants in PHCs/vision
centres Appointment of eye donation counsellors on contract basis
in eye banks under govt& NGO sector Grant in aid for NGO for
other eye d/s Special attention to clear cataract backlog &
take care of other eye care centres frm NE states Telemedicine in
ophthalmology Involvement of private practitioners A provision of
RS 1550 crore has been proposed for implementation NPCB in 11 five
yrs plan Vit A supplement &MMR vaccination via DBCS to prevent
childhood blindness Setting up of 5 centres of excellencefor eye
care services abhilash pm 23
24. Community health education is a built in component at all
levels of NPCB implementation School eye screening programme
Collection & utilization of donated eyes abhilash pm 24
25. Externally aided projects World bank assisted cataract
blindness control project Danish assistance to NPCB WHO assistance
for prevention of blindness abhilash pm 25
26. VISION 2020/ THE RIGHT TO SIGHT Global initiative to reduce
AVOIDABLE BLINDNESS by the yr 2020 Target d/s are cataract,
childhood blindness,corneal blindness,glaucoma,diabetic
retinopathy. Human resource development as well as
infrastructure& tech devpt@ various levels of health system
abhilash pm 26
27. structure Centres of excellence 20 ry rtia Te Training
centres 200 ary Service centres nd 2000 co Se ary Vision centres
20000 imPr abhilash pm 27