Community Ophthalmology – II

Dr.Swathi.NOphthalmology

• National programmes – NPCB, DBCS

• Vitamin A

• Trachoma

National program for Control of Blindness

First country to launch the NPCB

Year 1976 ; 100% centrally sponsored scheme

Objectives • To bring down the prevalence rate of cataract blindness from

1.49% to 0.8% by the year 2007. • To provide high quality of eye care to the affected population. • To expand coverage of eye care to the affected population. • To expand coverage of eye care services to the under-served

areas. • To reduce the backlog of blindness by identifying and

providing services to the affected population. • To develop institutional capacity for eye care services by

providing support for equipment and material and training personnel

Strategies • Decentralized implementation of the scheme through District Blindness

Control Societies (DBCS). • Reduction in backlog of blind persons by active screening of population

above 50 years of age. Organizing screening eye camps and transporting operable cases to eye care facilities.

• Involvement of voluntary Organization in various eye care activities. Participation of community and panchayat Raj institutions in organizing

services in rural areas. • Development of eye care services and improvement in quality of eye care

by training of personnel, supply of high-tech equipments, strengthening follow up and monitoring services.

Strategies• Screening of school going children for identification and treatment of

refractive errors with special attention in underserved areas. • Public awareness about prevention and timely treatment of eye

ailments. • Specific focus on illiterate women in rural areas. For this purpose

there should be convergence with various ongoing schemes for development of women and children.

• To make eye care comprehensive, besides cataract surgery other

operations for treatment of Glaucoma. Diabetic Retinopathy may also be provided free of cost to poor patients through Govt. and NGOs

Activities • Strengthening of eye care infrastructures in the state. • Improvement of quality of eye care services by training of eye

care personnel. • Provision of modern equipments instruments and other

commodity assistance by GOI. • Provision of vehicle. • Increased no of cataract surgery. • Abolition of reach out camps. • Introduction of cataract surgery with IOL implantation. • Involvement of NGOs. Component activities under NPCB:

Activities• Cataract surgery.

• School eye screening.

• Eye donation and Eye Banking.

• Training and capacity building of ASHAs to orient them towards Blindness control programme as well as create a core group of field functionaries who will initiate and create awareness on blindness control programme at the village level.

• • IEC and EYE health education at all levels to be undertaken.

Initiatives that will be integrated into the Blindness Control Programme

• Free surgery for cataract cases in rural areas. • Free transportation for patients of un reached areas. • Free medicine for all types of eye ailments. • Free spectacles for post operative care. • Free spectacles for poor school students. • All backlog cataract cases would be treated. • All schools would be covered for SES. • All children would be given vit-A supplementation and immunization

coverage. • Modern and advanced treatment would be available in all Medical College

Hospitals and, • Two Eye Banks to be established. • Establishment of one RIO (Regional Institute of Ophthalmology) in one of the

medical colleges.

District Blindness Control Society

Rationale:• District personnel can decide on the local needs and

priorities• Easier to coordinate activities of different agencies• Smallest administrative unit • Easier to involve local people in all activities• Variation in prevalence of blindness and available

resources

Primary Function

• Plan• Implement• Monitor all the blindness control activities in the district

• Collect• Compile • Report eye care information to the NPCB

District Blindness Control Society

• District personnel can decide on the local needs and priorities

• Easier to coordinate activities of different agencies

• Smallest administrative unit

• Easier to involve local people in all activities

• Variation in prevalence of blindness and available resources

FUNCTIONS

Plan, implement and monitor blindness control activities in the district as per pattern of assistance approved for the National Programme for Control of Blindness.

1. To assess the magnitude and spread of blindness in the district by means of active case finding

2. To organize screening camps - cataract surgery and other blinding disorders, organize transportation ,free medical or surgical services

3. To plan and organize training of community level workers, teachers and ophthalmic

assistants/nurses involved in eye care services

4. To procure drugs and consumables including micro-surgical instruments required in the

Government facilities

5. To receive and monitor use of funds, equipments and materials from the government and

other agencies/donors

6. To involve voluntary and private hospitals providing free/subsidized eye care services in the district and identify NGO facilities that can be considered for non-recurring grants under the programme

7. To organize screening of school children for detection of refractive errors and other eye problems and provide free glasses to poor children

8. To promote eye donation through various media and monitor collection and utilization of eyes collected by eye donation centres and eye banks.

COMPOSITION OF THE DBCS

15 members - 8 ex-officio and 7 other members :

Chairman : District Collector/District Magistrate/Deputy Commissioner

Vice-Chairman : Chief Medical & Health Officer/District Health Officer

Member Secretary : Deputy CMO - District Programme Officer

Technical Advisor : Chief Ophthalmic Surgeon of District hospital. Head of the Department of Ophthalmology

Members :

Medical Superintendent/ Civil Surgeon of Dist. Hosp

District Education Officer

Project Director DRDA/ITDA

Representative of Professional Medical Associations(IMA, District chapter of AIOS etc.)

Representatives from NGOs engaged in eye care services

District Mass media/ IEC officer

Prominent practicing eye surgeons

Eye Camps

Initiated under NPCB to provide comprehensive eye care to rural and outreach areas

Objectives:• Educate methods of prevention and proper ocular

hygiene• Provide medical and surgical treatment

Eye Camps

Functions:• Out-patient and in-patient care• Follow-up of operated cases• Refraction and prescription of glasses• School screening and village survey• Referral of cases requiring special care• Health education

Eye Camps

Operative camps:• Early camp phase• Mid camp phase• End camp phase• Follow-up visitScreening camps:• Screening at periphery• Base hospital approach

Vit A DeficiencyKeratomalacia

Deficiency of vitamin A : malnourished, elderly, chronically sick developing countries.

• Abnormal visual adaptation to darkness, • dry skin, hair, broken fingernails, • decreased resistance to infections

• leading cause of pediatric corneal blindness. ( 350,000 children each year. Most of these children die within a year of going blind.)

Visual Cycle

WHO Xerophthalmia Classification

• XN Night blindness• X1A Conjunctival xerosis• X1B Bitot’s spots• X2 Corneal xerosis• X3 Corneal ulceration Keratomalacia• XS Corneal scarring• XF Xerophthalmic fundus

XN - Night blindness

X1A - Conjunctival xerosis

X1B - Bitot’s spots

X2 - Corneal xerosis

X3 - Corneal ulceration

X3 - Keratomalacia

XS - Corneal scarring

National trachoma control programme

Govt. of India - national trachoma control programme-

Implementation in Punjab, Rajasthan and Uttar Pradesh

Extended in Gujarat, Madhya Pradesh, Bihar and Jammu & Kashmir.

Assistant Director of Health Services (Trachoma) at the Directorate level 2/3 Regional Trachoma Officers

to supervise the work of the trachoma control units.

The Health Education Officer and the Statistical Assistant at the Directorate level have to assist the Assistant Director of Health Services and the Regional Tra choma Officers in the every day super vision of the work in the field units and in organizing effective health education programme in the fields.

The main working unit - a trachoma control field unit, one medical officer in charge, six supervisors and 25 field workers as para-technical staff.

Three main periods : attack period (2 yrs), consolidation period (18 mths) maintenance period (>2 yrs)

Each trachoma control field unit covers one community development block( 75,000 people)

The methodology of treatment :

prophylactic treatment of children under ten or fourteen according to the endemicity,

treatment of their symptomatic family contacts

The treatment programme scheduled as to cover the period of seasonal peaks of associated bacterial conjunctivitis.

"SAFE" which stands for

Surgery for trichiasis (inturned eyelashes), Antibiotics, Facial cleanliness and Environmental improvement

• Write briefly about the National Program for the Control of Blindness (NPCB)

• Write briefly about the District Blindness Control Society (DBCS)

• Write a note on eye camps• Give the WHO classification of Trachoma• What is SAFE strategy?• Name two complications of Trachoma

• A 45 year old construction worker hailing from Rajasthan comes with chronic follicular conjunctivitis. Discuss in detail the etiology, clinical features, complications & management.

• Write the clinical features and treatment of trachoma

• Write the management of trachoma. If untreated, what are the possible complications?

• What is bitot’s spot? Describe its appearance• What is keratomalacia ? Give the

recommended schedule for prophylaxis and treatment of keratomalacia

• Write a brief note on WHO classification of Vit A deficiency

• Give the recommended schedule for Vit A prophylaxis

Thank you