Community ophthalmology

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Community ophthalmology

• Dr. Saman Wimalasundera
• MBBS DO Ph.D
• Senior lecturer in Community Medicine
• Community Ophthalmologist
• Department of community medicine
• P.O.Box. 70
• Galle
• Sri Lanka

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Community ophthalmology

• Synonyms
• Public health ophthalmology
• Preventive eye care
• Preventive Ophthalmology

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Community ophthalmology

• The Aim To provide the Ophthalmologic services
  to a whole group or sub group of people which
  benefit the largest number of people in the
  community at affordable cost in identifying and
  preventing sight threatening ocular conditions

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Community ophthalmology

• This is a new field.
• New concept for many countries yet.
• Difficult to get it moving.
• Future doctor has a great
• responsibility in developing this field

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Curative ophthalmology

• Remain at the center of all activities
• Community Ophthalmology does not
• dilute its importance
• Focus is only changed from individual
• to community

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What are the major differences in curative
preventive medicine ?
Curative
Preventive
Prevention of disease Population/community Healt
h survey (Community Diagnosis) Health education
improved sanitation, Hygiene, Immunization
etc Prevention of disease Improvement of quality
of life in community
Goals Target Diagnosis Therapy Results
Treatment cure Single patient Physical
examination. Drugs / Surgery Limited to
individuals
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Summary of Activities

• Applied to
• ophthalmology

• Public health
• principles

Activities in community
Prevent Blindness
Reduce the disability caused by poor vision
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Activities in Community

• Fact finding surveys / Research /Screening
• /Clinical care / Health education /Referral
• /Follow up/ Improvement of basic needs etc.

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• Therefore community ophthalmology can
• be explained as a discipline where
• The traditional care applied to an
• individual patient is diverted to a
• population with a prominence placed on
• preventive aspects

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Who is a community eye specialist
Community physician With basic clinical Aspects
of Ophthalmology

• Ophthalmologist
• With Knowledge on Community organization, need,
  structure, epidemiological principals,
  bio-statistics, managerial and communication
  skills

Role depend on the local needs of a country
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Major duties

• Designing and planning of fact finding surveys.
• Planning primary eye care programs.
• - Screening
• - Health education
• - Training
• - Promoting community participation

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Major duties

• Organizing community screening, preventive
  curative programmes
• - Eye camps
• - Surgical camps
• Research in to eye diseases.
• Co-ordination of activities and promoting to
  implement policies for prevention purposes.

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WHO activity on prevention of blindness (PBL)

• PBL Programme was established in 1978.
• At the beginning
• The number of blindness in the world
• Not known

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• Task force was appointed.
• - Surveys
• - According to international
  classification of diseases 1CD 10
• Obtained more epidemiological details.
• BDB (Blindness Data Bank)
• WHO Global data bank on blindness
• - Collection and dissemination of data.

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How to arrange a preventive eye care programmes

• Let us learn the activities involved
• and man power needed.

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Activity
Person

• Primary prevention
• In the community
• through Primary
• Health Care(PHC)
• Secondary
• prevention
• Identify and treat in
• the community

• Primary health care
• workers
• Volunteers(Trained)
• P.H.Workers
• General physicians
• Community
• Ophthalmologist.

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Activity
Person

• Identify and refer
• for Treatment
• Diagnose and
• treatment or
• Diagnose and
• refer

• PEC Workers
• Optometrists
• General physicians.
• PEC Workers.
• General physicians
• Community
• Ophthalmologist

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Activity

• PEC Workers To identify ocular diseases or
  systemic diseases that cause ocular
  problems.
• Work in the community
• Prevent visual disability and blindness.

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Concept involved in these programmes

• 1) Regular screening for early diagnosis.
• 2) Timely interventions -Referrals.
• 3) Improvement of basic personal needs and
  hygiene.

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Concept involved in these programmes

• 4) Provision of safe water / good nutrition.
• 5) Health education.
• 6) Integration of PHC workers in to the programme.

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Concept involved in these programmes

• 7) Promotion of community participations.
  Training of volunteers.
• 8) Mobilizing resources within the community and
  use of appropriate technology

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Organizing and delivery of eye care

• National eye care have been
• Programmes developed in
• developed countries
• Target Reduce blindness and
• Visual disability

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Organizing and delivery of eye care

• Organized by the health authority of a
• Country
• Supported by various
• N.G.O /Other institutions
• Universities etc.
• Eye care foundations.
• Follow the guidelines set by WHO

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How to organize a good national eye care
programme?

• For this purpose
• Goals should be carefully outlined first

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How to find the goals ?

• Goals for treatment Prevention
• Do search and surveys.
• Find the ground situation. Then find the
• gap of deficit.

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How to find the goals ?

• Fill the deficit need through national eye
• care Plan

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By organizing

• Eye clinics
• Mobile eye services
• Primary eye care programmes
• Blindness prevention activities
• Infra-structure developments
• Man power improvement
• Changing policies
• Community Ophthalmology

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Delivery of eye care- model
Community ophthalmology center
Primary eye care
Secondary eye care
Large hospitals
National teaching hospitals
Tertiary eye care
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What is a mobile eye unit ?

• Some Community ophthalmology centers have mobile
  eye units.
• Team - Ophthalmic medical auxiliary
• Assistant
• Vehicle driver.

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mobile eye unit

• All instruments for primary eye care and a
• vehicle is provided.
• Work on pre arranged schedule with rural
• health centers
• Visit rural health centers and perform in
• the community with the support from
• local health personal.
• Treatment and refer.

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mobile eye unit

• Mobile eye unit is based at a community
• ophthalmology center.
• Community Over all Incharge
• Ophthalmologist
• Have to regularly supervise the activities of
  mobile team.
• Regularly visit rural health centers.
• Organize curative camps.

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Primary eye care workers

• Survey Detection Referral Workers
• SDRW.
• What is a SDRW ?
• Is the most important person of this whole
  programme.
• Attached to the community ophthalmology
• center.

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Duties of SDRW

• Screen, Sensitize and inform patients
• and families on their problems.
• Refer for treatment
• provide simple medication

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How to select a good SDRW ?

• Communication skills and motivation is
• the criteria for selection (over any
• academic qualification)

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What is the position of the SDRW ?

• Should be recognized as a member of the staff of
  the community ophthalmology center.
• Regularly supervised by a head nurse.
• Work require Continuous supervision and
  encouragement

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What is the training a SDRW should have before
going to the field ?

1. Basic knowledge on structure and function of the
   eye
2. Recording of visual acuity.
3. Recognize a normal healthy eye common eye
   problems.

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What is the training a SDRW should have before
going to the field ?

• Ability to identify Cataract / Squint /
  Refractive errors / Eye injuries / Infections /
  FB.
• Identify corneal scars / differentiate from
  cataract.

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What is the training a SDRW should have before
going to the field ?

• Explanations about common eye problems
• - To explain it to the people
• To recognize and refer serious eye injuries

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What is the training a SDRW should have before
going to the field ?

1. Activities and responsibilities of the eye unit
   and staff.
2. How to meet with a family (communication skills)

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What is the training a SDRW should have before
going to the field ?

• During training they should witness at least
  three cataract surgeries
• - Taken visual acuity of 10 patient
• - Perform pinhole test.

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Primary eye care

• Broad concept
• Including prevention of potentially blinding eye
  diseases
• Through

Primary Health Care
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• Let us identify the eight essential
• components of primary health care(PHC)
• Education concerning main health problems.
• Promotion of food supply and good nutrition.

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Primary health care components

• Adequate supply of safe water and basic
  sanitation.
• Maternal Child Health Family planning
• Immunization against major infectious diseases

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Primary health care

1. Prevention and control of local endemic diseases
2. Appropriate treatment of common diseases and
   injuries
3. Provision of essential drugs

Primary eye care is derived out of these 8
essentials
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• Primary eye care is the essential building
• block for prevention of blindness
• restoration of vision
• In all communities all regions of the world
• Clinical care
• Provides individual attention
• Little is achieved in terms of prevention
• But primary eye care can not function effectively
  
• in isolation.
• Should go hand in hand with clinical field

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following eye conditions are Integrated in to
primary health care

• Cataract
• Trachoma
• Eye injuries
• Corneal ulcers
• Glaucoma

• Ophthalmic neonatorum
• Eye infections
• Pterigium
• Refractive errors
• Conditions with VA lt 3/60

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WHO Guidelines for primary eye care

• 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

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• Trauma
• - Sub conjunctival hemorrhages
• - Superficial FB
• - Blunt trauma
• Blinding Malnutrition

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• 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

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

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Integration of PEC in to PHC

• PEC should not be planned
• separately from PHC which is
• considered the mother system that
• carry the goals of PEC to the
• community by integration

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The Matrix given below shows how integration can
proceed.