Presentation on theme: "Community ophthalmology"— Presentation transcript:
1 Community ophthalmology Dr. Saman WimalasunderaMBBS DO Ph.DSenior lecturer in Community Medicine& Community OphthalmologistDepartment of community medicineP.O.Box. 70GalleSri Lanka
2 Community ophthalmology Synonyms= Public health ophthalmology= Preventive eye care= Preventive Ophthalmology
3 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
4 Community ophthalmology This is a new field.New concept for many countries yet.Difficult to get it moving.Future doctor has a greatresponsibility in developing this field
5 Curative ophthalmology Remain at the center of all activitiesCommunity Ophthalmology does notdilute its importanceFocus is only changed from individualto community
6 What are the major differences in curative & preventive medicine ? Prevention of diseasePopulation/communityHealth survey (Community Diagnosis)Health education improved sanitation,Hygiene, Immunization etcImprovement of quality of life in communityGoalsTargetDiagnosisTherapyResultsTreatment & cureSingle patientPhysical examination.Drugs / SurgeryLimited to individuals
7 Summary of Activities Applied to ophthalmology Public health principlesActivities in communityPrevent BlindnessReduce the disabilitycaused by poor visionMain Aims ofCommunityOphthalmology
8 Activities in Community Fact finding surveys / Research /Screening/Clinical care / Health education /Referral/Follow up/ Improvement of basic needs etc.
9 Therefore community ophthalmology can be explained as a discipline where“The traditional care applied to anindividual patient is diverted to apopulation with a prominence placed onpreventive aspects”
10 Who is a community eye specialist OphthalmologistWith Knowledge on Community organization, need, structure,& epidemiological principals, bio-statistics, managerial and communication skillsCommunity physicianWith basic clinicalAspects ofOphthalmologyRole depend on thelocal needsof a country
11 Major duties Designing and planning of fact finding surveys. Planning primary eye care programs.- Screening- Health education- Training- Promoting community participation
12 Major dutiesOrganizing community screening, preventive & curative programmes- Eye camps- Surgical campsResearch in to eye diseases.Co-ordination of activities and promoting to implement policies for prevention purposes.
13 WHO activity on prevention of blindness (PBL) PBL Programme was established in 1978.At the beginningThe number of blindness in the worldNot known
14 Obtained more epidemiological details. Task force was appointed.- Surveys- According to international classification of diseases 1CD – 10Obtained more epidemiological details.BDB (Blindness Data Bank)WHO Global data bank on blindness- Collection and dissemination of data.
15 How to arrange a preventive eye care programmes Let us learn the activities involvedand man power needed.
16 Activity Person Primary health care workers Volunteers(Trained) Primary preventionIn the communitythrough PrimaryHealth Care(PHC)SecondarypreventionIdentify and treat inthe communityPrimary health careworkersVolunteers(Trained)P.H.WorkersGeneral physiciansCommunityOphthalmologist.
17 Activity Person Identify and refer for Treatment Diagnose and treatment orreferPEC WorkersOptometristsGeneral physicians.PEC Workers.General physiciansCommunityOphthalmologist
18 ActivityPEC Workers To identify ocular diseases or systemic diseases that cause ocular problems.Work in the communityPrevent visual disability and blindness.
19 Concept involved in these programmes 1) Regular screening for early diagnosis.2) Timely interventions Referrals.3) Improvement of basic personal needs and hygiene.
20 Concept involved in these programmes 4) Provision of safe water / good nutrition.5) Health education.6) Integration of PHC workers in to the programme.
21 Concept involved in these programmes 7) Promotion of community participations. – Training of volunteers.8) Mobilizing resources within the community and use of appropriate technology
22 Organizing and delivery of eye care National eye care have beenProgrammes developed indeveloped countriesTarget Reduce blindness andVisual disability
23 Organizing and delivery of eye care Organized by the health authority of aCountrySupported by variousN.G.O /Other institutionsUniversities etc.Eye care foundations.Follow the guidelines set by WHO
24 How to organize a good national eye care programme? For this purposeGoals should be carefully outlined first
25 How to find the goals ? Goals for treatment & Prevention Do search and surveys.Find the ground situation. Then find thegap of deficit.
26 How to find the goals ? Fill the deficit need through national eye care PlanHOW
27 By organizing Community Ophthalmology Mobile eye services Eye clinicsMobile eye servicesPrimary eye care programmesBlindness prevention activitiesInfra-structure developmentsMan power improvementChanging policiesCommunity Ophthalmology
28 Delivery of eye care- model Communityophthalmology centerPrimary eye careSecondary eyecareLarge hospitalsNational teachinghospitalsTertiary eye care
29 What is a mobile eye unit ? Some Community ophthalmology centers have mobile eye units.Team :- Ophthalmic medical auxiliaryAssistantVehicle driver.
30 mobile eye unit All instruments for primary eye care and a vehicle is provided.Work on pre arranged schedule with ruralhealth centersVisit rural health centers and perform inthe community with the support fromlocal health personal.Treatment and refer.
31 mobile eye unit Mobile eye unit is based at a community ophthalmology center.Community Over all InchargeOphthalmologistHave to regularly supervise the activities of mobile team.Regularly visit rural health centers.Organize curative camps.
32 Primary eye care workers = Survey – Detection – Referral – WorkersSDRW.What is a SDRW ?Is the most important person of this whole programme.Attached to the community ophthalmologycenter.
33 Duties of SDRW Screen, Sensitize and inform patients and families on their problems.Refer for treatmentprovide simple medication
34 How to select a good SDRW ? Communication skills and motivation isthe criteria for selection (over anyacademic qualification)
35 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
36 What is the training a SDRW should have before going to the field ? Basic knowledge on structure and function of the eyeRecording of visual acuity.Recognize a normal healthy eye & common eye problems.
37 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.
38 What is the training a SDRW should have before going to the field ? Explanations about common eye problems- To explain it to the peopleTo recognize and refer serious eye injuries
39 What is the training a SDRW should have before going to the field ? Activities and responsibilities of the eye unit and staff.How to meet with a family (communication skills)
40 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.
41 Including prevention of potentially blinding eye diseases Primary eye careBroad conceptIncluding prevention of potentially blinding eye diseasesThroughPrimary Health Care
42 Let us identify the eight essential components of primary health care(PHC)Education concerning main health problems.Promotion of food supply and good nutrition.
43 Primary health care components Adequate supply of safe water and basic sanitation.Maternal & Child Health & Family planningImmunization against major infectious diseases
44 Primary eye care is derived out of these 8 essentials Primary health carePrevention and control of local endemic diseasesAppropriate treatment of common diseases and injuriesProvision of essential drugsPrimary eye care is derived out of these 8 essentials
45 Primary eye care is the essential building block for prevention of blindness &restoration of visionIn all communities & all regions of the worldClinical careProvides individual attentionLittle is achieved in terms of preventionBut primary eye care can not function effectivelyin isolation.Should go hand in hand with clinical field
46 following eye conditions are Integrated in to primary health care CataractTrachomaEye injuriesCorneal ulcersGlaucomaOphthalmic neonatorumEye infectionsPterigiumRefractive errorsConditions with VA < 3/60
47 WHO Guidelines for primary eye care Conditions to be recognized and treated by a trained primary eye care workerConjunctivitis and lid infections- Acute conjunctivitis- Ophthalmia neonatorum- Trachoma- Allergic & Irritative conjunctivitis- Lid lesions – chalazion
48 Trauma- Sub conjunctival hemorrhages- Superficial FB- Blunt traumaBlinding Malnutrition
49 Conditions to be recognized and referred after treatment has been initiated. Corneal ulcersLacerating or perforating injuries of the eye ballLid lacerationsEntropion / TrichiasisBurns - Chemical- Thermal
50 Conditions that should be recognized and referred for treatment. Painful red eye with visual lossCataractPtergiumVisual loss < 6/18 in either eye
51 Integration of PEC in to PHC PEC should not be plannedseparately from PHC which isconsidered the mother system thatcarry the goals of PEC to thecommunity by integration
52 The Matrix given below shows how integration can proceed.