1. 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

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 great
responsibility in developing this field

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

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

7. Summary of Activities Applied to ophthalmology Public health
principles
Activities in community
Prevent Blindness
Reduce the disability
caused by poor vision
Main Aims of
Community
Ophthalmology

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 an
individual patient is diverted to a
population with a prominence placed on
preventive aspects”

10. Who is a community eye specialist
Ophthalmologist
With Knowledge on Community organization, need, structure,& epidemiological principals, bio-statistics, managerial and communication skills
Community physician
With basic clinical
Aspects of
Ophthalmology
Role depend on the
local needs
of 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 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.

13. 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

14. Obtained more epidemiological details.
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.

15. How to arrange a preventive eye care programmes
Let us learn the activities involved
and man power needed.

16. Activity Person Primary health care workers Volunteers(Trained)
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.

17. Activity Person Identify and refer for Treatment Diagnose and
treatment or
refer
PEC Workers
Optometrists
General physicians.
PEC Workers.
General physicians
Community
Ophthalmologist

18. Activity
PEC Workers To identify ocular diseases or systemic diseases that cause ocular problems.
Work in the community
Prevent 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 been
Programmes developed in
developed countries
Target Reduce blindness and
Visual disability

23. 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

24. How to organize a good national eye care programme?
For this purpose
Goals 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 the
gap of deficit.

26. How to find the goals ? Fill the deficit need through national eye
care Plan
HOW

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

28. Delivery of eye care- model
Community
ophthalmology center
Primary eye care
Secondary eye
care
Large hospitals
National teaching
hospitals
Tertiary eye care

29. What is a mobile eye unit ?
Some Community ophthalmology centers have mobile eye units.
Team :- Ophthalmic medical auxiliary
Assistant
Vehicle driver.

30. 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.

31. 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.

32. 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.

33. Duties of SDRW Screen, Sensitize and inform patients
and families on their problems.
Refer for treatment
provide simple medication

34. How to select a good SDRW ?
Communication skills and motivation is
the criteria for selection (over any
academic 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 eye
Recording 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 people
To 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 care
Broad concept
Including prevention of potentially blinding eye diseases
Through
Primary 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 planning
Immunization against major infectious diseases

44. Primary eye care is derived out of these 8 essentials
Primary health care
Prevention and control of local endemic diseases
Appropriate treatment of common diseases and injuries
Provision of essential drugs
Primary eye care is derived out of these 8 essentials

45. 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

46. 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 < 3/60

47. 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

48. Trauma
- Sub conjunctival hemorrhages
- Superficial FB
- Blunt trauma
Blinding Malnutrition

49. 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

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

51. 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

52. The Matrix given below shows how integration can proceed.