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

Community ophthalmology Synonyms = Public health ophthalmology = Preventive eye care = Preventive Ophthalmology

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

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

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

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

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

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

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”

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

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

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.

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

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.

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

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.

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

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

Concept involved in these programmes 1) Regular screening for early diagnosis. 2) Timely interventions -Referrals. 3) Improvement of basic personal needs and hygiene.

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

Concept involved in these programmes 7) Promotion of community participations. – Training of volunteers. 8) Mobilizing resources within the community and use of appropriate technology

Organizing and delivery of eye care National eye care have been Programmes developed in developed countries Target Reduce blindness and Visual disability

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

How to organize a good national eye care programme? For this purpose Goals should be carefully outlined first

How to find the goals ? Goals for treatment & Prevention Do search and surveys. Find the ground situation. Then find the gap of deficit.

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

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

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

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

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.

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.

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.

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

How to select a good SDRW ? Communication skills and motivation is the criteria for selection (over any academic qualification)

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

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.

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.

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

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)

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.

Including prevention of potentially blinding eye diseases Primary eye care Broad concept Including prevention of potentially blinding eye diseases Through Primary Health Care

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

Primary health care components Adequate supply of safe water and basic sanitation. Maternal & Child Health & Family planning Immunization against major infectious diseases

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

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

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

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

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

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

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

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

The Matrix given below shows how integration can proceed.