1. Cataract Dr. Praveen Vashist
Dr. R.P. Centre for Ophthalmic Sciences, AIIMS

2. Cataract The human lens is a naturally clear structure
This loss of transparency of lens, or opacity formation is called Cataract

3. Symptoms
Cataracts produce a gradual, painless, progressive loss of vision
Glare, especially at night
Halos around lights
The need for brighter light for reading
Double vision in a single eye

4. Blindness Visual Acuity Less than 6/60 in the better eye
6 metres
Blindness
Visual Acuity Less than 6/60
in the better eye
with available correction

5. Magnitude Prevalence of Blindness 8% among 50+ age
Cataract was the commonest cause of blindness (77.5%), low vision (58.1%) and one-eyed blindness (57.5%).
Aged, rural, illiterate, females higher prevalence
Source: Rapid Assessment of Avoidable Blindness in India 2007

6. Causes of Blindness (National survey 2001)
62.6%
19.7%
5.8%
4.7%
0.9%
1.2%
5.0%
Cataract 62%
(Source: Current estimates of Blindness in India, BJO, March 2005)

7. PREVALENCE OF BLINDNESS (< 6/60)
INDIA - 8.5%
< 8.5 % %
> 11%

8. Cataract Surgeries (per million population)
Performance of Cataract Surgery:
Cataract Surgeries (per million population)
Nos. in Lakhs

9. CATARACT SURGICAL COVERAGE(PERSONS).
CS.C = the proportion of operable
cataract cases that have been operated on in a defined population at a particular point in
time
> 70%
50- 70%
< 50%

10. Risk Factors
Everyone is at risk of developing cataracts simply because age is the single greatest risk factor
Exposure to sunlight (UV light)
Smoking
Diabetes
Trauma (blunt or penetrating)
Family history of cataracts
Corticosteroid therapy
Radiation exposure
Dehydration due to repeated diarrheas

11. Risk Factors
Environmental factors - cataract occurs more often and at an earlier age in developing countries
In children due to Hereditary, Genetic and Metabolic Diseases and Maternal Infections like Rubella, Syphilis
DON’T KNOW ???????????

12. Prevention Do not smoke Eat a balanced diet
Protect from sunlight :Ultraviolet light protection
Diabetes Control
Regular eye examination and early detection of senile cataracts.

13. Cataract Surgery
When activities of daily living, such as driving, reading, working, and self-care are affected then surgery should be discussed
Cataract surgery is the only method to restore vision
Cataract surgery is one of the most cost-effective health interventions
short operation period
potential for high volume
high success rate
Low cost

14. Impact of cataract Surgery
A significantly better vision
Improved quality of life
Can retain jobs/occupations
Can become active members of the community.

15. Barriers To Surgery Ignorance of facilities
Don’t know that the operation is simple and safe
Bad Experience of operation in the Community
Services too far
Unaffordable
Waiting for the cataract to mature
No time
No one to accompany
people sometimes expect to go blind as a natural part of ageing, need not felt
Other eye in good condition
Fear
Contraindications

16. Infrastructure Gap Requirement for a Million Population:
What we What we
have need
Eye Hospitals 1 2
Eye Beds 10 50
Cataract Surgical Rate
Vision Centres

17. Human Resource Gap Requirement for a Million Population:
What we What we
have need
Ophthalmologist 10 20
Hospital based Paramedics
Community Based Paramedics
CBR Workers & itinerant teachers ? 15-20
Eye Care Managers ? 2

18. Skills Gap What we What we have need Proportion of IOL 90% > 95%
Visual Outcome < 6/60 33% 5%
Visual Outcome > 6/18 40% 90%
No. of surgeries / active OS

19. Strategies for Control of cataract Blindness

20. Infrastructure development
Construction of Dedicated Eye Wards & Op. rooms at sub-district level.
Provided with high tech ophthalmic equipment - Operating microscopes, Slit lamps, A-Scans and Yag Lasers.
Maintenance of equipments
Appropriate technology: SICS/ Phaco

21. Human resource for eye care
Training of eye surgeons in IOL Surgery, SICS, Phaco
Training of middle level eye-care personnel for primary eye care and supportive services and training in eye care management.
Training medical officers, ophthalmic assistants and other para-medical staff including ASHA and Aanganwadi workers in Primary Eye Care

22. Improved the quality of surgery
Increased the accessibility of free IOL surgery to the masses
Surgery at Base hospital with sterile OT environment & equipment
Follow up after surgery

23. Decentralized planning- DBCS
District Blindness Control Society (DBCS) as the nodal implementing body
The DBCS included representatives from the NGOs & Private Sector
Funds made directly available to the DBCS.
Grants to NGOs is also de-centralized.

24. Involvement of NGOs & Community
Funding for free cataract surgery
Upgrading or expanding of eye care facilities in underserved areas

25. Expanding coverage to underprivileged areas
Orientation of Village based link workers to identify blind persons and motivate them for surgery
Public awareness through mass media, traditional channels and interpersonal communication for increasing utilization of eye care services.

27. Strengthening Monitoring & Evaluation
Standard Cataract Surgery Records ,includes details of preoperative & post op visual acuity & complication
Sentinel Surveillance Units set up in different parts of the country to assess visual outcomes.

28. Projections :2020
The number of cataract blind is projected to increase from 7.75 million (2001) to 8.25 million (2020)
There would be a 2 times increase in cataract surgery among the 50+ population (3.38 million in 2001 to 7.63 million in 2020).
The projected Cataract Surgical Rate among those aged 50+ is projected to increase from 24025/million 50+ (2001) to (2020) per million 50+ .
If the incidence of newly blind and the existing prevalence is considered, then elimination of cataract blindness may not be achieved by 2020 in India.

29. Multi stakeholder Approach
Eye care: Govt , NGos and Pvt sector
Development sector
Education
Rehabilitation

30. Scope of present workshop
To define the Role and responsibilities of each stakeholder for achieving elimination of Blindness by 2020

31. THANK YOU