Community

Ophthalmology

(Public Health Ophthalmology,

Community
Eye
Health)
Bambang Setiohadji

Community Ophthalmology Unit

Cicendo Eye Hospital/Dept of
Ophthalmology Medical Faculty
of,Padjadjaran University

Prevention of Blindness
There are 4 important question to be
asked
when considering prevention of
blindness:
these are :
What is blindness ?
- DEFINITION
How many are blind ? - MAGNITUDE
Why are people blind ? - AETIOLOGY
What can we do ?
- CONTROL

What is Blindness
Classified visual impairment and blindness
into various grades (WHO)
CORRECTED VISUAL ACUITY IN BETTER EYE
6/6
- 6/18
:
<6/18 - 6/60 :
<6/60 - 3/60 :
IMPAIRMENT <3/60 -

NORMAL
VISUAL IMPAIRMENT
SEVERE VISUAL
NPL
:
BLIND

How many are blind

Estimates for the number of blind people
0.3% good economy/health services
0.6% reasonable economy/health
services
0.9% poor economy/health services
1.2% very poor economy/health
services

How many are blind

Estimates blind people in
Indonesia according prevalence of
blindness survey :
1982
:
1.2 %
1993-1996
:
1.5
%
0 % Problem
0.5 % >

0.5 % Clinical

1.0 % Public Health

problem
1.0 %
Social Problem

Why are people blind

The major causes of blindness in Asia

Cataract
Trachoma
Corneal disease
Glaucoma
Vitamin A deficiency

are :

Why are people blind

Prevalence of blindness in
Indonesia caused by :
Cataract
0.78 %
Glaucoma
0.20 %
Refraction error
0.14 %
Retinal disturbance 0.13 %
Corneal disease
0.10 %
Others
0.15
%
(Prevalence of blindness survey,19931996)

What We Can Do ?
Control of Blindness

Strategy Approach

Disease Orientated Approach

Services Approach

Community Approach

Control of Blindness
Strategy Approach
Primary Prevention
: prevent disease
occurring
Secondary Prevention : prevent visual loss
Tertiary Prevention

: restore vision

Control of Blindness
Disease Orientated Approach :
Cataract service delivery
Vitamin A supplementation
Trachoma control

Control of Blindness
Services Approach

Community

Eye Clinic

3
Training Centre

BLINDING EYE DISEASES

Trachoma
Onchocerciasis
Vitamin A Defi

Cataract
Glaucoma
Diabetic Retinopathy

Occurs Everywhere
Individuals/mainly adults
Needs An Eye Doctor
Eye DoctorBASED
HOSPITAL

Focal Disease
Communities
Doesnt Need

COMMUNITY BASED

BOTH ARE ESSENTIAL

Control of Blindness
Community Ophthalmology Activities
EYE CAMP
An EYE CAMP is an activity in which a
medical team from the hospital visits the
villages and examines peoples eyes to
detect any problems

CHILDHOOD BLINDNESS
Definition
:
A child is defined by UNICEF as individual
aged less than 16 years
Blindness is defined as corrected visual
acuity of less than 3/60 in the better eye
Severe visual impairment as a corrected
visual acuity in the better eye of < 6/60
3/60

Prevalence of blindness
in children
0.3/1000 - 1.5/1000 children
0.4/1000 children in high income region
0.7/1000 children in middle income region
0.9/1000 children in low income region

Incidence of blindness
INCIDENCE of BLINDNESS
A few data , suggest of 6-11/100.000 children/year
Estimation : 500.000 become blind each year
( 1 /minute) but 50%-60% die within one or two years
mainly as a result of the condition causing blindness
MAGNITUDE of BLINDNESS
Estimation : 1.400.000 blind children world wide
(73% in low income countries)

Trends in the major causes of childhood blindness

Levels socioeconomic development and health care
provision
ROP important cause of blindness in middleincome countries introduce intensive care services
CHILDHOOD BLINDNESS
IN THE CONTEX OF VISION 2020
The five priorities problems are :
Cataract
Trachoma
Childhood blindness
Onchocerciasis
Refractive errors

Vitamin A Deficiency
Xerophthalmia Classification (WHO,1976)
Signs
Classificatio
n
Primary
X1A

Conjungtival xerosis

X1B

Bitots spot with cunjungtival

xerosis

X2

Corneal Xerosis

X3A

Corneal ulceration with xerosis

X3B

Keratomalacia
Secondary

XN

Nightblindness

XF

Xerophthalmia fundus

XS

Corneal scars

Vitamin A Deficiency
Xerophthalmia Classification (WHO,1976)

Nightblindness
Cause is lack of rhodopsin in retinal
fotoreceptor
Usually reversible in 48 hours with treatment

Vitamin A Deficiency
Xerophthalmia Classification
(WHO,1976)
X1A - Conjungtival xerosis
Due absence of goblet cells
Improves to 2-4 days with treatment

Vitamin A Deficiency
Xerophthalmia Classification (WHO,1976)
X1B - Bitots spot
Due keratinisation, white or grey, foamy, usually temporal
take week or months to resolve with treatment

Vitamin A Deficiency
Xerophthalmia Classification (WHO,1976)
X2 - Corneal xerosis
drying of the cornea, decreased of wettability of the
cornea,
corneal epithelium keratinisation in severe cases

Vitamin A Deficiency
Xerophthalmia Classification
(WHO,1976)
X3A - ulceration of
less than 1/3 of the
cornea
X3B - ulceration of
1/3 or more of the
cornea
5-7 days to heal
with scar formation

Keratomalacia

Circumscribed
area of cornea
is missing
centrally
Iris bulging
through the
defect

Control of Vitamin A Deficiency

1. Short term
Single dose Vit A Capsules 200.000 IU
High risk group children e.g, measles,
malnourished,acute and prolonged
diarrhoea
Vit A Capsules 200.00O IU : 1st, 2nd and
15th
Vit A Capsules 400.000 IU : to children
at
childbirth
2.

Mid term
Remove risk factors, measles
imunisation and diarrhoea control

3.

Long term
Improve nutrition of children and
pregnant woman

Treatment of Xerophthalmia

Immediately on diagnosis
orally

The following day

4 weeks

200.000 IU Vit A

200.000 IU Vit A orally

200.000 IU Vit A orally

Children under 1 year old and any age who weight less
than
8 kg treat with half doses

Vitamin A Supplements :
Prevention of Vit A Deficiency

Children 1 6 years old

200.000
IU Vit A orally every 3 6 months

Infants 6-12 months old

Vit A
(any older children , <8 kg

100.000 IU