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Aravind Kumar
• Blindness
• National Programs
• Global Programs
• Conclusion
• Devastating condition
• Deep emotional and economic
implications
• Inability to perceive light
• WHO
– Best-corrected visual acuity in the better
eye less than 3/60 (Snellen)
– Field of vision less than 10°
Economic
Blindness <6/60-3/60
Social
Blindness <3/60-1/60
Legal
Blindness <1/60-PL
Total
Blindness No PL
Preventable Blindness:
Attacking at the
appropriate time
Avoidable Blindness
Curable Blindness:
Restoration by timely
intervention
• 285 million – visually impaired
• 39 million – blind
• 246 million – low vision
• 82% of blinds – 50 and above
• 50% of blinds – low-income areas
• 80% of blindness – preventable or
curable
DEVELOPING DEVELOPED
NATIONS NATIONS
Trachoma Cataract ARMD
Onchocerciasis Refractive Diabetic retinopathy
errors
Childhood blindness
Glaucoma
Xerophthalmia
Infectious diseases
Infants/ School-Age
Adulthood Late Adulthood Elderly
Preschoolers Children
Congenital and Developmental
Diabetes
Anomalies
Congenital Glaucoma Neurological Conditions Cataract
Industrial
Congenital Cataract Trauma Glaucoma
Injuries
Pathological
Optic Atrophy Retinal Vasculopathies
Myopia
Infectious
Retinoblastoma Trachoma
Diseases
Retinopathy of
ARMD
Prematurity
Xerophthalmia
• Blindness due to infections – reduced;
blindness due to age – increased
• Cataract – leading cause of blindness
• Correction of refractive errors – normal
vision for 12 million children
Inadequacy
of
ophthalmic
personnel
Disease Percentage Lack of
Man-made
availability
blindness
Cataract 62.6 of services
Vitamin A
Supplementation
Control of
Disease
Trachoma
Screening for
Refractive Errors
Ivermectin for
Onchocerciasis
• Primary Care – at community level
• Secondary care – at eye clinic level
Services • Tertiary care – at training or
referral center level
Community Approach
Other Programs
International Association
for the Prevention of
Blindness (IAPB)
Global
Vision 2020: The Right to
Sight
Establishment
of Permanent
Infrastructure
Intensification
of Eye Health
Education
• Done through state and district mobile ophthalmic
units
• “Eye camp approach” in rural areas
• Facilities provided:
– Medical and surgical treatment of common
ailments
– Detection and correction of refractive errors
– Thorough ocular examination, including in
children
– Rehabilitation
– Surveys
Peripheral
sector –
“primary eye
care”
Intermediate
sector –
“secondary eye
care”
Central sector –
“tertiary eye
care”
Apex National
Institute of
Ophthalmology
• Components
– Community worker
– Ophthalmic Assistant at PHC or BPHC
• Strengthened by:
– Providing necessary equipment and ophthalmic
Peripheral
assistants
sector
– Organizing refresher courses
• Services
– Treatment of common eye ailments
– Vitamin A prophylaxis
– Correction of refractive errors
• Components
– Subdivisional hospital
– District hospital
• Strengthened by:
Intermediate – Development of diagnostic and treatment facilities
sector at district and subdivisional levels
• Services
– Treatment of common causes of blindness
– Organization of MOU
– Eye camps through MOU
• Components
– Medical Colleges and RIOs
– State and National Hospitals
• Strengthened by:
Central – Upgradation of eye departments
sector – Establishment of RIOs.
• Services
– Sophisticated eye care
– Organization of eye banks
– CMEs and specialized training programs
– Research
• Dr. Rajendra Prasad Institute of
Ophthalmic Sciences, AIIMS, New Delhi
Apex National – Converted into a COE
Institute of
Ophthalmology – Overall leadership, supervision, and
guidance in matters to all services under
NPCB
• Done through mass media (IEC)
• Emphasis:
– Care and hygiene of eyes
– Prevention of avoidable diseases
• Hygiene of vision in school
– Good reading posture
– Proper lighting
– Avoidance of glare
– Maintenance of proper distance
• Cataract Surgery (2 months)
– ECCE, IOL, SICS, Phaco, Keratometry, Yag-laser
Capsulotomy
– SICS-trained surgeons proceed to Phaco
• Pediatric Ophthalmology (3 months)
– Amblyopia, Squint, Cataract, Glaucoma, and ROP
• Medical Retina and Vitreo-retinal Surgery (3 months)
– Indirect Ophthalmoscopy, Fundus Fluorescein
Angiography
• Low Vision Services (1 week)
– Handling of instruments, management of patients
• Construction of dedicated eye wards and operation
theaters
• Appointment of ophthalmic surgeons and assistants
• Ophthalmic assistants at primary health care centers
• Appointment of eye donation counselors
• Grant-in-Aid to NGOs for management of eye
ailments
• Treatment of childhood blindness
• Clearing cataract backlog from the northeastern
states
• Involvement of private practitioners
• Responsibility of National Program Management Cell,
DGHS, Govt. of India
• Bodies
– National Blindness Control Board
– National Program Coordination Committee
– National Technical Advisor Committee
• Activities
– Procurement of goods, services, and consultancy
– Aid to NGOs
– Organization of programs and IEC activities
• Implemented through State Governments
• State Program cell
– Five posts, including a Joint Director (NPCB)
• Activities
– Execution of civil works for new units
– Repair and renovation of existing units
– State Project Cell
– State-level training and IEC activities
• Functions
– Coordinate and monitor with district health societies
– Conduct regular review meetings with districts
– Procure equipment and drugs for use in GOI
– Receive and monitor use of funds, equipment, and
material
– Involve voluntary organizations
– Promote eye donation through various channels
• Formed in 1994
• “Achieve maximum reduction in avoidable blindness
through optimal utilization of available resources”
• Components
– Comprehensive Eye Care
– School Eye Service
– Community-based Rehabilitation
• Need for Establishment
– Control of blindness as part of Govt. policy
– Simplify administration and financial procedures
– Enhanced participation in both community and private
sectors
• Revised Activities
– Annual district action plan – submitted to
DBCS
– Accountability of NGO participation
– Utilization of existing govt. facilities
– Shift from camp surgery to institutional
surgery
– Infrastructure and manpower for IOL
implantation
• Functions
– Assess the magnitude and spread of blindness
in the district
– Organize screening camps
– Plan and organize training programs
– Receive and monitor use of funds
– Involve voluntary and private organizations
– Screening for schoolchildren
– Promotion of eye donation
• 307 dedicated wards and operation theaters built in
district-level hospitals
• Supply of equipment for diagnosis and treatment of
common ophthalmic ailments
• >2000 eye surgeons trained in IOL and other super-
specialties
• 50,40,336 cataract operations performed in 2006-07;
94% were with IOL implantation
– Passes the target of 45,00,000
• Increase of Cataract Surgery Rate – currently
4500/million
• Vitamin A Prophylaxis
– 2 lacs IU orally between 1-6 years
• Occupational Health Service
– Prevent and treat eye hazards in the
industrial force
• Launched by WHO in 1978
• Control Strategies
– Assessment of common blinding
disorders
– Establishment of national-level
programs
– Training of eye care providers
– Operational Research
• Established on January 1, 1975
• Coordinating, umbrella organization
• International effort for blindness
prevention activities
• Links professional bodies, NGOs,
educational institutions, and interested
individuals
• Universal Eye Health: A Global Action Plan
2014-2019
• Provision of effective and accessible eye care
• Three indicators to measure progress at the
national level:
– Prevalence and causes of Eye Impairment
– Number of eye care personnel
– Cataract surgical service delivery
• Global initiative by WHO
• February 18th, 1999
• Broad coalition with Task Force of
International NGOs
• Reduce avoidable (preventable and
curable) blindness by 2020
Objectives