Cataract

Dr. Praveen VashistDr. R.P. Centre for Ophthalmic Sciences, AIIMS

Cataract The human lens is a

naturally clear structure

This loss of transparency of lens, or opacity formation is called Cataract

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

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

6 metres

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

Causes of Blindness (National survey 2001)

(Source: Current estimates of Blindness in India, BJO, March 2005)

62.6%19.7%5.8%4.7%0.9%1.2%5.0%

Cataract 62%

PREVALENCE OF BLINDNESS (< 6/60)

8.5 - 11%

< 8.5 %

> 11%

INDIA - 8.5%

Nos. in Lakhs

Performance of Cataract Surgery: 1985-2007

Performance of Cataract Surgery 1985-2007

11.8510.9611.9715.1216.05

19.1421.67

24.7127.23

30.3531.7133.56

36.4437.0038.5741.98

44.91

49.0550.4052.73

11.96

12.0912.19

0

10

20

30

40

50

60

Cataract Surgeries (per million population)

CATARACT SURGICAL COVERAGE(PERSONS)

50- 70%

> 70%

< 50%

CS.C = the proportion of operablecataract cases that have been operated on in a defined population at a particular point intime

.

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

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 - ???????????

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.

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

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

Impact of cataract Surgery

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

Infrastructure GapInfrastructure Gap

Requirement for a Million Population:

What we What wehave need

Eye Hospitals 1 2

Eye Beds 10 50

Cataract Surgical Rate 5000 9000

Vision Centres 5-10 20

Requirement for a Million Population:

What we What wehave need

Eye Hospitals 1 2

Eye Beds 10 50

Cataract Surgical Rate 5000 9000

Vision Centres 5-10 20

Human Resource GapHuman Resource GapRequirement for a Million Population:

What we What wehave need

Ophthalmologist 10 20

Hospital based Paramedics 10-20 60-80

Community Based Paramedics 10 30-40

CBR Workers & itinerant teachers ? 15-20

Eye Care Managers ? 2

Requirement for a Million Population:What we What we

have needOphthalmologist 10 20

Hospital based Paramedics 10-20 60-80

Community Based Paramedics 10 30-40

CBR Workers & itinerant teachers ? 15-20

Eye Care Managers ? 2

Skills GapSkills Gap

What we What wehave need

Proportion of IOL90% > 95%

Visual Outcome < 6/60 33% 5%

Visual Outcome > 6/18 40% 90%

No. of surgeries / active OS 500 1000

What we What wehave need

Proportion of IOL90% > 95%

Visual Outcome < 6/60 33% 5%

Visual Outcome > 6/18 40% 90%

No. of surgeries / active OS 500 1000

Strategies for Control of cataract Blindness

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

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

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

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.

Involvement of NGOs & Community

Funding for free cataract surgery Upgrading or expanding of eye care facilities

in underserved areas

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.

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.

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 27817 (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.

Multi stakeholder Approach Eye care: Govt , NGos and Pvt

sector Development sector Education Rehabilitation

Scope of present workshop

To define the Role and responsibilities of each stakeholder for achieving elimination of Blindness by 2020

THANK YOU