1. CONTROL OFBLINDNESS

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3. Blindness??? WHO define visual acuity of less than 3/60 (snellen) or its equivalent. Or Inability to count fingers in day light at a distance of 3 metres abhilash pm 3

4. ICD classification of visual impairement cata Visual acuity gory Max less than Mini equal to or better than 0 6/18Low vision 1 6/18 6/60 2 6/60 3/60blindness 3 3/60 1/60 4 1/60 Light perception 5 No light perception abhilash pm 4

5. Problem statement world- 180million visually disabled 45 million blind Prevalence .2-1% 80% avoidable blindness SEAR 60 million 45 million visually disabled;15 million blind& .7million blind children 95% avoidable blindness abhilash pm 5

6. INDIA Annual incidence of cataract induced blindness 2million;~3million people need cataract surgery Prevalence; gen population 1.1% >50 yrs 8.5% 6-7% children have vision problem abhilash pm 6

7. Causes of blindnesscataract 62.6%Refractive error 19.7%glaucoma 5.8%Posterior segment pathology 4.7%Corneal opacity 0.9%Other causes 6.2% abhilash pm 7

8. Epidemiological determinants AGE SEX MALNUTRITION OCCUPATION SOCIAL CLASS SOCIAL FACTORS abhilash pm 8

9. CHANGING CONCEPTS IN EYEHEALTHCAREAcute intervention comprehensive eye healthcare1. Primary eye care2. Epidemiological approach3. Team concept4. Establishment of national programmes abhilash pm 9

10. Primary eye care Inclusion of an eye care component in primary healthcare system Promotion and protection of eye health together with on the spot treatment are its cornerstones Final objectives-increase the coverage and quality of eye healthcare through PHC, improve the utilization of existing resourcesEpidemiological approach Measurement of incidence, prevalence of disease and their risk factors abhilash pm 10

11. Team concept One eye specialist + auxiliary health personnelEstablishment of national programs Started by voluntary agencies Focused on single disease eye camps eg: national trachoma control National blindness control program abhilash pm 11

12. PREVENTION OF BLINDNESS Concept of avoidable blindness Components of action1. INITIAL ASSESSMENT2. METHODS OF INTERVENTION Primary eye care Trained primary health workers 1 village health guide for 1000 populn&2 MPWs for 5000 popln Provided essential drugs Refer cases Promotion of personal hygiene abhilash pm 12

13. Secondary care Definitive management of common blinding condn PHCs &district hospital& mobile eye clinics Cataract surgery; gen health surveys abhilash pm 13

14. Tertiary careEstablished @ national & regional capitalAsso with Med clg& Institute of medRetinal detachment sur; corneal grafting etcEye bankRehabilitation of blind abhilash pm 14

15. Specific programmes1. Trachoma control prog2. School eye health services3. Vitamin A prophylaxis4. Occupational eye health services3.LONG TERM MEASURES Control of infn Improving the quality of life& modifying the risk factors Health education4. EVALUATION abhilash pm 15

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17. NATIONAL PROGRAMME FORTHE CONTROL OF BLINDNESS 1976 Goal reduce prevalence of blindness from1 to .3 abhilash pm 17

18. REVISED STRATEGIES 1) To make NPCB more comprehensive by by strengthening services for other causes of blindness 2) shift frm eye camp approach to fixed facility surg approach;conventional surg to IOL 3) to expand world bank project 4) strengthen participation of voluntary organization 5) enhance the coverage of eye care services in tribal& other under served areas abhilash pm 18

19. OBJECTIVES 1. Reduce the backlog of blindness 2. develop eye care facilities in every district 3. develop human resources for providing eye care services 4. to improve quality of service delivery 5 .to secure participation of voluntary organizations in eye care abhilash pm 19

20. DEVELOPMENT OFINFRASTRUCTURE FOR EYE CARE Strengthening of PHCs Central mobile units Strengthening of Dist hosp Upgrading of Dpts of Ophthalmology in Med clgs Establishment of regional institutes Ophthalmic asst training centres Dist mobile units State ophthalmic cell Estb of DCBSs Eye banks Paramedical ophthalmic assistants posted abhilash pm 20

21. ORGANIZATIONAL STRUCTUREfor NPCBADMINISTRATIONCentral: ophth section Directorate General of health services, ministry of H& FW Delhi state: state ophthalmic cell ,Dir of Health services,State health societies District:DBCS abhilash pm 21

22. Service delivery & referral system Tertiary level : RIO& centres of excellence in eye care Secondary level: Dist hospital& NGO eye hospital Primary level: Sub dist level hosp/ CHC;mob ophth units;upgraded PHCs;link workers;panchayats abhilash pm 22

23. NEW INITIATIVES PROPOSEDUNDER NPCB Construction of dedicated eye wards& eye op theatre in dist hosp of NE state, j&k ,bihar etc Appointment of ophth surgeons &assist in new district hosp Appointment of ophth assistants in PHCs/vision centres Appointment of eye donation counsellors on contract basis in eye banks under govt& NGO sector Grant in aid for NGO for other eye d/s Special attention to clear cataract backlog & take care of other eye care centres frm NE states Telemedicine in ophthalmology Involvement of private practitioners A provision of RS 1550 crore has been proposed for implementation NPCB in 11 five yrs plan Vit A supplement &MMR vaccination via DBCS to prevent childhood blindness Setting up of 5 centres of excellencefor eye care services abhilash pm 23

24. Community health education is a built in component at all levels of NPCB implementation School eye screening programme Collection & utilization of donated eyes abhilash pm 24

25. Externally aided projects World bank assisted cataract blindness control project Danish assistance to NPCB WHO assistance for prevention of blindness abhilash pm 25

26. VISION 2020/ THE RIGHT TO SIGHT Global initiative to reduce AVOIDABLE BLINDNESS by the yr 2020 Target d/s are cataract, childhood blindness,corneal blindness,glaucoma,diabetic retinopathy. Human resource development as well as infrastructure& tech devpt@ various levels of health system abhilash pm 26

27. structure Centres of excellence 20 ry rtia Te Training centres 200 ary Service centres nd 2000 co Se ary Vision centres 20000 imPr abhilash pm 27

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