LVP Eye Health Pyramid
Glaucoma Care
Dr G. Chandrasekhar
LVPEI Eye Health Pyramid
From Screening to Management of
Complex Diseases
Adv. Tertiary
• Appropriate
Tertiary
• Available
Secondary
Primary
• Affordable
• Accessible
Community
Without Compromising Quality
PRIMARY CARE:
PUTTING PEOPLE FIRST
Organizing primary-care networks
• Continuity of care
• Bringing care closer to the people
• Responsibility for a well-identified
population
Village Vision Complex
Integrated Secondary & Primary Eye Care
Secondary Eye Care
+
10 Vision Centres
+
100 Vision Guardians
Direct Service to 100-200 villages
Center of Excellence
Four Tertiary
10+9 Secondary
89 Primary
Community
Adv.Tertiary 1987
Tertiary 2003
Secondary 1992
Primary 2002
Community 2004
Community Level
(Vision Guardian)
Centre of Excellence
Training centre
Service Centre
Vision Centre
Vision Guardian
•
•
General awareness
Refer those with
problems
Primary Care
(Vision Technician)
Centre of Excellence
Training centre
Service Centre
Vision Centre
Vision Guardian
•
•
•
•
•
History
High IOP
Optic nerve
Van Herrick’s
Referral
Secondary Care
(Ophthalmologist)
Centre of Excellence
Training centre
Service Centre
Vision Centre
Vision Guardian
•
•
•
•
•
•
History Slit lamp
Applanation tonometry
Gonioscopy
Optic nerve
Visual fields
Medical and Surgical Rx
Tertiary Care
(Subspecialities)
Centre of Excellence
•
Diagnosis & treatment
of complicated
problems
•
•
Training
Training centre
Service Centre
Vision Centre
Vision Guardian
Research
Advanced Tertiary Care
(Team of Subspecialists)
CENTRE OF EXCELLENCE
Centre of Excellence
•
Management of
complex cases
•
Training of
Subspecialists and
trainers
•
•
•
•
Educational standards
Training centre
Service Centre
Vision Centre
Vision Guardian
Research
Advocacy
Capacity building of
Training Centres
Advanced Tertiary Care
(Team of Subspecialists)
CENTRE OF EXCELLENCE
Capacity building of
Training Centres
Centre of Excellence
Training centre
Service Centre
Vision Centre
Vision Guardian
•
•
Situation analysis
•
Redesigning of physical
space
•
•
•
•
Equipment
Modification of
infrastructure
Training of Trainers
Implementation
Monitoring and
evaluation
Village Vision Complex
Integrated Secondary & Primary Eye Care
Secondary Eye Care
+
10 Vision Centres
+
100 Vision Guardians
Direct Service to 100-200 villages
Secondary Centres Data (1998-2011)
Centre Name
Mudhole
Tudukurthy
Adilabad
Karamchedu
Markapuram
Kandukur
Nellore
Paloncha
Cherukupalli
Total
Glaucoma
OPD
in OPD
Trab.
1162
213108
143528
534
71603
86
84997
481
44638
303
13854
156
21987
41
20990
156
2155
30
616860
2949
Yag PI
814
377
66
109
88
5
0
6
0
1465
409
118
23
30
0
0
0
64
0
644
Glaucoma – Vision Centres
April 2010 to Jan 2012
All Centers (76)
Screening High IOP
Total
249160
0.68% - High IOP > 21
1709
LVPEI Eye Health Pyramid
Glaucoma care
Challenges
IOP
Angle Closure
Disc and field damage
Glaucoma Epidemiology and
Molecular Genetics Study
GLEAMS
Methodology
Population based cross sectional study
Methodology
• Inclusion criteria
– People aged 40 years and above
– Residents for a min 6 months
– Willing to participate
• Exclusion criteria
– Cannot be contacted after 3 attempts
– People who are immobile
The Study Plan
Vision Guardian
Vision screening
Vision Technician 1
History, VA, Ref
Vision Technician 2
FDT, HVF, SL, NMFP, ASOCT
Vision Technician 1
DO, IOP, Gonio
Optometrist
Goni, dilated evaluation, OCT,
Fundus photo
Results
Analysis I
• Agreement of Optometrists with Glaucoma
Specialist Ophthalmologist in gonioscopy and Optic
Disc evaluation
Analysis II
• Diagnostic accuracy of a VG in vision screening,
pupillary abnormalities and anterior chamber
Results
Analysis III
• Skills of a VT in Gonioscopy and image acquisition
Analysis IV
• Role of Imaging in POAG and PACD diagnosis
Sample Size
Gonioscopy
• 150 eyes with 25 PACS and 25 PAC
Optic Disc Assessment
• 200 eyes with 30 disc suspects and 30 glaucoma eyes
Results
• Agreement between Optometrists and Glaucoma Expert
К (SE)
Gonioscopy (UK)
0.92 (0.12)
Optic Disc Assessment (UK)
0.90 (0.09)
Gonioscopy (JGB)
0.84 (0.10)
Optic Disc Assessment (JGB)
0.89 (0.09)
Progress of the Project
• No. of villages screened - 10
• Number of subjects screened till now – 2000
• Data available - 1832
No. of eyes with various types of glaucoma
LVPEI Eye Health Pyramid
Glaucoma care
Challenges
IOP
Angle Closure
Disc and field damage
The Glaucoma Continuum
Weinreb RN etal. Am J Ophthalmol 2004;138: 458-467
Shallow AC depth on Van Herrick
Corresponding ASOCT
BEST NMFP
Corresponding OCT
BEST MFP
WORST NMFP
Corresponding OCT
WORST MFP
Thank you!
L V Prasad Eye Institute
www.lvpei.org
Excellence
Equity
Efficiency