Community ophthalmology
Dr. Saman Wimalasundera
MBBS DO Ph.D
Senior lecturer in Community Medicine
& Community Ophthalmologist
Department of community medicine
P.O.Box. 70
Galle
Sri Lanka
Community ophthalmology
Synonyms
= Public health ophthalmology
= Preventive eye care
= Preventive Ophthalmology
Community ophthalmology
The Aim : To provide the
Ophthalmologic services to a whole
group or sub group of people which
benefit the largest number of
people in the community at
affordable cost in identifying and
preventing sight threatening ocular
conditions
Community ophthalmology
This is a new field.
New concept for many countries yet.
Difficult to get it moving.
Future doctor has a great
responsibility in developing this field
Curative ophthalmology
Remain at the center of all activities
Community Ophthalmology does not
dilute its importance
Focus is only changed from individual
to community
What are the major differences in curative
& preventive medicine ?
Curative
Preventive
Goals
Treatment & cure
Prevention of disease
Target
Single patient
Population/community
Diagnosis
Physical
examination.
Health survey
(Community Diagnosis)
Therapy
Drugs / Surgery
Results
Limited to
individuals
Health education
improved sanitation,
Hygiene, Immunization
etc
Prevention of disease
Improvement of quality
of life in community
Summary of Activities
Applied to
ophthalmology
Public health
principles
Activities in community
Prevent Blindness
Reduce the disability
caused by poor vision
Main Aims of
Community
Ophthalmology
Activities in Community
Fact finding surveys / Research /Screening
/Clinical care / Health education /Referral
/Follow up/ Improvement of basic needs etc.
Therefore community ophthalmology can
be explained as a discipline where
“The traditional care applied to an
individual patient is diverted to a
population with a prominence placed on
preventive aspects”
Who is a community eye
specialist
Ophthalmologist
With Knowledge on
Community
organization, need,
structure,&
epidemiological
principals, biostatistics,
managerial and
communication
skills
Community
physician
With basic clinical
Aspects of
Ophthalmology
Role depend on the
local needs
of a country
Major duties
1) Designing and planning of fact finding
surveys.
2) Planning primary eye care programs.
Screening
Health education
Training
Promoting community participation
Major duties
3) Organizing community screening,
preventive & curative programmes
Eye camps
Surgical camps
4) Research in to eye diseases.
5) Co-ordination of activities and promoting to
implement policies for prevention purposes.
WHO activity on prevention of
blindness (PBL)
PBL Programme was established in 1978.
At the beginning
The number of blindness in the world
Not known
Task force was appointed.
Surveys
According to international
classification of diseases
1CD – 10
Obtained more epidemiological details.
BDB (Blindness Data Bank)
WHO Global data bank on blindness
- Collection and dissemination of data.
How to arrange a preventive eye
care programmes
Let us learn the activities involved
and man power needed.
Activity
Person
Primary prevention
In the community
through Primary
Health Care(PHC)
Primary health care
workers
Volunteers(Trained)
Secondary
prevention
Identify and treat in
the community
P.H.Workers
General physicians
Community
Ophthalmologist.
Activity
Person
Identify and refer
for Treatment
PEC Workers
Optometrists
General physicians.
Diagnose and
treatment or
Diagnose and
refer
PEC Workers.
General physicians
Community
Ophthalmologist
Activity
PEC Workers
To identify ocular
diseases or systemic
diseases that cause
ocular problems.
Work in the community
Prevent visual disability and blindness.
Concept involved in these
programmes
1) Regular screening for early diagnosis.
2) Timely interventions
-Referrals.
3) Improvement of basic personal needs
and hygiene.
Concept involved in these
programmes
4) Provision of safe water / good
nutrition.
5) Health education.
6) Integration of PHC workers in to the
programme.
Concept involved in these
programmes
7) Promotion of community
participations. – Training of volunteers.
8) Mobilizing resources within the
community and use of appropriate
technology
Organizing and delivery of eye
care
National eye care
Programmes
Target
have been
developed in
developed
countries
Reduce blindness and
Visual disability
Organizing and delivery of eye
care
Organized by the health authority of a
Country
Supported by various
N.G.O /Other institutions
Universities etc.
Eye care foundations.
Follow the guidelines set by WHO
How to organize a good national eye
care programme?
For this purpose
Goals should be carefully outlined first
How to find the goals ?
Goals for treatment & Prevention
Do search and surveys.
Find the ground situation. Then find the
gap of deficit.
How to find the goals ?
Fill the deficit need through national eye
care Plan
HOW
By organizing
 Eye clinics
 Mobile eye services
 Primary eye care programmes
 Blindness prevention activities
 Infra-structure developments
 Man power improvement
 Changing policies
Community Ophthalmology
Delivery of eye care- model
Primary eye care
Community
ophthalmology center
Secondary eye
care
Large hospitals
Tertiary eye care
National teaching
hospitals
What is a mobile eye unit ?
Some Community ophthalmology centers
have mobile eye units.
Team :-
Ophthalmic medical auxiliary
Assistant
Vehicle driver.
mobile eye unit
All instruments for primary eye care and a
vehicle is provided.
Work on pre arranged schedule with rural
health centers
Visit rural health centers and perform in
the community with the support from
local health personal.
Treatment and refer.
mobile eye unit
Mobile eye unit is based at a community
ophthalmology center.
Community
Ophthalmologist
Over all Incharge
 Have to regularly supervise the activities of
mobile team.
 Regularly visit rural health centers.
 Organize curative camps.
Primary eye care workers
= Survey – Detection – Referral – Workers
SDRW.
What is a SDRW ?
Is the most important person of this
whole programme.
Attached to the community ophthalmology
center.
Duties of SDRW
☞ Screen, Sensitize and inform patients
and families on their problems.
☞ Refer for treatment
☞
provide simple medication
How to select a good SDRW ?
Communication skills and motivation is
the criteria for selection (over any
academic qualification)
What is the position of the
SDRW ?
Should be recognized as a member of the
staff of the community ophthalmology
center.
Regularly supervised by a head nurse.
Work require
Continuous supervision
and
encouragement
What is the training a SDRW
should have before going to the
field ?
1) Basic knowledge on structure and
function of the eye
2) Recording of visual acuity.
3) Recognize a normal healthy eye &
common eye problems.
What is the training a SDRW
should have before going to the
field ?
4) Ability to identify Cataract / Squint /
Refractive errors / Eye injuries /
Infections / FB.
5) Identify corneal scars / differentiate
from cataract.
What is the training a SDRW
should have before going to the
field ?
6) Explanations about common eye
problems
- To explain it to the people
7) To recognize and refer serious eye
injuries
What is the training a SDRW
should have before going to the
field ?
8) Activities and responsibilities of the
eye unit and staff.
9) How to meet with a family
(communication skills)
What is the training a SDRW
should have before going to the
field ?
10)During training they should witness at
least three cataract surgeries
- Taken visual acuity of 10 patient
- Perform pinhole test.
Primary eye care
Broad concept
Including prevention of potentially blinding
eye diseases
Through
Primary Health Care
Let us identify the eight essential
components of primary health
care(PHC)
1) Education concerning main health
problems.
2) Promotion of food supply and good
nutrition.
Primary health care
components
3) Adequate supply of safe water and
basic sanitation.
4) Maternal & Child Health & Family
planning
5) Immunization against major infectious
diseases
Primary health care
6) Prevention and control of local
endemic diseases
7) Appropriate treatment of common
diseases and injuries
8) Provision of essential drugs
Primary eye care is derived out of
these 8 essentials
Primary eye care is the essential building
block for prevention of blindness &
restoration of vision
In all communities & all regions of the world
Clinical care
Provides individual attention
Little is achieved in terms of prevention
But primary eye care can not function effectively
in isolation.
Should go hand in hand with clinical field
following eye conditions are
Integrated in to primary health care
☞ Cataract
☞ Ophthalmic neonatorum
☞ Trachoma
☞ Eye infections
☞ Eye injuries
☞ Pterigium
☞ Corneal ulcers
☞ Refractive errors
☞ Glaucoma
☞ Conditions with VA < 3/60
WHO Guidelines for primary
eye care
1. Conditions to be recognized and treated by
a trained primary eye care worker
☞
Conjunctivitis and lid infections
- Acute conjunctivitis
- Ophthalmia neonatorum
- Trachoma
- Allergic & Irritative conjunctivitis
- Lid lesions – chalazion
☞
Trauma
- Sub conjunctival hemorrhages
- Superficial FB
- Blunt trauma
☞
Blinding Malnutrition
2. Conditions to be recognized and
referred after treatment has been
initiated.
☞ Corneal ulcers
☞ Lacerating or perforating injuries of the
eye ball
☞ Lid lacerations
☞ Entropion / Trichiasis
☞ Burns
- Chemical
- Thermal
3. Conditions that should be recognized
and referred for treatment.
☞ Painful red eye with visual loss
☞ Cataract
☞ Ptergium
☞ Visual loss < 6/18 in either eye
Integration of PEC in to PHC
PEC should not be planned
separately from PHC which is
considered the mother system that
carry the goals of PEC to the
community by integration
The Matrix given below shows how
integration can proceed.