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Control of blindness
This document discusses control of blindness globally and in India. It defines blindness and provides classifications of visual impairment. Around 180 million people worldwide are visually disabled, with 80% of cases being avoidable. In India, the major causes of blindness are cataract, refractive error, and glaucoma. Prevention strategies include primary, secondary, and tertiary eye care as well as specific programs and long-term measures. The National Programme for Control of Blindness was established in 1976 with the goal of reducing blindness prevalence. It focuses on developing eye care infrastructure, human resources, and participation of voluntary organizations. The program's objectives are to reduce the backlog of blindness cases and improve service quality.
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Introduction to the topic of blindness control.
Blindness is defined by WHO in terms of visual acuity: less than 3/60 or inability to count fingers at 3 meters. ICD classification and visual impairment standards explained.
Worldwide, 180 million are visually disabled; 45 million are blind. Major causes include cataracts and preventable blindness. India has high cataract-induced blindness rates.
Blindness causes: cataracts (62.6%), refractive errors (19.7%), etc. Epidemiological determinants include age, sex, malnutrition, occupation, and social factors.
Focus on acute intervention and comprehensive eye healthcare through primary eye care and team concepts involving specialists and national programs.
Prevention strategies include initial assessment, primary and secondary care, community health education and specific programs targeting avoidable blindness.
Established in 1976, aims to reduce blindness prevalence. Objectives include developing eye care facilities and improving service quality.
Development of eye care infrastructure involves strengthening various healthcare levels and organizational structure for effective service delivery.
New initiatives for NPCB include appointment of staff, construction of facilities, telemedicine, and community health education for eye care.
Vision 2020 aims to reduce avoidable blindness globally through various initiatives and resource development, including existing external projects.
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Control of blindness
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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 ofvisual impairement cata Visual acuity gory Max less than Mini equal to or better than 0 6/18 Low vision 1 6/18 6/60 2 6/60 3/60 blindness 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 Annualincidence 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 blindness cataract 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 INEYE HEALTHCARE Acute intervention comprehensive eye healthcare 1. Primary eye care 2. Epidemiological approach 3. Team concept 4. 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 it’s cornerstones Final objectives-increase the coverage and quality of eye healthcare through PHC, improve the utilization of existing resources Epidemiological approach Measurement of incidence, prevalence of disease and their risk factors ©abhilash pm 10
- 11. Team concept One eye specialist + auxiliary health personnel Establishment 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 action 1. INITIAL ASSESSMENT 2. 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 care Established @national & regional capital Asso with Med clg& Institute of med Retinal detachment sur; corneal grafting etc Eye bank Rehabilitation of blind ©abhilash pm 14
- 15. Specific programmes 1. Trachoma control prog 2. School eye health services 3. Vitamin A prophylaxis 4. Occupational eye health services 3.LONG TERM MEASURES Control of infn Improving the quality of life& modifying the risk factors Health education 4. EVALUATION ©abhilash pm 15
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- 17. NATIONAL PROGRAMME FOR THECONTROL 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 OF INFRASTRUCTURE FOREYE 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 STRUCTURE for NPCB ADMINISTRATION Central: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 PROPOSED UNDERNPCB 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/ THERIGHT 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 im Pr ©abhilash pm 27
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