Current Concept and Practices of Community Ophthalmology

Dr. Suraj Senjam Faculty of Community Ophthalmology

Dr. R P Centre AIIMS New Delhi

Questions

What do you understand by Community Ophthalmology?

Why do we need to have such discipline ?

What should be the curriculum for this discipline?

What are spectrum of activities ?

Who are going to provide this ?

Community ophthalmology Initial viewed: Ophthalmology services should be solely provided through

tertiary health centers by Ophthalmologists

Epidemic of preventable blindness and visual impairment

Many eye problems are within the purview of public health concerned

First proposed by Dr. Patricia E. Bath in 1978

Relatively new in the Biomedical Sciences

Very few Institutions has this discipline

Community ophthalmology Public Health Ophthalmology Community Eye Health Preventive Ophthalmology Focus: Three community based activities:

preventive, curative, promotive.

British Journal of Ophthalmology, 1987, 71, 116-117

Community Ophthalmology

21st Century

The perspective of Public Health Discipline is growing, so as

too Community Ophthalmology

Applied all public health sub-dimensions

Community Ophthalmology An important branch of community medicine that aims at

comprehensive eye health care in the community setting employing the

knowledge of public health and social & preventive medicine to a large

extent, viz. epidemiology, health promotion, health economics, heath

management, environmental health, public health policy & planning,

social sciences & behavioral health, medical biostatistics and primary

health care.

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Community Ophthalmology Vs. Community eye care services

Community eye care servicesI. Promotive-Eye Health

Promotion

II. Preventive-screening

III. Curative

IV. Referral

V. Rehabilitation-visual

E.g. Eye Camp, School screening People think these are the activities

Community Ophthalmology1) Community eye care services2) Epidemiology of eye Diseases3) Epidemiological studies4) Policy & Planning of Eye health5) Management Iinformation System (MIS) on

eye health6) Monitoring and evaluation 7) Environmental eye health 8) Eye Health economics 9) Behavioral & Social Sciences on eye care10) Biostatistics 11) Managing and Presenting Public Health Data12) Project Cycle Management

Community Ophthalmology: Promotive-Eye Health Promotion

Educational or IEC materials for each important problems

Pamphlets, posters, banner, hoarding flip chart etc

Small booklets like what a patient should know about glaucoma/ DR etc

Booklets on low vision information

Improving personal hygiene, sanitation, environment modifications, diet habit

Various Media: Audiovisual and folk song, skit drama etc Eye health talk or Mela

Community Ophthalmology: Preventive measures

1. Etiological preventive measures

Nutritional blindness secondary to Vit. A deficiency

Clean face and good hygiene and sanitation

Onchocerciasis spread by black flies

2. Prevention from Blind and visual impairment

Surgical intervention of angle closure Glaucoma, DR,

3. Prevention from further loss of quality of life, deterioration of livelihood

Visual rehabilitation and vision aids

Community Ophthalmology Curative

Surgical removal of cataract LASIK Treatment of conjunctivitis

Rehabilitation Mobility and orientation training Training on Daily Living Activities Community Based Rehabilitation

Epidemiology of eye Diseases1. Non-infective

Example: Cataract, Refractive errors, Glaucoma

2. Infective Example: Trachoma, Conjunctivitis, Onchocerciasis

CataractClassification, Prevalence, incidence, risk factors, trends, ecological study

finding, Sign and symptoms , morbidity, economical impact, prevention and screening and briefly about management

TrachomaProblems statement, epidemiological determinants-agent factors, Host factors

environmental factors, mode of transmission, Sign and symptoms, control measures

Epidemiological studies

Study of the distribution, frequency and determinants of health

related events or diseases in a defined population and application of

this study to the control of health problems

Distribution: what ? Who? Where ? When?

Frequency: Incidence, prevalence,

Determinants: probable risk factors, protective factors

Epidemiological study

A. Descriptive studies Individuals

I. Case reports

II. Case series

III. Cross-sectional Population or ecological studies

B. Analytical studiesI. Case control

II. Cohort

III. Trials

DR. RPC AIIMS 13

In Community Ophthalmology

Cross Sectional Survey

1. Ideal Epidemiological survey Sample –representative Result-generalizable Time consuming Need more resources Need epidemiologist Suitable for high income

countries

DR. RPC AIIMS 14

2. Rapid Assessment survey Not representative Not generalizable Less time consuming Need less resources Simplified sampling methods Suitable for low-middle income

countries

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Rapid Assessment Survey

Rapid Assessment of Avoidable Blindness (RAAB)

Rapid Assessment of Visual Impairments (RAVI)

Rapid Assessment Refractive Error (RARE)

Trachoma Rapid Assessment (TRA)

Rapid Assessment of Cataract Surgical Services (RACSS)

Scientific study: Protocol

Sample size

Sampling techniques

Data collection

Data management

Data analysis and dissemination

Policy & Planning for Eye Health

Better health policy is a driving force for better life

Policy making based on sound scientific knowledge

Health research-evidence based decision making

National Blindness Survey (RAAB) in India

Program reform with special emphasis on structural and implementation

Financing eye health care-insurance, user fees

Public-Private partnerships in the services delivery

Management Information System

Better the information system, better the health care delivery, management and outcome

Designing good MIS Information on human resources, infrastructures, equipment,

activity related Geographical information on hospital facilities Computerize information system

Monitoring and evaluation MIS use for different management level

Program Monitoring and evaluation

Cataract surgical program

School vision screening program

Environmental and eye health Population changes (demography)

Effect on life expectancy on eye health Migration effect

Physical environment Temperature, UV, air pollution, humidity, wind, soil, chemicals Urban housing, lighting system

Biotic environment Infectious agents, vectors, forestry etc

Domestics environment Water supply, sanitation, smoking, diet, lifestyle etc. Work habits

Politico-cultural environments Conceptual or cultural practices, equity of health accessibility, national priority

Socio-economic environment poverty

Eye Health Economics Economics is the sciences of choice

GovernmentHospital eye health care orPublic health ophthalmic program

Allocative efficiency Some of amount resources where to allocate (program competes

each other for resources allocation)How many of the resources to allocate to each programOne program gains at the expense of other

This will by addressed by Cost-Benefit Analysis

Eye Health economics Technical efficiency

Best way to achieve the given objective The patient will be treated, but question is how Comparison of options with the same goal Day care cataract surgery vs. inpatient stay surgery for

cataract Day care LASIK vs, inpatient stay

This will be addressed by Cos-Effective Analysis

Behavioral & Social Sciences on eye health

Socio-cultural Belief (harmful or beneficial effect) Social norm Human behavior towards eye problems Factors influencing on decision to seek eye care QOL after treatment Individual behavior to treatment adherence Example: Urban people not willing to spend on glasses, rather prefer

spend on smart phone, mobile

Theories to change individual behavior

Health belief model Originally developed to explain why individuals participate in

health screening and immunization program Models explain the likelihood of an individual taking action

against a given health problem It can be applied in eye health Why few individuals still not corrected their refractive error or

not undergone cataract surgery

Biostatistics Software packages for analysis

Analysis of quantitative data

Analysis of qualitative data

Multivariate analysis

Managing and Presenting Public Health Data

When the data is large enough Develop data management plan for use in ophthalmic health

Roles-primary investigator, coordinator, data manager Coding system Consistency checking

Double entry technique Labels and file organization

Summarizing and presenting data

Adage: A picture is worth a thousand words

Keeping in mind the primary purpose is to communicate the

information

Tables

Graphs

Charts

Project Cycle Management Pre-project analysis Planning Budgeting Implementation Monitoring and evaluation

Take home message

Eye Care Services

Recommendation Current Status

Eye Care Services

• Ophthalmology • Community Ophthalmology

Eye Care Services

Thanks for your attention