community ophthalmology dr. saman wimalasundera mbbs do ph.d senior lecturer in community medicine...
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Community ophthalmology
Dr. Saman WimalasunderaMBBS DO Ph.D
Senior lecturer in Community Medicine& Community Ophthalmologist
Department of community medicineP.O.Box. 70
GalleSri 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 activitiesCommunity Ophthalmology does notdilute its importanceFocus is only changed from individual to community
What are the major differences in curative& preventive medicine ?
Goals
Target
Diagnosis
Therapy
Results
Treatment & cure
Single patient
Physical examination.
Drugs / Surgery
Limited to individuals
Prevention of disease
Population/community
Health survey (Community Diagnosis)
Health education improved sanitation, Hygiene, Immunization etcPrevention of disease Improvement of quality of life in community
Curative Preventive
Public health principles
Applied to
ophthalmology
Activities in community
Prevent Blindness Reduce the disability caused by poor vision
Main Aims of Community
Ophthalmology
Summary of Activities
Fact finding surveys / Research /Screening
/Clinical care / Health education /Referral
/Follow up/ Improvement of basic needs etc.
Activities in Community
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, bio-
statistics, 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
Primary preventionIn the communitythrough Primary Health Care(PHC)
SecondarypreventionIdentify and treat in the community
Primary health careworkers Volunteers(Trained)
P.H.Workers General physiciansCommunityOphthalmologist.
Person
Identify and referfor Treatment
Diagnose and treatment orDiagnose and refer
PEC Workers
Optometrists
General physicians.
PEC Workers.
General physicians
Community
Ophthalmologist
Activity Person
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 have been
Programmes developed in
developed countries
Target 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
Community ophthalmology center
Large hospitals
National teaching hospitals
Primary eye care
Secondary eye care
Tertiary eye care
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 communityophthalmology center.
Community Over all InchargeOphthalmologist
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 ophthalmologycenter.
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
☞ Trachoma
☞ Eye injuries
☞ Corneal ulcers
☞ Glaucoma
☞ Ophthalmic neonatorum
☞ Eye infections
☞ Pterigium
☞ Refractive errors
☞ 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.