Community ophthalmology

Halida Wibawaty

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

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

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
Identify and refer
for Treatment

Diagnose and
treatment or
Diagnose and
refer

Person
General physicians.

General physicians
Ophthalmologist

Concept involved in these

programmes
1) Regular screening for early diagnosis.
2) Timely intervention -Referrals.
3) Improvement of basic personal needs
and hygiene.

Concept involved in these

programmes
4) Provision of safe water / good
nutrition.
5) Health education.

Concept involved in these

programmes
7) Promotion of community
participations. Training of volunteers.
8) Mobilizing resources within the
community and use of appropriate
technology

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.

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

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