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 Health survey

examination. (Community Diagnosis)

Therapy Health education

Drugs / Surgery improved sanitation,
Hygiene, Immunization
etc
Results Prevention of disease
Limited to Improvement of quality
individuals of life in community
 Summary of Activities
Public health Applied to
principles ophthalmology

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 Community
physician
With Knowledge on
Community With basic clinical
organization, need, Aspects of
structure,& Ophthalmology
epidemiological
principals, bio-
statistics, Role depend on the
managerial and local needs
communication of a country
skills
 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 Primary health care
In the community workers
through Primary Volunteers(Trained)
Health Care(PHC)

Secondary P.H.Workers
prevention General physicians
Identify and treat in Community
the community Ophthalmologist.
Activity Person
Identify and refer PEC Workers
for Treatment Optometrists
General physicians.

Diagnose and PEC Workers.

treatment or General physicians
Diagnose and Community
refer 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 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
Primary eye care
ophthalmology center

Secondary eye Large hospitals

care

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 Over all Incharge

Ophthalmologist

 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.