Slide is all about current concept and practices of Community ophthalmology

1. Current Concept and Practices of
Community Ophthalmology
Dr. Suraj Senjam
Faculty of Community Ophthalmology
Dr. R P Centre AIIMS New Delhi

2. 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 ?

3. 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

4. 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

5. Community Ophthalmology
 21st Century
 The perspective of Public Health Discipline is growing, so as
too Community Ophthalmology
 Applied all public health sub-dimensions

6. 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.

7. Community Ophthalmology Vs. Community eye care services
 Community eye care services
I. 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
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 Community Ophthalmology
1) Community eye care services
2) Epidemiology of eye Diseases
3) Epidemiological studies
4) Policy & Planning of Eye health
5) Management Iinformation System (MIS) on
eye health
6) Monitoring and evaluation
7) Environmental eye health
8) Eye Health economics
9) Behavioral & Social Sciences on eye care
10) Biostatistics
11) Managing and Presenting Public Health
Data
12) Project Cycle Management

8. 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

9. 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

10. Community Ophthalmology
 Curative
 Surgical removal of cataract
 LASIK
 Treatment of conjunctivitis
 Rehabilitation
 Mobility and orientation training
 Training on Daily Living Activities
 Community Based Rehabilitation

11. Epidemiology of eye Diseases
1. Non-infective
 Example: Cataract, Refractive errors, Glaucoma
2. Infective
Example: Trachoma, Conjunctivitis, Onchocerciasis
Cataract
Classification, Prevalence, incidence, risk factors, trends, ecological study
finding, Sign and symptoms , morbidity, economical impact, prevention and
screening and briefly about management
Trachoma
Problems statement, epidemiological determinants-agent factors, Host factors
environmental factors, mode of transmission, Sign and symptoms, control
measures

12. 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

13. Epidemiological study
A. Descriptive studies
 Individuals
I. Case reports
II. Case series
III. Cross-sectional
 Population or ecological studies
B. Analytical studies
I. Case control
II. Cohort
III. Trials
DR. RPC AIIMS 13
In Community Ophthalmology

14. 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

15. 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)
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16. Scientific study: Protocol
 Sample size
 Sampling techniques
 Data collection
 Data management
 Data analysis and dissemination

17. 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

18. 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

19. Program Monitoring and evaluation
 Cataract surgical program
 School vision screening program

20. 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

21. Eye Health Economics
 Economics is the sciences of choice
 Government
Hospital eye health care or
Public 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 program
One program gains at the expense of other
 This will by addressed by Cost-Benefit Analysis

22. 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

23. 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

24. 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

25. Biostatistics
 Software packages for analysis
 Analysis of quantitative data
 Analysis of qualitative data
 Multivariate analysis

26. 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

27. 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

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

29. Take home message

30. Eye Care Services
RecommendationCurrent Status
• Ophthalmology
• Community Ophthalmology
Eye Care Services