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Asi Reddy

 Introduction

Blindness and its causes

Prevention of blindness NPCB (National Programme for Control of Blindness

in India)

Introduction
It is a system (rather than a branch of community medicine) which utilizes the full scope of ophthalmic knowledge, skill, services of other medical and nonmedical agencies -to promote ocular health and prevent blindness at the community level with an active, recognized and crucial role of community participation

Blindness and its Causes 1.Definitions

WHO definition of blindness -Visual acuity of less than 3/60 (Snellen) or its equivalent -Inability to count fingers in day-light at a distance of 3 metres
Visual filed less than 10, irrespective of the level ofvisual acuity in also labelled as blindness

Other definitions
Economic blindness: vision in better eye <6/60 to

3/60
Social blindness: Vision in better eye <3/60 to 1/60 Legal blindness: Vision in better eye <1/60 to

perception light
Total blindness: No light perception (PL -ve)

*Avoidable blindness= Preventable blindness +Curable Blindness

Magnitude of Blindness
180 million people worldwide are visually disabledof

whom nearly 45 million are blind. 90% of the worlds blinds live in developing countries and around 60% of them reside in sub-Saharan Africa, China and India. Regional burden of blindness: This means the ratio of the proportion of the number of blind in a particular region to the global number of blind and the proportion of the regional population to the world population

Magnitude of blindness in India

India has 8.9 million blind people,
Prevalence Source

1.38% ICMR (1971 - 74)7

1.49% WHO-NPCB (1986-89)8 1.1%

NPCB (2001-2002)9

Factors for higher prevalence of blindness in India are:

1. Inadequacy of ophthalmic personnel. 2. Lack of services near the homes 3. Under-utilisation of manpower. 4. Rural/urban imbalance in availability of services. 5. Lack of knowledge and concern, malnutrition,lack of eyecare; superstitions and ignorance. 6. Infections. 7. Man-made blindness due to quack practice and home remedies.

Major causes of blindness in India

Differences in causes of blindness

Developed
Age related macular

Developing
Cataract, Infectious diseases, Xerophthalmia, Injuries, Glaucoma, and

degeneration (ARMD), Glaucoma, Diabetic retinopathy, Cataract.

onchocerciasis.

GLOBAL INITIATIVES FOR PREVENTION OF BLINDNESS

The major global initiatives taken for prevention of blindness are:
Global programme for prevention of blindness. Vision 2020: The Right to Sight. Vision for the future (VFTF).

GLOBAL PROGRAMME FOR CONTROL OF BLINDNESS

National Blindness Control Programme.

Control strategies suggested by WHO include: 1. Assessment of common blinding disorders at local, regional and national levels. 2. Establishment of national level programme for control of blindness suited to the national and local needs. 3. Training of eye care providers. 4. Operational research to improve and apply appropriate technology. National Blindness Control Programme.

VISION 2020: THE RIGHT TO SIGHT

Launched by WHO in Geneva on Feb. 18,1999

Partners of Vision 2020: Right to Sight include:

-I. World Health Organisation (WHO), -II. Task Force of International NGOs,

International Agency for Prevention ofBlindness (IAPB) Christopher Blindness Mission (CBM) Helen Keller International ORBIS International Sight Savers International Al Noor Foundation International Federation of Ophthalmological Societies Lions Clubs International Foundation Operation Eye Sight Universal The Carter Centre

Objective of vision 2020. Objective of this new global To eliminate avoidable blindness by the year 2020 Implementation of vision 2020. Vision 2020 will be Four phases of five year plans, the first one started in 2000 and second in 2005. The two subsequent phases of implementation will commence from 2010 and 2015, respectively.

Strategic approaches
Disease prevention and control,
Training of eye health personnel, Strengthening of existing eye care infrastructure,

Use of appropriate and affordable technology,

Mobilization of resources.

Disease prevention and control

Globally, WHO has identified five major blinding eye conditions, for immediate attention to achieve the goals of Vision 2020, which are:
Cataract Childhood blindness -Vitamin A deficiency, measles, conjunctivitis,
ophthalmia neonatorum, congenital cataract andretinopathy of prematurity (ROP)

Trachoma, Refractive errors and low vision, and Onchocerciasis.

VISION FOR THE FUTURE (VFTF)

Implementation of this program is being done by International Council of Ophthalmology (ICO)
Enhancement of ophthalmology residency training Development of model guidelines and Training of medical students and allied health personnel. Advocacy and support for Vision 2020: Right to Sight,.

Helping national ophthalmologic societies

Develop more effective organizations

NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS (NPCB) IN INDIA

India was the first country in the world to launch the

National Programme for Control of Blindness (NPCB) (1976) OBJECTIVES To provide comprehensive eye care facilities for primary, secondary and tertiary levels of eye health care. To reduce the prevalence of blindness in population from 1.38% (ICMR 971-74) to 0.31 by 2000 AD.

PLAN OF ACTION AND ACTIVITIES

Basic programme components, Programme organization, Strategic plan for Vision 2020: Right to Sight in India.

BASIC PROGRAMME COMPONENTS

Extension of eye care services. (Eye camp, Rehabilitation,
Survey)

Establishment of permanent infrastructure.

(Primary eye care centre, Intermediate sector, Tertiary care, Apex National Institute of Ophthalmology- Dr. RajendraPrasad Centre for Ophthalmic Sciences, New Delhi)

Intensification of eye health education. Mass

Communication media (television talks, radio talks, films, seminars and
books)

PROGRAMME ORGANIZATION
Central level Director General Health Services (DGHS)
-National Blindness Control Board, chaired by Secretary Health to GOI.
- National Programme Co-ordination Committee, chaired by Additional Secretary to GOI. -National Technical Advisor Committee, headedby Director General Health Services, GOI.

1Procurement of goods (major equipments, bulk consumables, vehicles, etc.) 2. Non-recurring grant-in-aid to NGOs. 3. Organizing central level training courses. 4. Information, education and communication (IEC) activities (prototype development and mass media). 5. Development of MIS, monitoring and evaluation. 6. Procurement of services and consultancy. 7. Salaries of additional staff at the central level.

 State level State Blindness Control Society

(SBCS)

l. Execution of civil works for new units. 2. Repairs and renovation of existing units/ equipments. 3. State level training and IEC activities. 4. Management of State Project Cell. 5. Salaries for additional staff.

District level - District Blindness Control Societies

(DBCS)

District blindness control society

Objective of DBCS establishment is to achieve the

maximum reduction in avoidable blindness

Composition of DBCS. Each DBCS will have a

maximum of 20 members, consisting of 10 ex-officio and 10 other members with following structure:
Chairman, Vice-chairman, Member Secretary, advisor.

Strategic Plan for VISION 2020

A. Strengthening advocacy B. Reduction of disease burden

-Cataract,
-Childhood blindness, Detection of eye disorders. Preventable childhood blindness (Xeropthalmia, trachoma,, glaucoma,
ROP.etc)

Curable childhood blindness -Refractive errors and low vision, -Corneal blindness, -Diabetic retinopathy, -Glaucoma, and Trachoma (focal)

C. Human resource development, Mid-Level Ophthalmic

Personnel (MLOP) , Hospital based, Community based.

D. Eye care infrastructure development

Primary level vision centre , service centre, training centre, Centre for excellence

ROLE OF EYE CAMPS IN PREVENTION OF BLINDNESS

Objectives
Organization of an eye camp

- Comprehensive eye care camps with Reach-out Approach,

- Screening eye camps (Reach-inApproach)

Comprehensive eye care camps

-Preparatory phase - Finalization of organizers and medical team - Permission to hold eye camp - Selection of the camp site - Publicity and mobilization of community resource - Intensive phase
Set up OPD, Ward, OT, Fumigation, Refraction, Surgeries

- Consolidation phase - Post Op care - Culmination and retrieval phase (Discharge) - Follow-up phase

Screening eye camps (Reach-inApproach)

to shift from Reach-out to the Reach-in-Approach
transported to the nearest well-equipped hospitals

(Base hospital approach).

Documentation, monitoring and evaluation

EYE BANKING
an organization which deals with the collection, storage

and distribution of cornea for the purpose of corneal grafting, research and supply of the eye tissue for other ophthalmic purposes.

Functions Promotion of eye donation Registration Collection Receiving and processing Preservation Distribution Research activities

 Eye bank personnel

-Eye bank incharge Eye bank technician Clerk-cum-storekeeper Medical social worker or public relation officer Driver-cum-projectionist

Eye collection centres

Functions

-Local publicity for eye donation.

-Registration of voluntary donors. - Arrangement for collection of eyes after death. - Initial processing, packing and transportation of collected eyes to the attached eye bank.

Personnel

-Ophthalmic technician -Local honorary workers/voluntary agencies like Lions club, Rotary club etc. donation campaign. Services of honorary ophthalmic surgeon or medical officer trained in enucleation available on call.

Facts about eye donation

1 Almost anyone at any age can pledge to donate eyes after death; all that is needed is a clear healthy cornea. 2 The eyes have to be removed within six hours ofdeath. 3 Eye donation gives sight to two blind persons as one eye is transplanted to one blind person. 4 The eyes can be pledged to an eye bank and can be actually donated to any nearest eye bank at the time of death. 5 The donated eyes are never bought or sold. 6 Eye donation is never refused.

7 The eyes cannot be removed from a living human being inspite of his/her consent and wish.

Legal aspect. The collection and use of donated eyes come under the
perview of The Transplantation of Human Organs Act, 1994.

REHABILITATION OF THE BLIND

1. Medical rehabilitation
Training and psychosocial rehabilitation Educational rehabilitation

Vocational rehabilitation

To conclude, it should never be forgotten that, one of the basic human rights is the right to see.