Community Ophthalmology

Community Ophthalmology

National Programme for Control of Blindness & Visual Impairment (NPCBVI):

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Program Details

  • Funding: Danish International Development Agency (DANIDA).
  • Target: Blindness rate <0.25% in community by 2025

Terminology for Visual Impairment

Terminology
Visual acuity in the better eye with available/best possible correction
Visual impairment
<6/18
Blindness
<3/60

Definitions of Blindness:

  • Clinically:
    • No perception of light.
  • According to NPCBVI (As amended in 2017) and WHO:
    • Visual acuity <3/60 in the better eye with best possible correction.
    • OR
    • Limitation of Visual field <10 degrees from centre of fixation
Terminology
Visual acuity in the better eye
with available/best possible correction
Visual impairment
<6/18
Blindness
<3/60
Term
Definition
Blindness (BCVA/Pinhole)
Best corrected visual acuity <3/60 in better eye.
Blindness
(<3m from chart)
<3/60 in better eye with available correction
Severe Visual Impairment (SVI)
(kasera aduppikuka → from 6m to 3m)
6/60 – 3/60 in better eye
Moderate Visual Impairment (MVI)
(18-60)
6/18 – 6/60 in better eye
Early Visual Impairment (EVI)
(12→18)
6/12 – 6/18 in better eye
Functional Low Vision
6/18 or visual field <10° from fovea
+ usable vision retained
WHO ICD
NPCB
Visual Acuity
Correlate
Low Vision
LESMA
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Category (1)
Low vision
6/18 - 6/60
Moderate Visual Impairment
Category (2)
Economic blindness
Work Vision
6/60 - 3/60
Severe Visual Impairment
Blindness
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Category (3)
Social blindness
Walk Vision
3/60 - 1/60
Blindness
Category (4)
Manifest blindness
<1/60 - perceptions of light
Blindness
Category (5)
Absolute blindness
No perceptions of light
Blindness

WHO ICD vs. NPCB

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  • Most Common (M/C) Causes:
    • Blindness (India & Worldwide):
      • Cataract
        • Responsible for 66-67% (2/3ʳᵈ) of blindness.
    • Visual Impairment (India):
      • Cataract
    • Ocular Morbidity:
      • Uncorrected refractive error
    • Preventable Blindness:
      • Children: Vitamin A deficiency
      • Adults: Cataract

Causes of Blindness:

Age Group
Blindness
Visual Impairment (<6/18)
≥50 years
- Cataract (m/c)
- Corneal opacity
- Cataract (m/c)
- Refractive error
0–49 years
- Non trachomatous Corneal opacity (m/c)
- Amblyopia
- Refractive error (m/c)
- Cataract
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COOA
CRRC

Rashtriya Bal Swasthya Karyakram (RBSK):

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  • Under National Health Mission (NHM)
  • Screening + early intervention for age 0–18 years
  • “Bal” : 0-18 yrs children
  • Strategy :
    • Screening of children for 4D’s in anganwadi & schools
      • Developmental delays
      • Diseases
        • except Congenital glaucoma
      • Deficiencies
        • except Vit K and C
      • Defects
    • Newly added :
      • Hypothyroidism, sickle cell anemia, β-thalassemia
      • Tuberculosis, Leprosy
    • Total diseases screened
      • 32
  • Screened By:
      • Age Group
      Target Group
      Screened By
      Birth – 6 weeks
      Born at public health facilities
      Mobile health team
      6 weeks – 6 years
      Rural areas, urban slum
      ANM
      6 years – 18 years
      School children
      Questionnaire by district hospitals

Health Conditions Screened under RBSK

Category
Conditions
1. Defects at Birth
- Neural tube defect
- Down’s syndrome
- Cleft lip/palate
- Club foot (Talipes)
- Developmental dysplasia of hip
- Congenital cataract
- Congenital deafness
- Congenital heart diseases
- Retinopathy of prematurity
2. Deficiencies
- Severe anaemia
- Bitot’s spot (Vitamin A deficiency)
- Rickets (Vitamin D deficiency)
- Severe acute malnutrition
- Goiter
3. Childhood Diseases
- Skin diseases: scabies, fungal infections, eczema
- Otitis media
- Rheumatic heart disease
- Reactive airway disease
- Dental caries
- Convulsive disorders
4. Developmental Delays
- Vision & hearing impairment
- Neuro-motor/motor delay
- Cognitive/language delay
- Behavioral disorder (Autism)
- Learning disorder
- ADHD
Optional Conditions
- Congenital hypothyroidism
- Sickle cell anaemia
- Beta-thalassemia
Other Non-Child-Specific Conditions
- Tuberculosis
- Leprosy

Vision 2020

Overview

  • Launched: 1999, Geneva
  • Adopted in India: 2001, Goa

Aims

  • Reduce blindness to 25 million by 2020
  • Eliminate avoidable blindness
  • Leading cause of childhood blindness that can be prevented?
    • Vitamin A Deficiency
  • Added later → Glaucoma
  • In India, the recent addition to the Vision 20/20 program
    • Refractive error and low vision

Diseases Covered

Region
Diseases
India
- Cataract
- Refractive errors
- Childhood blindness
- Trachoma (Endemic)
- Glaucoma
- Diabetic retinopathy
- Corneal blindness
Globally
- Cataract
- Refractive errors
- Childhood blindness
- Trachoma (Endemic)
- Onchocerciasis

Cataract Intervention in Community/Village/Population

Reach-In Approach

  • NPCBVI program:
    • Patient
      • Taken in a mobile van To Base hospital
      • Perform surgery, Post-op care
      • Brought back To Community/Village.
  • Note: Reach-out approach/ makeshift hospitals
    • discontinued due to cataract surgery complications.
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Strategy

Centres under NPCBVI Strategy

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