1. CONTROL OF
BLINDNESS

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3. Blindness???
 WHO define “ visual acuity of less than
3/60 (snellen) or its equivalent. ”
Or
 Inability to count fingers in day light at a
distance of 3 metres
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4. ICD classification of visual impairement
cata Visual acuity
gory
Max less than Mini equal to or
better than
0 6/18
Low vision 1 6/18 6/60
2 6/60 3/60
blindness 3 3/60 1/60
4 1/60 Light perception
5 No light
perception
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5. Problem statement
 world-
 180million visually disabled
 45 million blind
 Prevalence .2-1%
 80% avoidable blindness
 SEAR
 60 million
 45 million visually disabled;15 million blind& .7million
blind children
 95% avoidable blindness
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6.  INDIA
 Annual incidence of cataract induced
blindness 2million;~3million people need
cataract surgery
 Prevalence;
gen population 1.1%
>50 yrs 8.5%
 6-7% children have vision problem
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7. Causes of blindness
cataract 62.6%
Refractive error 19.7%
glaucoma 5.8%
Posterior segment pathology 4.7%
Corneal opacity 0.9%
Other causes 6.2%
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8. Epidemiological determinants
 AGE
 SEX
 MALNUTRITION
 OCCUPATION
 SOCIAL CLASS
 SOCIAL FACTORS
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9. CHANGING CONCEPTS IN EYE
HEALTHCARE
Acute intervention comprehensive eye healthcare
1. Primary eye care
2. Epidemiological approach
3. Team concept
4. Establishment of national programmes
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10. Primary eye care
 Inclusion of an eye care component in primary healthcare
system
 Promotion and protection of eye health together with on
the spot treatment are it’s cornerstones
 Final objectives-increase the coverage and quality of eye
healthcare through PHC, improve the utilization of
existing resources
Epidemiological approach
 Measurement of incidence, prevalence of disease and
their risk factors
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11. Team concept
 One eye specialist + auxiliary health personnel
Establishment of national programs
 Started by voluntary agencies
 Focused on single disease eye camps eg: national
trachoma control
 National blindness control program
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12. PREVENTION OF BLINDNESS
 Concept of avoidable blindness
 Components of action
1. INITIAL ASSESSMENT
2. METHODS OF INTERVENTION
 Primary eye care
 Trained primary health workers
 1 village health guide for 1000 populn&2
MPWs for 5000 popln
 Provided essential drugs
 Refer cases
 Promotion of personal hygiene
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13.  Secondary care
• Definitive management of common
blinding condn
• PHCs &district hospital& mobile eye
clinics
• Cataract surgery; gen health surveys
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14. Tertiary care
Established @ national & regional capital
Asso with Med clg& Institute of med
Retinal detachment sur; corneal grafting etc
Eye bank
Rehabilitation of blind
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15.  Specific programmes
1. Trachoma control prog
2. School eye health services
3. Vitamin A prophylaxis
4. Occupational eye health services
3.LONG TERM MEASURES
 Control of infn
 Improving the quality of life&
modifying the risk factors
 Health education
4. EVALUATION
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17. NATIONAL PROGRAMME FOR
THE CONTROL OF BLINDNESS
 1976
 Goal reduce prevalence of blindness
from1 to .3
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18. REVISED STRATEGIES
 1) To make NPCB more comprehensive by by
strengthening services for other causes of
blindness
 2) shift frm eye camp approach to fixed facility
surg approach;conventional surg to IOL
 3) to expand world bank project
 4) strengthen participation of voluntary
organization
 5) enhance the coverage of eye care services in
tribal& other under served areas
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19. OBJECTIVES
 1. Reduce the backlog of blindness
 2. develop eye care facilities in every district
 3. develop human resources for providing eye
care services
 4. to improve quality of service delivery
 5 .to secure participation of voluntary
organizations in eye care
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20. DEVELOPMENT OF
INFRASTRUCTURE FOR EYE CARE
 Strengthening of PHCs
 Central mobile units
 Strengthening of Dist hosp
 Upgrading of Dpts of Ophthalmology in Med clgs
 Establishment of regional institutes
 Ophthalmic asst training centres
 Dist mobile units
 State ophthalmic cell
 Estb of DCBSs
 Eye banks
 Paramedical ophthalmic assistants posted
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21. ORGANIZATIONAL STRUCTURE
for NPCB
ADMINISTRATION
Central: ophth section Directorate General of health
services, ministry of H& FW Delhi
state: state ophthalmic cell ,Dir of Health
services,State health societies
District:DBCS
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22. Service delivery & referral system
 Tertiary level : RIO& centres of excellence in eye
care
 Secondary level: Dist hospital& NGO eye hospital
 Primary level: Sub dist level hosp/ CHC;mob ophth
units;upgraded PHCs;link workers;panchayats
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23. NEW INITIATIVES PROPOSED
UNDER NPCB
 Construction of dedicated eye wards& eye op theatre in dist hosp of NE
state, j&k ,bihar etc
 Appointment of ophth surgeons &assist in new district hosp
 Appointment of ophth assistants in PHCs/vision centres
 Appointment of eye donation counsellors on contract basis in eye banks
under govt& NGO sector
 Grant in aid for NGO for other eye d/s
 Special attention to clear cataract backlog & take care of other eye care
centres frm NE states
 Telemedicine in ophthalmology
 Involvement of private practitioners
 A provision of RS 1550 crore has been proposed for implementation NPCB
in 11 five yrs plan
 Vit A supplement &MMR vaccination via DBCS to prevent childhood
blindness
 Setting up of 5 centres of excellencefor eye care services
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24.  Community health education is a built in component at
all levels of NPCB implementation
 School eye screening programme
 Collection & utilization of donated eyes
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25. Externally aided projects
 World bank assisted cataract blindness
control project
 Danish assistance to NPCB
 WHO assistance for prevention of
blindness
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26. VISION 2020/ THE RIGHT
TO SIGHT
 Global initiative to reduce “AVOIDABLE
BLINDNESS” by the yr 2020
 Target d/s are cataract, childhood
blindness,corneal
blindness,glaucoma,diabetic retinopathy.
 Human resource development as well as
infrastructure& tech devpt@ various levels
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27. structure Centres of
excellence
20
ry
rtia
Te
Training
centres 200
ary
Service centres
nd
2000
co
Se
ary
Vision centres 20000
im
Pr
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