1. Community OphthalmologyCommunity Ophthalmology
J.B. ChandJ.B. Chand
Himalaya Eye HospitalHimalaya Eye Hospital
Pokhara, NepalPokhara, Nepal

2. Community Ophthalmology ?
– It represents a conceptual shift from
individualized eye care delivery system to
community directed approach aimed at the
improvement of the ocular health of the entire
community
– Comprehensive strategy for providing
Promotive, Preventive, Curative and
Rehabilitative eye care services to the
community

3. Blinding Eye Diseases
• Cataract
• Glaucoma
• Diabetic Retinopathy
– Occurs everywhere
– Affects Individuals
– Affects mainly adults
– Requires surgery/Laser
– Needs an eye doctor
• Hospital Based
• Trachoma
• Onchocerciasis
• Vit A deficiency
– Focal disease
– Affects Communities
– Starts in Children
– Require s medicine
– No need eye doctor
• Community Based
Both are Essential

4. Prevention of Blindness
Four important question to be asked when
considering prevention of blindness
– What is blindness? Definition
– How many are blind? Magnitude
– Why are people blind? Aetiology
– What can we do? Control

5. Definition of Blindness
• WHO has classified visual impairment and
blindness into various grade:
6/6-618 Normal vision
<6/18-6/60 Visual impairment
<6/60-3/60 Severe visual impairment
<3/60-NPL Blind
(Best available correction in the better eye)

6. An overview of the Blindness
• Many countries in the world have used
different definition for designating
somebody as blind in view of the
prevailing local conditions

7. Defining Blindness
• Economic Blindness:
– The level of blindness that prevents an individual from
earning his wages.
– Vision less then 6/60 with the better eye with best
correction
• Legal Blindness
– The level of blindness that necessitates welfare
measures and legal protection
– Vision less then 6/60 in better eye with best correction
and visual field less then 10 degree.

8. Defining Blindness..
• Social Blindness
– Hampers an individual from socially interacting with
the family and peer groups in a satisfactory manner
– Vision less then 3/60 with the better eye with best
correction
• Manifest Blindness
– Constraints the accomplishment of tasks for daily
living leading to impairment in mobility and
corresponding to a vision of 1/60

9. Defining Blindness..
• Absolute Blindness
– Inability to perceive light secondary to irreversible
damage to the nerve carrying the visual signals can
be classified as absolute blindness (optic atrophy)
• Curable Blindness
– The stage of blindness where the damage is
reversible by prompt management.
– Cataract is an example of curable blindness

10. Defining Blindness..
• Preventable Blindness
– The loss of vision that could have been completely
prevented by institution of effective preventive and
prophylactic measures
– Xerophthalmia and trachoma are the example of
preventable blindness
• Avoidable Blindness
– The sum total of preventable and curable blindness is
often referred to as avoidable blindness. 90% of
blindness in our country is avoidable

11. Defining Blindness..
• Incurable Blindness
– The stage of blindness that can not be
treated, prevented and cured and refers to
absolute blindness is called incurable
blindness. 5-10% of all blindness may fall in
this category.

12. Magnitude
• There are 161 million visually impaired
people in the world of which 37 million are
blind (WHO: 2002)
• Prevalence of the blindness is varies in
different part of world according to
economy and health care

13. Magnitude
Economy and
Health Care
%
Blind
Blind
Per Million
Good 0.25 2500
OK 0.50 5000
Poor 0.75 7500
Very poor 1.00+ 10000+

14. Global Causes of Blindness 2002
Causes %
Cataract 47.8
Glaucoma 12.3
ARMD 8.7
Corneal opacities 5.1
Diabetic retinopathy 4.8
Childhood blindness 3.9
Trachoma 3.6
Onchocerciasis 0.8
Other 13

15. Nepal: Causes of Blindness 1981
SN Causes %
1 Cataract 72
2 Retinal disease 3.3
3 Glaucoma 3.2
4 Other infection 3.2
5 Trachoma 2.4
6 Smallpox 2.2
7 Trauma 2.2
8 Amblyopia 1.3
9 Nutritional etiology 0.9
10 Miscellaneous 7.5
11 Undetermined 1.8
Total 100

16. Aetiology
• Asia:
– Cataract, Trachoma, Corneal disease, Glaucoma and
Vitamin A deficiency
• Africa:
– Cataract, Trachoma, Corneal disease, Glaucoma,
Vitamin A deficiency and Onchocerciasis.
• Latin America:
– Cataract, Glaucoma & Diabetic retinopathy
• North America and Europe:
– ARMD, Diabetic retinopathy &Glaucoma

17. Trends in Global Blindness
Year Number of Blinds (Millions)
1975 28
1984 31
1990 38
1995 35
2000 50?
2002 37

18. Causes of Increasing Blindness
• Increasing in population
• Increasing in life expectancy
• Inadequate eye care services
• Lack of awareness to seek eye care
services
• Poverty

19. Control
• Blindness can be control by the different
level of prevention
– Primary Prevention
– Secondary Prevention
– Tertiary Prevention

20. Primary Prevention
• To prevent the disease to ever occurring
• Example:
– VADX Good nutrition
– Trachoma Good water &
sanitation
– Rubella & measles Immunization

21. Secondary Prevention
• To prevent loss of vision from established
disease
• Example:
– Cataract Surgery
– Glaucoma Medical & surgical
– Diabetic retinopathy Medical & laser T/T
– Refractive error Spectacles
– Onchocerciasis Medical treatment
(Ivermectin)

22. Tertiary Prevention
• Restore vision to a blind person
• Example:
– Cataract Surgery
– Corneal scarring Keratoplasty
– Low vision Low vision aids

23. Where do Most blinds Live?
• Most blind people live in developing
countries
–India 9 million
–Africa 7 million
–China 6 million

24. Important Activities for PBL
• Every where:
– Cataract service delivery
– Screening and treatment of refractive error
• Focal diseases:
– Vitamin A supplementation and dietary counseling
– SAFE strategy for trachoma
– Ivermectin distribution for ochocerciasis
• Specialist service:
– Glaucoma
– Diabetic retinopathy
– Childhood blindness

25. Thank You