1. PRIMARY LEVEL
EYECARE SERVICES
PALESA DUBE

2. Introduction:
 Primary level Services
 Human resource
 Equipment
 Screening programs
 Community Participation/Awareness(Health
Promotion)
 Monitoring of services

3. VISION 2020
VISION 2020
VISION 2020
 Vision 2020 will strive to make refractive services
and corrective spectacles affordable and available
to the majority of the population through primary
health care facilities, vision screening in schools
and low-cost production of spectacles. Similar
strategies will be adopted to provide low vision
services.

4. PHC vs PEC
 Primary health care in relaltion to Primary
eyecare
1. Better nutrition-Prevents vitamin A deficiency
2. Water and sanitation programmes-Relevant in
trachoma control
3. Delivery of maternal and child health care-
Reduce retinopathy of prematurity
4. Health education-Prevention of eye trauma

5. IAPB MEETING IN DURBAN
IAPB Durban
IAPB MEETING IN DURBAN
 Refractive services can be the entry point for
developing health care and for screening for
other diseases, eg glaucoma, diabetic retinopathy
etc.
 Integration is therefore critical

6. Refractive Correction: Priority
 -High Priority: < 6/18
 -Moderate Priority: <6/12
 -Low Priority: <6/9
 -Children: < 6/12
 -Adults: < 6/18
 This should inform services at the primary eye
care level

7. Priority Groups
 Children aged 11-15 with myopia and people over
the age of 45 years who require spectacles for near
vision

8. Refractive error in Children
 Visual acuity screening of children can be
performed at community level by teachers,
health care workers etc.

9. STRATEGIES
STRATEGIES
STRATEGIES
Vision 2020
Ophth., Opt.,
Specialists Managers
OphN., Oph.Tech,
Mid Level Dispensing Opt.
Personnel
Com W orker,
Comm. Teacher,
PHCW
Level

10. Primary Eyecare
Key components:
 Prevention
 Awareness
 Community involvement etc.

11. The Importance of Primary
Eyecare
 Training
 Supervision
 Support
 Referral
This extends from from the clinic nurse at the
district and community health centre to the eye
nurse at the district hospital and the eye doctor
at the regional hospital.

12. Primary Level Services
Community Level
Primary Level Services
Services provided:
 Screening programs
 Case Finders
 Sifting out and correcting Presbyopes
 Readers for presbyopia
 Referring for ocular disease

13. District Health System
District Health System
District Health System
WHO: Framework for delivery
WHO: Framework for Delivery
WHO: Framework for delivery
HEALTH
DISTRICT SPECIALIST & SUPER-
SPECIALIST CARE (40)
3o LEVEL CARE
NON-
CLINIC SPECIALISED SERVICES
SPECIALIST
COMMUNIT
Y HEALTH DISTRICT REGIONA
CENTRE HOSPITA L
L HOSPITA PROVINCIA
CLINIC L L HOSPITAL
COMMUNIT
Y HEALTH DISTRICT REGIONA
CENTRE HOSPITA L
L HOSPITA
CLINIC L
Fig

14. District Hospital
•Refer to district:
Ophthalmic nurse/OCO/Optometrist/Refractionist
­ Treatment of Ocular Disease
­ Refraction including Diagnoses of astigmatism
­ Basic Low Vision

15. Human Resources Required
 Primary Health Care nurses
 Community Health Care facilitators
 Community Health Care workers
 Teachers, Social workers
 Community representatives and structures

16. Skills needed
 Recognition and primary care management of
the following:
-Eye injuries
-Refractive errors
-Eyelid swelling
-Red eye
-Cataract
-Educating patients about hypertensive and
diabetic retinopathy, trachoma etc

17. Training needs
 Training Needs
-Vision assessments
-Vision screening/ School screening techniques
-Presbyopic correction
-Management of basic eye conditions eg.
conjunctivitis

18. Responsibilities
 Case History
 Visual Acuity
 External exam with a penlight
 Installation of eyedrops and ointments
(Antiallergic and antibiotic ointments and
eyedrops)
 Awareness of cataract surgery, other eye
conditions etc.

19. Equipment required
 Screening Tools:
Distance VA charts
Near VA charts
+2.00 spectacles (Children sreening)
Ocludder
Pinhole
Pd ruler
Torch

20. Provision of spectacles
Provision of Spectacles
spectacles
 -Affordable and or subsidised
 -Ready mades: Presbyopic correction
 Inventory of spectacles for same day
dispensing

21. SCREENING
PROGRAMS

22. School based screening
School based screening

23. Aim of school vision testing
Aim of school vision testing
Aim of school vision testing
 Amblyopia
 Refractive errors
 To detect eye diseases in older children
 Limited by resources: human,
infrastructure and finance

24. Age of vision screening
Age of vision screening
Age of vision screening
 Options:
 Preschool age
 Primary school age
 Secondary school age

25. CHILDREN
Children
CHILDREN

26. Adults over 45 45
Adults over years
Adults over 45

27. Community Screening
Community Screening
Community Screening
 Primary health care centers
 Collaboration with community based
organisations
 For children in the community the same school
screening techniques should be followed.

28. COMMUNITY
PARTICIPATION

29. Community Participation
Providing affordable (even free) and
accessible services does not guarantee
that they will be used.
-Cultural and other beliefs and/or fears
-Sense of ownership is important in
ensuring uptake of services

30. Community Participation
 Access to and uptake of existing eye-care
services:
- Ensure there are no barriers or other
constraints to the use of services at the eye
unit itself.
- Develop outreach services that operate
effectively.
- Ensure adequate number of staff working in
primary eye care and in outreach facilities.

31. Community Participation
 Continuation:
- Ensure that community members seek out eye-
care services when needed.
- Ensure that communities are actively involved in
eye-screening.

32. AWARENESS

33. Potential approaches to increase
awareness/health promotion
 Basic eye health workers and general health
staff
 CBR workers
 Village health workers
 Survey/questionnaire/focus groups
 Mass media
 Traditional healers
 School teachers and schoolchildren
 Community groups (women’s groups,
religious groups)

34. Monitoring of services
-School children identified with refractive errors
and provided with spectacles.
-Number of adults given presbyopic corrections
-Number of referrals for refraction at the
secondary level
-Uptake of spectacles
-Number of people referred for other eye
conditions