Community Ophthalmology
Community ophthalmology is a branch of ophthalmology focused on the prevention of blindness and promotion of eye health at the community level. It integrates eye care with public health principles to address avoidable blindness through screening, education, and outreach services.
Blindness
1. Definition of Blindness (WHO & NPCB)
- WHO Definition:
- Visual acuity <3/60 (20/400) in the better eye with the best possible correction.
- Or a visual field <10° from fixation in the better eye.
- National Programme for Control of Blindness (NPCB, India):
- Visual acuity <6/60 in the better eye with best possible correction (used for epidemiological purposes in India).
2. Categories of Visual Impairment (WHO)
- Normal vision: 6/6 to 6/18
- Moderate visual impairment: <6/18 to 6/60
- Severe visual impairment: <6/60 to 3/60
- Blindness: <3/60
3. Magnitude of Blindness
- According to WHO, globally about 43 million people are blind.
- In India, blindness prevalence has significantly reduced due to various programs but remains a public health concern.
4. Causes of Blindness
- Globally:
- Cataract (most common)
- Glaucoma
- Age-related macular degeneration (AMD)
- Diabetic retinopathy
- Corneal opacity
- In India:
- Cataract
- Refractive errors (uncorrected)
- Corneal blindness
- Glaucoma
- Childhood blindness (Vitamin A deficiency, congenital cataract)
- Trachoma
Prevention of Blindness
1. Levels of Prevention:
- Primordial Prevention: Reducing risk factors (e.g., nutrition, hygiene).
- Primary Prevention: Health education, immunization (e.g., measles), Vitamin A prophylaxis.
- Secondary Prevention: Early detection and treatment (e.g., school screening for refractive errors).
- Tertiary Prevention: Rehabilitation and surgical interventions (e.g., cataract surgery, low-vision aids).
2. Vision 2020: The Right to Sight
- A global initiative by WHO and International Agency for the Prevention of Blindness (IAPB).
- Goal: Eliminate avoidable blindness by 2020 (efforts continue post-2020).
- Target Diseases: Cataract, refractive errors, trachoma, onchocerciasis, childhood blindness.
National Programmes Related to Blindness in India
1. National Programme for Control of Blindness and Visual Impairment (NPCBVI)
- Launched: 1976
- Vision: Reduce the prevalence of blindness to 0.3% by 2020 (further extended).
- Objectives:Provide comprehensive eye care facilities.
- Cataract surgery backlog elimination.
- School screening for refractive errors.
- Strengthening regional institutes and district hospitals for eye care.
- Promotion of eye donation.
- Key Strategies:Cataract Operations: Increasing cataract surgery rates.
- School Eye Screening: Early detection of refractive errors among school children.
- Eye Donation Campaigns: Encouraging corneal donation to treat corneal blindness.
- Tele-ophthalmology: Reaching remote areas with specialist consultations.
- District Blindness Control Societies (DBCS): Manage program activities at the district level.
2. Universal Eye Health - A Global Action Plan 2014–2019 (WHO)
- Aims to reduce avoidable visual impairment by 25% by 2019 (ongoing impact).
- Emphasizes integrated, people-centered eye care (IPEC).
3. Other Related Initiatives
- Vitamin A Prophylaxis Programme: To prevent childhood blindness due to xerophthalmia.
- Trachoma Control Programme: Mass drug administration (MDA) with azithromycin and improved hygiene.
- Integrated Child Development Services (ICDS): For nutritional improvement preventing ocular morbidity.
- Janani Shishu Suraksha Karyakaram (JSSK): Preventing congenital eye diseases via maternal care.
Recent Advances and Community Approaches
- Mobile Eye Units: Portable surgical units for cataract surgery in remote areas.
- Public-Private Partnerships (PPP): Collaboration with NGOs like Aravind Eye Care and LV Prasad Eye Institute.
- Primary Eye Care Integration: Training primary healthcare providers for early detection.
- Low Vision Clinics: Providing rehabilitative care for irreversible visual loss.
Key Points for Medical Exams
- Always highlight Cataract as the leading cause of blindness in India.
- Emphasize the NPCBVI and Vision 2020 initiatives.
- Discuss the levels of prevention in ophthalmology.
- Be prepared to write short notes on school eye screening, Vitamin A supplementation, and eye donation campaigns.