DR.MAHESWARI JAIKUMAR

BLINDNESS

CAUSES OF BLINDNESS• Cataract (62.6%) Refractive Error (19.70%)

Corneal Blindness (0.90%), Glaucoma (5.80%), Surgical Complication (1.20%) Posterior Capsular Opacification (0.90%) Posterior Segment Disorder (4.70%), Others (4.19%)

• Estimated National Prevalence of Childhood Blindness /Low Vision is 0.80 per thousand

•

• The WHO has defined blindness as "visual acuity of less than 3/60 (Snellen) or its equivalent", &

• nonspecialised personnel it is further described as "inability to count fingers in daylight at a distance of 3 meters". India has 6 million blind out of 38 million blind present in the world

EXTENT OF THE PROBLEM• 40-45 million people are blind

worldwide.

• 135 million people have low vision.

• 12 million people are blind in India.

• As per Survey in 2001-02, prevalence of blindness is estimated to be 1.1%.

• According to WHO estimation, by the year 2020 the number of people who are blind and visually impaired will be twice the current level unless aggressive and innovative approaches are taken.

• India is committed to reduce this burden of blindness by adopting the strategies advocated for vision

2020 - “THE RIGHT TO SIGHT."

PREVALENCE RATE• By 1974 the prevalence rate of blindness in

India was 1.38%.

• During 1986-89 the prevalence rate was 1.49%.

• During 1999-01 survey in 15 districts of the country indicated that 8.5% of 50+ population are blind.

NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS(NPCB)

• First country to launch it in 1976

• 80-90% of the blindness are either curable or preventable.

• Cataract is the leading cause of blindness

• as a public health problem, blindness was included in the Prime Minister's 20-point programme in 1982.

• National Programme for Control of Blindness was launched in the year 1976 as a 100% Centrally Sponsored scheme with the goal to reduce the prevalence of blindness from 1.4% to 0.3%.

OBJECTIVE• To bring down the prevalence rate

of cataract blindness from 1.49% to 0.8% by the year 2007.

• To provide high quality of eye care

to the affected population.

• To expand coverage of eye care to the affected population.

• To expand coverage of eye care services to the under-served areas.

• To reduce the backlog of blindness by identifying and providing services to the affected population.

STRATEGIES• Decentralized implementation of the scheme

through District Blindness Control Societies.

• Reduction in backlog of blind persons by active screening of population above 50 years of age. Organizing screening eye camps and transporting operable cases to eye care facilities.

• To expand coverage of eye care to the affected population.

• To expand coverage of eye care services to the under-served areas.

• To reduce the backlog of blindness by identifying and providing services to the affected population.

• Involvement of voluntary Organization in various eye care activities.

• Participation of community and Panchayat Raj institutions in organizing services in rural areas.

• Development of eye care services and improvement in quality of eye care by training of personnel, supply of high-tech equipments, strengthening follow up and monitoring services.

• Screening of school going children for identification and treatment of refractive errors with special attention in underserved areas.

• Public awareness about prevention and timely treatment of eye ailments.

• Specific focus on illiterate women in rural areas. For this purpose there should be convergence with various ongoing schemes for development of women and children

To make eye care comprehensive, besides cataract surgery other interlobular surgical operations for treatment of Glaucoma.

• Treatment for Diabetic Retinopathy may also be provided free of cost to poor patients through Govt. and NGOs

ACTIVITIES• Strengthening of eye care

infrastructures in the state.

• Improvement of quality of eye care services by training of eye care personnel.

• Provision of modern equipments instruments and other commodity assistance by GOI.

• Provision of vehicle.

• Increased no. of cataract surgery.

• Abolition of reach out camps.

• Introduction of cataract surgery with IOL implantation.

• Involvement of NGOs.

• Training & capacity building of ASHAs to orient towards blindness Control Prog & create a group of field functionaries who will initiate & create awareness on BCP at the village level.

• School eye screening.

• Cataract surgery.

• IEC & EYE health education at all levels to be undertaken

COMPONENTS1.Cataract surgery.

2.Eye screening.

3.Eye donation. (Eye donation fortnight -25 Aug to 8 Sep)

4.Voluntary organization.

5.Vit “A’ prophylaxis. (Vit “A” syrup –oral – for all pre school children)

6.IEC activities.(World Sight Day –II Thursday of october)

INDICATORS• Cataract operation in bi-lateral Blind • Cataract surgery in Female. • Cataract surgery in SC ST population. • Cataract surgery in different facilities • Cataract surgery in different age

groups.

INITIATIVES THAT WILL BE INTEGRATED INTO THE BLINDNESS CONTROL PROGRAMME

• Free surgery for cataract cases in rural areas.

• Free transportation for patients of un reached areas.

• Free medicine for all types of eye ailments.

• Free spectacles for post operative care.

• Free spectacles for poor school students.

• All backlog cataract cases would be treated.

• All schools would be covered for SES.

• All children would be given vit-A supplementation and immunization coverage.

• Modern and advanced treatment would be available in all Medical College Hospitals and DHHs

• Two Eye Banks to be established.

• Establishment of one RIO (Regional Institute of Ophthalmology) in one of the medical colleges.

ADMINISTRATIVE SET UP• CENTRAL LEVEL:• Ophthalmology Cell, Ministry of

Health and Family Welfare, New Delhi.

REGIONAL LEVEL

• Regional Institute of Ophthalmology

STATE LEVEL

• State, Ophthalmic Cell and Directorate of Health and Family Welfare

DISTRICT LEVEL

• District Blindness control Societies (DBCS). District Collector will held the chairmanship.

MEGA EYE CAMPS IN UNDERSERVED AREAS

• In the Golden Jubilee year of the India's independence a special programme for organizing mega eye camps in underserved areas has been undertaken

XI TH FIVE-YEAR (2007-12)• Sanctioned huge amount and

introduced new schemes on diabetic retinopathy, glaucoma, childhood blindness like congenital cataract, squint, strabismus, besides the core diseases like cataract, focal trachoma, refractive errors and low vision.

• Integration of NPCB with the National Rural Health mission [NRHM] for ensuring optimal utilization of the existing infrastructure at various levels

VISION 2020• Regional strategy by WHO: “Right to Sight”.

This is to reduce avoidable blindness by the year 2020.

SAFE strategy for Trachoma:• S- Surgery for in turned eyelids• A- Antibiotic use.• F- Facial cleanliness• E- Environmental improvement.

ACTIVITIES• Cataract Operation• Involvement of NGOs• Civil Works• Training• Commodity Assistant

• Information Education and Communication• Management Information

System• Monitoring and Evaluation

GOALS & OBJECTIVES OF NPCB IN THE XII PLAN

•

• To reduce the backlog of blindness through identification and treatment of blind at primary, secondary and tertiary levels based on assessment of the overall burden of visual impairment in the country.

GOALS• To reduce the prevalence of blindness

(1.49% in 1986-89) to less than 0.3%;

• To establish an infrastructure and efficiency levels in the programme to be able to cater new cases of blindness each year to prevent future backlog.

OBJECTIVES• To establish eye care facilities for

every 5 lakh population.

To develop human resources for eye care services at all levels the primary health centres, CHCs, sub-district levels,

To improve quality of service delivery and

To secure participation of civil society and the private sector.

STRATEGIES1.Strengthening service delivery,2. Developing human resources for

eye care3. Promoting outreach activities and

public awareness4. Developing institutional capacity.

• Develop and strengthen the strategy of NPCB for “Eye Health” and prevention of visual impairment; through provision of comprehensive eye care services and quality service delivery.

• Strengthening and up gradation of RIOs

to become centre of excellence in various sub-specialities of ophthalmology

• Strengthening the existing and developing additional human resources and infrastructure facilities for providing high quality comprehensive Eye Care in all Districts of the country• To enhance community awareness

on eye care and lay stress on preventive measures

Increase and expand research for prevention of blindness and visual impairment

To secure participation of Voluntary Organizations/Private Practitioners in eye Care

CATARACT BLINDNESS CONTROL PROJECT

• The Cataract Blindness Control Project supported by the World Bank became effective on January 31, 1995, and closed on June 30, 2002 after an extension of one year.

• Project objectives were to support India's efforts to upgrade the quality of cataract surgery; to expand the coverage of India's National Program for the Control of Blindness (NPCB) to underprivileged areas

Special attention to women, tribal, and isolated areas; and to assist in the reduction of cataract blindness in seven states that accounted for more than 70 percent of India’s cases of cataract blindness

• (Andhra Pradesh, Madhya Pradesh, Maharashtra, Orissa, Rajasthan, Tamil Nadu, and Uttar Pradesh).

RESULTS• A countrywide shift in surgical

technology resulted in a total of 15.3 million cataract operations performed, without which the affected persons would have eventually gone blind.

RIGHT TO SIGHT