Appendix 1 – PROPOSALS FOR WORKGROUP DISCUSSION

Specific Disease intervention – Cataract, Refractive Error, Diabetic Eye Disease

HEALTH PROMOTIONHEALTH PROMOTION

Areas of Concern

Plan of Action Specific Activities Issues to Resolve

Lack of public awareness on cataract, refractive error and diabetic eye disease

1. Increase public awareness through mass media and related activities

2. Produce Health Education Materials

3. Establish a committee to organise and monitor promotional activities

1. World Sight Day Observance

1. Who to organise funding, yearly theme etc.

2. Regular production and Educational materials

2. Who to take charge of producing educational materials, funding, distribution – how many in a year? What is the cost?

3. Radio/TV Talks 3. Who to organise?4. What to

produce?5. Who to fund?6. How often?

SuggesteSuggested d outcomeoutcome- form a subcommittee for health promotion

7. Documentary on TV on the 3 diseases

8. Catchy TV advertisements

9. Billboards

10.Newspaper

11.Public Forums

12.Form a subcommittee and have regular meetings.

Required:Feedback to Task Force

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CASE DETECTION

Areas of Concern

Plan of Action Specific Activities Issues to Resolve

Inadequate case detection

1. Increase case detection by intensifying screening programmes/activities

2. Improve referral system

3. Monitor and reporting of effectiveness of screening programmes

1. Opportunistic Screening at MCH Clinic to continue

Training – for discussion

Policy Change

Funding

Monitoring – sustainability of programme

Evaluation

Suggested Outcome

Form a subcommittee for Primary Eye Care Training

2. Review current screening programme for Diabetic Retinopathy and extend pilot project to other KK

3. Involve Optometrists and Opticians in screening for the 3 diseases. – school health, DR Screening

4. Review current screening programmes at the preschool and school health level and suggest improvement/alternative programmes

Doktor Muda School Health Club Adopt a

school/kindergarten programme

Reactivate Ophthal. Soc. Home Vision Screening Activity

5. Annual Vision screening programme by

NGOs Village Volunteers

where applicable

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What else?

TrainingTrainingAreas of Concern

Plan of Action Specific Activities Issues to Resolve

A. Lack of awareness on eye care among primary healthcare providers both in the public and private sectors

1. Provide training to primary health care providers

2. Provide materials for training

3. Evaluate and monitor effectiveness of primary eye care training programmes

1. Review Curriculum of JM,SN, MA, Medical Students

Implementation issues

2. Refresher Courses

3. Extend 3 day eye care courses to private, industrial and estate healthcare providers

4. Reactivate Ophthalmological Soc. of MMA training to GPs on Diabetic Retinopathy.

5. Review and develop teaching tools and kits

B. Lack of awareness on eye care among medical officers

1. Provide knowledge on Public Health Ophthalmology

2. Enhance the current eye care training module for medical students

1. Review curriculum and allocate more time for PEC in Public Health training module

2. Review curriculum and train medical

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students to enable them to carry out their role in PEC upon graduation.

C. Unsatisfactory product of Ophthalmologist Training programme – training objectives not met

1. Improve the training programme of Ophthalmologist

2. Improve the facilities for training especially in the open system

3. Emphasise importance of management and PHO in eye care delivery

1. Review curriculum and training needs based on role upon completion of gazettement as a specialist.

2. Recognise the need for higher surgical training for Ophthalmologist to improve quality of patient care and initiate the formulation and implementation of HST programme.

3. Include management course in training programmes.

4. Include PHO in training programmes.

5. Review role/effectiveness of Specialty Conjoint board as a coordinating body

6. Alternatively

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suggest/pass over role of coordinating body to Academy of Medicine’s Specialty Board

7. Monitoring of Training Programmes by coordinating body

Areas of Concern

Plan of Action Specific Activities Issues to Resolve

D. Inadequate number of experienced teachers in the Ophthalmologist Training programme

1. Increase the pool of teachers through collaboration with other governmental or private centres

2. Increase the number of subspecialists and subspecialty centres

1. Regional Training Programmes rather than duplicating programmes

2. Improve access to distant learning using ICT

3. Sign MOU with private institutions or universities including neighbouring countries

4. Increase number of subspecialists in the various subspecialties

5. Establish subspecialty centres in stages to improve care as well as training

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E. Inadequate Research in Eye Diseases and Eye Care Delivery System

1. Facilitate research in Eye Care

2. Monitor research activities

1. Form an Eye Research Interest Group

2. Conduct Research in Refractive Error, Low Vision, DR, ARMD, Glaucoma and Cataract

3. Provide Funds for Research

4. Provide incentives for researchers

SERVICE DELIVERY

Areas of Concern

Plan of Action Specific Activities Issues to Resolve

A. Unsatisfactory Cataract Surgical rate

1. Increase CSR 1. Outreach programmes

2. Efficient use of available resources in public hospitals

3. Improve facilities in public hospitals

4. Improve standard of care – CPGs, SOP workshop

5. Day Care surgery

B. High cost of cataract surgery

1. To make cataract surgery

1. To promote use of good quality but low

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affordable and accessible

2. Promote small incision cataract surgery

cost IOL

2. IOL subsidy schemes

C. Refractive Error a major cause of visual impairment

1. To make basic Optometry services available to all

2. To improve accessibility by shifting some responsibility to Opticians and Optometrists

3. Facilitate Optometrist to provide the desired level of care

1. Community services by private optometrist

1. drugs to be used by Optometrists

2. Proposal – partnership with Ophthalmologists to facilitate use of cycloplegics

2. Free spectacles programmes – improve access

3. Used spectacles programmes

4. Post optometrists to district hospitals/visiting optometrists

5. Equip public hospitals with basic equipments

6. Evaluate and Improve school health programmes

D. Increasing incidence, late presentation and inadequate facilities in the management of Diabetic eye Disease

1. Improve early detection through screening programmes

2. Upgrade facilities and improve standard of care at secondary centres to ensure there is no discontinuity of laser and Vitreoretinal services

3. Monitor and evaluate laser and Diabetic vitrectomy services

1. Screening programmes as above

2. Ensure supply, replacement and maintenance of laser and vitrectomy machines etc.

3. SOP workshop, review CPG

4. Conduct studies on clinical outcomes

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EYE HEALTH INFORMATION SYSTEM

Areas of Concern

Plan of Action Specific Activities Issues to Resolve

Lack of a complete Eye Health Information System essential for planning and research

1. To establish a national Eye Health Information system

2. To integrate such a system with the currently available system in MOH

3.

1. Sustain NCSR – participation by private sectors necessary

2. Develop and sustain VISION 2020 web site

3. ICD 10

4. Conduct NES in 2006

5. Low vision registry

6. Blindness registry

REHABILITATION

Areas of Concern

Plan of Action Specific Activities Issues to Resolve

1. Very small number of blind & low vision children receiving education

A) Improve early detection, intervention, and referral services

B) Increase enrolment level to that of national average

i) Public awareness of importance of such servicesii) Train all categories of workers & persons who come into touch with babies & young children, especially those below 3 years old i) Provide training for all

Ministries of Information, Health, and EducationMinistries of Health, Social Welfare, and Education

Ministry of Education & NGOs

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C) Accelerate expansion of Inclusive Education “Schools for All”D) Assist Residential Special schools to convert to Resource Centres

in-service teachers in special needs education of VIPsii) Ensure that the above training is also built into the curriculum of all teacher training colleges

Ministry of Education

2. Equally small number of VI youths and adults, who are blind or have LV, being trained & rehabilitated

A) Improve identification & referral systemsB) Improve, expand and decentralise Training programmes

3. Even more limited training & employment/income generation opportunities

A) Establish &/or improve Placement services.

4. Lack of CBR and referral system

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Appendix 2

VISION/ MISSION / OBJECTIVES AND STRTEGIES FOR THE NATIONAL

PERVENTION OF BLINDNESS PROGRAMME - VISION 2020 MALAYSIA-

THE RIGHT TO SIGHT

VISION

All Malaysians shall enjoy eye health resulting from equal, affordable

and timely access to quality ophthalmic services at all levels of care

by the year 2020.

MISSIONMISSION

VISION 2020 Malaysia is committed to the elimination of avoidable blindness and

low vision through:

1. The provision of accessible quality eye care using appropriate technology at an

affordable cost

2. The promotion of the preventive aspects of ocular health, with emphasis on public

education and the participation of each individual in his/her own care.

3. The training of all categories of eye care providers

4. The provision of appropriate and effective education, training and rehabilitation of

the irrevocably blind and refracted low vision with special needs.

5. The quest for better understanding of local disease patterns, to enable healthcare

related strategies to be more effectively planned and evaluated

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GENERAL OBJECTIVEGENERAL OBJECTIVE

To prevent and control major avoidable blindness and to make essential eye care

available to all

SPECIFIC OBJECTIVESSPECIFIC OBJECTIVES

BY 2020:

1. To reduce the prevalence of blindness from 0.29% to 0.15%

2. To consolidate/strengthen the existing programme for cataract intervention and

increase the Cataract Surgical Rate to 5000 per million population per year

3. To initiate and sustain a workable intervention programme for low vision and

reduce its prevalence rate from 2.4% to 1%

4. To increase awareness on and strengthen services to manage Diabetic Retinopathy

5. To train adequate numbers of appropriate health personnel to provide eye care

6. To develop an eye health information system

7. To promote community participation in the prevention of blindness

8. To ensure intersectoral collaboration in eye care

STRATEGIES

1. To determine the extent of visual impairment among the Malaysian population

and identify the major causes of blindness and low vision

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2. To initiate and propagate effective intervention aimed at primary, secondary and

tertiary prevention of visual impairment

3. To create intersectoral collaboration to foster a joint effort towards the

accomplishment of VISION 2020 Malaysia

4. To maintain an ongoing human resource development programme in response to

the local needs

5. To initiate a Center for Eye Care Research, focusing on essential research areas

for eye health and eye care service delivery.

To maintain a regular evaluation programme on the delivery of eye care services and training programme, including an effective feedback mechanism to the program manager and the public

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Reading Material for the Prevention of Blindness Workshop

1 The prevalence of blindness and low vision in Malaysian population: results

from the National Eye Survey 1966. M Zainal, SM Ismail, AR Ropialh, H Elais,

D Alias, J Fathilah, T O Lim, L M Ding, PP Goh. Br J Ophthamol 2002;86, 951-

956

2 Articles form Journal of Community Eye Health ( available at : www.

jceh.co.uk)

2.1 A Global Initiative for the Elimination of Avoidable Blindness. Vol. 11 issue

25,1998

2.2 Cataract Surgical Coverage: An Indicator to Measure the Impact of Cataract

Intervention Programmes. Vol. 11 Issue 25, 1998

2.3 The Role of Patient Counsellors in Increasing the Uptake of Cataract

Surgeries and IOLs Vol. 11 Issue 25, 1998

2.4 Community Participation -‘Putting the Community into Community Eye

Health’. Vol. 12 issue 31,1999

2.5 Health Promotion and Community Participation in Eye Care Services. Vol.

12 Issue 31, 1999

2.6 People Who Do Not Sue Eye Service: ’Making the Invisible Visible’. Vol.

12 issue 31,1999

2.7 National Prevention of Blindness Program and VISION 2020. Vol. 13,

Issue 36 2000

2.8 National Prevention of Blindness Programmes, Vol. 13 Issue 36, 2000

2.9 Cambodia’s National Eye Care Programme and VISION 2020: The Right to

Sight. Vol. 13 Issue 36, 2000

2.10 Importance of Affordable Eye Care. Vol. 14 Issue 37 ,2001

2.11 Cost Containment in Eye Care. Vol. 14 Issue 37 ,2001

2.12 Financial Sustainability. Vol. 14 Issue 37 ,2001

2.13 New Issues In Childhood Blindness. Vol. 14 Issue 40 ,2001

2.14 Guidelines for Setting Up a Low Vision Programme for Children. Vol. 14

Issue 40 ,2001

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2.15 Training Ophthalmologists for Children’s Eye Care Centres. Vol. 14 Issue

40 ,2001

2.16 Evaluation of Training. Vol. 14 Issue 40 ,2001

2.17 How Can We Improve Patient Care? Vol. 15 Issue 41, 2002

2.18 The Patients View: How Can We Improve Patient Care? Vol. 15 Issue 41,

2002

2.19 Patients’ Perspective: An Important Factor in Assessing Patient Satisfaction.

Vol. 15 Issue 41, 2002

2.20 Teaching Resources: Be Prepared! Vol. 15 issue 41, 2002

2.21 Technology for VISION 2020. Vol. 15 Issue 42, 2002.

2.22 The role of optometry in vision 2020 vol 15 issue 43, 2002

2.23 Case Finding for Refractive Errors: Assessment of Refractive Error and

Visual Impairment in Children. vol 15 issue 43, 2002

3. Action ‘urgently needed’ to avert crisis in Canadian ophthalmic health care, warns

study-An article from Eurotimes –A European outlook of the world of

Ophthalmology vol 8,issue 2. February 2003

4. Report of a WHO/IAPB Scientific Meeting on ‘Preventing blindness in children’ ,

publication from World Health Organization and International Agency for the

Prevention of Blindness ( hard copy )

5. Asia Pacific Regional Low Vision Workshop, Hong Kong, 28-30 May 2001,

publication from World Health Organization and International Agency for the

Prevention of Blindness (hard copy)

6. Breaking Down Barrier –A Practical Guide for Eye Units in Developing countries

by Geert Vanneste, a publication of Christoffel – Blindenmission (hard copy)

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