npcb by pushkar dhir
DESCRIPTION
TRANSCRIPT
NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS VISION
2020 & RURAL EYE CAMPS
Presenter – Dr.PushkarModerator- Dr. Jayeeta Bose
INTRODUCTION• NPCB launched in the year 1976 ,Centrally Sponsored
scheme .
• Goal to reduce the prevalence of blindness to 0.3% by 2020.
• To achieve this target min. of 21 million cataract operations are to be performed.
• Survey on Avoidable Blindness conducted under NPCB during 2006-07 showed reduction in the prevalence rate of blindness from 1.1% (2001-02) to 1% (2006-07).
• 230 crore approved by empowered programme committee (EPC) for 2013-14 for NPCB.
THE ORGANISATION
CENTRAL• Ophthalmology Section,
DGHS,MOHFW• Procurement of goods• Grant –in Aid to NGOs• Organizing central level
trainning courses• Monitoring & evaluation• Procurement of
consultancy &services
STATE• State opthalmic cell, Directorate
of health services, State health societies
• Coordinate and monitor with all the District Health Society
• Procure equipment and drugs which required in GOI facilities
• Receive and monitor use of funds, equipments and material from the Government
• Promote eye donation & monitor the districts for collection and utilization of eyes collected by eye donation centres and eye banks.
DISTRICT• District blindness control
society• Organize screening camps
for identifying those requiring cataract surgery and other blinding disorders
• Organize screening of school children.
• To plan and organize training• Procure drugs and
consumables• Promote eye donation • Regular screening for and
other diseases in the out reach camps
Service Delivery & Referral Systems
Tertiary level(Regional Institute of
Ophthalmology/ Centres of Excellence in Eye care &
Medical colleges
Secondary Level
(District Hospital & NGO Eye hospital)
Primary Level
(Sub district level hospitals/CHC/Mobile
Ophthalmic units, PHC /Panchayats)
Definition of Blind under NPCB
• Inability of a person to count fingers from a distance of 6 meters or 20 feet Technical Definition
• Vision 6/60 or less with the best possible spectacle correction
• Diminution of field vision to 20° or less in better eye
Main causes of Blindness in India are
63%
20%
1%
6%
1%
1%
5% 4%Cataract
Refractive Error
Corneal Blindness
Glaucoma
Surgical Complication
Posterior Capsular Opacification
Posterior Segment Disorder
Others
Objectives of the Programme are
•To reduce the backlog of blindness through identification and treatment of blind.
•To develop Eye Care facilities for every 5 lac population
•To develop human resources for providing Eye Care Services.
•To improve quality of service delivery by establishing Regional institute of •ophthal , up gradation of medical colleges & district hospital.
•To secure participation of Voluntary Organizations in eye care.
•To enhance community awareness on eye care
INFRASTRUCTURE DEVELOPMENT UNDER NPCB
At RP centre and 10 other Regional
Institutes of Ophthal, a
National institute of Ophthal has
been established for manpower
develop, research and
referral services.Medical colleges are upgraded
under NPCB & at certain med
institutes & paramedical ophthalmic
assistants are trained.
Eye banks have been
developed in govt and non-govt sectors.
>500 Dist hospitals have been equipped
with ophthalmic equipments
and requisite manpower is
posted.
DBCS was started as pilot
project in 5 districts and
now over a 500 centres under
the chairmanship
of DC/Dep Com have been set
up.
Prevalance of Blindness being
acute in rural areas, NPCB has tried to expand the
accessibility to these areas by the means of PHC, mobile
eye units
DANIDA:Man power development Establishment & development of monitoring and evaluation system at state levelTraining Preparation of health education material, teaching & information aids.
WHO:40 intra country fellowship in Institutes of excellenceSurvey on childhood blindness in East Delhi to estimate prevalence & causes of blindness in children <15 yr.Study on refractive errors in school drop outs.Establishing National Surveillance Unit.Launch work shop on vision 2020.
BOOST UP FOR NPCB
Performance of Cataract Surgery: 1985-2003
Revised Strategy of NPCB
Construction of dedicated Eye Wards and Eye Operation theaters in DistrictsAppointment of Ophthalmic Surgeons and Ophthalmic Assistants in new districts
Appointment of Ophthalmic Assistants in PHCs/ Vision Centers where there are none (at present ophthalmic assistants are available in block level PHCs only)
Appointment of Eye Donation CounselorsGrant-in-aid for NGOs for management of other Eye diseases other than Cataract like Dr, Glaucoma
Management, Laser Techniques, Corneal Transplantation, VR Surgery
Treatment of childhood blindness etc of Rs. 750 per case for Cataract/IOL Implantation Surgery and Rs.1000 per case of other major Eye Diseases .For North-Eastern States, Hilly and Desert Areas Rs. 850
for Cataract and Rs.1100 for other major Eye Care Management is proposed.
Special attention to clear Cataract Backlog and take care of other Eye Health Care Centers from NE States.
Telemedicine in Ophthalmology {Eye Care Management Information and Communication Network}
Involvement of Private Practitioners.
A provision of Rs.1550 crore has been proposed for implementation of NPCB during 11th Five Year Plan.
A COMBINED EFFORT OF WORLD HEALTH ORGANIZATION & NGOS
Launched in Geneva on Feb 18, 1999, to combat problem of avoidable blindness in the world.
Helen Keller Worldwide
FOUNDING MEMBERS OF VISION 2020 WHO IAPB ChristoffelBlind mission. Helen Keller Worldwide. SightSavers International. ORBIS International
Al Noor Foundation. American Academy of Ophthalmology. Asian Foundation for the Prevention of Blindness. The Canadian National Institute for the Blind. The Carter Centre. Foundation Dark and Light Blind Care. The Fred Hollows Foundation.
IMPACT – EMRO
International Centre for Eye Care Education.
IFOS
International Trachoma.
Internazionale per la prevensione della Cecita.
Lighthouse International.
Lions Club International Foundation.
Operation Eye sight Universal.
Royal National Institute for the Blind.
SEVA Foundation.
Vision 2020 Australia.
Vision 2020 UK.
World Council of Optometry.
SUPPORTING MEMBERS
• Present estimation:– 45 million people blind
+– 135 million visually disabled
Present situation Worldwide
LowVision
Blind
< 6/18 - 3/60Or less than 20 deg
Visual field< 3/60
Best corrected VA
International classification ignores the burden of uncorrected refractive error
WHO defination
Global Distribution of Blindness by Cause
Cataract42 %
Trachoma15 %
Glaucoma14%
Oncho.1 %
Other28 %
Macular degeneration
Diabetic retinopathy
+Refractive errors
(uncorrected)
Without intervention the number of people with blindness might reach 76 million by 2020.
Global ageing of populations makes world blindness increase by about 2 million annually.
AIM OF THIS INITIATIVE• To INTENSIFY AND ACCELERATE present prevention of blindness
activities so as to achieve the goal of eliminating avoidable blindness by the year 2020.
• Globally 5 conditions have been identified: Cataract Trachoma Onchocerciasis Childhood blindness Refractive errors and Low Vision.
Chosen on basis of contribution to burden of blindness and feasibility&affordability of interventions to control them.
Over the period 1995-2002, glaucoma and DR have been included
Group 2 : FOCAL IN
DISTRIBUTION ( POORCOMMUNI
TIES) – vit a def, trachoma, onchocer.
Group 3 : INCREASING IN
MAGNITUDE, DIAGNOSTIC AND MGT STRATEGIES ARE NOT WELL DEFINED AND NOT COST EFFECTIVE –
Glaucoma , DR
Group 1: UNIVERSAL
CONDITIONS WHICH CAN BE SUCCESSFULLY TREATED and hence cost-
effective- cataract and R errors.
Cataract Trachoma Onchocerciasis Childhood blindness
Refractive Errors and Low
vision50% global incidence 146 million people
worldwide17 million people
affected 1.5 million
children are blind
Backlog 20 million unoperated cases
cataract surgery performance rate- 10
million annually
Targets projected : 4000/million
population/year = 32 million cataract sxy by
year 2020
10.6 million adults have
sequele( trichiasis,entropion).
More in Africa, China, Middle-east.
SAFE strategy adopted
Targets : eliminating trichiasis/entropion
and reducing prevalance of
trachoma to 5%.
0.3-0.6 million are blind.
African and Latin- American
countries
Target : establish National programmes after
effective surveillance such
as by 2020 no new cases are
reported.
1.3 million in Asia & Africa.
Targets :To eliminate vit a def diseases and
achieve nil incidence in all
countries.
Services developed for treatable dis :
cataract, glaucoma, ROP
Refraction and evaluation
for pt`s requirement of
corrective devices.
Manufacture of proper devices
Vision 2020 in India:Launched in 2001.Inculcated in 2002 with NPCB for future planning for control of
blindness.
Target diseases : Cataract, Childhood blindness, Ref Errors & Low Vision, Corneal blindness, DR, glaucoma, Trachoma (focal basis).
Strategies for corneal blindness
• Major obstacle in tackling corneal blindness is the wide gap b/`w the requirement and availability of donor corneas for which recommendations include:-
o Strengthening of hospital corneal retrieval systems.
o Assessment of persons needing corneal grafting.
o For vit a def related diseases: focus on eco backward classes is needed
Strategies for glaucoma and DR
• Immediate term :
training ophthalmologists to handle these conditions. Comprehensive eye evaluation via better clinical practice in slit lamp biomicroscopy, AT, disc and retinal evaluation and gonioscopy.
• Intermediate term:o Residency training prog in med colleges.o Training of MLOP in handling these
conditions in peripheries.o Training non ophthalmic physicians on
clinical profile of these conditions.o Public education
• Long term:o To provide high quality eye care at all
levels
Global trends :
• Over 1995 – 2002, constant factors – ageing, population growth and underdevelopment.
• Chronic diseases as glaucoma and DR have shown an increase incidence due to change in life expectancy and life-styles.
• Strategy is to bring about awareness of these conditions and also about the compliance and adherence to Rx schedules.
• Need an effective Public health approach
• This can happen with HRD & Infrastructure appropriate technology.
COST EFFECTIVENESS OF VISION 2020
• Frick and Foster calculated $ 102 billion of economic gain if VISION 2020 is successful.
Benefits of vision 2020: Blindness alleviation to 50
million. Enhanced ophthalmic training. Paramedical training. Creation and upgradation of
facilities. Access to modern technology.
Rural eye camps
Camps – effective modality for medical service delivery on a mass scale and it is cost effective.
In ophthalmology – effective strategy to combat illness at
grassroots level.
Over the years, Ophthalmic camps have become cataract centered.
Other eye camps – One day screening camps: Glaucoma, DR,School screening or refraction camps
Rural eye camps
In last few years, surgical camps are being phased out by the govt. because –
Certain surgical camps as 1986 Khurja and Muradabad camps have shown disastrous results. These have led to a decrease in credibility of the surgical eye camps.
Protocol of a surgical camp OT installation protocol and procedure
1. Planning : informing organizer about camp methodology and requirements like generators, adequate OT facility and location.
2. Camp site feasibility study
3. Surgical team : surgeons, optometrists, OT technicians, camp coordinator.
1. Advisable to get a running OT in a govt. setup or private hospital freshly whitewashed or painted.
2.Cleaning with detergent and disinfectants.
3. All openings and cracks are sealed.
4. AC and other electrical appliances installed.
5. Furniture and microscopes cleaned and installed.
6.Fumigation for 36-48 hrs & after every day of surgery.
PREOP TREATMENT
POST OPERATIVE CARE
CONCLUSION
1. Broad spectrum topical a/b.
2. Topical povidone iodine.
3. Local hygeine.
4. Continuation of systemic med.
5. Pt`s personal hygeine and cleanliness
1. Daily exam in the postop period.
2. Topical and sysytemic med
3. Complications recognized and managed at
the earliest
4. At discharge: VA ( PH). First follow up date notified
5. Follow ups at 6th and 8th wks.
• Surgical camps though being phased out are an effective way to reach distant rural and tribal population and also an effective means to control cataract blindness – backlog + new cases.