Community Ophthalmology

·         WHO definition of blindness. In order to have comparable national and international statistics, the WHO in 1972 proposed a uniform criterion and defined blindness as, “Visual acuity of less than 3/60 (Snellen) or its equivalent”. In order to facilitate the screening of visual acuity by non-specialised persons, in the absence of appropriate vision charts, the WHO in 1979 added the “Inability to count fingers in day-light at a distance of 3 metres” to indicate vision less than 3/60 or its equivalent. Visual filed less than 10º, irrespective of the level of visual acuity in also labelled as blindness (WHO, 19774).

·         Other definitions of blindness in vogue are:

_ Economic blindness: vision in better eye <6/60 to 3/60

_ Social blindness: Vision in better eye <3/60 to 1/60

_ Legal blindness: Vision in better eye <1/60 to perception light

_ Total blindness: No light perception (PL -ve).

·         Vision 2020: The Right to Sight’,10 is a global initiative launched by WHO in Geneva on Feb. 18,1999 in a broad coalition with a ‘Task Force of International Non-Governmental Organisations (NGOs)’ to combat the gigantic problem of blindness in the world. Partners of Vision 2020: Right to Sight include:

I. World Health Organisation (WHO),

II. Task Force of International NGOs, which has following members:

_ International Agency for Prevention of Blindness (IAPB)

_ Christopher Blindness Mission (CBM)

_ Helen Keller International

_ ORBIS International

_ Sight Savers International

_ Al Noor Foundation

_ International Federation of Ophthalmological Societies

_ Lions Clubs International Foundation

_ Operation Eye Sight Universal

_ The Carter Centre

·         W.H.O. has organized an Alliance for Global Elimination of Trachoma by the year 2020 (GET 2020).

·         Vision for the future (VFTF): International Ophthalmology Strategic Plan to Preserve and Restore Vision11, launched in Feb 2001, is another global initiative (in addition to Vision 2020) for prevention of blindness. Implementation of this program is being done by International Council of Ophthalmology (ICO) by working closely with other international, supranational and national organizations. It is parallel to and complementary of ‘Vision 2020’. Care is being taken to avoid duplication.

Top priorties for action of this programme are:

1. Enhancement of ophthalmology residency training around the world, particularly through definition of principles, guidelines and curricula.
2. Development of model guidelines and recommendations for ophthalmic clinical care in critical disease areas.
3. Dissemination of sample curricula for training of medical students and allied health personnel.
4. Advocacy and support for ‘Vision 2020: Right to Sight’, particularly by encouraging national ophthalmologic societies to support the initiative and become involved.
5. Helping national ophthalmologic societies develop more effective organizations.

·         Target diseases identified for intervention under ‘Vision 2020’ initiative in India include:

_ Cataract,

_ Childhood blindness,

_ Refractive errors and low vision,

_ Corneal blindness,

_ Diabetic retinopathy,

_ Glaucoma, and

_ Trachoma (focal)

·         Mid-Level Ophthalmic Personnel (MLOP). The term MLOP has been introduced to include all categories of paramedics who work full time in eye care. Broadly two streams of such personnels are envisaged:

1. Hospital-based MLOP. These include ophthalmic nurses, ophthalmic technicians, optometrists, and orthoptists etc.
2. Community-based MLOP include those with outreach/field functions such as primary eye care workers and ophthalmic assistants.

·         Presently two types of eye camps are held:

Comprehensive eye care camps with ‘Reach-out Approach’, and

Screening eye camps (Reach-in-Approach with comprehensive eye care). As mentioned earlier the recent emphasis is on the ‘Reach-in-Approach’.