VISION 2020SIVATEJA CHALLA

LAY OUT

INTRODUCTION CAUSES FOR AVOIDABLE BLINDNESS VISION 2020 INDIA-VISION AND MISSION STRATEGY STRUCTURE SPECIFIC ACTIVITIES

INTRODUCTION

Avoidable blindness has been defined as blindness that could reasonably be prevented or cured within the limits of resources

Approximately 80% of all blindness is considered to be avoidable.

According to WHO estimate 45 million people are blind in the World as of 2000

Causes of 45 million cases of blindness (<3/60)

Millions Blind

Every year, an additional 1-2 million persons go blind.

Without proper interventions the number of blind will increase to 75 million by 2020.

Restoration of sight is one of the most cost-effective interventions in health care.

Ministries of Health

International NGOs

February 18, 1999

Projected Trends in Global Blindness

2000 2010 2020

Without VISION 2020

With VISION 2020

=100M fewer people with blindness

Analysis: Causes of Blindness

45 million Blind

Cataract

Refractive Error

TrachomaOnchocercias

isVitamin A Deficiency

Glaucoma Diabetic

Retinopathy

ARMDRP

Others

Treatable25 million

Preventable

3 million

Partly Preventabl

e7 million

Research10 million

Five key areas for action

Cataract, Trachoma, Onchocerciasis, Childhood blindness, Refractive error and low vision.

These conditions have been chosen on the basis of their contribution to the burden of blindness and the feasibility and affordability of interventions to control them.

five basic strategies to combat blindness are Disease prevention and control Training of personnel Strengthening the existing eye care infrastructure Use of appropriate and affordable technology Mobilization of resources

IN INDIA…

Aims to Eliminate Avoidable Blindness from India The National Forum (VISION 2020: The Right to Sight INDIA) is a

key driver, formed in 2004

An India free of avoidable blindness Where every citizen enjoys the gift of sight And the visually challenged have enhanced

quality of life as a right

To work with eye care organizations in India for the elimination of avoidable blindness by provision of equitable and affordable services as well as rehabilitation of visually challenged persons through development of

AIM

Strategic Approaches

1.STRENGTHENING ADVOCACY

Public awareness and information about eye care and prevention of blindness.

Introduction of topics on eye care in school curricula. Involvement of professional organizations such as AIOS,EBAI and

IMA To strengthen the functioning of DBCS To enhance involvement of NGOs, local community societies and

community leaders. strengthen hospital programmes for eye donation through

effective counselling by involving volunteers

2.REDUCTION OF DISEASE BURDEN

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 Trachoma (focal)

Implementing specific programmes to control the major causes of blindness.

Disease Control

Programmes

Cataract

Refractive Error

And low vision

Diabetic Retinopathy

Glaucoma

Trachoma

Childhood Blindness

SAFE strategy

Intensified surgical interventionYAG caps at all district hospitals

Disease Control Programmes

School eye screening prog.Vit. A prophylaxis

Refraction centres in all PHC’S by 2010Low vision service centres in all teritiary care centres

Opportunisitic screening at eye care institutions,eye campsAwareness generation by health workers.laser treatment of diabetic retinopathy at tertiary level.

Corneal blindness

Eye banking

Cataract

Objective. To improve the quantity and quality of cataract surgery.Targets and strategies include: To increase the cataract surgery rate 6000 by 2020. IOL surgery for >80% by the year 2005 and for all by the year 2010. YAG capsulotomy services at all district hospitals by 2010

INDIA: Cataract Operations 1985-2005(Data from Aravind Eye Care System)

0.01.02.03.04.05.0

5% with IOL in 1993 increased to 90% in 2005

Fourfold Increase over 20 years

0.8/1000 children Common causes are vitamin A deficiency, measles, conjunctivitis, ophthalmia neonatorum, injuries, congenital cataract, retinopathy of prematurity (ROP)childhood glaucoma.

Childhood blindness

Cont….

•To identify areas where childhood blindness from preventable disease is common and to encourage preventive measures, for example:

(a) Measles immunization; (b) Vitamin A supplementation; (c) Nutrition education; (d) Avoidance of harmful traditional practices; (e) Monitoring of use of oxygen in newborns.

•To provide specialist training and services for the management of surgically remediable visual loss in children from:

(a) Congenital cataract; (b) Congenital glaucoma; (c) Corneal scar; (d) Retinopathy of prematurity.

Refractive errors and low vision

1. Refraction services to be available in all primary health centres by 2010.

2. Availability of low- cost, good quality spectacles for children to be insured.

3. Low vision service centres are to be established at 150 tertiary level eye care institutions.

major causes of this blindness are corneal ulcers due to infections, trachoma, ocular injuries and keratomalacia caused by nutritional deficiencies.

ACTIONS TAKEN Vit. A supplementation prog. Measles vaccination Better water supply and sanitation leading to redn. In

trachoma and other infections. Eye banks

Corneal blindness

Opportunisitic screening at eye care institutions should be done in all persons above the age of 35 years, those with diabetes mellitus, and those with family history of glaucoma.

Community based referral by multi-purpose workers of all persons with dimunition of vision, coloured haloes, rapid change of glasses, ocular pain and family history of glaucoma.

Opportunistic screening at eye camps in all patients above the age of 35 years.

GLAUCOMA

Awareness generation by health workers All known diabetics to be examined and referred to Eye Surgeon

by the Ophthalmic Assistant. To provide laser treatment to all those requiring it at teritiary

level

DIABETIC RETINOPATHY

S surgery to correct lid deformities and prevent blindness A antibiotics F facial hygiene E environmental hygiene

TRACHOMA

3.STRENGTHENING HUMAN RESOURCES

1. Uniform curriculum in UG medical education.2.Training of postgraduates, increase in seats,3. Assessment of potential DNB institutions 4. CME for ophthalmologists.5.Increase in no. of paramedical personnel.6. Development of dedicated district programme managers.

4.INFRASTRUCTURE DEVELOPMENT

WHOVISION

2020

NGDOsProfession

sCorporatio

ns

NATIONALVISION 2020

BODIES

IAPB

Ministries of

Health

DISTRICT VISION 2020 SERVICE UNITS

District Level Implementation

Eye Care Team

Equipment & Supplies

Community-Patients

PrinciplesImplementing VISION 2020 at the District Level:n I ntegrated

n S ustainable

n E quitable

n E xcellent

Implementation Unit

I - SEE

Infrastructure Development•Development of district-level eye care services, with primary eye care integrated into the PHC system for a population of between 0.5 and 2 million people.

•To provide practitioners, hospitals and clinics with information on good-quality and affordable appropriate technology.

•To provide appropriate donated equipment to countries which cannot afford its purchase.

•To assist users to evaluate, select and purchase appropriate equipment using methods which will help to prolong its useful life.

•To introduce new technologies such as computers and computer networks to improve management efficiency and information exchange.

•Conduct feasibility studies on new technologies to ensure cost-effectiveness.

Service Delivery Model for VISION 2020

Primary

Secondary

Tertiary

Advanced Tertiary

Eye care infrastructure development

Centre's of Excellence 20Professional leadership

CME , ResearchLaying of Standards & QA

Strategy developmentTraining Centre's 200

Tertiary eye care including retinal surgery, corneal transplantation , Glaucoma surgery

Training & CME

Service Centre's 2000Cataract surgery

Other common eye surgeriesFacilities for refraction

Referral services

Vision centre's 20000Refraction & prescription of glasses

Primary eye careSchool eye screening programme

Screening & Referral services

Primary

Secondary

Tertiary

Useful resources http://www.vision2020.org/main.cfm http://www.iceh.org.uk http://www.iapb.org/ http://www.who.int/blindness/partnerships/vision2020/en/ www.v2020eresource.org www.seeingisbelieving.org.uk www.worldblindunion.org www.sightsavers.org www.cbm.org www.icoph.org

THANK YOU!