Transcript CATARACTS - Mobile application development

Cataract
Dr. Praveen Vashist
Dr. R.P. Centre for Ophthalmic Sciences, AIIMS
Cataract


The human lens is a
naturally clear structure
This loss of
transparency of lens, or
opacity formation is
called Cataract
Symptoms





Cataracts produce a gradual, painless, progressive
loss of vision
Glare, especially at night
Halos around lights
The need for brighter light for reading
Double vision in a single eye
6 metres
Blindness
Visual Acuity Less than 6/60
in the better eye
with available correction
Magnitude



Prevalence of Blindness 8% among 50+ age
Cataract was the commonest cause of
blindness (77.5%), low vision (58.1%) and
one-eyed blindness (57.5%).
Aged, rural, illiterate, females higher
prevalence
Source: Rapid Assessment of Avoidable Blindness in India 2007
Causes of Blindness (National
survey 2001)
Cataract 62%
62.6%
19.7%
5.8%
4.7%
0.9%
1.2%
5.0%
Cataract
Ref. Errors
Glaucoma
Post. Seg. Disorders
Corneal Blindness
Surgical Comp.
Others
(Source: Current estimates of Blindness in India, BJO, March 2005)
PREVALENCE OF BLINDNESS (< 6/60)
INDIA - 8.5%
< 8.5 %
8.5 - 11%
> 11%
Performance of Cataract Surgery:
1985-2007
Cataract Surgeries
(per million population)
Performance of Cataract Surgery 1985-2007
60
50
40
30
20
Nos. in Lakhs
52.73
50.40
49.05
44.91
41.98
38.57
36.4437.00
33.56
31.71
30.35
27.23
24.71
21.67
19.14
16.05
15.12
12.09
12.19
11.9611.8510.9611.97
10
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
0
CATARACT SURGICAL COVERAGE(PERSONS)
.
> 70%
50- 70%
< 50%
CS.C = the
proportion of
operable
cataract cases
that have been
operated on in a
defined
population at a
particular point in
time
Risk Factors









Everyone is at risk of developing cataracts simply
because age is the single greatest risk factor
Exposure to sunlight (UV light)
Smoking
Diabetes
Trauma (blunt or penetrating)
Family history of cataracts
Corticosteroid therapy
Radiation exposure
Dehydration due to repeated diarrheas
Risk Factors



Environmental factors - cataract occurs more often
and at an earlier age in developing countries
In children due to Hereditary, Genetic and Metabolic
Diseases and Maternal Infections like Rubella,
Syphilis
DON’T KNOW
- ???????????
Prevention





Do not smoke
Eat a balanced diet
Protect from sunlight :Ultraviolet light protection
Diabetes Control
Regular eye examination and early detection of senile
cataracts.
Cataract Surgery

When activities of daily living, such as driving,
reading, working, and self-care are affected then
surgery should be discussed

Cataract surgery is the only method to restore vision

Cataract surgery is one of the most cost-effective
health interventions




short operation period
potential for high volume
high success rate
Low cost
Impact of cataract Surgery




A significantly better vision
Improved quality of life
Can retain jobs/occupations
Can become active members of the community.
Barriers To Surgery












Ignorance of facilities
Don’t know that the operation is simple and safe
Bad Experience of operation in the Community
Services too far
Unaffordable
Waiting for the cataract to mature
No time
No one to accompany
people sometimes expect to go blind as a natural part of ageing,
need not felt
Other eye in good condition
Fear
Contraindications
Infrastructure Gap
Requirement for a Million Population:
What we
have
What we
need
Eye Hospitals
1
2
Eye Beds
10
50
Cataract Surgical Rate
5000
9000
Vision Centres
5-10
20
Human Resource Gap
Requirement for a Million Population:
What we
have
Ophthalmologist
10
Hospital based Paramedics
What we
need
20
10-20
60-80
10
30-40
CBR Workers & itinerant teachers
?
15-20
Eye Care Managers
?
2
Community Based Paramedics
Skills Gap
What we
have
What we
need
90%
> 95%
Visual Outcome < 6/60
33%
5%
Visual Outcome > 6/18
40%
90%
No. of surgeries / active OS
500
1000
Proportion of IOL
Strategies for Control of cataract
Blindness
Infrastructure development


Construction of Dedicated Eye Wards & Op. rooms at
sub-district level.
Provided with high tech ophthalmic equipment Operating microscopes, Slit lamps, A-Scans and Yag
Lasers.

Maintenance of equipments

Appropriate technology: SICS/ Phaco
Human resource for eye care



Training of eye surgeons in IOL Surgery, SICS, Phaco
Training of middle level eye-care personnel for
primary eye care and supportive services and
training in eye care management.
Training medical officers, ophthalmic assistants and
other para-medical staff including ASHA and
Aanganwadi workers in Primary Eye Care
Improved the quality of surgery



Increased the accessibility of free IOL surgery to the
masses
Surgery at Base hospital with sterile OT environment
& equipment
Follow up after surgery
Decentralized planning- DBCS


District Blindness Control Society (DBCS) as the nodal
implementing body
The DBCS included representatives from the NGOs &
Private Sector

Funds made directly available to the DBCS.

Grants to NGOs is also de-centralized.
Involvement of NGOs & Community


Funding for free cataract surgery
Upgrading or expanding of eye care facilities in
underserved areas
Expanding coverage to
underprivileged areas


Orientation of Village based link workers to identify
blind persons and motivate them for surgery
Public awareness through mass media, traditional
channels and interpersonal communication for
increasing utilization of eye care services.
Strengthening
Monitoring & Evaluation


Standard Cataract Surgery Records ,includes details of
preoperative & post op visual acuity & complication
Sentinel Surveillance Units set up in different parts of the
country to assess visual outcomes.
Projections :2020



The number of cataract blind is projected to increase from 7.75
million (2001) to 8.25 million (2020)
There would be a 2 times increase in cataract surgery among
the 50+ population (3.38 million in 2001 to 7.63 million in
2020).
The projected Cataract Surgical Rate among those aged 50+ is
projected to increase from 24025/million 50+ (2001) to 27817
(2020) per million 50+ .
If the incidence of newly blind and the
existing prevalence is considered, then
elimination of cataract blindness may
not be achieved by 2020 in India.
Multi stakeholder Approach




Eye care: Govt , NGos and Pvt sector
Development sector
Education
Rehabilitation
Scope of present workshop
To define the Role and
responsibilities of each
stakeholder for achieving
elimination of Blindness by
2020
THANK YOU