Public Health Ophthalmology

Public health ophthalmology
Objective
definition of impairment, disable and
handicap
register of blindness
epidemiology of blindness
prevention of blindness
principle of visual rehabilitation

Impairment
function loss of organ system
Disable
loss of ability of the person
Handicap
loss of socioeconomic well being of the person

A 43-year-old man suffered from eye trauma. His
vision is CF in both eyes. He can go to work as a
lecturer in one university but he can not drive a
car. He lives with his wife and has 1 son. His
family accept for his condition and are happy.
What is the impairment?
What is his disable?
Does this man a handicap?

A 54-year-old man suffered from POAG. He has
poor visual acuity of 20/200 and very constricted
visual field. He has experienced multiple car
accident. He can difficulty reading and cannot
work as a architect any more. He was divorced
and live alone with some help from his mother.
What are his disable?

A 18-year-old man is not accepted for a medical
student application because of his color blindness.
His VA are 20/20 in both eyes. VF are within
normal limited. He failed in Ishihara Test.

What are his disable?

Visual impairment
bilateral condition
presenting visual acuity
visual field
degree of impairment (level)
Visual impairment
level
Low vision
blindness
Presenting
VA
VF
<6/18 (20/60) 10-30 degree

-6/60(20/200)
<6/60(20/200)
-3/60(10(200)
<3/60(10/200) 5-<10 degree

-1/60(CF3 Ft)
<1/60(CF 3Ft)
-PL
NLP
<5 degree

A 54-year-old man suffered from POAG. He has
poor visual acuity of 20/200 and very constricted
visual field(<5 degree) in both eyes.
Is this man classified as low vision or blindness?
Which level of visual impairment will you classify
this man?
Register of blindness


33 year old man suffered from cataract. His vision
are OD:20/200 improved to 20/40 with pinhole
and OS:CF 2Ft. VF are within normal limited.
Is this man classified as low vision or not?
Will you register him as a visual impairment(low
vision or blindness)? And why?
Register of blindness
any level of visual impairment
Irreversible
clearly apparent
no eye(post enucleation/exenteration)
phthisis bulbi/atrophic bulbi
examination
phthisis bulbi
not reactive pupil
optic atrophy/full cupping
extensive retinal scar

A 24-year-old man want to be blindness registered.
VA are OU:CF 1 Ft. VF are constricted in both eyes.
Retinitis Pigmentosa
What is the proper management?
Example
A 6-year-old girl suffered from glaucoma.
VA are 20/200 . VF are very constricted.
Refer for register blindness & education
A 31-year-old girl suffered from glaucoma.
VA are 20/200 . VF are very constricted.
Refer for register blindness, medical rehabilitation
(orientation & motility training) and occupational
training(Thai massage, agriculture, etc.)

Global data on visual impairments 2010
Total number
Visual impairment 285 m
low vision 246m
blind 39m
or prevalent of
Visual impairment 4.24%
low vision 3.65%
blind 0.58%
Epidemiology of blindness
Prevalence of blind, low vision and visual impair /thousand
60
in region
50
40
30
20
blind/thousand
10
low
vision/thousand
visual
impair/thousand
0
AFR
AMR
EMR
EUR
SEAR
WPR
india
china

Blind/visual impairment ratio
Africa = 0.224
America = 0.121
East Mediterranean = 0.209
Europe = 0.096
Southeast Asia = 0.133
West Pacific = 0.159
India = 0.129
China = 0.109
Epidemiology of visual impairment

age
Population
(million)
Blind
(percent)
Low vision
(percent)
Visual impair
0-14
1848.5
0.065
0.948
1.025
15-49
3548.2
0.163
2.099
2.27
50or>
1340.8
2.399
11.489
13.888
All ages
6737.5
0.584
3.65
4.24
(percent)
Epidemiology of visual impairment

global cause of visual
impairment
global cause of blindness
RE
refractive error
cataract
cataract
undetermine
undetermine
glaucoma
glaucoma
childhood
childhood
AMD
AMD
DR
DR
trachoma
trachoma
CO
CO
Thailand
1.2
1.14
What happen?
0.8
0.58
0.6
0.59
0.4
0.31
0.2
0
1983
1987
1994
2006
prevalent of
blindness(percent)
prevalent of blinding
cataract(percent)
Population growth of thailand
Epidemiology of blindness
cause of blindness in Thailand
RE
cataract
undetermine
glaucoma
childhood
AMD
DR
trachoma
CO
Very similar
Thailand blindness situation

Unknown incidence
Incidence of 1:1,000
Other cause of blindness

about 210,000
Other treatment
& rehabilitation
Estimate Thai population of 70m, we
will reduce prevalent of blindness to
0.3-0.4% in 3-4 years
Blinding Cataract
about 210,000
Cataract surgical rate

>2:1,000
>140,000 cataract surgery/year
>100 cataract surgery/year/Ophthalmologist
But must be 100% blinding cataract and
Just only one eye operation
Thailand blindness situation

What is the trend of visual impairment in
Thailand?
What should be the cause of blindness in Thailand
in the next 10 years?
Prevalence of blindness in New Zealand 2009
Impact of visual impairment

Economic
Quality of life
Prevention of blindness
Primary prevention
prevent disease occurring
Host, Agent &Environment control
Secondary prevention
prevent complication by early
Dx and early Rx
screening
Tertiary prevention
prevent disability
treatment and rehabilitation
Which cause of blindness is the major target in
prevention of blindness?
What is your role in prevention of blindness?
What can we do in our country?
Cataract
secondary/tertiary prevention
cataract surgery is cost-effective procedure
low rate of complication BUT may be severe
Cataract surgery program

Routine
Less patients
Long waiting time
Regular
Less complication
Campaign
more patients
short waiting time
occasionally
more complication
Campaign may be use during the early stage in

some area with large backlog but routine is better
in the long run.
Cataract surgery program

Policy setting blinding cataract
decrease waiting time <..months
incentive
free of charge if indicate
How do you determine the criteria for cataract

surgery?
DR screening
Screening tool
Direct ophthalmoscope
Indirect ophthalmoscope
Slit lamp biomicroscopic examination
Fundus camera
?
?
/
/
DR screening
Who will take the responsibility of
fundus camera interpretation?
What is the criteria for referring to

Ophthalmologist?
How do we do ?
Amblyopia screening
Preschool age 4-6 year old
effective treatment
reliability
Screening tool
VA chart: E-game, Randolts broken ring, etc.
Alignment/Stereopsis
Amblyopia screening
Amblyopia screening
Who should be involved in Amblyopia screening?
How do you do in visual impaired children?
Is this program effective in prevention of
blindness?
Why does it ?
ROP screening
prematurity / oxygen therapy
high risk group
BW < 1500 gm GA < 32 week oxygen Rx > 4 hour
Fundus examination
criteria for screening
criteria for treatment
ROP screening
What is the cause of blindness in ROP?
How will we do for detection of its complication?
Does it cost-effective procedure?
Glaucoma screening
2 of 3 criteria
increase ocular tension
visual field defect
optic nerve damage
POAG is the main target

asymptomatic
high prevalence
Risk of POAG
aging > 40
family history
Glaucoma screening
What is the proper strategy
for disease screening?
Which test will you use for
screening?
If you has good idea about it,

please do it and you may win
a big prize.
Prophylactic for Ophthalmia

neonatorum
Cause
GC, chlamydia, other bacteria
virus, and chemical
Prophylacis
Credes solution ( 2% AgNO3)
but severe reaction
1% AgNO3
GC is cause in the most
severe cases, and is the
main target to treated.
Prophylactic for Ophthalmia

neonatorum
1% AgNO3 may cause chemical conjunctivitis?
What is the alternative prophylacis of Ophthalmia

neonatorum?
What is the other strategy for prevention of this
condition?
Pterygium/Pinguecular prevention
Exposure to UV
Tropical area, farmer & fisherman
Sunglasses is the most effective

prevention.
Bad image of sunglasses
How will you educate of wearing
sunglasses?
Eye trauma prevention
Eye trauma prevention
Eye trauma prevention in factory

Environmental health
5S explanation
Ergonomy
Promotion of immunity
protective device
healthy labor
Health policy
early treatment
maintaining of health
Eye protective instrument
Eye Traffic injury prevention
Safety standard
Eye Traffic injury prevention

Safe street
safe driver
Driving Licence
BUT
Visual rehabilitation
Agent
Disorder
Impairment
Disable
Handicap
anatomical
functional
skill/ability
social &
economic
Primary
prevention
Secondary
prevention
Tertiary
prevention
(Treatment)
Medical
rehabilitation
Doctor role
Social & Education

rehabilitation
Quality of life dimension
Sighted guide
Living with the blind
High contrast & simple

Public Health Ophthalmology

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Public Health Ophthalmology

Uploaded by

Copyright:

Available Formats

Public health ophthalmology