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Dear Readers,
Primary eye care (PEC) is an integral part of comprehensive eye care. It is targeted not only towards preventing blindness and visual impairment, but also towards providing services to redress ocular morbidity. PEC is a frontline activity, providing care and identifying disease before it becomes a serious medical condition. Primary eye care is delivered in many different ways. However, it all aims at making eye care services available within reach of the community. In the long run this allows each better penetration of services and reduced cost for the patient.

Components of primary eye care

  • Eye health education
  • Symptom identification
  • Visual acuity measurement
  • Basic eye examination
  • Diagnosis
  • Timely referral

This Site news explores the Perspectives of Primary Eye Care as well as Human Resource for Primary Eye Care and Primary Eye Care Models. This issue also covers Primary Eye Care - Integration, Primary Eye Care - Across the World and Setting up the Service. In this issue, Featured Organization is InFOCUS University, to meet the needs of underserved communities; InFOCUS developed a user-friendly path to vision care, the Vision Station.



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Regards,
Library Team
The Issue Features...
Primary Eye Care
Vol.9 No.4 August 2012
•  Introduction
•  Perspectives of Primary Eye Care
•  Human Resource for Primary Eye Care
•  Primary Eye Care Service Models
•  Primary Eye Care - Integration
•  Primary Eye Care - Across the world
•  Setting up the service
•  Featured Organization

•   Past Issues


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  • Public interests are served when patients have access to primary eye care services that meet their needs for healthy eyes and best possible vision. Ophthalmologists are specifically trained to provide these services. However, they are few and concentrated in urban centers. Also it is not viable to have them perform community level screening. This is left to primary centres. Primary eye care provides an entry point for patients to receive refractions and glasses or contact lenses, screenings for asymptomatic eye diseases, diagnosis and treatment of most eye conditions, referral to specialists, and coordination with other aspects of medical care. While it is the ophthalmologist’s responsibility to perform the comprehensive medical eye evaluation, certain aspects of data collection may be conducted by trained individuals under the supervision of the ophthalmologist. PEC can also influence better compliance to treatment as they can access the patients easily and monitor compliance to medication or follow up visits.

    Primary eye care services include the following:

    • Educating patients about maintaining and promoting healthy vision.
    • Performing a comprehensive examination of the visual system.
    • Screening for eye diseases and conditions affecting vision that may be asymptomatic.
    • Recognizing ocular manifestations of systemic diseases and systemic effects of ocular medications.
    • Making a differential diagnosis and definitive diagnosis for any abnormalities that are detected.
    • Performing refractions.
    • Fitting and prescribing optical aids such as glasses and contact lenses.
    • Deciding on a treatment plan and treating patients’ eye care needs with appropriate therapies.
    • Counselling and educating patients about their eye disease conditions.
    • Recognizing and managing local and systemic effects of drug therapy.
    • Determining when to triage patients for more specialized care and referring to specialists as needed and appropriate.
    • Coordinating care with other physicians involved in the patient’s overall medical management.
    • Following up with patients to monitor their compliance to advice – referral, surgery, medication or review visits.




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  • PERSPECTIVES ON PRIMARY EYE CARE

  • Even a cursory review of systems across the world reveals that there is no common understanding of what primary eye care means and there exists a wide variation both in its content and in the way in which itis delivered.

  • THE IMPORTANCE OF PRIMARY EYE CARE

  • The principles of PHC (i.e., fair distribution; community involvement; focus on prevention; appropriate technology; multi-sectorial approach) should all apply in primary eye care. This article presents strategies to deal with preventable and treatable causes of blindness using primary care centres.

  • ESSENTIAL COMPONENTS OF PRIMARY EYE CARE

  • This article presents the framework for planning for the components of Primary eye care.
    • Clinical service component
    • Eye health protection and promotion component.


  • PREVENT BLINDNESS THROUGH PRIMARY EYE CARE

  • This poster focuses on basic eye diseases and eye injuries and the importance of primary eye care to address these.

  • HEALTH PROMOTION AND COMMUNITY PARTICIPATION IN EYE CARE SERVICES

  • This article focuses on the role of active public participation in community eye care programmes, particularly in developing countries. Itshouldbepointedout, however,that the potential success of health promotion in practice is closely associated with a comprehensive approach that integrates as many of the five components of health promotion as possible.

  • OPHTHALMIC PRIMARY CARE

  • This article presents a definition of ophthalmic primary care, its scope, staffing and examples.



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  • PRIMARY EYE CARE - OPTOMETRISTS

  • This document explores the deployment of optometrist in PEC.

  • TRAINING PRIMARY CARE PHYSICIANS IN COMMUNITY EYE HEALTH: EXPERIENCES FROM INDIA

  • This paper describes the impact of training on primary-care physicians in community eye health through a series of workshops. 865 trainees completed three evaluation formats anonymously. The questions tested their knowledge on magnitude of blindness, the most common causes of blindness, and district level functioning of the National Programme for Control of Blindness (NPCB). Knowledge of the trainers significantly improved immediately after the course. This was independent of the timing of workshops and number of trainees per batch. Presentation, content and relevance to job responsibilities were most appreciated. There is immense value addition from training primary-care physicians in community eye health. Despite a long series of training sessions, trainer fatigue was minimal; therefore, such capsules can be replicated with great success.

  • SELF-SUSTAINING COMMUNITY-BASED PRIMARY EYE CARE

  • Four years ago the FOCOMETER was described as a new refractive devicefor developing countries.The instrumentwas designed to provide accurate and reliable determinations of visual refractive errors, including correction for astigmatism, for people in poor and remote areas.

  • TASK SHIFTING IN PRIMARY EYE CARE – LITERATURE REVIEW

  • Task shifting could be the solution for making primary eye care available to the community in a situation where there is a shortage and mal-distribution of health care workers. This review looks at shifting “primary eye care” from ophthalmic personnel to general health workers.

  • PRIMARY EYE CARE TRAINING MANUAL

  • Promote a high standard of practice for allengaged in primary eye care, especially for non-eye care professionals and volunteers working with medically underserved and economically disadvantaged populations.



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  • COMMUNITY EYE CARE: EXPERIENCES IN PILOT PROJECTS IN BASTI AND SALEM DISTRICTS

  • This article focuses on eye camps conducted in two districts (Basti and Salem), theinfrastructure of these districts, design of pilot project, and school screening activities.

  • DEVELOPING A MODEL TO REDUCE BLINDNESS IN INDIA: THE INTERNATIONAL CENTRE FOR ADVANCEMENT OF RURAL EYE CARE

  • With the continuing high magnitude of blindness in India, fresh approaches are needed to effectively deal with this burden on society. The International Centre for Advancement of Rural Eye Care (ICARE) has been established at the L.V. Prasad Eye Institute in Hyderabad to develop such an approach. This paper describes how ICARE functions to meet its objective. The three major functions of ICARE are design and implementation of rural eye-care centres, human resource development for eye care, and community eye-health planning. ICARE works with existing eye-care centres, as well as those being planned, in underserved areas of India and other parts of the developing world. The approach being developed by ICARE, along with its partners, to reduce blindness is that of comprehensive eye care with due emphasis on preventive, curative and rehabilitative aspects. This approach involves the community in which blindness is sought to be reduced by understanding how the people perceive eye health and the barriers to eye care, thereby enabling development of strategies to prevent blindness.

  • OUTREACH: LINKING PEOPLE WITH EYE CARE

  • Service delivery in prevention of blindness is usually based ontwo different models. The first model focuses mainly on making eyecare accessible to as many people as possible. This model is bestemployed in the urban areas of a country, where there are sufficienteye care professionals, but many of the poor cannot afford eye carefrom their small household budgets due to the high cost of services.

  • REACHING OUT: A STRATEGY TO PROVIDE PRIMARY EYE CARE THROUGH THE INDIGENOUS EDUCATIONAL SYSTEM IN PAKISTAN

  • This article is to determine the prevalence ofblindness and low vision among students inthe age group of five to 15 years. It offers anagenda for primary eye care and highlightsthe importance of integrated health carereforms at the national level for this largenon-government community educationsystem that caters to an estimated half a million children throughout Pakistan.

  • ASSESSMENT OF VISION CENTRE AS A PRIMARY EYE CARE DELIVERYMODEL, USING THE HEALTH SYSTEMS APPROACH - A CASE STUDY

  • The VC has been well accepted as a practical model for delivering barrier free primary eye care to remote underserved communities by utilizing community resources. Thenature and extent to which health services are delivered and the pattern of their uptake inthe target groups is greatly dependant on the various health system components that serveas building blocks for creating the required foundation.

  • BANGLADESH MODEL OF EYE CARE (MODULAR EYE CARE, MEC)

  • This article describes the comprehensive eye care service in Bangladesh, that links activities in the community with primary eye care and tertiary services called the Modular Eye Care service model.

  • COMPARATIVE ANALYSIS OF DELIVERY OF PRIMARY EYE CARE IN THREE EUROPEAN COUNTRIES

  • Primary eye care services in Europe is not uniform. While in some countries primary eye care is exclusively within the scope of practice of ophthalmologists, other systems rely on a variety of different professions providing essential parts of primary eye and vision health care. The study at hand addresses the question whether costs and outcomes of primary eye care services differ between heterogeneously organised systems. Therefore a special focus on the participation of opticians and optometrists was set. Having similar populations and economic conditions, but differently organised eye care systems, the countries France, Germany and the UK were exemplarily analysed as target countries. Based on an initial description of the different primary eye care systems, a criteria-based evaluation of costs and outcomes was conducted.



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  • INTEGRATION OF TRADITIONAL HEALERS INTO PRIMARY EYE CARE

  • In Africa, doctors, nurses and traditional healers have to share the burden of health care services. It is inconceivable and impossible to disregard the role of traditional healers in culturally bound rural communities. Traditional healers are not only important but crucial in primary eye care in developing countries.

  • DEVELOPMENT OF PRIMARY EYE CARE AS AN INTEGRATED PART OF COMPREHENSIVE HEALTH CARE

  • Primary eye care is a vital componen of primary health care and includes the promotion of eye health and the prevention and treatment of conditions that may lead to visual loss. Primary eye care should include promotive, preventive, curative and rehabilitative components.

  • INTEGRATION OF PRIMARY EYE CARE INTO PRIMARY HEALTH CARE

  • Primary health care (PHC) is a fundamental WHO concept for improvement of health. And Primary eye care is an integral part of PHC and is made a priority service by WHO.

  • TRAINING FOR PRIMARY EYE CARE IN LEPROSY

  • Reported are the results of a primary eye care training programme for community-based leprosy control workers in the Republic of Korea. The 20-hour programme emphasized the detection and management of lagophthalmos (and its complications) and chronic iridocylitis. Leprosy patients in four resettlement villages were examined independently by the health workers and ophthalmologists. Agreement between the health workers and the ophthalmologists was good for the detection of most signs (lagophthalmos, acute iridocyclitis, and chronic iridocyclitis). Based on these preliminary results, it is recommended that primary eye care be included as a part of the training for leprosy paramedical works.

  • THE HEALTHY EYES ACTIVITY BOOK – A HEALTH TEACHING BOOK FOR PRIMARY SCHOOLS

  • The book will help you know the best thing to do if you or your family has a problem with your eyes. The book also helps you know how to keep youreyes healthy. This book is an activity book – the children should be active as they use it; the book does not tell them all the answers, it encourages them to think and to do things at school and at home. The book should be used to encourage the children to learn by doing, not by telling.



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  • PRIMARY EYE CARE IN SUB-SAHARAN AFRICAN: DO WE HAVE THE EVIDENCE NEEDED TO SCALE UP TRAINING AND SERVICE DELIVERY?

  • The models for addressing the delivery of an eye-care service in sub-Saharan Africa have seen considerable revision in the last 30 years, and the on-going challenges, as well as the future needs, will probably require many morechanges and new systems. There is a need to assess the different models that are currently employed, in order to ensure that all potential contributions to the elimination of avoidable blindness are used; the evolving concept ofprimary eye care (PEC) requires such assessment

  • PRIMARY EYE CARE IN SINGAPORE: PERSPECTIVES FROM AN OPTOMETRIST

  • This article explores the evolution of primary eye care services over the decades in Singapore’s several optical stores and optician clinics. It explains the emergingrole that trained optometrists play in providing this service.

  • PRIMARY EYE CARE IN MALAWI

  • Malawi’s primary health care system includes provision for the prevention and treatment of eye diseases and injuries. The training of ophthalmic medical assistants and other development workers to organize, treat and refer eye conditions has helped the extension of eye health services to rural communities. Mobile eye units have a very important role in this work.

  • KNOW-HOW OF PRIMARY EYE CARE AMONG HEALTH EXTENSION WORKERS (HEWS) IN SOUTHERN ETHIOPIA

  • Frontline health personnel can play key role in preventing and controlling blindness if they havegood understanding of primary eye care (PEC). This study determined knowledge, attitude and practice of PEC among health extension workers (HEWs) in southern Ethiopia.

  • HEALTH FACILITIES FOR PRIMARY EYE CARE IN SULTANATE OF OMAN

  • This descriptive study randomly selected staff from 84 health institutions and 36 primary health institutions to carry out quality assurance procedures. Ophthalmologists trained in this evaluation were field staff who evaluated the resource status, such as health staff, space for eye care delivery, instruments, materials for health education, referring cases (for continuous medical education of the primary health staff), drugs for eye care, etc., in each health institution. In addition to availability, the standards of eye care delivery were also estimated.

  • GUIDELINES FOR DEVELOPMENT OF EYE CARE PROGRAMAND SERVICES IN THE CARIBBEAN

  • This document pretends to describe the desirable Eye Care Benefit Package and Eye Care Policy to be included in the National Health Care Plans, it includes preventive measures that detects disease early in high riskgroups through screening at appropriate intervals. The document also describes the suggested eye care treatments and rehabilitation measures. The application of the Eye Care Policy will assure eye health and good vision for the entire population. However, as this document presents the desirable Eye Care Policy it represents in essence suggested goals which territories should seek to attain. It will obviously not be possible for any territory to achieve all these goals immediately. It is therefore recommended that governments should coordinate with the Eye Care National Committees and local ophthalmologists to determine the priority areas in each territory.

  • MANAGEMENT AND PLANNING FOR PRIMARY EYE CARE OF THE ELDERLY: THE NEED TO CREATE PUBLIC AWARENESS OF AGE-RELATED CATARACT IN PAKISTAN

  • This article focuses on the significance of management and planning for primary eye care for the population aged 60 and over, in Pakistan. It takes the case of age-related cataract and highlights the importance ofcreating public awareness about cataract in terms of the respective roles of health planners, policy makers and service providers.



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  • VISION CENTER MANUAL

  • This is a guide developed by VISION 2020: The Right to Sight INDIA is designed to give an operational overview to set up vision centres.



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  • INFOCUS UNIVERSITY

  • Based in Houston, Texas, the InFOCUS University serves as the hub of global efforts to expand access to vision care. Working with universities, professionals and health organizations, the Center:
    • Provides training, information resources and technical assistance to service providers
    • Promotes awareness of primary eye care needs and program strategies
    • Fosters research on clinical methods and technologies
    • Initiates and participates in collaborative projects; and
    • Develops and implements programs to respond to critically unmet needs. InFOCUS reaches out to people and programs near and far to promote healthy eyes and clear vision for all.




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