Data from a population based longitudinal study in Central India has shown that, if representative of the whole of India. 3.8 million people are blinded by cataract each year in India. At present only 1.2 million cataract extractions are performed each year. Our efforts should therefore increaseto achieve at least 3 times as much surgery to meet the increasing demands and fresh incidence of cataract - a difficult task.

The traditional Eye Camp approach has served the Country's needs well. and still applies in certain areas, but not being a permanent feature it has certain drawbacks. One newer approach is to set up Peripheral Eye Clinics (PEC) in rural areas as an alternative to sporadic Eye Camps.

The PEC in a rural area is established and run hy the local community which has link to a well established Hospital or Clinic in the nearby town.

Why Peripheral Eye Clinics?
Through out the world eye doctors and eye hospitals are found in towns or in big citics. This is especially the case in developing countries. Rural areas generally do not have any eye treatment or surgical facilitics. Patients have to walk many miles for treatment. In the absence of any local treatment facility many go blind. Today the prevalence of blindness in India is between 0.5% and 1% (in some States over 1%). while in a developed country it is often as low as 0.2%. The PEC is an alternative approach to reduce the prevalence or blindness in India.

Waiting for an eye consultation, Kanpur, India.

1. The PEC is an extension of eye treatment/operation facilities existing in a town, to a rural area. The clinic uses the services of established eye doctors who are either settled in a hospital or in private practice.
2. The PEC is organised regularly on prearranged days, for example 1 to 4 times a month. at a fixed place.
3. The PEC is organised with the help of the local community. If the local doctor participates in the programme it will be very helpful.
4. The PEC should preferably be more than 20 km away from any other eye treatment facility, but less than lOOkm distant.

1. The PEC operates on a small scale with 50 to lOO outpatients and 5 to 10 (indoor) eye operations per session.
2. The PEC is conducted on a regular basis. 1 to 4 times a month at a fixed place and date.
3. There is a well established referral link.
4. The PEC is organised in a purpose designed building with adequate operating theatre facilities and 5 or more inpatient beds.
5. Follow-up of patients following surgery is easily arranged.

1. The provision of medical and surgical treatment (free of charge or with a nominal charge) for the prevention and control of common eye diseases, cataract and other routine surgical procedures and the prescription of spectacles at low cost.
2. Making communities aware, through education. of the prevention of eye diseases and the care of the eyes.
3. Referral of patients to the Central Hospital.
4. Good documentation of records of all patients seen.
5. Provision of good follow-up of patients treated or having surgery at the clinic.
6. Involvement of communities in the provisionof eye care services.

1. A local group of interested people must be involved. This can be any Service Club. Panchayat or other Society which should be committed to the project and be recognised as an officially registered body.
2. The local group or society should be able to contribute either in kind or in cash towards the cost of establishing and running the PEC.
3. The local group or society will arrange for a building in the village to be adapted for use. or constructed as necessary.
4. The local group or society will take responsibility for the ongoing support of the PEC, liaison with the Central Hospital, eye specialists, arrangement of dates for PEC clinics/surgery, publicity, etc.
5. The professional and medical standards of the PEC will be supervised by the Central Hospital.
6. The PEC will operate daily. A permanent PEC Attendant will register the names of patients presenting with eye problems.
7. If an emergeney should present the Attendant will refer the patient to the doctor at the Central Hospital. If the Central Hospital approves, the PEC Attendant may give some first aid to the patient.
8. A doctor and a refractionist will visit the PEC on pre-arranged days, for example, one day each week.
9. The PEC can operate either on a totally free basis or require nominal charges, which will he decided by the local group or society in consultation with the Central Hospital.
10. A budget for the proposed PEC in India, including staff costs, is given in Table 2.