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

Blindness Visual Acuity Less than 6/60 in the better 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) 62.6% 19.7% 5.8% 4.7% 0.9% 1.2% 5.0% Cataract 62% (Source: Current estimates of Blindness in India, BJO, March 2005)

PREVALENCE OF BLINDNESS (< 6/60) INDIA - 8.5% < 8.5 % 8.5 - 11% > 11%

Cataract Surgeries (per million population) Performance of Cataract Surgery: 1985-2007 Cataract Surgeries (per million population) Nos. in Lakhs

CATARACT SURGICAL COVERAGE(PERSONS) . CS.C = the proportion of operable cataract cases that have been operated on in a defined population at a particular point in time > 70% 50- 70% < 50%

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 What we have 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 What we have need Ophthalmologist 10 20 Hospital based Paramedics 10-20 60-80 Community Based Paramedics 10 30-40 CBR Workers & itinerant teachers ? 15-20 Eye Care Managers ? 2

Skills Gap What we What we have need Proportion of IOL 90% > 95% Visual Outcome < 6/60 33% 5% Visual Outcome > 6/18 40% 90% No. of surgeries / active OS 500 1000

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

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