1. Primary Health Care Eye Health Sensitization
This presentation was developed by The Caribbean Council for the Blind with financial support for the European Union
This workshop is funded by the European Union

2. Aim of PHC training
To sensitize (at least) 1,240 Primary Healthcare/community workers and teachers.
To promote eye health awareness and screening of children and adults at the community level
To develop the ability to identify and refer cases to secondary facilities.
To sensitize a network of individuals with the common goal of screening up to 6 million people over the next 5 years.
To contribute to the reduction of the prevalence of blindness and visual impairment in the targeted countries (including) Guyana, Haiti, Jamaica and St. Lucia.

3. What is Vision? What is Vision Acuity? What is Functional Vision?
This workshop is funded by the European Union

4. describes the degree of visual resolution
Visual Acuity
describes the degree of visual resolution
Contrast
is the ratio of light/dark and describes the border of the image ( reduced contrast is often describes as ‘glare’)
This workshop is funded by the European Union

5. Vision Acuity (in the better eye with presenting vision)VA
Min of Arc
WHO Definition
20/20
1 min
Normal
20/40
2 min
mild LV
20/60
3 min
WHO definition LV
20/70
3.5min
Mod LV
20/200
10 min
Severe LV
20/400
20 min
Profound LV
20/1000
50 min
Near total blindness
This workshop is funded by the European Union

6. Functional Vision Bangkok definition:
A person with low vision is one who has impairment of visual functioning even after treatment and/or standard refractive correction and has a visual acuity of less than 6/18 to light perception, or a visual field less than 10 degrees from the point of fixation, but who uses, or is potentially able to use vision for the planning and/or execution of a task. (WHO, 1992)
 Levak (1991) Definition:
Having a significant visual impairment but also having some usable vision:
moderate low vision is acuity of 20/70 – 20/160 (better eye with correction)
severe low vision is acuity of 20/200 – 20/400 or visual field of 20 degrees or less
  Corn (1981)Definition:
One who is still severely visually impaired after correction, but who may increase visual functioning through the use of optical aids, non-optical aids, and or techniques
This workshop is funded by the European Union

7. Premise
There are differences in the ways children with congenital low vision and adults with adventitious low vision use and learn to use vision
There are differences with how children and adults with different types of low vision (e.g., low acuity, reduced visual fields) use and learn to use vision.
This workshop is funded by the European Union

8. Premise
There are different levels of visual efficiency that can be achieved at different levels of visual functions (e.g., 20/100 vs. 20/800).
Visual functions and functional vision go hand in hand.
For children and adults to attain maximum levels of visual independence, ALL must work together.
This workshop is funded by the European Union

9. Prevalence of Blindness
How Big a Problem is It
This workshop is funded by the European Union

10. Global Picture 37 million blind
7 m with NLP = require substitute training
Of 30 m remaining…50% require surgery
15 m requiring low vision care
124 million Low Vision
74 m require cataract surgery (60%)
50m requiring low vision services
= 65 m needing Low Vision Services
This workshop is funded by the European Union

11. This workshop is funded by the European Union

12. Caribbean Picture Blind Low vision Prevalence 1% of the population
Causes of blindness
Cataract: 52%
Cataract and Open Angle Glaucoma: 9%
Open Angle Glaucoma alone: 10%
Diabetic retinopathy: 10%
Others: 19%
Low vision
Prevalence 3% of the population

13. Anatomy Of The EYE
This workshop is funded by the European Union

14. This workshop is funded by the European Union

15. CORNEA clear, transparent section of the outer coat of the eyeball
SCLERA white part of the eye forming an external protective coat
CHOROID vascular, intermediate coat providing nourishment to the eyeball
IRIS coloured part of the eye in front of the lens regulating the amount of light entering the eye by changing the size of the pupil
PUPIL opening at the centre of the iris
LENS transparent body that focuses light passing through the eye on the retina
RETINA the innermost lining of he eye connected with the optic nerve and upon which any visual image is focused. Has ‘nerve’ cells for sight (rods and cones)
MACULA small depression in the retina adapted for fine vision
OPTIC NERVE part of the central nervous system carrying the sense of sight from the retina to the brain.
AQUEOUS clear, watery fluid that fills the front part of the eye
VITREOUS transparent, gelatinous material filling the eyeball behind the lens
This workshop is funded by the European Union

16. Priority Eye Conditions in the Caribbean
Cataract
Diabetic Retinopathy
Glaucoma
Childhood Blindness
Uncorrected Refractive Errors
and Low Vision
This workshop is funded by the European Union

17. Cataract
Cataract is clouding of the lens of the eye which impedes the passage of light. Although most cases of cataract are related to the ageing process, occasionally children can be born with the condition, or a cataract may develop after eye injuries, inflammation, and some other eye diseases.
This workshop is funded by the European Union

18. Cataract
This workshop is funded by the European Union

19. This workshop is funded by the European Union

20. Prevalence of Cataract
Global
Age related cataract is responsible for 48% of world blindness, which represents about 18 million people.
Caribbean (Barbados Eye Study)
Cataract is responsible for 52% of blindness
This workshop is funded by the European Union

21. Prevalence of Cataract Cont’d
Although cataracts can be surgically removed, in many countries surgical services are inadequate, and cataract remains the leading cause of blindness. As people in the world live longer, the number of people with cataract is growing. Cataract is also an important cause of low vision in both developed and developing countries. Even where surgical services are available, low vision associated with cataract may still be prevalent, as a result of the long period spent waiting for operations and barriers to surgical uptake, such as cost, lack of information, and transportation problems.

22. Treatment of Cataract
The treatment of cataract is an operation, which is very successful in restoring sight. The opaque lens is removed and replaced by an artificial intraocular lens.
This workshop is funded by the European Union

23. This workshop is funded by the European Union
Before
After
This workshop is funded by the European Union
This workshop is funded by the European Union

24. Risk Factors for Cataract
Age
diabetes mellitus
hypertension
trauma
high body mass
cigarette smoking
ultraviolet light exposure
alcohol consumption
This workshop is funded by the European Union

25. Diabetic Retinopathy Definition Prevalence Treatment Risk Factors
This workshop is funded by the European Union

26. Definition of DR
Characteristic group of lesions found in the retina of individuals having had diabetes mellitus for several years. Diabetic retinopathy is considered to be the result of vascular changes in the retinal circulation.
In the early stages vascular occlusion and dilations occur.
Progresses into a proliferative retinopathy with the growth of new blood vessels
Macular edema (the thickening of the central part of the retina) can significantly decrease visual acuity.
This workshop is funded by the European Union

27. This workshop is funded by the European Union

28. Prevalence of DR
It is estimated that in 2002 Diabetic Retinopathy (DR) accounted for about 5% of world blindness, representing almost 5 million persons who are blind.
In the Caribbean DR has a prevalence of 5.9% and increases to 28.5% for those who suffer from Diabetes. (Barbados Eye Study)
As the incidence of diabetes gradually increases, there is the possibility that more individuals will become blind from the disease
This workshop is funded by the European Union

29. Treatment of DR
The following actions can decrease some of the risk to vision caused by diabetic retinopathy.
Eating a balanced diet and reduced consumption of sugar sweetened drinks.
Regular exercise, including walking as much as possible.
Maintaining a normal blood sugar level.
This workshop is funded by the European Union

30. Risk Factors for DR Duration of diabetes Level of glycemia
Presence of high blood pressure
Dependence on insulin
Pregnancy
Levels of selected serum lipids
Nutritional and genetic factors
This workshop is funded by the European Union

31. Glaucoma Increased Intra-Ocular Pressure (IOP) Changes in Optic Nerve
Peripheral Vision
This workshop is funded by the European Union

32. Diagnosis for Glaucoma
A precise comprehensive definition and diagnostic criteria are yet to be finalised. People with glaucoma probably lose their sight because increased pressure in the eye and other factors (such as poor blood flow) affect the optic nerve at the back of the eye. The eye slowly loses nerve function, and loss of side (peripheral) vision. This occurs painlessly, even unnoticeably.
There are several types of glaucoma, however, the two most common are primary open angle glaucoma (POAG), having a slow and insidious onset, and angle closure glaucoma (ACG), which is less common and tends to be more acute.
This workshop is funded by the European Union

33. Prevalence of Glaucoma
Worldwide
61 million projected
8 million by 2020 US
1.86% > age 40
10% > age 70
Caribbean (Barbados Eye Study)
7% > age 40
16% > age 70

34. Treatment of Glaucoma Open-Angle Glaucoma
Treatment with eye drops to decrease the IOP. Note: you may need to change from one type to another. This is a life-long disease and your eyes must be checked regularly to make sure you are getting the best treatment. You must follow the strict medication schedule your doctor gives you .
You must not allow your glaucoma drops to run out
Surgery is an option (trabeculectomy)
Glaucoma patients should be encouraged to request this option.
Will Help to prevent further loss of vision.
This workshop is funded by the European Union

35. Risk Factors for Glaucoma
Family History
Age
Nearsightedness
Ethnic background
Raised IOP
Trauma
Diabetes
Cataract
This workshop is funded by the European Union

36. Childhood Blindness Definition Prevalence Treatment Risk Factors
This workshop is funded by the European Union

37. Definition of Childhood Blindness
Childhood blindness has many causes. In poor countries the main ones are:
corneal scarring and cataract.
ROP (Retinopathy of prematurity)
Some causes of blindness is hereditary.
This workshop is funded by the European Union

38. Prevalence of Childhood Blindness
1.4 million are children under 16. (of the 45 million global blindness)
1.5 per 1000 In low-income countries
0.3 per 1000 children in high-income countries
Closer to 1 per thousand in Caribbean countries.
The vast majority of childhood blindness happens before the age of five.
Puberty is believed to be a significant cause of visual impairment –Usually correctable with prescription glasses.
This workshop is funded by the European Union

39. Treatment
Prevention and treatment of childhood blindness is disease specific.
Properly planned and implemented national vaccination programmes against measles has reduced the prevalence of eye complications.
In middle income countries, retinopathy of prematurity (ROP) is among the leading causes of blindness, the incidence of which can be reduced through availability and affordability of screening and curative services.
Early treatment of cataract and glaucoma can be beneficial, while low vision devices are helpful in children with residual vision.
Early detection of visual impairment and prescription of appropriate eye glasses, is important.
This workshop is funded by the European Union

40. Uncorrected Refractive Errors and Low Vision
Definition
Prevalence
Treatment
Risk Factors
This workshop is funded by the European Union

41. Definition of Refractive Error
myopia (short-sightedness)
hyperopia (long-sightedness)
astigmatism (when the eye can sharply image a straight line lying only in one meridian).
This workshop is funded by the European Union

42. Prevalence of Refractive Error
World wide, severe refractive errors have been estimated to account for about 5 million persons who are blind.
According to the most recent data available to WHO, there are an estimated 124 million people in the world with low vision.
Caribbean Prevalence
Myopia 22% >age 40
Hyperopia 47% > age 40
This workshop is funded by the European Union

43. Treatment of Refractive Error
Refractive errors can be rectified with appropriate optical correction
GLASSES
This workshop is funded by the European Union

44. Presbyopia
As people age, they often begin to have difficulty focusing their eyes for reading or close work. This is called presbyopia and is the normal aging of the eyes. It usually affects people over the age of forty as the eye starts to lose some of its flexibility.
Treatment This condition is easily corrected with eye glasses of increasing strength as a person ages. Bifocal of trifocal lenses may be prescribed to some people with presbyopia who also have other refractive problems such as myopia (near-sightedness), hyperopia (far-sightedness) or astigmatism (distorted vision due to a irregularly shaped cornea).
This workshop is funded by the European Union

45. Definition of Low Vision
• (WHO) Low vision is visual acuity less than 6/18 and equal to or better than 3/60 in the better eye with best correction.
When does a person require Low Vision Services ?
One who has impairment of visual functioning even after treatment and/or standard refractive correction, and has a visual acuity of less than 6/18 to light perception, or a visual field less than 10 degrees from the point of fixation, but who uses, or is potentially able to use, vision for the planning and/or execution of a task for which vision is essential.
This workshop is funded by the European Union

46. Prevalence of Low Vision
There are an estimated 180 thousand persons in the Caribbean with low vision.
Three (3) out of every one hundred persons in your village-district could be affected by low vision.
1 out of every 4 could benefit from low vision services
This workshop is funded by the European Union

47. Treatment of Low Vision
Lighting
Environment
Magnification
Vision Aids
This workshop is funded by the European Union

48. Environment Lighting Improved Contrast Bold Magnification Tactile
This workshop is funded by the European Union

49. Vision Aids
People with low vision may be helped with low vision device
Magnifiers
Telescopes
CCTV
JAWS
This workshop is funded by the European Union

50. This workshop is funded by the European Union
Magnifiers
This workshop is funded by the European Union
This workshop is funded by the European Union

51. This workshop is funded by the European Union
Magnifiers
This workshop is funded by the European Union
This workshop is funded by the European Union

52. This workshop is funded by the European Union
Telescope
This workshop is funded by the European Union
This workshop is funded by the European Union

53. Vision Assessment History Distance Acuity Near Vision Other Referral
Follow Up
This workshop is funded by the European Union

54. Vision Assessment Tools
This workshop is funded by the European Union
This workshop is funded by the European Union

55. Eye Screening Correct Environment Correct Distance Correct Tool
lighting
noise
distractions
Correct Distance
20 foot
10 foot
Correct Tool
choice of chart
Spectacle mounted telescope positioned in the top portion of the spectacle lens at a standard drop and angle used for driving (depending on state laws).
This workshop is funded by the European Union

56. This workshop is funded by the European Union

57. This workshop is funded by the European Union
3/25/2017
This workshop is funded by the European Union

58. This workshop is funded by the European Union
3/25/2017
This workshop is funded by the European Union

59. School Eye Screening WHO? Kindergarten Grade 6
This workshop is funded by the European Union

60. School Eye Screening
This workshop is funded by the European Union

61. Community Health Fairs
This workshop is funded by the European Union
This workshop is funded by the European Union

62. Referral Process What Perimeters for Referral? Who to Refer to?
Follow-Up?
This workshop is funded by the European Union

63. Referral Form
This is a sample referral form used by St. Lucia Blind Welfare Association
Each country should use their own referral form or referral system

64. E-MAIL: info@eyecarecaribbean.com
PRESENTED BY
Tel: (268) /
The End