Introduction 1. Comprehensive health care includes the activities of health promotion, diseaseprevention, curative measures at the timeof illness, and rehabilitation if the damage caused by the disease is disabling. This type of health care may be made available, accessible,affordable to the poorest rural population and should be sustainable.

Primary eye care : Primary eye care is a vital component in primary health care and includes the promotion of eye health care, the prevention and treatment of conditions that may lead to visual loss, as well as the rehabilitation of those who are already blind. Primary eye care (PEC) is the most basic eye care available to individuals and families wherever they live and whatever their socio-economic condition.

The aim of primary eye care is to change the pattern of eye care services, currently often limited to the central hospitals and eye units in the cities, to countrywide blindness prevention programmes.

Primary eye care is the primary health care approach to the prevention of blindness and it should be an integral part of primary health care. Primary health care is defined as essential health care based on methods and technology that are practical and scientifically sound, as well as socially acceptable; accessible to the community, affordable for the community with good community participation.

In most developing countries like india avoidable blindness constitutes a major public health problem. There are distinct, closely related components in the primary health care approach to blindness prevention

Primary eye care activities are The essential components of primary eye care are: 1. Promotive 2. Preventive 3. Curative 4. Rehabilitative

Such care can be provided by

OPHTHALMIC OFFICERS

Creating awareness (promotive). This is the strengthening of community awareness and co-operation to promote health within the family unit. Appropriate information is disseminated to as many people in the community as possible.

Prevention: This includes stimulation of individuals and their community to participate in activities in blindness prevention; social and community development that promotes health through changes in behaviour and environment and leads to the reduction or elimination of factors contributing to ocular disease.

Curative activities: This involves delivery of eye care to all individuals with potentially blinding disorders in the communities. For example: First aid treatment and/or timely referral of patients with injuries. Identification and treatment/referral of common eye diseases. Identification and referral of patients with potentially blinding diseases for appropriate management. Identification and referral of curable blinding diseases like cataracts.

Rehabilitation activities: What happens to those who are incurably blind? Do we merely sympathise with them and their families? Since primary eye care is mainly concerned with the community level, the issue of rehabilitation becomes very important.

To have a successful primary eye care To have a successful primary eye care To have a successful primary eye care To have a successful primary eye care programmeprogrammeprogrammeprogramme,,,,

there needs to be coordinatedthere needs to be coordinatedthere needs to be coordinatedthere needs to be coordinated teamwork. teamwork. teamwork. teamwork.

There should be regular interactionThere should be regular interactionThere should be regular interactionThere should be regular interaction between the full time eye providers.between the full time eye providers.between the full time eye providers.between the full time eye providers.

@ ROLE AND RESPONSIBILITY Of OPHTHALMIC OFFICER AT PRIMARY LEVEL ( Revised ) 1. Screening and identification of eye diseases at Primary level: a) Cataract b) Uncorrected refractive errors c) Glaucoma d) Childhood blindness e) Diabetic retinopathy f) Squint g) Trachoma h) Corneal opacity i) Uveitis j) Screening for colour vision (not for issuing certificate)

2. Treatment/ Medical intervention at Primary level (PHC) of the following common eye diseases a) Trachoma b) Conjunctivitis c) Allergies of eye lids and conjunctiva d) Dry eye e) Eyelid problems (blepharitis, stye, chalazion) f) Vitamin A Deficiency g) Lacrimal system Disorder, h) Superficial corneal abraison

@ ROLE AND RESPONSIBILITY Of OPHTHALMIC OFFICER AT PRIMARY LEVEL

3. Usage of following medications a) Mydratics b) Cycloplegics drugs for refraction c) Topical anaesthetics for diagnostics d) Basic antibiotics, pain killers, antihistaminics, antialergics

@ ROLE AND RESPONSIBILITY Of OPHTHALMIC OFFICER AT PRIMARY LEVEL

@ ROLE AND RESPONSIBILITY Of OPHTHALMIC OFFICER AT PRIMARY LEVEL

4. Refraction & prescription of spectacles, 5. Dispensing of spectacles 6. Identify, initiate primary medical treatment (as per the protocol) and refer to an Ophthalmologist immediately in the following emergency cases: a) Chemical burns b) Perforating injuries of eyeball or lids c) Corneal infections d) Gluocoma 7. Minor surgical procedures a) Epilation for Trichiasis b) Superficial foreign body removal

8. Enucleation of the eye in cornea donation after proper training 9. Follow up of post operative cases 10. Referral 11. Health education and training at Primary level: For all Primary level functionaries and Volunteers 12. Organization and management at Primary level a) Documentation b) Counseling c) Screening camps d) School eye health e) Health education sessions f) Coordination with other departments (ICDS, social justice, primary health) g) Tele-ophthalmology h) Epidemics

@ ROLE AND RESPONSIBILITY Of OPHTHALMIC OFFICER AT PRIMARY LEVEL

Role & Responsibility at Secondary Level In the out patient department 1. Record complaints, history, preliminary anterior segment eye examination 2. Assessment of vision 3. Refraction : Manual & automated a. Dilatation for refraction b. Prescription of glasses 4. Tonometry(shiotz, applanation, non-contact tonometry) 5. Evaluation of lacrimal duct patency 6. Visual fields testing 7. Diplopia and hess charting 8. Binocular vision testing 9. Contact lens fitting, Low vision aids trial after getting appropriate training 10. Non invasive investigating techniques after training from a recognised institute 11. Prosthetic eye implant fitting 12. Coordination with primary level

13. Pre-operative work up 1. Slit lamp examination 2. Biometry: A Scan, Keratometry 3. Blood pressure

Operation Theatre & Wards 14. Independently 1. Administration of pre and post operative medications and counselling

15. Under Supervision 1. Administration of local anaesthesia under supervision of ophthalmic surgeon 2. Intramuscular and intradermal injections 3. Assist in surgery: draping of the patient, handing over instruments and handling surgical supplies

ophthalmic officers front line in

eye care ….serving the community

saving the sight………..