Vol. 12 May 2005

Dear Readers,

Thank you very much for your encouragement and support. Today this website is being accessed in over 104 countries and over 1270 people are accessing it everyday. It is truly turning out to become the website for management resources in eye care.

we want to continue to bring you through SiteNews resources related to various issues of managing eye care. These include addressing issues of quality, planning, sustainability, and evaluation. We have been covering the priority diseases under Vision 2020 in the past year. This year we hope to take it to a newer level of detail be looking at their management from a different angle.

The theme for this issue is "Cataract". Taking inspiration from this theme we have decided to focus this issue on management resources related to cataract.

We look forward to your continuous patronage of our website as well as recommendation of materials that we can add to this storehouse of management resources in eye care.

With your support this resource site will continue to grow and be of relevance!

Happy Reading!

Regards,

Vision 2020 e-resource team
Understand the problem

Resources

Strategies

Collaborating Partner

Contribute

Register
 Solution

Barriers

Health Education for Community

Talk to Us

Pastissues
A synopsis of the present situation

Worldwide, it is estimated that at least 38 million people are blind and that an additional 110 million have severely impaired vision. In all, about 150 million people are visually disabled in the world today, and the number is steadily increasing because of population growth and aging. Overall, the data show that more than 90% of all blind people live in developing countries and that more than two-thirds of all blindness is avoidable (either preventable or curable). Unfortunately, little information is available on the incidence of blindness around the world; it seems probable, however, that there are some 7 million new cases of blindness each year and that despite every intervention, blindness in the world is still increasing by 1 to 2 million cases a year. Thus, trend assessment points to a doubling of world blindness by the year 2020 unless more aggressive intervention is undertaken.

As a first gait, we feature the management issues and solutions related to Cataract eye Care Service Delivery. This includes the following areas covered to approach the problem in a holistic way.


Understand the Problem

In order the achieve the VISION 2020 objective of eliminating the main causes of avoidable blindness by the year 2020, and to give all people the right to sight an understanding of cataract problem is essential.
This means one should know:
  1. Magnitude - incidence and prevalence of the disease
  2. Social and economic magnitude of the disease and the lives of the people
  3. Clinical aspects, in terms of what causes the disease, what are the various ways to treat etc
  4. We need to know the current status of the problem
The following resources provide you a brief understanding of the problem in cataract service. It also provides you with links to the most current information and resource you need to address the problem.

Resources

Magnitude of the Problem
  • MAGNITUDE OF CATARACT BLINDNESS ESTIMATION
    Abstract:
    This tool will help you to find the magnitude of blindness in the given service area Population and also estimate the Incidence of blindness in the given service area population. The Users of this tool are any new Eye Hospitals before its set up, already existing Hospitals and Consultants or Private practitioners.

  • ASSESSING NEEDS FOR STARTING A NEW EYE HOSPITAL
    Abstract:
    Currently there is no planning tool available for starting an eye hospital. Many hospitals are started without adequate planning and after execution end up under utilizing resources like manpower, equipment, etc and having to remodel their building design. This can be avoided by assessing the magnitude of blindness, estimating the workload, planning the manpower, estimating the income & expenditure, cost recovery and determining the price for services during the initial stage.
    A tool can be developed to estimate the magnitude of blindness for the service area and based on the current performance - assess the gap which can be the basis for estimating the potential workload for the hospital. Several templates of building plans can be created so that the hospital can make modifications based on the available land area and the workload. Project management templates with various tasks for starting an eye hospital can be created with duration and person responsible. This will help the hospital to estimate the time duration required for completing the construction and setting up the hospital before the hospital can be opened to the public. The earlier tool on workload estimation & financial projections can be used along with this tool.

  • EXISTING EYE HOSPITAL STRATEGIC PLANNING TOOL
    Abstract:
    It is necessary that every hospital should do strategic planning once a year to know their opportunities and weakness. To facilitate strategic planning, workload estimation and financial projections become vital. This tool would provide the capacity of the hospital based on their bed strength and systems & procedures followed in the hospital. The workload estimation will include information regarding the outpatients seen and different types of surgeries performed along with the various categories of patients (paying, free and subsidized). The estimated workload can give an idea about the required manpower for the hospital. With the above inputs, financial statements can be developed to arrive at the income and expenditure for the projected workload and human resource and the cost recovery position of the hospital by fixing appropriate price for services.

  • CHILDHOOD CATARACT: MAGNITUDE, MANAGEMENT, ECONOMICS AND IMPACT
    Abstract:
    This article focuses the magnitude of childhood cataract and the management of childhood cataract to reduce it.
    Source:
    B.R.Shamanna and R.Muralikrishnan from Journal of Community Eye Health.

Social and Economic Impact

Clinical Aspects (Causes and Types)
  • QUALITY CATARACT SERIES - CLINICAL STRATEGIES
    Abstract:
    Clinical Strategies deals with benchmarks from monitoring quality volume and sustainability, evolution of cataract surgical techniques, clinical strategies, IOL microsurgery training course, and Manual Phacoextraction training course. Apart from this there are appendices on preoperative evaluation, preoperative preparation and anesthesia, intraoperative considerations, postoperative management and pediatric cataract.

  • QUALITY ASSURANCE IN CATARACT SURGERY
    Abstract:
    This book deals with the diagnosis, how the cataract surgery is done, preoperative medication, anaesthesia, surgery procedure, phacoemulsification technique, and postoperative care with the IOL In-patient Record. Apart from this there are appendices on preoperaparative evaluation, preoperative preparation and anesthesia, intraoperative considerations, postoperative management and paediatric cataract.

  • CATARACT SURGERY TECHNIQUES
    Abstract:
    The Cataract Surgical Protocol deals with the techniques to be followed during the cataract surgeries. The patient examination and the preoperative techniques to be followed such as admission, investigation, decision making on patients with systematic diseases, asthmatics, instruction regarding dilatation, cleanliness and day of surgery are given in detail. The Surgical Protocol includes how the anaesthetic solution is selected, its quantity, sterilization of needles, checking of case records, Anaesthesia, hypotony, managing anaesthetic complications etc. The Postoperative protocol includes Routine Management of uncomplicated cases, routine medication, explaining the patient during discharge, timing of resurgeries and routine follow-up.

  • SICS CLINICAL TRIAL - CLINICAL TRIAL OF MANUAL SMALL INCISION SURGERY AND STANDARD EXTRACAPSULAR SURGERY
    Abstract:
    This article provides details on manual small incision cataract surgery, methods, and results.
    Source:
    Parikshit Gogate MS (Ophth) DNB FRCS Ed MSc from Journal of Community Eye Health

  • SUTURELESS CATARACT SURGERY: PRINCIPLES AND STEPS
    Abstract:
    This article focus on Cataract Surgical Techniques for Cataract Surgeons with the processes on Incision, mobilization of the nucleus, removal of the nucleus, wound closure, problems and solutions
    Source:
    John Sandford-Smith FRCS FRCOphth from Journal of Community Eye Health

Current status
  • VISION 2020: THE CATARACT CHALLENGE
    Abstract:
    This article provides the cataract surgery statistics of cataract blindness, operable cataract eyes and cataract surgical rate.
    Source:
    Allen Foster FRCS FRCOphth from Journal of Community Eye Health


Solution

Having identified the problem, we need to identify the solution for the problem. This is in the form of various interventions at the clinical level, preventive and curative care and also at examining what we have to do at the community level to educate the people. Besides knowing the solutions rather we need to have standardized well-defined indicators or benchmarks for all these interventions made and also find out the success of the outcome.
The main subject matter covered under this area is:
1. Interventions (Clinical and Community)
2. Outcome Benchmarks
Hence we provide various articles under these topics which instruct one to have clear idea on the solutions and interventions ever done in this focus of Cataract Eye Care service delivery.

Resources

Clinical

Preventive Interventions

Curative Interventions
  • QUALITY CATARACT SERIES - COMMUNITY OUTREACH
    Abstract:
    Community Outreach Initiatives consists of purposes of community outreach, community outreach activities in various fields and more challenges in community outreach and how to overcome it for improving patient awareness and increasing the uptake of cataract services.

Community
  • COMMUNITY BASED CASE-FINDING AND REHABILITATION: DETECTION OF CATARACT PATIENTS AND POST-OPERATIVE FOLLOW-UP
    Abstract:
    This article focus on the recommendations for all those concerned with restoring sight to cataract patients and thus with getting these patients to attend an eye hospital.
    Source:
    Geert Vanneste from Journal of Community Eye Health

  • COMMUNITY OUTREACH FOR CATARACT
    Abstract:
    The Cataract Outreach Activities Protocol guides about the pre-camp activities such as monthly plan/weekly plan schedule, to contact the sponsor, explaining the sponsor about the camp procedures, suggest a suitable date and camp site, to give standard format of notice and poster for sponsor's publicity, periodical meetings, transport management etc. and the camp-day activities such as to make ready op& IP registers, collect furniture, instructing the volunteers, collect patients, preparing medical records, arranging food, arranging transport to take the patients to the hospital etc. and the post-camp activities such as admitting and treatment of patients, to draw camp reports etc. A Flow chart of examination protocol at campsite and the standardized clinical protocol for the campsite is also given for good management.

Outcome Benchmarks
  • MONITORING CATARACT SURGICAL OUTCOMES: METHODS AND TOOLS
    Abstract:
    This article details the methods of assessing cataract surgical outcomes and the tools used for this along with guidelines for quality assessment.
    Source:
    Hans Limburg PhD DCEH from Journal of Community Eye Health

  • COUNTRY-WIDE MONITORING OF CATARACT SURGICAL OUTCOMES
    Abstract:
    This article provides information on the experience of Malawi Eye Care Programme which resulted in high volume cataract surgery in the country.
    Source:
    Lalit Dandona MD MPH from Journal of Community Eye Health

  • CATARACT SURGERY OUTCOMES: A PRIORITY AGENDA ITEM
    Abstract:
    This article focus on cataract surgery outcomes like visual acuity, ICCE or ECCE without IOL versus IOL Surgery, Factors contributing to Post-operative Visual Impairment and Blindness and the goal of good surgical outcomes.
    Source:
    Leon B Ellwein PhD from Journal of Community Eye Health

  • MONITORING CATARACT SURGICAL OUTCOMES: 'HAND WRITTEN' REGISTRATION METHOD
    Abstract:
    The article provide a practical method to monitor qualitatively the results of the cataract surgery done.
    Source:
    Colin Cook MBChB FCS(Ophth)SA FRCOphth from Journal of Community Eye Health

  • WHAT DO WE MEAN BY CATARACT OUTOMES?
    Abstract:
    This article provides you details on clinical trials of India and Nepal and the population-based surveys in Asia.
    Source:
    Lalit Dandona MD MPH from Journal of Community Eye Health

  • HOW TO IMPROVE THE OUTCOME OF CATARACT SURGERY
    Abstract:
    This article discusses the reasons for poor outcome of cataract surgery and how to overcome the same.
    Source:
    Colin Cook MBChB FCS(Ophth)SA FRCOphth from Journal of Community Eye Health

  • IMPORTANCE OF MONITORING CATARACT SURGICAL OUTCOMES
    Abstract:
    This article provides details on the settings for monitoring cataract outcomes, the clinical audit needed, and the guidelines for measuring it in a population setting.



Resources

To implement the solution or to overcome the problem, we need to avail the variety of resources namely:
  1. Infrastructure
  2. Human resources
  3. Skills and competence
  4. Utilization benchmarks

Infrastructure

 This implies building a system of eye care on the basis of primary health care and making available the best technology that can be afforded at the public health level. If any blindness-prevention and eye care scheme is to be successful, awareness of eye disease and its prevention and treatment opportunities must be increased in the poorest population groups.

  • QUALITY CATARACT SERIES - ARCHITECTURAL DESIGN MODULE
    Abstract:
    Architectural Design consists of examples and models, design principles such as hygiene, technology, function, community design, beauty, economic issues, and development process. This module is useful for several different architectural projects such as building anew facility on a new site, adding another building to the current site, acquiring an existing building and renovating it, renting an existing bilding and negotiating with the landlord to make changes to and redesigning and renovating the current building

Human Resource Development

 One of the main focuses of a global initiative to combat cataract blindness must be human resource development. To increase the efficiency of ophthalmologists in clinical work, further training of support staff such as paramedical ophthalmic assistants, ophthalmic nurses and refractionists is proposed. Enhance management training for medical and paramedical staff.

  • QUALITY CATARACT SERIES - PARAMEDICAL CONTRIBUTIONS
    Abstract:
    Paramedical Contributions consists of objective of the paramedical module, examples and modules, ophthalmic paramedical training, the Aravind model of paramedical staffing etc.

  • JOB DESCRIPTION FOR GENERAL OPHTHALMOLOGISTS
    Abstract:
    This is a model job description for the Medical Officers in an Eye Hospital. It clearly focuses the duties of the Medical Officers, and how to manage the duties in an organized way.

  • JOB DESCRIPTION FOR CAMP ORGANISORS
    Abstract:
    This is a model job description for the Camp Organisors. It clearly focuses the duties of the Camp Organisor, and how to manage the duties in an organized way.

  • PRODUCTIVITY: GETTING CATARACT PATIENTS "THROUGH AND OUT"
    Abstract:
    This article focus on increasing the capacity and efficiency of the existing system of service delivery, which will be a genuine need in developing countries.
    Source:
    RD Thulasiraj MBA, S Saravanan MHM from Journal of Community Eye Health

  • PATIENT COUNSELLORS: THE ROLE OF PATIENT COUNSELLORS IN INCREASING THE UPTAKE OF CATARACT SURGERIES AND IOLS
    Abstract:
    This article focuses on selecting, training and working skill of counsellors with some common questions asked by patients which a counsellor needs to answer.
    Source:
    Asim Kumar Sil DO DNB from Journal of Community Eye Health

  • TRAINING A CATARACT SURGEON
    Abstract:
    This article focus on training the cataract surgeon in identifying of tasks, length of training and its content, equipments and training materials, requirements of trainer etc.
    Source:
    M Daud Khan MBBS DO FRCS FRCOphth FCPS, M Babar Qureshi BMBCh DOMS MSc from Journal of Community Eye Health

Skills and Competence

 To improve the service of your organization, you will need to ensure that your staff has the skills and competence necessary to perform effectively. This can be attained by selecting the right candidates and providing formal training.

  • QUALITY CATARACT SERIES - MANAGEMENT PRINCIPLES AND PRACTICES
    Abstract:
    Management Principles and Practices consists of management framework, contributing factors, leadership and attitude, manpower and human resources, building and infrastructure, instruments and equipments, policies and systems etc.

  • CATARACT SERIES
    Abstract:
    This booklet provides information on the cataract disease, its types, evaluation, low vision aids, surgical management, surgical techniques, Outcomes of the surgery, and the complications involved with the surgery.

  • TRAINING CENTRES AND LEARNING RESOURCES FOR SMALL INCISION CATARACT SURGERY
    Abstract:
    This document provides a list of SICS training centres in India, Pakistan, Nepal and Africa with the learning resources available with authors' name.
    Source:
    Journal of Community Eye Health

Equipments and Instruments

 With the rapid and continuous development of technology the delivery of eye care services is becoming increasingly sophisticated and also expensive. While equipping an eye hospital one has to keep in mind very strongly the scope of clinical services and the anticipated patient flow. Most of the interventions for eye care require a secondary level setting. Hence the secondary level eye care includes cataract, refraction and other diagnostic procedures really forms the back bone of eye care services.

  • STANDARD CATARACT SURGICAL KIT
    Abstract:
    This cataract kit contains the minimum and desirable equipments and medicines needed for five surgeries. The Items needed, their brand option, manufacturer, category & use, and quantity for ECCE and SICS for preoperative, intraoperative and postoperative care is given in detail that enables the user to prepare for a surgery.

Utilization benchmarks

 Bench Marks is one of the most comprehensive sets of social and environmental criteria available for eye care indicator. You will find the Bench Marks useful for developing and monitoring cataract surgeries and managerial issues related to it. We tried to provide the possible resources under each of these categories and also the link to open up them.

  • QUALITY CATARACT SERIES - FINANCIAL SUSTAINABILITY
    Abstract:
    Financial Sustainability consists of examples and models, cost recovery issues, and cost recovery principles such as pricing, accountability etc. and also a cost recovery exercise to record lessons learned in the achievement of cost recovery in eye care programmes, to describe the factors and principles to consider when implementing cost recovery measures for financial sustainability, and to remind those responsible for economic development, costing decisions and financial decisions to ask the right questions to the right people at the right time in the planning process.

  • MEDICAL RECORDS
    Abstract:
    This document covers the standard protocol to maintain medical records and issue reports. It provides model case sheets for various patient categories including preoperative cataract/IOL, cataract/IOL surgery record, postoperative cataract/IOL surgery record, follow-up and discharge record, as well as flowcharts illustrating the work flow for new and review registration.



Barriers
Despite improvements in the availability of blindness preventing and restoring treatment in the developing world, enormous barriers remain to increasing the use of services. The barriers are varying from place to place. The barriers could be from the perspective of the receiver or a client/patient. Few receiver barriers are cost of surgery, Distance to the Hospital, Cultural and Social Barriers, Knowledge of Services.

Provider Perspective

Infrastructure and Quality


Strategies

Solutions do not lend by themselves to implement because of the challenges post by the barriers. Hence various strategies have been attempted in order to overcome the barriers and facilitate reaching of the solution to the people with the problem. In this context a wide variety of successful case studies and interventions will be looked at.
There are two types of Strategies that could be looked in:
  1. Current Strategies
  2. Innovative Strategies
The current strategies provide the description of the present strategies adopted to prevent blindness due to Childhood problems with some case studies from various Eye Hospital including Aravind.

Currently Used and Innovative Strategies
  • COUNTRY-WIDE MONITORING OF CATARACT SURGICAL OUTCOMES
    Abstract:
    This article provides information on the experience of Malawi Eye Care Programme which resulted in high volume cataract surgery in the country.
    Source:
    Moses C Chirambo MD from Journal of Community Eye Health

  • BANGLADESH MODEL OF EYE CARE
    Abstract:
    This article provides details on the model of Modular Eye Care (MEC) developed in several districts of Bangladesh between 1994 and the end of 1999.
    Source:
    M Jalaluddin Khan FCMA BSc DipPM from Journal of Community Eye Health

  • CATARACT SURGERY IN SENEGAL
    Abstract:
    This article focus on the study concerned with cataract surgery in Senegal which involved 1,000 eyes for the research.
    Source:
    W Williamson MD L Poirier MD H Jouni MD AB Diallo P Verin MD from Journal of Community Eye Health

  • EARLY RESULTS OF CATARACT SURGERY AT MECHI EYE CARE CENTRE IN NEPAL
    Abstract:
    This article focus on study made on cataract surgery at Mechi eye care centre in Nepal
    Source:
    Sanjay Kumar Singh MD, Ophthalmologist In-charge Tulasi Dahal, Ophthalmic Assistant Divya Sharma, Ophthalmic Assistant from Journal Of Community Eye Health

  • MONITORING CATARACT SURGICAL OUTCOMES: COMPUTERISED SYSTEMS
    Abstract:
    This article focuses on the need for monitoring cataract surgical outcomes through computerized systems with details on how to monitor it.
    Source:
    David Yorston FRCS FRCOphth from Journal of Community Eye Health

  • COMPARISON OF CATARACT SURGERY IN A BASE HOSPITAL AND IN PERIPHERAL EYE CAMPS
    Abstract:
    This articles compares the methods to reach out the community for surgical coverage in two modes, reach in and reach out and the results got for both of it.
    Source:
    Parikshit Gogate, MS (Ophth) MSc FRCS(Ed) Anil N Kulkarni MS (Ophth), from Journal of Community Eye Health

  • CATARACT SURGICAL COVERAGE IN KOLENCHERY, KERALA, INDIA
    Abstract:
    This article provides a model for cataract surgical coverage in an area in Kerala, the materials and methods used to reach the surgical rate and the success results got with a community based programme.
    Source:
    Sasikumar S MS DO Mohamed Naved MS DO DNB Saikumar S J MS DO DNB from Journal of Community Eye Health

  • GIFT OF VISION: CATARACT SERVICES IN CENTRAL ASIA
    Abstract:
    This document is a case study which provides the details on the cataract services rendered in Central Asia by Sri Satguru Netra Chikitsalaya Hospital and their evolution.
    Source:
    Mr. Anand Sudan, Sri Sadguru Netra Chikitsalaya



Health Education for Community

Health education materials help improve the health of all people in the community. As far as eye care is concerned a lot of health education materials have to be developed for creating awareness about the eye diseases. We have provided you with the links of various health education materials that can be used by eye care professionals.
  • CATARACT COUNSELLING GUIDELINES WITH FAQ
    Abstract:
    The Cataract counselling guidelines deals about the responsibilities of patient counsellors in counselling individual or groups of patients and the role of patient counselling coordinators, training required, departmental duties and the challenges faced by the patient counselors. A set of frequently asked counseling guidelines queries help counsellors in counselling the patients in an efficient way. The three stages of counseling such as preoperative, postoperative and surgery guidelines are also dealt.



Brochures


Posters


Collaborating Partner

Since 1992, The Fred Hollows Foundation has worked with local partners in more than 29 countries to eradicate avoidable blindness in developing countries, with a focus on cataract. In Australia, we work to improve the health outcomes of Indigenous Australians. The Foundation is inspired by the work and example of the late Professor Fred Hollows.
Through the Foundation's active and participatory partnerships, the beneficiaries of their programs are becoming increasingly independent - patients with restored sight are returning to work, doctors are passing on their new-found skills by training their colleagues, Indigenous Australians are taking ownership of those activities which impact on their health and socio-economic status and our program partners are sharing their experiences with each other and modeling the outcomes.
Visit www.hollows.org to find out more about the work of The Foundation, to learn about our partnerships and to meet our people. We explore more way of collaboration with Fred Hollows Foundation and appreciate their work and service delivery for prevention of blindness.

Talk to Us

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Vision 2020 e-resource team,
Lions Aravind Institute of Community Ophthalmology,
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Tamil Nadu, India,
E-mail:eyesite@aravind.org
Phone: 91-452-2537580

Contribute
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Past Issues