COMMUNITY

OPHTHALMOLOGY
Ahmad Ashraf

Social
ophthalmology
=
Community
ophthalmology is one of ophthalmology subdivision
that oriented to comprehensive health community
(promotive,
preventive,
curative
dan
rehabilitative)with focus on promotive and
preventive aspects
Clinical Ophthalmology is a branch of medical
science that focus to individually and oriented to
secondary services and located in institution

ophthalmology include :
Promotive
Target is community
Preventive
Promotive = Promotion is a process of study from,
by and for community that is fixed with local social
culture .

Promotif = Promotion is a process study

from, by and for community that fixed with
local social culture
Community = participated

People can recognize, maintain, protect

and improve eye health

Preventive in community ophthalmology focus on:

- Glaucoma
- Refraction
- Degenerative
- Corneal disorder
Preventive
3 type :
1.Primary
prevent diseases
2.Sekunder
prevent loss of visual acuity
3. Tertiary
rehabilitation of visual
acuity to blind person ex : cataract

primary
prevention
prevention
of
diseases occurrence
Examples :
Vitamin A deficiency : good nutrition
Trachoma: good sanitation
varicella / mumps: imunization
refractive errors : watching TV with minimal
distance 5X TV diagonal. Reading distance 30
cm with good enough light
Glaucoma: above 40 yo, control IOP regularly

Sondary prevention : prevent loss of vision from

existing disease, example :
Vitamin A deficiency : if there are symptoms of
night blindness, vitamin A 2x per year and
improve nutrient
cataract : surgery if decrease vision
Glaucoma : saving sight with surgery or
regular check up
Diabetic Retinopathy : saving sight with retinal
laser

Tertiary prevention : improve vision in blind

person , example :
cataract: surgery
Corneal scar : keratoplasty
Low vision person : low vision aid, example :
loup, magnifier
Blindness : condition of vision that 3/60 with best
correction or visual field 10o from fixation point.

How many people are blind :

Almost 50 million persons are blind worldwide,
where 1,5 million below 16 yo.
Prevalence of blindness varied in many places
In Indonesia prevalence of blindness about 1,5%

Some terms
UKM/PK : upaya kesehatan mata dan
pencegahan kebutaan
PKKP
: penanggulangan kebutaan katarak
paripurna
Both are implemented integrated to all sector and
active role from community are needed to realize
eye health for all

Magnitude of blindness in Indonesia:

Based on sight survey 1993-1996 : prevalence of blindness
1,5% 1,5% X 200 m = 3 million
Causes of blindness :
- 52% cataract : 52% X 3 jt = 1.560.000
- 9,5% refractive error :
9,5% X 3.000.000 = 285. 000
- 13,4% glaucoma: 13,4%X3 jt = 402.000
- 8,5% retinal disorder :
8,5% X 3.000.000 = 255.000
- 6,4% corneal disorder : 6,4%X3 jt= 192.000
- 10,2% other diseases : 10,2%X3.000.000 = 306.000

Cataract blindness in productive ages about + 1416% from all cataract = 249.000
If average income Rp. 80.000,-/month, so
economic loss because of cataract blindness in
productive age about
250.000 X 12 X Rp. 80.000,- = Rp. 240.000.000
These not yet include economic loss due to
cataract blindness because of family burden .
Cataract incidence 0,1%
0,1% X 200.000.000 = 200.000
Cataract blindness : burden to family and local
income due to decrease of productivity

Eye Survey results :

1982
1,2% blind rate
1993-1996
1,5% (52% by cataract)
8 province
Why increase: 1,2%
1,5% cause by:
1. UHH: usia harapan hidup / life expectancy
increase from 60 to 66 yo
2. Degenerative diseases more than infectious
disease
3. Lack of eye health facility.

Problem in community :
1.
2.

Increasing Prevalence : 1,5%

Man Power : lack of ophthalmologist , eye
paramedic,
3. Low Budget , community ability to pay also
decrease
4. Political will does not strong enough to take
community participation

THE MAIN EYE MORBIDITY PREVALENCI

Refractive Error
Pterygium
Cataract
Conjuntivitis
Corneal Scar
Glaucoma
Blepharitis
Retinopathy
Hordeolum
Strabismus

22,1
13,9
7,3
2,0
1,4
0,4
0,3
0,2
0,3
0,3

BLINDNESS PREVALENCE AND CAUSES OF

BLINDNESS OF BOTH EYE
Lens

0,78

Glaucoma / N II

0,20

Refractive Error

0,14

Retina

0,13

Cornea

0,10

Others

0,15

Total blindness

1,5

Blind Rate: 1,5%

Population 200.000.000
Blind : 1,5% X 200.000.000 = 3.000.000
by cataract: 0,78% x 200.000.000 = 1.560.000
Number of surgery in Indonesia / year :
+ 60.000
remain : 1.560.000-60.000= 1.500.000
This number : BACK LOG

Defenition Back Log: Number of cataract patients

that not operated in 1 year
Incidence: Number of new cases in 1 year: 1 o/oo
So, every year new cases of cataract :
1o/oo X 200.000.000 = 200.000/tahun

Causes of Back Log:

- Social economy
- Lack of knowledge in community
- Geography
- Lack of eye specialist
- Majority in rural area
- Mainly facility located in urban area
Strategic steps cataract management :
- Social marketing
- Operational preparation
- Surgery
- Follow up by ophthalmologist or GP

Social marketing:
Local population
Map of area
Determine target surgery
Cooperation with health infrastructure
Local government announcement
Local NGO participation

WHO , if prevalence of blindness :

0,5%
: clinical problem
>0,5% - < 1%
: community problem
>1%
:
social
problem
influencing national health development
specially eye health
National program are :
Decreasing blindness rate < 1% in 2003
Decreasing eye morbidity
Socialization eye services in community

Blind criteria WHO:

Visual acuity < 3/60 with maximal correction
Ratio
WHO

: 1 ophthalmologist for 350.000

population
: 1 ophthalmologist for 250.000
population

Government strategies to solve high blindness rate

with cooperation
LSM (Lembaga Swadaya Masyarakat) / NGO local,
national or international :
Training UKM/PK for eye cadres for case finding of
operable cataract
Training for paramedic for cataract case finding and post
operative management
Training for General practitioners in PHC
Training for teacher for early detection of refractive error
Mass cataract surgery called SAFARI KATARAK with low
cost or free of charge

Glaucoma as second
following cataract : 0,2%

causes

of

blindness

To decrease this number : intraocular pressure

(IOP) regular check for patient 40 yo or above to
detect :
chronic simple glaucoma:
Symptoms :
Intraocular pressure > 20,6 mmHg
visual field defect
cupping of the disc

Visual field :
Medial
: 50 o
Superior : 60 o
Inferior
: 70 o
Lateral
: 90 o
Visual category in opthalmology:
> 6/18
: normal
6/60 - 6/16
: visual impairment
3/60 6/60
: low vision
< 3/60
: blind

Some NGO that in cooperation in cataract

eradication program :
yayasan Dharmais Perdami
Lions Club
Rotary Club
Hellen Keller International
Dark and Light International
Christoffell Blinden Mission: CBM
dll

Infrastructure eye services :

primary eye care : Puskesmas

Secondary eye care : RS type C/B dan BKMM
Tertiary eye care
: RS type A
subspesialistic services
BKMM : Balai Kesehatan Mata Masyarakat
secondary services provide by
ophthalmology

Important activities to decrease blindness :

In all places there must be :
1. Providing eye services
2. Early Detection / screening and refractive error
management
3. In specific place :
- Vitamin A supplement
- Trachoma program with SAFE strategy
(Surgery, antibiotic, Face washing,
Environmental)

Specialistic services:
1. Diagnostic and management of glaucoma
2. Diagnostic and management of retinopathy
3. Specialist center for childhood blindness

Thank you