Post on 24-Dec-2015
Dr G. Chandrasekhar
LVP Eye Health Pyramid
Glaucoma Care
• Appropriate
• Available
• Affordable
• Accessible
Without Compromising Quality
From Screening to Management of Complex
Diseases
LVPEI Eye Health Pyramid
Community
Secondary
Tertiary
Adv. Tertiary
Primary
Organizing primary-care networks
•Continuity of care•Bringing care closer to the people•Responsibility for a well-identified population
PRIMARY CARE: PUTTING PEOPLE FIRST
Village Vision Complex
Integrated Secondary & Primary Eye Care
Secondary Eye Care
10 Vision Centres
100 Vision Guardians+
+
Direct Service to 100-200 villages
89 Primary
10+9 Secondary
Four Tertiary
Center of Excellence
Community
Primary 2002
Secondary 1992
Tertiary 2003
Adv. Tertiary 1987
Community 2004
• General awareness
• Refer those with problems
Centre of Excellence
Training centre
Service Centre
Vision Centre
Vision Guardian
Community Level(Vision Guardian)
• History
• High IOP
• Optic nerve
• Van Herrick’s
• Referral
Primary Care(Vision
Technician)
Centre of Excellence
Training centre
Service Centre
Vision Centre
Vision Guardian
• History Slit lamp
• Applanation tonometry
• Gonioscopy
• Optic nerve
• Visual fields• Medical and Surgical
Rx
Secondary Care
(Ophthalmologist)Centre of Excellence
Training centre
Service Centre
Vision Centre
Vision Guardian
• Diagnosis & treatment of complicated problems
• Training
• Research
Tertiary Care
(Subspecialities)Centre of Excellence
Training centre
Service Centre
Vision Centre
Vision Guardian
• Management of complex cases
• Training of Subspecialists and trainers
• Educational standards
• Research
• Advocacy
• Capacity building of Training Centres
CENTRE OF EXCELLENCE
Advanced Tertiary Care
(Team of Subspecialists)
Centre of Excellence
Training centre
Service Centre
Vision Centre
Vision Guardian
• Situation analysis
• Modification of infrastructure
• Redesigning of physical space
• Equipment
• Training of Trainers
• Implementation
• Monitoring and evaluation
Capacity building of Training Centres
Centre of Excellence
Training centre
Service Centre
Vision Centre
Vision Guardian
CENTRE OF EXCELLENCE
Advanced Tertiary Care
(Team of Subspecialists)
Village Vision Complex
Integrated Secondary & Primary Eye Care
Secondary Eye Care
10 Vision Centres
100 Vision Guardians+
+
Direct Service to 100-200 villages
Secondary Centres Data (1998-2011)
Centre NameTotal OPD
Glaucoma in OPD Trab. Yag PI
Mudhole 213108 1162 814 409Tudukurthy 143528 534 377 118Adilabad 71603 86 66 23Karamchedu 84997 481 109 30Markapuram 44638 303 88 0Kandukur 13854 156 5 0Nellore 21987 41 0 0Paloncha 20990 156 6 64Cherukupalli 2155 30 0 0 616860 2949 1465 644
Glaucoma – Vision Centres
April 2010 to Jan 2012
All Centers (76) Screening High IOP
Total 249160 1709
0.68% - High IOP > 21
LVPEI Eye Health Pyramid
Glaucoma careChallenge
sIOPAngle ClosureDisc and field damage
Glaucoma Epidemiology and Molecular Genetics Study
GLEAMS
Population based cross sectional study
Methodology
• Inclusion criteria– People aged 40 years and above– Residents for a min 6 months– Willing to participate
• Exclusion criteria– Cannot be contacted after 3
attempts– People who are immobile
Methodology
Vision Guardian Vision Guardian
Vision Technician 1Vision Technician 1
Vision Technician 2Vision Technician 2
OptometristOptometrist
The Study Plan
Vision Technician 1Vision Technician 1
Vision screeningVision screening
History, VA, RefHistory, VA, Ref
FDT, HVF, SL, NMFP, ASOCT
FDT, HVF, SL, NMFP, ASOCT
Goni, dilated evaluation, OCT, Fundus photo
Goni, dilated evaluation, OCT, Fundus photo
DO, IOP, GonioDO, IOP, Gonio
Analysis I• Agreement of Optometrists with
Glaucoma Specialist Ophthalmologist in gonioscopy and Optic Disc evaluation
Analysis II• Diagnostic accuracy of a VG in vision
screening, pupillary abnormalities and anterior chamber
Results
Analysis III• Skills of a VT in Gonioscopy and image
acquisition
Analysis IV• Role of Imaging in POAG and PACD diagnosis
Results
Gonioscopy• 150 eyes with 25 PACS and 25 PAC
Optic Disc Assessment• 200 eyes with 30 disc suspects and 30
glaucoma eyes
Sample Size
• Agreement between Optometrists and Glaucoma Expert
Results
К (SE)
Gonioscopy (UK) 0.92 (0.12)
Optic Disc Assessment (UK) 0.90 (0.09)
Gonioscopy (JGB) 0.84 (0.10)
Optic Disc Assessment (JGB) 0.89 (0.09)
Progress of the Project
• No. of villages screened - 10• Number of subjects screened till now –
2000• Data available - 1832
No. of eyes with various types of glaucoma
LVPEI Eye Health Pyramid
Glaucoma careChallenge
sIOPAngle ClosureDisc and field damage
Weinreb RN etal. Am J Ophthalmol 2004;138: 458-467
The Glaucoma Continuum
Shallow AC depth on Van Herrick
Corresponding ASOCT
BEST NMFP Corresponding OCT
BEST MFP
WORST NMFPCorresponding OCT
WORST MFP
L V Prasad Eye Institutewww.lvpei.org
Thank you!
Excellence
Equity
Efficiency