A Comprehensive Eye Care System

The OPC’s strategy opposes the logic behind interventionist aid. One of its main objectives for public health is to help give autonomy to the most deprived populations facing problems to do with visual impairment and loss of sight, which are often synonymous with social isolation and extreme poverty.

In collaboration with the relevant Ministries of Health and universities of the countries concerned, the OPC provides ophthalmology training for health workers living in partner countries, guarantees on-going training and provides surgical equipment, food, drink, and 4x4 vehicles which enable staff to care for the most isolated of villagers.

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Jean-François Ceccon, the OPC’s former Director of Programmes, explains the development objectives in the domain of public eye health.

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The comprehensive eye care system set up by the OPC is made up of two components (the first, said to be ’horizontal’ is implemented at the community level, the second, said to be ’vertical’, relates to the more medical aspects) as set out in the plan for the fight against blindness.

There are three levels to the system :

• First level : Primary eye care
• Second level : Secondary eye care
• Third level : Tertiary eye care

"Primary eye care" is part of a horizontal approach to improving the general health of a population.

At village community level, the primary health care system is involved in the development of the following eight components :

  Health education ;
  Environmental sanitation ;
  Vaccination at the community level ;
  Promotion of a balanced diet ;
  Identification and implementation of appropriate treatments ;
  Provision of essential medicine ;
  Protection of mothers and infants ;
  Community participation in the fight against transmitted diseases and/or epidemics.

In this context, the primary eye care which is available from community health workers is provided in three stages :

1) AWARENESS : concerning the promotion of one or more of the following :

 Safety at work (especially in rural areas) ;
  Individual hygiene (hands and face) and collective (environmental sanitation and treatment of organic waste) ;
  Promotion of the measles vaccination ;
  Advocating breastfeeding and improved weaning practices ;
  A diet rich in vitamin A (red berries and green leaves).

2) PREVENTION : the prevention of one or more of the following :

  Prevention of neo-natal conjunctivitis ;
  Prevention of blindness arising from complications associated with onchocerciasis (river blindness), early treatment of trachoma and the prevention of its associated complications ;
  Prevention of vitamin A deficiency ;
  Detecting and correcting refractive errors in order to prevent children failing and dropping out of school.

The framework supporting the awareness and prevention of blindness should be gradually put in place and carried out by the community health workers who have been trained by the OPC.

3) EYE CARE : early eye care administered to patients with conjunctivitis thus regulating the transferral of patients to secondary eye care centres and to patients suffering from other diseases affecting their eyes. The community health workers can also identify people suffering from cataract, which serves as the leading cause of blindness in the least developed countries.

Those detected at village level are either :

  Sent to health centres with an operating room, (usually supplied by the OPC), if the time taken to reach the centre is less than half a day’s journey.
  Brought together in order to benefit from the surgical procedures provided by a mobile eye surgery, if the time required to reach the surgery is longer than half a day’s journey.

The “secondary eye care centres” and the mobile teams are operated by specialist nurses in ophthalmology (many of them trained by the OPC) or by ophthalmologists. It is at this level where the majority of ocular trauma (the most common and severe) are cared for, as well as patients with complications associated with trachoma.

When the necessary level of care cannot be provided at these secondary eye care centres, patients are referred to the university hospital’s department of ophthalmology (where ‘tertiary eye care’ is provided). This is reserved for those patients who pose the greatest problems or who need highly skilled treatment or the use of expensive equipment. When the need arises, the OPC helps to provide the necessary equipment and services.

The OPC is committed to ensuring that this system of ‘comprehensive eye care’ works with health professionals in the countries concerned (ophthalmologists and ophthalmic specialist nurses) and offers quality services at each level of intervention. That is why the OPC is also committed to providing training to fight against professional isolation. The OPC is also committed to updating a directory of a network of eye care specialists (réseau d’entraide pour la santé oculaire - RESO). This network enables ophthalmologists “in the field” to have access to relevant information for solving problems whilst also increasing the number of professional contacts at their disposal from each of the sectors in the fight against blindness.