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Eye Care is a broad concept, encompassing the prevention of likely blinding eye diseases through primary health care. Eye Care includes the identification, with treatment or referral, of individuals with treatable causes of blindness; and the diagnosis and treatment of common eye diseases, particularly those causing an acute red eye. The principles of health care (i.e., fair distribution;community involvement; focus on prevention; appropriate technology; multi-sectorial approach) should all apply in primary eye care. If many of the essential elements of health care are applied, this would contribute significantly to the prevention of eye diseases and blindness.
The eight essential elements of health care are as follows:
It has been estimated that 500,000 children become blind every year, the majority from corneal scarring due to vitamin A deficiency, measles and the use of harmful traditional eye medicines. Much of this blindness could be prevented if the underlying causes could be addressed through health care principles, i.e., safe water supplies to prevent diarrhoea, immunisation to prevent measles infection, promotion of food supplies and good nutrition, the availability of essential drugs to reduce dependence on harmful traditional remedies, and maternal and child health. These activities should all be included in eye care.
In Western countries diabetic retinopathy is an important cause of potentially preventable blindness in people of working age. Screening programmes, undertaken by appropriately trained personnel, exist is many communities to diagnose and refer those needing photocoagulation to prevent blindness. Open angle glaucoma affects an estimated 13.5 million people worldwide; these individuals need to be identified and referred for treatment to prevent blindness. Eye care is, therefore, essential in all communities, and in all regions of the world.
Of the estimated 38 million who are blind, 20 million are blind from cataract, a condition where sight can be restored by surgery. Individuals requiring cataract surgery need to be identified and referred, an activity which also comes within the remit of primary eye care.
Eye care, therefore, includes many activities which can be implemented in the community, or at the primary level of health care. Eye care is the essential building block for prevention of blindness in all communities and in all regions of the world. Without primary eye care only those individuals who present to secondary and tertiary facilities will be diagnosed and treated, and little will be achieved in terms of prevention. Different cadres of worker can be involved, many of whom already have many duties and responsibilities. This is one of the dilemmas and challenges facing the effective and integrated implementation of primary health care. Consideration also needs to be given to the training requirements of these cadres so that they become integrated eye care workers. Eye care cannot function effectively in isolation. It is very important that there is good communication as well as effective referral systems to the secondary and tertiary levels of eye care where there are facilities and personnel trained more specifically in the treatment of ocular diseases.
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