Celebrating the 12th year of Vision 2020: The Right to Sight in the Caribbean

Preventing blindness and visual impairment while restoring sight and creating opportunities for persons whose sight cannot be restored Lower All Saints Road - P.O. Box 1517 - Antigua, West Indies Tel: 1-(268)-462-4111/462-6369/562-2216 - Fax: (268)-462-6371 E-mail: arvel.grant@eyecarecaribbean.com; keva.richards@eyecarecaribbean.com; frank.bowen@eyecarecaribbean.com; carolyn.gopaul@eyecarecaribbean.com Website: www.eyecarecaribbean.com; www.ccb1967.com www.v2020caribbean.com

2012 ANNUAL MEETING OF VISION 2020 COMMITTEES - REPRESENTATIVES FOR THE CARIBBEAN AGENDA
VENUE: The Savannah Suite, Pegasus Hotel, Georgetown, Guyana Tuesday 11th & Wednesday 12th Dec, 2012 CHAIR: Arvel Grant, CEO, CCB-Eye Care Caribbean
This meeting is being implemented with the technical and financial support of:

AGENDA
2012 ANNUAL MEETING OF VISION 2020 COMMITTEES REPRESENTATIVES FOR THE CARIBBEAN
Purpose of the meeting: This meeting will provide a platform for sharing, learning and networking and will strengthen links between V2020 Committees and persons involved in eye health. Participants will become familiar with perspectives from other areas and will be exposed to new thinking, technologies and opportunities that they can use to benefit eye health service delivery in their countries. The meeting will also be used to launch a 6-monthly web-based conference call involving Vision 2020 Committee Representatives from across the CARICOM area, using CCB-Eye Care Caribbeans VENTRILO-based conferencing facility. DAY ONE: Tuesday 11th December, 2012 START TIME: 8.15 am to 5.00 pm OPENING SESSION
8:15 - 8:30 8:30 8:40 Getting seated and meeting your neighbors Call to order and welcome Moment of Meditation Roll call of delegates

8:40 8:50

8:50 9:00

House-keeping matters and questions for clarification

Arvel Grant, CEO, CCB-Eye Care Caribbean Meeting Chair Keva Richards, Vision 2020 Project Manager, CCB-Eye Care Caribbean Doc. 1: List of Delegates; page 7 Charles Vandyke, Vision 2020 Programme Manager, Eye Care Guyana

SETTING THE CONTEXT

9:00 9:20 Vision 2020 : The Right to Sight - A global initiative A look at global progress in our effort to guarantee The Right To Sight Dr Louis Pizzarello (MD,MPH) Chairman for the North American Region of the International Agency for the Prevention of Blindness (IAPB) Doc. 2: Hyderabad Declaration; page 9 Doc. 2.1: WHO Resolution. Page 11 Dr Juan Carlos Silva (MD, MPH) Regional Advisor in Prevention of Blindness, PAHO-WHO Doc. 3: Session Presentation; page 12 Dr Juan Carlos Silva Doc. 4: Strategic Framework for V2020 (Caribbean Region); page 15

9:20 9:35

9:35 9:50

WHO Action Plan on Avoidable Blindness 2014-2019 The process to date; Whats in Draft Zero; what happens next. Strategic Framework for V2020 Caribbean Region (2010) Recap on Indicators and Priorities

9:50 -10:05

10:05 10:15 10:15 10:45

Delivering V2020 in the Caribbean (EC Contract No. DCI-NSA PVD / 2009 / 222-937) Progress to date and planned actions Q & A on all Presentations COFFEE BREAK

Philip Hand, Programme Manager (Caribbean), Sightsavers; Doc. 5: Session Presentation; page 35 Facilitated by Arvel Grant

IMPLEMENTING V2020 PROGRAMMES DISEASE CONTROL & RESEARCH

10:45 11:00 Glaucoma KAP studies Barbados, Guyana, Jamaica & St. Lucia Dr Dawn Grosvenor Consultant Ophthalmologist, & Glaucoma Specialists& Principal Investigator- Barbados Doc. 6: Abstract; page 37 Dr S. Sugrim Consultant Ophthalmologists, & Glaucoma Specialists, Georgetown Public Hospital, Guyana. Doc. 7: Abstract; page 38 Dr Norman Waldron Researcher University of the West Indies, Mona Campus Department of Community Health and Psychiatry Doc. 8: Abstract; page 40 Dr Sandra Jackson Researcher University of the West Indies, Mona Campus Department of Community Health and Psychiatry Doc. 9: Abstract; page 42 Dr Hazel Shillingford-Ricketts Consultant Ophthalmologists & Associate Professor, University Of Ottawa Doc. 10: Session Presentation; page 44 Peter Ackland, CEO of IAPB Video Presentation Facilitated by Arvel Grant

11:00 -11:15

Diagnosing and treating Glaucoma in an ethnically diverse society The Guyana experience

11:15 11:30

Preliminary results of a KAPB study among cataract patients in Kingston Jamaica - Factors influencing uptake of cataract surgery among older patients in Jamaica

11:30 -11:45

Chlamydia as a cause of childhood blindness - a review of specimens at the University Hospital Of The West Indies - Chlamydia trachomatis frequency in patients presenting to Ophthalmology Clinics in Kingston, Jamaica Training Eye Health Theatre Nurses for the Caribbean The Role of the Dominica Health Services

11:45 12:10

12:10 12:30

Advancing Optometry Worldwide An address to the World Council of Optometry Conference, June 2012

12:30 12:45 12:45 1:45

Q&A LUNCH BREAK (Own Account)

NON-COMMUNICABLE DISEASES (NCDs)

1:45 2:00 Non-Communicable Diseases Overview NCDs and Visual Impairment Facilitated by PAHO Office Doc. 11: IAPB Briefing Paper Blindness & the NCDs (2011); page 46

WORKING TOGETHER TO ACHIEVE V2020 GOALS GROUP WORK

2:00 2:10 2:10 4:00 Includes working Coffee Break Group Work Objectives Defining Groups Group Work Group 1: Integrating Eye Health into National Health Plans & Policies Group 1: Facilitator: Dr.Juan Carlos Silva Resource Person: PAHO NCD Expertise Rapporteurs: Emma Bernard & Frank Bowen Doc. 12: Group Work Activity Group 1; page 50 Doc. 12.1: World Bank LAC Factsheet, Jamaica; page 51 Doc. 12.2: World Bank LAC Factsheet, Eastern Caribbean; page 53 Group 2: Identifying practical and costeffective ways to train eye health professionals in / for the region Group 2: Facilitator Charles VanDyke Resource Person: Dr Hazel Shillingford-Ricketts Rapporteurs: Keva Richards & Philip Hand Doc. 13: Group Work Activity Group 2; page 54 4:00 4:30 4:30 4:45 Presentation and discussion of Group Work Video Presentation Facilitated by Philip Hand Kathy Barrett, Communications Officer, CCB-Eye Care Caribbean 4:45 5:00 Closing remarks (end of day 1) Arvel Grant Philip Hand

DAY TWO: Wednesday 12th December, 2012

8.30 am to 5.00 pm

STATUS OF V2020: THE RIGHT TO SIGHT

8:30 8:45 8:45 12:15 Coffee Break to be included at convenient time Call to order and welcome The Status of V2020: The Right to Sight in participating countries Each national delegation is invited to present for up to 15 minutes: 12:15 12:30 12:30 12:45 12:45 1:45 Antigua & Barbuda Barbados Belize Commonwealth of Dominica; Grenada Guyana (The Republic) Haiti (The Republic) Jamaica St. Kitts & Nevis St. Lucia St. Vincent & The Grenadines Suriname (The Republic) Trinidad & Tobago (The Republic) Arvel Grant Facilitated by Dr Juan Carlos Silva Doc. 14: National Data Template; Page 56 Doc. 14.1: Page 62 Doc. 14.2: Page 67 Doc. 14.3: Page 73 Doc. 14.4: Page 78 Doc. 14.5: Page 86 Doc. 14.6: Page 91 Doc. 14.7: Page 96 Doc. 14.8: Page 102 Doc. 14.9: Page 110 Doc. 14.10: Page 115 Doc. 14.11: Page 121 Doc. 14.12: Page 126 Doc. 14.13: Page 131 Keva Richards Arvel Grant

Regional Analysis Q&A

LUNCH BREAK (Own Account)

INCORPORATING PREVENTION OF BLINDNESS PROGRAMMES INTO PRIMARY HEALTH CARE

1:45 3:00 Incorporating Prevention of Blindness programmes into Primary Health Care A plenary discussion with resource input by: Charles Vandyke, Conrad Harris, Florence Mayas & Tony Avril Facilitated by Dr. Martin Christmas, Director of Primary Health Care, Dominica Doc. 15: Perspectives on Primary Eye Care; page 136 Doc. 16: Declaration of Alma-Ata; page 138

3:00 3:30

COFFEE BREAK

FUTURE INITIATIVES
3:30 3:50 Rapid Assessments of Avoidable Blindness (RAAB) Overview of RAAB RAABs in the Caribbean 3:50 4:15 Low Vision Introductory Session Dr Juan Carlos Silva & Philip Hand Doc. 17: Rapid assessment of avoidable blindness survey methodology (ICEH); page 144 Denise Godin, CCB-Eye Care Caribbean Low Vision Focal Person Doc. 18: Introduction to Low Vision; page 147 Doc. 19: When someone has low vision (Community Eye Health Journal 2012) page 153 4:15 4:30 4:30 4:45 4:45 5:00 Video Presentation Ventrilo V2020 Conferencing Closing Remarks (end of Meeting) Kathy Barrett Senator Kerryann Ifill Arvel Grant

LIST OF DELEGATES
No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Country Antigua & Barbuda Antigua & Barbuda Antigua & Barbuda Antigua & Barbuda Antigua & Barbuda Antigua & Barbuda Antigua & Barbuda Barbados Barbados Belize Columbia Columbia Dominica Dominica Dominica Dominica Grenada Grenada Guyana Guyana Guyana Guyana Guyana Guyana Guyana Guyana Name Arvel Grant Carolyn Gopaul Frank Bowen Keva Richards St. Clair Soleyn Nyoka Reynolds Edson Joseph Dawn Grosvenor Senator Kerryann Ifill Leolyn Garcia Luisa Casas Luque Dr. Juan Carlos Silva Dr. H. ShillingfordRicketts Dr. Martin Christmas Nurse Nicole Alleyne Nathalie Murphy Nurse Esther Charles Hermlyn Andrew Michele Ming Dr. Shailendra Sugrim Charles Vandyke Dr. Rameeza McDonald Dr. Shamdeo Persaud Roubinder Rambaran Dr. Emanuel Cummings Pauline Lucas-Cummings Post Chief Executive Officer Operations & Lab Services Manager Resource Mobilisation Manager V2020 Project Manager Statistician PAS Permanent Secretary Glaucoma Specialist President of the Senate (Barbados) Dir. of Programmes & Senior Optometrist Education Officer Regional Advisor in Prevention of Blindness Consultant Ophthalmologist Director of Primary Health Care Ophthalmic Nurse Executive Director Manager Ophthalmic Department Rehabilitation Field Officer President-Elect V2020 Chairman National V2020 Program Manager Consultant Ophthalmologist Chief Medical Officer Manager Dean-Faculty of Health Sciences Programme Officer Organisation Caribbean Council for the Blind Caribbean Council for the Blind Caribbean Council for the Blind Caribbean Council for the Blind Ministry of Health Ministry of Health Ministry of Health Group 1 2 1 2 1 2 1 2 1 1 2 1 2 1 2 1 2 1 2 1 2 2 1 1 2

Ministry of Health Belize Council for the Visually Impaired Brien Holden Vision Institute PAHO/WHO Ministry of Health Ministry of Health Ministry of Health Dominica Association of Persons with Disabilities General Hospital Grenada Society of Friends for the Blind CARIOA/Guyana Optometry Assn Ministry of Health CCB-Eye Care Guyana Linden Hospital Ministry of Health Ministerial Secretariat University of Guyana Delegation of the EU to Guyana, Suriname, Trinidad and Tobago and for the Dutch Overseas Countries and Territories

27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42

Guyana Haiti Haiti Jamaica Jamaica Jamaica Jamaica Jamaica Jamaica St. Kitts & Nevis St. Kitts & Nevis St. Lucia St. Lucia St. Lucia St. Lucia St. Vincent & the Grenadines Trinidad & Tobago Trinidad and Tobago Trinidad & Tobago United Kingdom USA USA

Karen Roberts Florence Mayas Dr. Valery Blot Jeff James Dr. Norman Keith Waldron Dr. Sandra Jackson Conrad Harris Dr. Marlene Smith-Day Nurse Joyce Gooden Sandra Williams Sonia Daley Denise Godin Emma Bernard-Joseph Anthony Avril Nurse Juliette Joseph Dr. Orly James Adams

Focal Point NCDs Project Manager National V2020 Coordinator Director Researcher Researcher V2020 Coordinator Consultant Ophthalmologist Nurse Assistant Nurse Manager Matron Low Vision Focal Person V2020 Coordinator Executive Director Asst. Principal Nursing Officer Senior Registrar
nd

PAHO Office La Socit Hatienne dAide aux Aveugles (SHAA) Comit national de Prvention de la Ccit (CNPC-Haiti) HelpAge Caribbean UWI-Mona Campus UWI-Mona Campus Jamaica Society for the Blind Mandeville Eye Clinic, SRHA Mandeville Eye Clinic, SRHA J. N. Frances General Hospital Ministry of Health St. Lucia Blind Welfare Association St. Lucia Blind Welfare Association St. Lucia Blind Welfare Association Ministry of Health Cato Milton Memorial Hospital

2 2 1 2 1 2 1 2 2 1 2 2 1 1 2 2

43 44

Rudolph Paponette Dr. Akenath Misir

Former 2 Vice President Chief Medical Officer

Trinidad & Tobago Blind Welfare Association Ministry of Health

2 1

45 46 47 48

Earl Henry

Policy Development Specialst

Ministry of Health

1 2

Philip Hand Louis Pizzarello Joan Mcleod

Caribbean Program Manager Chairman of N.A. Region Director M&E, LAC, Sr. Technical Advisor

Sightsavers Internation Agency for the Prevention of Blindness ORBIS

2 1

Preventing blindness & visual impairment; while restoring sight and creating opportunities for persons whose sight cannot be restored. Lower All Saints Road - P.O. Box 1517 - Antigua, West Indies Tel: 1-(268)-462-4111/462-6369/562-2216 Fax: (268)-462-6371 E-mail: arvel.grant@eyecarecaribbean.com; carolyn.gopaul@eyecarecaribbean.com; frank.bowen@eyecarecaribbean.com Website: www.eyecarecaribbean.com

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11

ZERO DRAFT UNIVERSAL ACCESS TO EYE HEALTH: A GLOBAL ACTION PLAN, 2014-2019

Background

ZERO DRAFT UNIVERSAL ACCESS TO EYE HEALTH: A GLOBAL ACTION PLAN, 2014-2019
Juan Carlos Silva

WHO WHA endorsed the Action Plan for the prevention of avoidable blindness and visual impairment 2009-2013
At the 130th session of the WHO Executive Board (2012).
Progress report 2009 - 2013 plan reviewed Develop new action plan for the period 2014 2019.

PROGRESS - Global Level

2004
WHO estimated: 314 million people with visual impairment. Including 45 million blind.

Lessons Learnt 2009-2013

Develop & implement national policies Integrate eye diseases control programs into wider health care delivery systems Engagement with private sector & social entrepreneurship: HR & financial allocations Strengthen partnerships = Effectiveness

2010
WHO estimates: 285 million people were visually impaired, Including 39 million blind.

Lessons Learnt 2009-2013

Eye health included into broader NCDs frameworks Assess the magnitude and causes of blindness and VI & trends Setting national targets & monitoring

Lessons Learnt 2009-2013

Operational research to provide evidence on: appropriate cost-effective strategies improving and preserving eye health in communities

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GLOBAL ACTION PLAN, 2014-2019

Goal To reduce blindness and visual impairment as a global public health problem MEASURABLE Indicators (i) Magnitude of blindness in the world

GLOBAL ACTION PLAN, 2014-2019

PURPOSE
To improve eye health through comprehensive eye care services integrated in health systems

Measurable Indicators
(i) Eye care personnel per million population

(ii) Magnitude of severe and moderate visual impairment in the world

(ii) Cataract Surgical Rate

GLOBAL ACTION PLAN, 2014-2019

Objective 1
Evidence generated and used to advocate for increased political and financial commitment of Member States for eye health.

GLOBAL ACTION PLAN, 2014-2019 Activities Objective 1

Undertake population based surveys
Assess the capacity of Member States to provide comprehensive eye care service delivery and identify gaps in service provision

Measurable Indicators
Number (%) of countries undertook and published prevalence surveys over the last five years in 2018 Number (%) of countries published eye care service assessment over last five years in 2018 Observation of World Sight Day.

Document best practice in eye health programmes and use them to advocate for improving eye health programs

GLOBAL ACTION PLAN, 2014-2019

Objective 2 National policies, plans and programs for eye health integrated into national health systems Measurable Indicators
# (%) of countries with policies and/or plans for eye health.

GLOBAL ACTION PLAN, 2014-2019 Activities Objective 2

Provide leadership and governance Secure financial resources Develop and maintain a sustainable workforce Provide comprehensive eye care services at 1 2 and 3 levels. Technology and medicine Indicators in national information system

# (%) of countries with an eye health committee, and/or a national coordinator # (%) of countries including products for eye care as part of their national list of essential medicines.

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GLOBAL ACTION PLAN, 2014-2019

Objective 3 Measurable Indicators

GLOBAL ACTION PLAN, 2014-2019 Activities Objective 3

Engage non-health sectors PBL policies and plans. Enhance effective international and national partnerships and alliances. Integrate eye health into poverty reduction strategies, initiatives and socioeconomic policies.

Multi-sectoral engagement and effective partnerships for improved eye health strengthened.

Number (%) countries that refer to a multi-sectoral approach in their national eye health plans and policies Number (%) of countries having eye health incorporated into poverty reduction & wider socioeconomics policies

Thank you

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STRATEGIC FRAMEWORK FOR VISION 2020: THE RIGHT TO SIGHT CARIBBEAN REGION

PAN AMERICAN HEALTH ORGANIZATION WORLD HEALTH ORGANIZATION VISION 2020 Barbados 2010

STRATEGIC FRAMEWORK FOR VISION 2020: THE RIGHT TO SIGHT CARIBBEAN REGION

PAN AMERICAN HEALTH ORGANIZATION WORLD HEALTH ORGANIZATION VISION 2020

Barbados 2010

CONTENTS

ACKNOWLEDGEMENT ACRONYMS INTRODUCTION 1. DISEASE CONTROL AND PREVENTION OF VISUAL IMPAIRMENT 4 1.1 REDUCE BLINDNESS AND VISUAL IMPAIRMENT IN ADULTS 1.1.1 Reduce cataract blindness 4 1.1.2 Reduce blindness from diabetic retinopathy..5 1.1.3 Reduce blindness due to open-angle glaucoma (OAG)7 1.1.4 Reduce visual disability due to uncorrected refractive errors in adults. 7

1.2 REDUCE BLINDNESS AND VISUAL IMPAIRMENT IN CHILDREN 1.2.1 Reduction of the preventable & of treatable causes of childhood blindness. 8 1.2.2 Reduce visual disability by detecting and treating uncorrected refractive errors in school children9 1.3 REDUCE THE BURDEN OF BLINDNESS AND VISUAL IMPAIRMENT IN THE GENERAL POPULATION 1.3.1 Enhance vision related quality of life for people with functional low vision..10 1.3.2. Inclusive services..11 2. EYE CARE SYSTEMS 2.1 CENTRAL ORGANIZATION, LEADERSHIP AND GOVERNANCE13 2.2 EYE CARE WORKFORCE.13 2.3 MEDICAL PRODUCTS AND TECHNOLOGY.14 2.4 EYE CARE INFORMATION SYSTEMS AND MONITORING ..14 3. EYE CARE PROMOTION, PUBLIC EDUCATION & ADVOCACY 3.1. ADVOCACY 15 3.2. PUBLIC AWARENESS AND EDUCATION .15

BIBLIOGRAPHY ANNEX 1

xvii

ACRONYMS
CBM Christoffel Blinden Mission CCB Caribbean Council for the Blind IAPB International Agency for the Prevention of Blindness ICEE International Centre for Eye Care Education ICEVI International Council for Education of People with Visual INGO International Non Governmental Organizations MoH Ministry of Health MoE Ministry of Education NGDO Non-governmental Development Organization OAG Open Angle Glaucoma OSWI Ophthalmological Society of the West Indies PAAO Pan American Association of Ophthalmology PAHO Pan American Health Organization PBL Prevention of Blindness PEC Primary Eye Care PHC Primary Health Care ROP Retinopathy of Prematurity UNCRPD United Nations Convention on the Rights of Persons with Disabilities WBU World Blind Union WHO World Health Organization

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ACKNOWLEDGEMENT
The valuable financial support provided by CCB, Sightsavers, CBM and the Pan American Health Organization, Regional Office of the World Health Organization, which made possible the services assessment, this meeting and document is gratefully acknowledged. The organizations participating in the consultation consisted on the Ministry of Health of Dominica, Ministry of Health of Grenada, Ministry of Health Guyana, Ministry of Health of Jamaica, Ministry of Health of St Vincent, Eye Care Guyana, Caribbean Optometrists Association, Socit Hatienne DAide aux Aveugles (SHAA), National Prevention of Blindness Committee of Haiti, Jamaica Society for the Blind, St Lucia Blind Welfare Association, CCBEye Care Caribbean, Sightsavers, CBM, ORBIS International, Help Age International, International Agency for the Prevention of Blindness-IAPB, Operation Eyesight, International Center for Eye Care Education and the Pan American Health Organization-PAHO-WHO. The meeting participants consisted on Hazel Shillingford-Ricketts, Joan McLeod-Omawale, Dave Duncan, Julian McKoy-Davis, Lucine Edwards, Narine Singh, Charles Vandyke, Ava-Gay Timberlake, Peter Ackland, Pat Ferguson, Nelson Rivera, Jillia Bird, Nigel St Rose, Conrad Harris, Anthony Avril, Philip Hand, Arvel Grant, Frank Bowen, Keva Richards, Kathy Barrett, Gavin Henry, Rachelle Noelsaint, Reginald Paul, Martin Ruppenthal, Juan Carlos Silva.

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INTRODUCTION
Blindness and low vision are a public health problem throughout the world, this is why the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB) together with NGOs have launched VISION 2020 - the global initiative for the elimination of avoidable blindness. This initiative that brings together governments, WHO, international and national NGOs, as well as associations of professionals in eye care, aims to determine global, regional and national plans of action in prevention of avoidable blindness and inclusive services. In the Caribbean VISION 2020 was officially launched in Trinidad-Tobago in April 2000. The World Health Organizations Fifty-Sixth World Health Assembly approved Resolution WHA56.26, which requested the Director to strengthen WHOs collaboration with Member States on the Global Initiative for the Elimination of Avoidable Blindness. In Resolution WHA59.25, the Fifty-Ninth World Health Assembly reaffirmed its commitment to give priority to the prevention of blindness. The 144th Session of the Pan American Health Organization - PAHO Executive Committee recommended that the Directing Council adopt a resolution as a way to bolster regional and national efforts to reach the objectives of the Plan of Action for the Prevention of Avoidable Blindness and Visual Impairment. In September 2009 the 49th PAHO Directing Council - WHO 61st Session of the Regional Committee approved the prevention of blindness plan of action and passed the resolution (Annex 1). In the year 2002 a VISION 2020 strategic plan was developed for the Caribbean region through a series of in-house discussions in PAHO, as well as through meetings with member states, the IAPB, national and international nongovernmental organizations and scientific societies. In the Caribbean, PAHO, implement the VISION 2020 initiative in alliance with the IAPB, Sightsavers, Caribbean Council for the Blind-CCB, CBM, ORBIS and the ICEE. Significant progress has been achieved in the Caribbean in the prevention of avoidable blindness, and access to eye care services has been increasing in most countries working in this initiative. On December 1st 2009 PAHO, CCB, Sightsavers, CBM, ORBIS and all Caribbean Vision 2020 partners organized a meeting in Barbados to review and update the Vision 2020 Caribbean Plan that was produced in the year 2002. This new strategic framework for VISION 2020 in the Caribbean Region was prepared utilizing a very participatory methodology that included consultation with several Ministries of Health of the English speaking countries, national and international partners and incorporated the strategies of the Plan of Action on the Prevention of Avoidable Blindness and Visual Impairment approved by the PAHO 49th DIRECTING COUNCIL in 2009. This strategic framework serves as a guideline to support countries and stakeholders in priority setting and objectives development, it does not pretend to be a norm and each country may adapt it to its own realities, priorities and resources. Each priority established by a country should utilize a primary health care approach and have a referral system available for quality care for every condition.

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1.

DISEASE CONTROL AND PREVENTION OF VISUAL IMPAIRMENT

The most prevalent causes of blindness in the Caribbean are non-operated cataract and glaucoma, followed by diabetic retinopathy and uncorrected refractive errors. Childhood blindness is not as prevalent, but is a main cause of blinding years in the population. An important percentage of blindness in the Caribbean region is avoidable (preventable or curable). Cataract and diabetic retinopathy can be cured with relatively inexpensive surgical treatments; refractive errors are correctable with simple optical devices; and preventive strategies and effective referral systems can reduce the burden of childhood blindness. The application of new technology can be used in future to improve the detection and treatment of glaucoma.

1.1 REDUCE BLINDNESS AND VISUAL IMPAIRMENT IN ADULTS

1.1.1 Reduce Cataract blindness In Latin America and the Caribbean, cataract (opacification of the lens) is the most prevalent cause of blindness; cataract surgery has been shown to be one of the most cost-effective of all health care interventions. Most cataracts are age-related and cannot be prevented, but cataract surgery with insertion of an intraocular lens (IOL) is highly effective, providing almost immediate visual rehabilitation. Magnitude of Problem The results of the Barbados Eye Study show that 12% of people 40-84 years old have visual impairment or visual acuity worse than 6/12 (normal value 6/6). Three percent (3%) have severe visual impairment worse than 6/60 and most have cataract or lens opacities, thus demonstrating that most visual impairment in this population is associated with lens opacities. Issues Inadequate public awareness of cataract and how it can be rectified with a straightforward surgical procedure, leading to low demand for services. Numerous barriers between needs and services, including poor availability and accessibility and high costs. Evidence of good vision outcomes lacking after surgery. Insufficient information on outputs and outcomes in public sector, private sector and bilateral cooperation initiatives.

Expected Outcome Provide cataract surgical services at a rate adequate to eliminate the backlog of cataract, at a price that is affordable for all people, both rural and urban and with high success rate in terms of visual outcome.

Proposed actions for Member States Make national assessments of cataract surgical services, including availability, access, affordability and quality, as well as collection and management of information and data. Measure prevalence of cataract blindness, determine services coverage level and identify barriers to access in selected countries. Develop country and district-specific cataract service plans with measurable targets that address equity (availability, accessibility, affordability) and quality of services. Ensure eye health services are integrated into a primary health care system to detect and refer people with eye diseases. Develop a human resources development plan for cataract surgical services. Promote high-quality surgery and ensure satisfactory visual outcomes and patient satisfaction. Develop appropriate communication strategies for the target population- viz. adults 50 years and older.

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Proposed actions for organizations supporting VISION 2020 activities Provide technical cooperation for the design of Rapid Assessment of Avoidable Blindness (RAAB) and similar studies. Develop a situation analysis of cataract surgical services at regional and national levels. Advocate and provide technical cooperation for development and implementation of national cataract plans. Mobilize resources with regional and international partners. Indicators Reach a cataract surgical rate (CSR) of 2,000 per 1 million population per year in the majority of countries by the year 2014. (See Table 2 below)

4 countries utilizing a cataract outcomes monitoring tool/system in 2014.

Table 2. Caribbean Cataract Surgical Rate, Year 2009 Country Population Thousands Antigua Bahamas Barbados Belize Dominica Grenada Guyana Haiti Jamaica St Lucia St Vincent Trinidad 88 342 256 307 67 104 762 10,033 2719 172 109 1339

CSR year 2010

Target 2014

1345 2500 2001 1648 1746 1062 1700 440 1000 843 1066 2600

1800 3000 2500 2000 2000 1500 2000 1000 1500 1500 1500 3000

1.1.2 Reduce the prevalence of blindness from diabetic retinopathy Diabetes causes weakening of the blood vessels in the body. Retinal blood vessels are particularly susceptible and weakening of these blood vessels, accompanied by structural changes in the retina, is termed as diabetic retinopathy. Diabetic retinopathy is symptomless in its early stage and eye examinations/screening is the only way to identify affected people to prevent them from going blind. Evidence-based treatment is available to significantly reduce the risks of blindness and of moderate vision loss. Clinical studies spanning more than 30 years have shown that appropriate treatment with laser can reduce the risks by more than 90%. Magnitude of the problem The prevalence of diabetes among adults in Latin America and the Caribbean varies from country to country. More than 75% of patients who have had diabetes mellitus for more than 20 years will have some form of diabetic retinopathy. After 15 years of diabetes, approximately 2% of people become blind, and about 10% develop severe visual impairment. In Barbados, 18% of persons of African descent between the ages of 40 and 84, report having a history of diabetes mellitus; among people with diabetes 30% has diabetic retinopathy 8.6% of diabetics have clinically significant macular edema and 1% has proliferative diabetic retinopathy needing laser treatment.

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Issues Inadequate medical management and control of diabetes. Inadequate development of detection and referral systems. Insufficient public awareness relating to cause and prevention of blindness due to diabetes. Insufficient awareness and knowledge of PHC practitioners, general physicians and internists regarding their role in the prevention of blindness due to diabetes. Limited number of ophthalmologists with training in diagnosis and treatment of diabetic retinopathy. Inadequate technological infrastructure in the health services. Poor resourcing and low capacity of national diabetes associations.

Expected Outcome Countries implementing early detection, referral and treatment for diabetic retinopathy

Proposed actions for Member States Integrate blindness prevention strategies into national diabetes programs and ensure their incorporation into non communicable chronic diseases programs of the Ministries of Health. Encourage strategies for prevention, early detection and effective treatment of diabetes and hypertension, which will prevent complications that lead to blindness. Develop public awareness programs to target groups that are at high risk. Establish referral systems from services for diabetics to the ophthalmologic services. Establish screening services using digital photography to detect and refer treatable diabetic retinopathy. Ensure laser treatment services for diabetic retinopathy are available, accessible and affordable. Proposed actions for organizations supporting VISION 2020 activities Perform a situation analysis of the management of diabetic retinopathy in the Region as a baseline for planning and advocacy. Conduct national assessments of services for diabetic retinopathy in selected countries. Develop education packages and training programs for the general public and health care providers. Develop continuing medical education programs for ophthalmologists and optometrists. Support countries in the development of screening programs and laser services for Diabetic Retinopathy. Establish regional protocols and management guidelines Establish an inter-country referral system for treatment according to an established protocol. Diabetes Associations playing a lead role in awareness raising and prevention of blindness due to diabetes.

Indicators Situation analysis conducted in five selected countries by the year 2014. At least three of the selected countries integrate early detection and treatment programs for diabetic retinopathy into non-communicable chronic diseases programs by the year 2014. Increase the number of countries with digital photograph screening and laser treatment programs from 1 to 4 by the year 2014.

1.1.3 Reduce the incidence of blindness due to open-angle glaucoma (OAG) in high-risk groups OAG is a major public health problem in the Afro-Caribbean population, where it is a major cause of visual loss and the leading cause of irreversible blindness. Vision 2020 programs need to include mechanisms for glaucoma detection and treatment for high-risk segments of the population, including persons of African descent in the Caribbean population, persons over 40 years of age, and individuals with a family history of glaucoma. Magnitude of the problem Open Angle Glaucoma prevalence in Afro-Caribbean people over 40 years of age is over 7% and increases with age. In the Barbados Eye Study, OAG affected 1 in 11 Afro-Caribbeans older than 50 years of age, reaching a prevalence

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of 1 in 6 in those over 70 years. About 2% of individuals over 40 years are blind and, of that percentage, one-third are blind due to OAG. Issues High disease frequency. Very limited availability of sensitive and specific screening methods at reasonable cost. Silent nature of the disease. Late detection and poor compliance. High cost of medication. Lack of public awareness about need for people over 40 years of age to get eyes checked for glaucoma. Expected Outcome Strengthen national programs for detection and treatment of glaucoma in segments of the population with risk factors as outlined in national eye care plans. Proposed actions for Member States Include glaucoma detection as an integral part of comprehensive eye examinations for persons over 40 years of age. Ensure that eye care units are have the capacity (equipment & HR) to provide glaucoma diagnosis and treatment. Increase awareness among the general population of the importance of regular eye examinations and glaucoma screening for those over age 40, as well of other risk factors for glaucoma. Provide affordable treatments and medications. Proposed actions for organizations supporting VISION 2020 activities Utilize available epidemiologic information to promote early detection and treatment in countries in highrisk groups. Utilize best practices to promote and design public awareness programs and interventions. Mobilize technical and financial resources to strengthen national eye care services in glaucoma detection and treatment Train professionals to implement existing evidence-based protocols. Indicators Increasing from 3 to 6 the number of countries carrying out glaucoma community awareness programs by the year 2014. A regional procurement and distribution system for affordable glaucoma medications Number of countries including glaucoma eye medications in subsidized drug list and encouraging practitioners to use it

1.1.4. Reduce visual disability by detecting and treating uncorrected refractive errors in adults The Barbados Eye Studies found high prevalence of myopia and hyperopia in adults. Most adults over 50 years of age suffer presbyopia. Proposed actions for Member States Include refraction in a comprehensive eye examination to identify spectacles requirements in adults. Increase public awareness through information, education, and communication strategies. Proposed actions for organizations supporting VISION 2020 activities Promote and support screening and refractive errors correction in adults, including presbyopia.

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1.2. REDUCE BLINDNESS AND VISUAL IMPAIRMENT IN CHILDREN 1.2.1 Reduction of the preventable causes and of treatable causes of childhood blindness. Magnitude of the problem As the causes of Blindness in children differ from those in adults, different control measures are needed; childrens eye problems need timely attention or they may become irreversibly blind; specific expertise and equipment are required. While data is limited, the following causes of childhood blindness has being reported in the Caribbean Region: Retinopathy of Prematurity (ROP) , cataract and glaucoma in children have been reported in some countries, corneal scarring (the drying out and scarring of the outer eye because of vitamin A deficiency) is not common and has been reported in a few countries. However, visual impairment from trauma is commonly reported in Jamaica, especially among boys. Issues Insufficient data about the causes or magnitude of childhood blindness and visual impairment in the Caribbean. Lack of policies that support inclusion of an eye care component in Maternal & Child Health programs. Insufficient awareness and knowledge among pediatricians, obstetricians, general physicians and health personnel about their role in prevention of childrens visual impairment and blindness. Insufficient involvement of general ophthalmologists in prevention of childhood blindness programs. Expected Outcome Provide services to detect and treat children with Retinopathy of Prematurity, congenital cataract, congenital glaucoma and corneal ulcer or scarring, and other non-blinding eye problems, such as strabismus, trauma, Proposed actions for Member States Integrate childhood blindness prevention with early diagnosis, evaluation and treatment into all national maternal and child health plans and policies. Assess the main causes of blindness and visual impairment in children in the Caribbean as a base for future planning. Promote detection of eye diseases and eye problems as part of the national policies in maternal and child health. Provide ocular prophylaxis of newborns to prevent neonatal conjunctivitis through utilization of Povidone Iodine. Reduce blindness in premature babies due to retinopathy of prematurity Prevention of blindness due to ROP is planned on three levels: a) Primary prevention: reduce the incidence of ROP through improved prenatal and neonatal care. b) Secondary prevention: early identification of severe cases of ROP in premature babies in neonatal care through regular examination of those deemed to be high-risk by skilled ophthalmologists and timely treatment with laser or cryotherapy of severe ROP c) Tertiary prevention: restore useful vision in children with retinal complications through vitreoretinal surgery and/or offer rehabilitation. Promote systems, networks and protocols for safe neonatal care, adequate referral, and follow-up. Elaborate and promote national guidelines and minimum acceptable standards. Ensure the availability of the necessary equipment for primary prevention, examination and treatment. Improve the quality of available information on neonatal care. Proposed actions for organizations supporting VISION 2020 activities Collect and analyze information on causes of childhood blindness in school children who are blind utilizing the appropriate documentation. Conduct national assessments of needs and resources for ROP programs. Organize regional and national workshops to increase awareness. Organize regional and national training programs for professionals (obstetricians, pediatricians, nurses, and ophthalmologists). Promote the utilization of regional guidelines on neonatal care and ROP programs.

25

Support countries in the development of ROP services Organize a referral pediatric ophthalmology center

Indicators Documentation on causes of childhood blindness in school children who are blind in the Caribbean. Increase the number of countries that have a national ROP prevention policy from 1 to 4 by the year 2014. Number of countries that are implementing an eye care component in maternal and child care programs. Number of countries with capacity (pediatric oriented ophthalmologists and equipment) in tertiary facility to perform pediatric cataract, ROP examinations and treatment, and other blinding and non-blinding childrens eye conditions.

1.2.2 Reduce visual disability by detecting and treating uncorrected refractive errors in school children

Magnitude of the problem According to epidemiologic studies in Latin America PAHO-WHO estimates that about 7% of school children may require spectacles for correction of refractive errors. The steps in the provision of refraction services are as follows: (a) Screening: identification of individuals with poor vision which can be improved by correction. (b) Eye examination: to evaluate the condition of the eye and identify coexisting pathologies requiring care. (c) Refraction: determine what correction is required. (d) Dispensing: provide and supply appropriate corrective eyeglasses. (e) Follow-up: ensure compliance with prescription, care of the eyeglasses, repair or substitution of spectacles, if needed. Issues No data available on need for spectacles in school children. No data available on best practices on refractive errors programs in schools children. Different priorities and criteria in eye care programs for school children in the different countries. Lack of policies that include an eye care component in school health programs. Small number of ophthalmologic and optometry services that diagnose refractive errors in school children of low socio-economic status. Spectacles often too expensive for the majority of patients. Inadequate collaboration between health and education stakeholders. Lack of parents awareness and commitment to comply. Expected Outcome Prevention of visual impairment and blindness due to uncorrected refractive errors in school children by integrating eye health into policies and practice in health and education sectors. Proposed actions for Member States Develop national guidelines for the detection and treatment of refractive errors, taking into account national realities. Establish screening during the first school level and during the sixth grade. Develop and follow pilot refractive error programs to identify and disseminate best practices. Promote refractive error services and provision of spectacles in the public sector for school children, adults and any person in need Increase availability and affordability of eyeglasses and facilitate their production through the establishment of low-cost laboratories. Increase public awareness through information, education, and communication strategies.

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Proposed actions for organizations supporting VISION 2020 activities Promote the utilization of the regional guide in refractive errors programs. Standardize technology: screening kit and affordable instruments. Develop advocacy plan for health and educational authorities. Promote a study in refractive error correction needs for school children. Support development of low cost spectacle production and distribution systems. Indicators Increase the number of countries implementing a national standard refractive errors program as part of national eye care policies and plans from 2 to 7 by the year 2014. Increase in the spectacle labs producing affordable, quality spectacles

1.3. REDUCE THE IMPACT OF BLINDNESS AND VISUAL IMPAIRMENT IN THE GENERAL POPULATION 1.3.1 Enhance vision related quality of life for people with functional low vision. Low-vision services are aimed at people who have residual vision that can be used and enhanced by specific aids. Low vision is currently defined as visual acuity of < 6/18 down to and including 3/60 in the better eye, from all causes. Magnitude of the problem It is estimated that for every thousand people, 17 has low vision, of those about 6 could benefit from low vision interventions. Expected outcome Provide comprehensive low-vision services for persons who are blind or severely visually impaired integrating clinical eye care, rehabilitation and educational services in each country. Issues Inadequate government policy for visual rehabilitation. Limited public and eye care professionals awareness of low vision. Insufficient professional services and technical expertise in this specialty. Insufficient affordable optical devices for assessment and prescription. Insufficient rehabilitation and educational services for people with low vision. Insufficient adapted teaching materials and technologies for students with low vision. Proposed actions for Member States Develop national policies on comprehensive low-vision care. Establish low-vision services at the national level in public facilities. Promote early identification of all children and adults who are irrevocably blind severely visually impaired and ensure that an effective referral system is in place. Establish units that can provide comprehensive low vision services, utilizing technicians in optometry to perform low vision examinations, assess and counsel patients, prescribe optical devices and provide instruction in device use. Promote low vision services for children as early as possible through an integrated system of clinical and pedagogic services. Proposed actions for organizations supporting VISION 2020 activities Organize low-vision courses at regional and national congresses of ophthalmology. Promote the establishment of resource centers for the training of trainers, curricula standardization, and technology development.

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Support the organization of low-vision centers in underserved countries currently without such services. Develop a system to make low-vision aids affordable. Advocate for national inter-sectoral policies and plans for inclusive education and for rehabilitation programs for persons who are blind Train low-vision teams (eye care, low-vision therapy, rehabilitation, education, and social services). Create regional or national funding bases for the purchase of devices Develop specific continuing education programs in low vision care for existing/available personnel.

Indicator Increase the number of countries with low-vision services from 3 to 6 by the year 2014.

1.3.2. Inclusive services Children who are blind should have access to inclusive education and supportive services; adults who are blind require rehabilitation (adjustment to blindness) programs to strengthen their emotional and social capabilities; as well as training in daily living skills, orientation mobility skills, and vocational training. Insofar as it is feasible, inclusive education and adjustment to blindness services should be supported by access to adaptive aids, including devices for reading and writing; white canes; adapted domestic aids; and low-vision appliances and technologies. Issues Inadequate government policy for visual rehabilitation. Insufficient rehabilitation and educational services for people with low vision and blindness. Insufficient adapted teaching materials and technologies. Expected outcome Education and Rehabilitation services available for persons with blindness or visual disability. Proposed actions for Member States Legislation and policies approved/enacted that support implementation of the UN Convention on the Rights of Persons with Disabilities UNCRPD (Signed in 2009) National Disability Plan is approved and implemented by the Government (MoE and MoH) Ensuring availability and accessibility of inclusive services (Rehabilitation, education and social services) Education and social services department is strengthened to provide expanded service delivery for children and adults who are blind. MoE provides sufficient support to meet the educational needs of blind and VI students. Proposed actions for organizations supporting VISION 2020 activities Advocate for inclusive services in every country. Coordinate efforts among NGOs to resource social and education services. Make available affordable technical equipment and special supplies for blind and visually impaired. Conduct a region wide situation assessment on rehabilitation and education services for persons who are blind.

Indicator Number of countries that are implementing national plans for inclusive education and adjustment to blindness by 2014.

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2. EYE CARE SYSTEMS

2.1 Central Organization, Leadership and Governance Expected outcome: Provide leadership and governance that ensures an effective and equitable eye care system. Involves ensuring strategic policy combined with coalition building, the provision of appropriate regulations, incentives and accountability. Regional and National Strategy Ensure national strategic policy framework. Encourage National Committee and a Focal Person for the Prevention of Blindness that will assist the ministry of health, education and other national authorities and organizations in the development of regulations and plans and the implementation and monitoring of programs. Support the implementation of the plan. Keep updated information on VISION 2020 implementation at all levels. Promote networking and capacity building. 2.2 Eye Care Workforce Issues Insufficient ophthalmology and optometry training programs in the region, resulting in an inadequate number of qualified professionals in ophthalmology, optometry and allied health personnel. In the Caribbean the surgical productivity per ophthalmologist is low, in part because several clinical ophthalmologists do not perform surgery. Others work in private practice and limit their services to patients who can afford their fees. In many countries primary eye care is not yet implemented. Expected outcome: Have a well-performing health workforce fair and efficient to achieve the best eye care outcomes possible given available resources and circumstances. There are sufficient numbers and mix of staff, fairly distributed; they are competent and productive. Regional and National Strategy Organize new ophthalmology and optometry training programs in the Region and strengthen those that exist. Expand numbers of mid level personnel such as refractionists, ophthalmic assistants and low vision technicians in the delivery of eye care in the Caribbean. Identify and or train sub-specialists in pediatric ophthalmology and retinal services including the necessary referral system for the established referral services. Train primary health care (PHC) workers in primary eye care at the national level. Establish the productivity norms for key resources (for example cataract surgeries per ophthalmologist per year). Develop continuing educational programs. Develop manpower for equipment maintenance repair, low cost spectacle production and eye drops preparation. Indicators Number of countries reaching the minimum ratio set of one active ophthalmic surgeon per 50,000 populations. Number of countries reaching the minimum ratio set of one active optometrist per 50,000 populations. Number of countries reaching the minimum ratio set of one active ophthalmic nurse per 50,000 populations Number of countries having an active PEC service integrated to the PHC service. Number of countries with network of maintenance technicians available covering all hospitals in country by 2014. Increase the number of countries having spectacles lab technicians from 3 to 6.

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2.3. Medical Products and Technologies Issues Limited availability of affordable consumables. Limited production of spectacles and medications. Underutilization of equipment due to lack of skills. Limited government understanding of eye care equipment management. Expected outcome: To ensure an optimal supply of appropriate, high-quality, affordable equipment, instruments, consumables essential for the delivery of eye care services. Regional and national Strategy Promote the utilization of small incision cataract surgery. Produce and/or distribute affordable consumables. Provide practitioners, ministries of health, hospitals and clinics with information on good quality and affordable appropriate technology. Ensure availability of spectacles, ophthalmic supplies and equipment at costs appropriate to local economies. Provide training to support staff in maintaining and repairing ophthalmic equipment. 2.4. Eye Care Information Systems and Monitoring Issues Insufficient data on outputs and outcomes of services to support planning, monitoring, advocacy and reporting. Expected outcomes: Include eye care in the national planning, health and education information system. Periodic information available on the situation and trends on eye care delivery in the Caribbean. Regional and national Strategy Identify mechanisms to include eye care in the present Health Management Information system. Develop data management systems for eye care: data collection, compilation, reporting and analysis Define how analysis and distribution of information will be carried out. Define procedures for annual, mid-term and final review of the strategy implementation. Identify feedback mechanisms for various levels of staff.

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3. EYE CARE PROMOTION, PUBLIC EDUCATION & ADVOCACY

About 80% of blindness is avoidable: it either results from conditions that could have been prevented or conditions that may have being successfully treated to restore sight. It is necessary that high risks groups have adequate information to ensure they look for services to detect and treat eye problems and that they increase compliance on follow-up and treatments. The aim of eye care promotion and public education is to improve knowledge, attitudes, motivation and action for high risk groups and health authorities. The promotion of eye health as part of the national health policy is, invariably, a necessary prerequisite for a National Program for the Prevention of Blindness. This fosters public awareness, leads to societal responsiveness and participation and facilitates co-ordination of activities carried out by various partners, such as nongovernmental organizations, the private sector and the government itself. 3.1. Advocacy Expected Outcomes Increased political commitment in all countries to include eye health in the national health plans. Increased commitment of professional societies to regional and national eye care programs. Regional and National Strategy Ministries of Health are acquainted with the PAHO and WHO resolutions in prevention of blindness. Strengthen national data-gathering capabilities, to facilitate regional collection of epidemiological and service delivery information and allow disaggregation of data by gender and age. Establish and keep current a register of all known persons with visual disability. Promote epidemiological and service delivery assessments. Participate in ophthalmic regional professional societies meeting. Promote eye care professionals gathering regionally and sub-regionally for continuing medical education and eye care planning. Promote V2020 / Prevention of Blindness Committees gathering regionally for cross learning, skill sharing and collaboration. Publish papers in regional scientific journals. Advocate for the inclusion of critical eye care in the national health information systems. Observe the second Thursday of October every year as World Sight Day. Celebrate any day to promote specific topics. Indicators Number of countries celebrating the World Sight Day and related days each year. Increase the number of countries implementing a national vision 2020 plan from 6 to 10 by 2014. Number of countries including eye health services in the national health plan from 4 to 8 by 2014. 3.2 Public awareness and education Expected outcome: Increased public knowledge and utilization of eye care services. Regional and National Strategy Assess the baseline data in knowledge, beliefs, attitudes and actions of the population in regard to eye care. Develop a communication program including printed and audio-visual materials. Utilise general health and eye health professionals to create public awareness. Indicators Increase the number of countries implementing an eye care public awareness program. Increase the number of people using eye care services by 30% over 5 years

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BIBLIOGRAPHY
1. 2. 3. World Health Organization. Vision 2020 The Right to Sight: Global Initiative for the elimination of avoidable blindness; Action Plan 2006-2011. Geneva, Switzerland: 2007. Pan American Health Organization. Forty-ninth Directing Council, 61st Session of the Regional Committee. Washington DC, PAHO, 2009 (Resolution CD49/19). Pan American Health Organization. Health in the Americas. Health conditions and Trends. Ocular Health. Regional Volume. PAHO: Washington DC;2007:141-142. Available at: http://www.paho.org/HIA/homeing.html. Accessed: February 17, 2010. Vision 2020. Latin American Region. Available at: http://www.vision2020.org/main.cfm?Type=WEFLA&objectid=2812. Accessed January 13. 2010. Foster A, Resnikoff S. The impact of Vision 2020 on global blindness. Eye 2005; 19:1133-1135. Gilbert C, Foster A. Childhood blindness in the context of VISION 2020the right to sight. Bull World Health Org 2001;79:227-232. Yorston D. The global initiative Vision 2020: The right to sight childhood blindness. Community Eye Health 1999;12:44-45. Limburg H, Barria F, Gomez P, Silva JC, Foster A. Review of recent surveys on Blindness and Visual impairment in Latin America. Br J.Ophthalmol 2008;92;315-319. Pongo guila LP, Carrin R, Luna W, Silva JC, Limburg H. Ceguera por catarata en personas mayores de 50 aos en una zona semirrural del norte del Per. Pan Am J Public Health 2005,17:387-393. Beltranena F, Casasola K, Silva JC, Limburg H. Cataract blindness in four regions in Guatemalaresults of a population-based survey. Ophthalmology 2007;114:1558-1563. Nano ME, Nano HD, Mugica JM, Silva JC, Montana G, Limburg H. Rapid assessment of visual impairment due to cataract and cataract surgical services in urban Argentina. Ophthalmic Epidemiol 2006;13:191-197. Eduardo Leite Arieta C, Nicolini Delgado AM, Jos NK, Temporini ER, Alves MR, de Carvalho Moreira Filho D. Refractive errors and cataract as causes of visual impairment in Brazil. Ophthalmic Epidemiol 2003;10:1522. Hernndez Silva JR, Ro M, Padilla C. Resultados del RACSS en ciudad de la Habana, Cuba, 2005. Rev Cubana Oftalmol 2006:19:1-9. Duerksen R, Lansingh V. Vision 2020 in Latin America. Cataract Refract Surg Today. May 2007. 64-67. Silva JC, Bateman JB, Contreras F. Eye disease and care in Latin America and the Caribbean. Survey Ophthalmol 2002;47:267-274. Limburg H, Silva JC, Foster A. Cataract in Latin America: findings from nine recent surveys. Rev Panam Salud Publica 2009;25:449-455. Duerksen R, Limburg H, Carron JE, Foster A. Cataract blindness in Paraguayresults of a national survey. Ophthalmic Epidemiol 2003;10:349-357. Lansingh VC, Resnikoff S, Tingley-Kelley K, Nano ME, Martens M, Silva JC, Duerksen R, Carter MJ. Cataract surgery rates in latin america: a four-year longitudinal study of 19 countries Ophthalmic Epidemiol. 2010 Mar;17(2):75-81. Chiriboga F. Yaruqui-Ecuador: An ongoing district VISION 2020 programme. Community Eye Health 2005;18:96. Maul E, Barroso S, Munoz SR, Sperduto RD, Ellwein LB. Refractive error study in children: results from La Florida, Chile: Am J Ophthalmol 2000;129:445-454. Sauerbrey M. The Onchocerciasis Elimination Program for the Americas (OEPA). Ann Trop Med Parasitol 2008;102:1:25-29. Arieta CE, de Oliveira DF, Lupinacci AP, Novaes P, Paccola M, Jose NK, Limburg H. Cataract remains an important cause of blindness in Campinas, Brazil. Ophthalmic Epidemiol 2009;16:58-63. Salomao S, Mitsuhiro M, Belfort R. Visual impairment and blindness: an overview of prevalence and causes in Brazil. An Acad Bras Cienc 2009;81:539-549.

4. 5. 6. 7. 8. 9. 10. 11. 12.

13. 14. 15. 16. 17. 18.

19. 20. 21. 22. 23.

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Annex 1
PAN AMERICAN HEALTH ORGANIZATION WORLD HEALTH ORGANIZATION

49th DIRECTING COUNCIL

61st SESSION OF THE REGIONAL COMMITTEE Washington, D.C., USA, 28 September-2 October 2009

CD49/19 (Eng.) Annex B ORIGINAL: ENGLISH

PROPOSED RESOLUTION PLAN OF ACTION ON THE PREVENTION OF AVOIDABLE BLINDNESS AND VISUAL IMPAIRMENT

THE 49th DIRECTING COUNCIL, Having reviewed Document CD49/19 Plan of Action on the Prevention of Avoidable Blindness and Visual Impairment; Recalling Resolution WHA56.26 of the World Health Assembly on the elimination of avoidable blindness; Noting that visual disability is a prevalent problem in the Region and is related to poverty and social marginalization; Aware that most of the causes of blindness are avoidable and that treatments available are among the most successful and cost-effective of all health interventions; Acknowledging that preventing blindness and visual impairment relieves poverty and improves opportunities for education and employment; and Appreciating the efforts made by Member States in recent years to prevent avoidable blindness, but mindful of the need for further action,

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RESOLVES: 1. To approve the Plan of Action on the Prevention of Avoidable Blindness and Visual Impairment. To urge Member States to: establish national coordinating committees to help develop and implement national blindness prevention plans; include prevention of avoidable blindness and visual impairment in national development plans and goals; advance the integration of prevention of blindness and visual impairment in existing plans and programs for primary health care at the national level, ensuring their sensitivity to gender and ethnicity; support the mobilization of resources for eliminating avoidable blindness; encourage partnerships between the public sector, nongovernmental organizations, private sector, civil society, and communities in programs and activities that promote the prevention of blindness; and encourage intercountry cooperation in the areas of blindness and visual impairment prevention and care. To request the Director to: support the implementation of the Plan of Action on the Prevention of Avoidable Blindness and Visual Impairment; maintain and strengthen PAHO Secretariats collaboration with Member States on the prevention of blindness; and promote technical cooperation among countries and the development of strategic partnerships in activities to protect ocular health.

2. (a)

(b)

(c)

(d) (e)

(f)

3. (a)

(b)

(c)

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DELIVERING V2020 IN THE CARIBBEAN

Project Overview

Delivering V2020 in the Caribbean

Promoting Vision 2020: The Right to Sight to eliminate avoidable blindness through capacity building in Guyana, Haiti, Jamaica, St. Lucia and the Caribbean Region
A Partnership between

Total Funding: 5,429,856 (73.67% EC Funded)

Duration: January 2010 December 2014

Countries covered: Guyana, Haiti, Jamaica, St. Lucia, Caribbean Region Project objectives: Reduce prevalence of blindness Strengthen collaboration and coordination Build capacity of partners and V2020 Committees

GUYANA

St.Lucia Blind Welfare Association

With technical support from PAHO and Brien Holden Vision Institute Foundation This project is funded by the European Union

Sightsavers

Sightsavers

Project Update
RESULT / ACTIVITIES PROGRESS TO DATE

Project Update
RESULT / ACTIVITIES PROGRESS TO DATE

Strengthen partner capacities, systems and processes

All project partners benefited from staff support, computer and accounting systems development, training and mentoring

Human Resource Development

11 Ophthalmology residents in training 16 Optometry students in training plus project providing inputs to support 34 others
8 Refractionists completed training course also provided inputs to support 4 Refractionists funded by Government of Antigua & Barbuda 607 PHC workers trained 87 Low Vision Counselors trained 4 Spectacle Lab Techs trained Continuous support to University of Guyana Optometry and Refractionist courses

Support development, Project supports data collection which implementation and facilitates review of progress against Regional review of National V2020 Framework indicators Eye Health Plans with Partners contributing to development and mentoring and implementation of V2020 Plans in project support for V2020 countries Committees Partners and project contributed to disease control workshops in Jamaica (LV, RE, DR) Supporting V2020 Committees and activities in 3 of 4 countries Regional V2020 Committees meetings held
Sightsavers

Sightsavers

Project Update
RESULT / ACTIVITIES PROGRESS TO DATE

Project Update
RESULT / ACTIVITIES PROGRESS TO DATE

Infrastructure Development

Guyana (Georgetown and Linden) operating theatre equipment installed Nov 2012 Haiti - Eliziar Germain Hospital (PauP) damaged OT equipment being replaced Haiti - St Nicholas Hospital (St Marc,) OT & VC equipment with project partner in Haiti pending franchise Jamaica Mandeville Regional Hospital OT and support facilities construction completed Jamaica - Mandeville OT equipment in situ Guyana & St Lucia Spec labs upgraded Antigua & Jamaica Spec lab equipment ordered Vision Centres equipped in Haiti, Jamaica & Guyana

Communications

CCB website links Members and partners and provides general information on eye health and social inclusion. Newsletters, bulletins, press releases and human interest stories produced regularly Over 40 videos produced that reinforce messaging from other media and advocate for policy development, social inclusion of visually impaired persons and prevention of avoidable blindness Support to special events such as World Sight Day, Glaucoma Day, Blindness Awareness Day and Health Fairs IEC materials & KAP Studies under development

Sightsavers

Sightsavers

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Planned activities 2013 / 14 include:

Support to National V2020 Committees and for Regional V2020 Meetings 2013 / 14 Awareness activities with general health professionals Scholarships for 7 Refractionists Training LV Specialists and LV Counsellors Training Maintenance Techs, Lab Techs, Dispensing Techs and PHC workers Surfacing Lab and Maintenance Lab (CCB Antigua) Operating Theatres (Haiti & St. Lucia) Vision Centre & Spectacle Lab (SHAA, Haiti) Vision Centres in Jamaica (2) and St Lucia (1) KAP Studies focus on Glaucoma and DR RAABs Guyana and Jamaica
Sightsavers Sightsavers

Delivering V2020 in the Caribbean

We look forward to your continued support and involvement

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Abstract for CCB Conference Presentation on Regional KAPB Study

Glaucoma is the leading cause of irreversible blindness worldwide, but blindness from glaucoma is preventable by early detection and appropriate treatment. There are large numbers of patients living with this chronic disease in the Caribbean, and given the aging population and glaucomas increasing prevalence with age, these numbers are likely to increase. Successful management of glaucoma to prevent vision loss not only requires the medical fraternity to adequately diagnose and prescribe treatment for the condition, but is heavily dependent on the patients ability to successfully manage their condition: to adhere to an agreed treatment plan, to continue to attend eye checks, and to minimize the impact on their family by informing and encouraging others to be tested for glaucoma. This is only possible if patients have the necessary understanding of their disease and their role in its management, and then go on to consistently fulfill that role. We therefore have undertaken a regional study to explore the knowledge, attitudes and practices of persons living with glaucoma in four Caribbean countries: Barbados, Guyana, Jamaica and St. Lucia. A structured interview, administered to a systematic sample of glaucoma patients attending the eye clinics in the respective countries, will be used. Preparations thus far have involved a series of consultations with management, academic and clinical staff in partner institutions in the participating countries. We are now awaiting ethical approval by the institutional review boards before data collection can begin. This regional study is being conducted as part of the overall efforts of the participating individuals and organizations, funded by the European Commission in partnership with Sightsavers and The Caribbean Council for the Blind, to prevent low vision and blindness from glaucoma, as one of the Vision 2020 (Right to Sight) priorities in the Caribbean. We hope that the results from this study will enhance our understanding of the issues affecting glaucoma patients and having an impact on their ability to manage their disease. In the long term this should inform public health policy and clinical strategies to improve the care of glaucoma patients. Miss Dawn Grosvenor, MBBS, MRCOphth, FRCS (Glasg), FRCOphth

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Diagnosing and treating Glaucoma in an Ethnically Diverse Society The Guyana Experience
Dr Shailendra Sugrim, Consultant Ophthalmologist and Glaucoma Specialist, Georgetown Public Hospital Corporation, Georgetown, Guyana

Based on empirical data and also from studies from individual countries in the Caribbean, primary open angle glaucoma (OAG) is the most common form of glaucoma in the Caribbean region. Studies of black West Indian populations in St. Lucia and Barbados show a prevalence of 8.8% and 6.6%, respectively.3,4 . Studies in other parts of the world (including the US and Europe) have shown that its the most common form. Most literature contend that primary open angle glaucoma varies significantly according to race and ethnicity. Despite the fact that people of Asian descent are more likely to develop angle closure glaucoma (ACG), open angle glaucoma is more common (including in Japan and India). The Ocular Hypertension Treatment Study (OHTS) showed that black race was a risk factor for conversion from ocular hypertension to open angle glaucoma.12 However, it also showed that corneal thickness and cup-to-disc ratio may present a better means of evaluating risk factors than race. In Guyana, our two major ethnic groups are of Indian origin and African origin. Hence, in assuming the prevalence risks for Glaucoma in our country, looking at data from studies with similar ethnicity gives us an idea of what the dimension is like. In 2009, a random sampling and analysis of data from records at Georgetown Public Hospital showed that 9% of patients presenting to the Eye Clinic were likely to

have a diagnosis of simple open angle glaucoma with majority of patients being of African ethnicity.
Diagnosis is straightforward with advanced cases with all the characteristic features. Diagnosis becomes more technical in early glaucoma cases or in normal tension cases. Tonometry (measuring of IOP) is now an accepted mode of management here. Modern developments and research on glaucoma has now enabled us to go beyond this where we need also to consider other factors such as characteristics of the neuroretinal rim, size of the optic nerve and the central corneal thickness. The use of Humphreys Visual Field as a diagnostic tool needs to be carefully done by those trained in interpreting these fields. In Guyana, POAG in the Afro-Guyanese population presents usually with very advanced features with a tremendous loss of vision. This finding is common in both old and young age group. The usual approach is to try to initiate or maximise their topical glaucoma medications until maximum tolerated medical therapy is achieved. Its especially difficult to convince younger patients with advanced field loss (tunnel vision) with 20/20 central vision, to undergo surgery. Typical profile for these patients are high IOPs, deep excavated cups with thin neuroretinal rims, C:D ratios usually 0.7 and higher. 50% of times there is a positive family history, but this may be higher due to undiagnosed cases in the family. Normal tension glaucoma seems to be more common in Indo-Guyanese patients who are also more prone to diabetes. These patients present in various stages from early disease to advanced disease. Most cases are initialised on topical glaucoma eye drops and their IOPs and Visual Fields are monitored for effectiveness of treatment. HVF measurement is found to be highly unreliable across the population usually due to difficulty in interpreting the instructions during the test. Also in elderly patients, apart from comprehending the intructions, response time affects their ability to give reliable readings. Hence, we can only rely on clinical judgement along with IOPs as our guide for treatment. A few cases of Primary Angle Closure Glaucoma exist and they are commoner in the indigenous (Amerindian) population. Otherwise a few have been found in Indo-Guyanese and Afro-Guyanese patients. Secondary ACG cases are present in cases with neovascular glaucoma and lens-induced glaucoma. Management of these cases are initially attempted medically since our hospital does not have

38

facility for YAG Laser Peripheral Iridotomy. Patients recommended for YAG PI have the option of going to a private hospital or at regional eye hospital in outlying district. Maybe 1-2 cases needed surgical intervention. Secondary Glaucomas does not affect any ethnicity in particular due to the fact that the primary causes go across the board. Secondary cases include those from trauma (which has a male predominance), steroid induced, inflammatory induced, lens-induced and other rare causes. Congenital Glaucoma presents rarely and these cases are managed surgically with long-term followup at our clinics. Availability of medications is another pertinent issue despite the fact that at least four major medicine groups are available free to the public. Patient education is a key issue with glaucoma management. Careful counselling is important so that patients are educated on the pattern of visual loss, their options for treatment and also the irreversibility of glaucomatous optic neuropathy. This is difficult in a public system where clinics are overcrowded and overtaxed with human resources. Another issue one has to deal with is compliance. Its difficult sometimes for patients to understand visual loss from glaucoma if they arent having a noticeable scotomas or blurred visual effects. This affects their compliance. Using race and ethnicity factors in glaucoma diagnosis and treatment is a tempting proposition, but it is pertinent that each patient be managed with their idiosyncracies. The strongest advocate for looking at race and glaucoma risk and treatment seems to be the fact that African-American patients are more likely to develop OAG and more likely to become blind from the disease. The differences observed between race/ethnicity and disease prevalence may vary according to genetics, environment, socioeconomic status and cultural differences. For now, evaluating intraocular pressure, the optic disc, central corneal thickness and the angle with gonioscopy seems most pertinent. One thing that is certain in patients across all racial and ethnic divides: many are not aware that they have glaucoma.

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The University of the West Indies Faculty of Medical Sciences Department of Community Health and Psychiatry

30th April, 2012 Factors influencing uptake of cataract surgery among older patients in Jamaica

Investigators
Dr. Desmalee Holder-Nevins Dr. Kenneth James Dr. Norman Waldron

In collaboration with the Jamaica Society for the Blind and the Caribbean Council of the Blind

40

Summary of the study The adult prevalence of cataract in Jamaica is unknown and the cataract surgery rate is disproportionately low in comparison to other countries of the region, with Jamaica at only 50% of the Vision 2020 CSR target to be achieved by 2014. An examination of the factors that influence health-seeking behaviour and cataract surgery uptake in person age 60 years and over is warranted. A qualitative study is proposed. It is aimed at developing an understanding about barriers which influence decisions about accessing cataract surgery services among person age 60 years and over and the implications for public health actions. Qualitative interviews will be manually and digitally recorded and after leaving the field, transcripts will be generated from these data. All audio records will then be destroyed to protect the identity of the interviewers. All persons selected will be apprised of the study and their rights to refuse to participate. Those who agree to participate will be asked to give written consent, informed by full explanation that they will not be named in any reports coming out of the study and their option to refuse or withdraw without any sanctions against them. Persons to be included in this study will be recruited because of the specific problem under investigation and not because of easy availability, diminished autonomy or social bias. The principles enunciated in the FMS/UHWI Guidelines for the conduct of research will be complied with throughout this investigation.

41

Department of Community Health and Psychiatry

RESEARCH PROPOSAL

Chlamydia trachomatis frequency in patients presenting to Ophthalmology Clinics in Kingston, Jamaica

Prepared by: Dr. Sandra Jackson Dr. Ken James

April 2012

Chlamydia trachomatis frequency in patients presenting to Ophthalmology Clinics in Kingston, Jamaica

42

SUMMARY
Although the contribution of Chlamydia trachomatis conjunctivitis or Trachoma to visual impairment and blindness worldwide has decreased from 15% in 1995 to 3.6% in 2002, continued monitoring and evaluation of ocular Chlamydia serotypes is necessary in order to achieve the Vision 2020 goal of the elimination of avoidable blindness by the year 2020. (1) Caribbean countries face many socio-economic and demographic challenges resulting in varying health disparities among individual countries. Poor socioeconomic conditions within certain regions of Jamaica, Jamaicas proximity to countries such as Haiti whereocular endemic strains of Chlamydia trachomatis exist, the international exchange of legal and illegal- immigrants and the absence of Trachoma monitoring and evaluation services in Jamaica, are risk factors which predispose to the resurgence of this disease. (2) This study will evaluate the prevalence of Chalmydia trachomatis serotypes A, B, Ba and C in Kingston,Jamaicaand Trachoma associated risk factors. Conjunctival swabs will be selected though systematicsampling of patients from two ophthalmology clinics of different socio-demographic profiles.Amplification and qualitative detection

of Chlamydia trachomatis will be performed using real-time PCR (Sacace Chlamydia trachomatis Real-TM). (3) Results of this study will be used to establish the prevalence of Chlamydia trachomatis infection in Kingston, Jamaica and will contribute to theevaluation of
Jamaicas status towards the elimination of infectious causes of visual impairment and blindness in keeping with the global initiative of the World Health Organization (WHO) and Vision 2020.(3, 4)

43

Training Eye Health Theatre Nurses for the Caribbean

GOAL and OBJECTIVE

Training Eye Health Theatre Nurses for the Caribbean
The Role of the Dominica Health Services
Dr. Hazel Shillingford-Ricketts MBBS (UWI); FRCS (C) Consultant Ophthalmologist

Goal: Competent Ophthalmic or Eye Health Operating Room Nurses Objective: An apprenticeship program to train nurses to acquire a basic set of skills needed to assist at different stages in ophthalmic surgery.

Nurse Nicole Alleyne Registered Nurse Operating Room

Knowledge and Skills:

Patient, Staff and the Environment
Patient care: Pre-op, Intra-op and Post-op Personal Protective Equipment Aseptic techniques Drugs Ophthalmic consumables Microsurgical instruments: Care and Handling Waste Management Duties of the operating room nurse
Pre op Floor or circulating nurse Scrub nurse Sterilization room Inventory management

Pre-op
Preparation of patient before surgery day
Medical history documented Teaching of dos and donts in the peri-operative period

Arrangement for:
Measurement for intra-ocular lens Pre op assessment by Anesthetist or Medical Doctor Admission process with records and accounts department Surgical list Consent

Preparation of patient on surgery day

Patients notes and identification of correct patient for correct procedure
Consent form signing Vitals signs Dilating eye drops

Intra-op
The roles of the circulating or floor nurse: Safety of the patient and staff in the operating room
Ensure that the correct patient is operated on with the correct procedure Provide the additional surgical instruments needed Assist the scrub nurse in setting up for the surgery Review the checklist with the scrub nurse

Intra-op
The roles of the scrub nurse: To set up the instruments and consumables needed for the surgery to be performed To go through the checklist before the surgery is started To assist the surgeon by passing the correct instruments and consumables as needed during the operation

To assist the surgeon as needed and instructed

To pass on the instruments at the end of the surgery for cleaning and sterilization

44

Post-op
Recovery room duties Help patients being discharged home with appropriate medications, instructions and eye clinic follow-up appointments
Hand over patients to family members or other person who accompanied them with appropriate information.

Sterilization
Wash instruments
Inspect instruments for damage Package and place instruments in correct packs for sterilization Sterilization methods

Management
Inventory:
Maintain and document adequate stocks of functioning instruments and consumables Update check list Maintain equipment and ensure its state of readiness for use

Evaluation
Observation of skills during the program Feed back during tutorials Mock set up Examination Certification on successful completion

Liaise with maintenance staff for repairs Keep staff and self current with new surgical procedures

45

46

47

48

49

Group Work Activity

Group 1

Group 1

V2020 Committees Meeting Tuesday 11th December, 2012

Group work 1hr 50mins (Includes working coffee break) Feedback Presentation 15mins

Time allocation:

Integration of Eye Health into National Health Plans

One of the Objectives of the draft WHO Action Plan Universal access to eye health: a global action plan 2014-2019 is: National policies, plans and programmes for eye health which are integrated into national health systems developed and/or strengthened and being implemented along the lines of the WHO health system building blocks. IAPBs The Right to Eye Health Hyderabad Declaration (2012) urges governments to: Ensure that eye health and blindness prevention are prioritized and included in national health policies and plans. Integration of eye health into National Health Plans and policies will help to maximize opportunities for development and resourcing of eye health personnel and services. Integration of eye health into wider health care delivery systems at all levels is critical and eye health is relevant in all of the WHO health system building blocks: governance, health financing, service delivery, human resources for health (HRH), pharmaceutical management, and health information systems (HIS) Integration opportunities exist as typically National Health Plans have sections relating to Non-Communicable Diseases (NCDs), Primary Health Care (PHC), Neo-natal care, Health promotion, Information systems and Leadership.

Objective of Group Work:

Identify approaches for integration of eye health into National Health Plans
Group should: 1. Establish the current level of integration of eye health in National Health Plans (present good and not-so-good examples) 2. Identify when your countrys current National Health Plan expires and when the review / development process is likely to start 3. State what you can do to ensure eye health professionals & focal persons are involved in the development of the next National Health Plan 4. Identify how eye health can be integrated in any or all of the following areas: Governance Health financing Service delivery Human resources for health (HRH) Pharmaceutical management Health information systems (HIS) 50

51

52

53

Group Work Activity

Group 1

Group 2

V2020 Committees Meeting Tuesday 11th December, 2012

Group work 1hr 50mins (Includes working coffee break) Feedback Presentation 15mins

Time allocation:

Identifying practical and cost-effective ways to train eye health professionals in / for the region
One of the Actions of the draft WHO Action Plan Universal access to eye health: a global action plan 2014-2019 is: Develop and maintain a sustainable workforce for the provision of comprehensive eye care services as part of the broader human resources for health workforce. The Eye Health Workforce section of the Strategic Framework for V2020: The Right to Sight Caribbean Region has a number of indicators related to ensuring an adequate number of eye health professionals: Number of countries reaching the minimum ratio set of one active ophthalmic surgeon per 50,000 populations. Number of countries reaching the minimum ratio set of one active optometrist per 50,000 populations. Number of countries reaching the minimum ratio set of one active ophthalmic nurse per 50,000 populations Number of countries having an active PEC service integrated to the PHC service. Number of countries with network of maintenance technicians available covering all hospitals in country by 2014. Increase the number of countries having spectacles lab technicians from 3 to 6.

In order to achieve the expected outcomes of the Strategic Framework there is need to establish the national eye health workforce requirements and ensure adequate policies and resources are in place to enable: Initial and Refresher training Continuing Medical Education On-going access to mentors, expertise and technical support

Within the Caribbean and in Latin American there are a number of facilities and personnel available to train ophthalmologist, optometrists, refractionists, ophthalmic nurses, PHC workers, community members, low vision personnel, maintenance technicians, spectacle lab technicians, dispensing technicians and other personnel involved in eye health service delivery and management.

54

Objective of Group Work:

Identify practical and cost-effective ways to train eye health professionals
Group should: 1. Identify strategies for strengthening the eye health component of general primary health care training 2. Identify ways to increase investment in and opportunities for mid-level eye health personnel 3. Discuss the viability and usefulness of a Regional Human Resource Development Database which could provide training resources, information on training facilities and trainers, links to publications, etc. Sub-groups may be formed

55

National VISION 2020 Data Collection

VISION 2020: The Right to Sight: VISION 2020 is the global initiative for the elimination of avoidable blindness, a joint programme of the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB) with an international membership of NGOs, professional associations, eye care institutions and corporations. VISION 2020 was officially launched in the Caribbean in Trinidad-Tobago in April 2000. The Pan-American Health Organisation (PAHO/WHO) support implementation of the Caribbean VISION 2020 initiative in alliance with the IAPB, Caribbean Council for the Blind (CCB) and a number of national and international non-government agencies and in collaboration with government ministries, departments and health facilities. National V2020 Data collection: The purpose of this National V2020 data collection form and process is to help measure achievement and progress against V2020 targets at national and regional level. This form is to be completed annually by national health authorities, with the support of National V2020 / Prevention of Blindness committees where available. The form collects data in five key areas: 1. Central Organization, Leadership and Governance 2. Disease Control 3. Human Resources 4. Infrastructure 5. Qualitative assessment (related to the eye health action plan and/or strategic framework for each country) If you require assistance completing this form please contact: Ms Keva Richards, Project Manager V2020 Programmes, Caribbean Council for the Blind (CCB-Eye Care Caribbean) Tel: (268) 462-4111 Email: keva.richards@eyecarecaribbean.com When completed, this for is to be returned to keva.richards@eyecarecaribbean.com and to Dr Juan Carlos Silva PAHO Regional Advisor silvajuan@paho.org

56

National VISION 2020 Data

Country: Year of data: Country Population: Source(s) of National V2020 data: Approved by VISION 2020 National Committee or MOH: 1. Central Organization, Leadership and Governance
Is there a signed National Declaration in support of VISION 2020? Did your country celebrate World Sight Day or other eye health related days in this period? Is there an active National Vision 2020 Committee Was there a National V2020 workshop / meeting / conference organized in the past year? Is there a designated focal person to assist the V2020 Committee and MoH? Is there a National Vision 2020 strategic framework approved by the Ministry of Health? Is your country implementing a National Vision 2020 plan? Is eye health included in National health plans, policies and systems? What is the Governments financial contribution to Eye Health? Y/N Y/N - If yes, give date signed and name of Signatory Y/N if yes include a brief summary of activities Y/N if yes how frequently does the Committee meet? Y/N if yes state the focus / theme of the activity

Y/N

Provide contact information:

Y/N

Provide an electronic copy:

Y/N Y/N

Briefly explain and provide results /progress: Provide reference and electronic copy of relevant policies, plans:

Provide in local currency (& USD$ official conversion) figures and % of annual Health Budget.

57

2. Disease Control
How many cataract surgeries were performed in the public sector in this period? How many cataract surgeries were performed in the private sector in this period? How many cataract surgeries were performed by others in this period (e.g. Cuban initiative, volunteers, etc.)? Total number of cataract surgeries for this period Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at : http://www.cehjournal.org/files/s1001.html Glaucoma Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country? Are glaucoma eye medications included in the subsidized drug list? Diabetic Has a Diabetic retinopathy Services situation analysis Retinopathy been conducted in your country? Cataract Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program? Is digital photography screening available in a. public sector, b. private sector Are diabetic patients routinely referred to ophthalmology units for examination? Are laser treatment services available in a. public sector b. private sector Childhood Blindness Is there any documentation on causes of childhood blindness in the country? Is there a national Retinopathy of Prematurity (ROP) prevention policy? Are there ROP screening and treatment services available? How many children were treated for ROP in this period? Is eye care integrated into maternal and child health programs?

Y/N

Y/N if yes provide a brief description Y/N if yes provide a brief explanation Y/N if yes state when the analysis was carried out. Y/N

a. Y/N state number screened b. Y/N state number screened Y/N state number referred a. Y/N state number treated b. Y/N state number treated Y/N if yes provide electronic copy Y/N please provide electronic copy Y/N

Y/N if yes, how? 58

Refractive Error

Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and treatment? Please provide the following information annually: 1. Total number of children examined in out-patients departments of eye health facilities 2. Total number of paediatric cataract surgeries 3. Total number of other paediatric eye surgeries Are there refractive error services available in the public sector? Is there a school screening programme being implemented? Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker) Provide the number of spectacles dispensed per year (from public and not-for-profit sector): Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age) Are Low Vision services available with 1. Trained professional(s), 2. the necessary equipment and 3. Low Vision appliances available? Please specify if in the public sector, private sector, both or none Are there any national plans for inclusive education? Are there any national plans for rehabilitation / adjustment to blindness?

Y/N

Y/N if yes provide a brief description Y/N if yes provide a brief description Y/N

Y/N

Low Vision

Y/N Y/N Y/N

Inclusive Services

Y/N please provide electronic copy(s) Y/N please provide electronic copy(s)

59

3. Human Resources
Ophthalmologists Total number of ophthalmologists in country Total number of ophthalmologists performing surgery in public sector Total number of ophthalmologists performing surgery in private sector Number of Optometrists in public sector Number of Optometrists in private sector Total number in country Total number in country Total number in country Total number trained in this period: Brief description of training activity(s)

Optometrists

Refractionists Ophthalmic nurses Ophthalmic assistants Primary Health Care personnel trained in Eye Health

4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department? Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period? Y/N

Y/N if yes what are the findings

5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country)
Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period:

Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period:

60

What are the proposed actions to strengthen eye health services and prevention of blindness services in your country?

What are the proposed actions to strengthen inclusive education services in your country?

What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country?

61

National VISION 2020 Data

Country: Antigua & Barbuda Year of data: 2011-2012 Country Population: 89,700 Source(s) of National V2020 data: Ministry of Health (MSJMC) Approved by VISION 2020 National Committee or MOH: Y/N 1. Central Organization, Leadership and Governance
Is there a signed National Declaration in support of VISION 2020? Did your country celebrate World Sight Day or other eye health related days in this period? Is there an active National Vision 2020 Committee Was there a National V2020 workshop / meeting / conference organized in the past year? Is there a designated focal person to assist the V2020 Committee and MoH? Is there a National Vision 2020 strategic framework approved by the Ministry of Health? Is your country implementing a National Vision 2020 plan? Is eye health included in National health plans, policies and systems? What is the Governments financial contribution to Eye Health? Y/N Y/N - If yes, give date signed and name of Signatory Y/N if yes include a brief summary of activities : Glaucoma Day Y/N if yes how frequently does the Committee meet? Y/N if yes state the focus / theme of the activity

Provide contact information:

Y/N

Provide an electronic copy:

Y/N Y/N

Briefly explain and provide results /progress: Provide reference and electronic copy of relevant policies, plans:

Provide in local currency (& USD$ official conversion) figures and % of annual Health Budget.

62

2. Disease Control
How many cataract surgeries were performed in the public sector in this period? How many cataract surgeries were performed in the private sector in this period? How many cataract surgeries were performed by others in this period (e.g. Cuban initiative, volunteers, etc.)? Total number of cataract surgeries for this period Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at : http://www.cehjournal.org/files/s1001.html Glaucoma Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country? Are glaucoma eye medications included in the subsidized drug list? Diabetic Has a Diabetic retinopathy Services situation analysis Retinopathy been conducted in your country? Cataract Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program? Is digital photography screening available in a. public sector, b. private sector Are diabetic patients routinely referred to ophthalmology units for examination? Are laser treatment services available in b. public sector b. private sector Childhood Blindness Is there any documentation on causes of childhood blindness in the country? Is there a national Retinopathy of Prematurity (ROP) prevention policy? Are there ROP screening and treatment services available? How many children were treated for ROP in this period? Is eye care integrated into maternal and child health programs? Not available Not available Not available

Not available Y/N

Y/N if yes provide a brief description Y/N if yes provide a brief explanation Y/N if yes state when the analysis was carried out. Y/N

c. Y/N state number screened d. Y/N state number screened Y/N state number referred a. Y/N state number treated b. Y/N state number treated Y/N if yes provide electronic copy Y/N please provide electronic copy Y/N Not available Y/N if yes, how? 63

Refractive Error

Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and treatment? Please provide the following information annually: 4. Total number of children examined in out-patients departments of eye health facilities 5. Total number of paediatric cataract surgeries 6. Total number of other paediatric eye surgeries Are there refractive error services available in the public sector? Is there a school screening programme being implemented? Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker) Provide the number of spectacles dispensed per year (from public and not-for-profit sector): Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age) Are Low Vision services available with 4. Trained professional(s), 5. the necessary equipment and 6. Low Vision appliances available? Please specify if in the public sector, private sector, both or none Are there any national plans for inclusive education? Are there any national plans for rehabilitation / adjustment to blindness?

Y/N

Not available

Y/N if yes provide a brief description Y/N if yes provide a brief description Y/N

Not available

Y/N

Low Vision

Y/N Y/N Y/N

Inclusive Services

Y/N please provide electronic copy(s) Y/N please provide electronic copy(s) Information not available

64

3. Human Resources
Ophthalmologists Total number of ophthalmologists in country Total number of ophthalmologists performing surgery in public sector Total number of ophthalmologists performing surgery in private sector Number of Optometrists in public sector Number of Optometrists in private sector Total number in country Total number in country Total number in country Total number trained in this period: 2 2 2 1 6 4 2 Brief description of training activity(s)

Optometrists

Refractionists Ophthalmic nurses Ophthalmic assistants Primary Health Care personnel trained in Eye Health

4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department? Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period? Y/N

Y/N if yes what are the findings

5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country)
Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period:

Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period:

65

What are the proposed actions to strengthen eye health services and prevention of blindness services in your country?

What are the proposed actions to strengthen inclusive education services in your country?

What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country?

66

National VISION 2020 Data

Country: Barbados Year of data: 2011 Country Population: Approx 273,925 (World Bank) Source(s) of National V2020 data: Ministry of Health/Queen Elizabeth Hospital Approved by VISION 2020 National Committee or MOH: Yes 1. Central Organization, Leadership and Governance
Is there a signed National Declaration in support of VISION 2020? Did your country celebrate World Sight Day or other eye health related days in this period? No

No. Barbados celebrated World Glaucoma Week (March 11-17, 2012) No

Is there an active National Vision 2020 Committee Was there a National V2020 workshop / meeting / conference organized in the past year?

Is there a designated focal person to assist the V2020 Committee and MoH?

No

Is there a National Vision 2020 strategic framework approved by the Ministry of Health? Is your country implementing a National Vision 2020 plan? Is eye health included in National health plans, policies and systems? What is the Governments financial contribution to Eye Health?

No

Yes. The MOH met with Dr. Juan Carlos Silva in October 2011 to discuss the Draft Prevention of Blindness and Visual Impairment Eye Care Strategic Framework for Barbados and to develop Terms of Reference for a National Committee on Eye Care Services in Barbados. Provide contact information: Briefly explain and provide results /progress: In July 2012, the MOH received Cabinet approval to establish a National Committee on Eye Care Services in Barbados. Provide an electronic copy: N/A

No No Provide reference and electronic copy of relevant policies, plans:

Provide in local currency (& USD$ official conversion) figures and % of annual Health Budget. This financial information is not collected specifically to Eye Health. 67

2. Disease Control
Cataract How many cataract surgeries were performed in the public sector in this period? How many cataract surgeries were performed in the private sector in this period? How many cataract surgeries were performed by others in this period (e.g. Cuban initiative, volunteers, etc.)? Eight Hundred and Forty-Five (845) Information Not Available None. In 2010, the Barbados/Cuba Eye Care Programme Operacin Milagro was halted. N/A No

Total number of cataract surgeries for this period Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at : http://www.cehjournal.org/files/s1001.html Glaucoma Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country? Are glaucoma eye medications included in the subsidized drug list? Diabetic Has a Diabetic retinopathy Services situation analysis Retinopathy been conducted in your country?

No

Yes Yes A Preliminary Situation Analysis Report on Eye Care Services in Barbados was completed in 2010 Yes

Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program? Is digital photography screening available in a. public sector, b. private sector Are diabetic patients routinely referred to ophthalmology units for examination? Are laser treatment services available in c. public sector b. private sector Childhood Blindness Is there any documentation on causes of childhood blindness in the country? Is there a national Retinopathy of Prematurity (ROP) prevention policy? Are there ROP screening and treatment services available? How many children were treated for ROP in this period?

e. No f. Yes Information Not Available No a. Yes Eighty (80) b. Yes Not Available

Yes No Yes One Hundred (100) 68

Is eye care integrated into maternal and child health programs?

Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and treatment? Please provide the following information annually: 7. Total number of children examined in out-patients departments of eye health facilities 8. Total number of paediatric cataract surgeries 9. Total number of other paediatric eye surgeries Are there refractive error services available in the public sector?

Yes Through the primary health care system, there is one Ophthalmology unit at the Winston Scott Polyclinic which caters to the School Eye Care Services. Minor eye care conditions like conjunctivitis are managed at the primary care level by the Medical Officers in the 8 polyclinics in the country. Yes

1. Three thousand and eleven (3011) 2. Five (5)

Refractive Error

Is there a school screening programme being implemented?

Low Vision

Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker) Provide the number of spectacles dispensed per year (from public and not-for-profit sector): Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age) Are Low Vision services available with 7. Trained professional(s),

Yes Refractive error services are available only for children ages 3 18 yrs. Yes The School Eye Services Programme This was started in 1973 for the screening of children between the ages of 3-18yrs. (See Attached Report) Yes

Public - 1015 No

Yes- Prv. S No-Pub. S 69

Inclusive Services

8. the necessary equipment and Yes- Prv. S No-Pub. S 9. Low Vision appliances available? Yes- Prv. S No-Pub. S Please specify if in the public sector, private sector, both or none Are there any national plans for inclusive education? No Are there any national plans for rehabilitation / adjustment to blindness? No

3. Human Resources
Ophthalmologists Total number of ophthalmologists in country Total number of ophthalmologists performing surgery in public sector Total number of ophthalmologists performing surgery in private sector Number of Optometrists in public sector Number of Optometrists in private sector Total number in country Total number in country Twenty-two (22) Twelve (12) Not Available Nil 0 Thirty-three (33) Not Available There are 11 Nurses and 1 Nursing Assistant trained in Ophthalmology. These individuals do not carry the title of Ophthalmic Nurse /Assistant There are 11 Nurses and 1 Nursing Assistant trained in Ophthalmology. These individuals do not carry the title of Ophthalmic Nurse /Assistant Nil

Optometrists

Refractionists Ophthalmic nurses

Ophthalmic assistants

Total number in country

Primary Health Care personnel trained in Eye Health

Total number trained in this period:

70

4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department? Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period? No No The Preliminary Situational Analysis Report on Eye Care Services in Barbados was carried out in 2010

5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country)
Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: N/A Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: N/A What are the proposed actions to strengthen eye health services and prevention of blindness services in your country? The Ministry of Health is in the process of establishing a National Committee on Eye Care Services in Barbados. The aim of the National Committee will be to develop and support a National Eye Care Policy and Strategic Plan that addresses the prevention of blindness and low vision in Barbados. The following are the objectives of the National Committee: 1) To establish leadership and governance polices that ensures an effective and equitable eye care system; 2) To develop strategies to assist in improving the health workforce to achieve the best eye care outcomes possible; 3) To facilitate provision of the necessary infrastructure, medical products, technology and services for eye care patients. 4) To identify mechanisms to include eye care in the Health Information System; 5) To develop cataract service plans that address equity and quality of service; 6) To identify strategies to reduce the prevalence of blindness from diabetic retinopathy and open-angle glaucoma; 7) To determine strategies to reduce blindness and visual impairment in children; 8) To develop national policies on comprehensive low-vision care; 9) To increase public knowledge of prevention of blindness and low vision and utilization of eye care services 71

What are the proposed actions to strengthen inclusive education services in your country? The Ministry of Health has not identified specific actions to strengthen inclusive education services in Barbados What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country? The Ministry of Health has not identified specific rehabilitation/adjustment to blindness services in Barbados. actions to strengthen

72

National VISION 2020 Data

Country: Year of data: Country Population: Source(s) of National V2020 data: Belize 2011 330,000 The Belize Council for the Visually Impaired (BCVI) Approved by VISION 2020 National Committee or MOH: No 1. Central Organization, Leadership and Governance
Is there a signed National Declaration in support of VISION 2020? Did your country celebrate World Sight Day or other eye health related days in this period? Is there an active National Vision 2020 Committee Was there a National V2020 workshop / meeting / conference organized in the past year? Is there a designated focal person to assist the V2020 Committee and MoH? Is there a National Vision 2020 strategic framework approved by the Ministry of Health? Is your country implementing a National Vision 2020 plan? Is eye health included in National health plans, policies and systems? What is the Governments financial contribution to Eye Health? NO YES, signed in April 2001 by Said Musa, who was then the Prime Minister YES TV, Radio and social media, Public Awareness activities on major blinding conditions (by BCVI) NO NO

Provide contact information:

YES

There is a National Eye Health Plan 2010 - 2014

YES NO

BCVI continues to provide the public eye care for the country

Provide in local currency (& USD$ official conversion) figures and % of annual Health Budget. BCVI received a total of BZ$120,000 (US$60,000) from MOH and NHI in 2011.

73

2. Disease Control
How many cataract surgeries were performed in the public sector in this period? How many cataract surgeries were performed in the private sector in this period? How many cataract surgeries were performed by others in this period (e.g. Cuban initiative, volunteers, etc.)? Total number of cataract surgeries for this period Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at : http://www.cehjournal.org/files/s1001.html Glaucoma Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country? Are glaucoma eye medications included in the subsidized drug list? Diabetic Has a Diabetic retinopathy Services situation analysis Retinopathy been conducted in your country? Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program? Is digital photography screening available in a. public sector, b. private sector Cataract Are diabetic patients routinely referred to ophthalmology units for examination? Are laser treatment services available in d. public sector b. private sector Childhood Blindness Is there any documentation on causes of childhood blindness in the country? Is there a national Retinopathy of Prematurity (ROP) prevention policy? Are there ROP screening and treatment services available? How many children were treated for ROP in this period? Is eye care integrated into maternal and child health programs? Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and 225 N/A N/A

225 plus NO

NO

NO NO NO

g. NO h. NO

NO a. YES -203 b. YES N/A

YES BCVIs register of people who are blind NO NO NONE NO NO 74

treatment? Please provide the following information annually: 10. Total number of children examined in out-patients departments of eye health facilities 11. Total number of paediatric cataract surgeries 12. Total number of other paediatric eye surgeries Are there refractive error services available in the public sector?

1. 750 2. 5 3. 11 strabismus YES BCVI operates 5 clinics strategically located around the country NO

Refractive Error

Is there a school screening programme being implemented? Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker) Provide the number of spectacles dispensed per year (from public and not-for-profit sector): Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age) Are Low Vision services available with 10. Trained professional(s), 11. the necessary equipment and 12. Low Vision appliances available? Please specify if in the public sector, private sector, both or none Are there any national plans for inclusive education?

YES

3779

YES

Low Vision

YES 2 optometrists YES YES At BCVI YES -50 children who are blind in regular schools YES BCVI runs a rehabilitation programme

Inclusive Services

Are there any national plans for rehabilitation / adjustment to blindness?

75

3. Human Resources
Ophthalmologists Total number of ophthalmologists in country Total number of ophthalmologists performing surgery in public sector Total number of ophthalmologists performing surgery in private sector Number of Optometrists in public sector Number of Optometrists in private sector Total number in country Total number in country Total number in country Total number trained in this period: 3 All in private practice BCVI uses volunteers, mainly from USA 3 4 working with BCVI None 0 2 4 with BCVI 0 Brief description of training activity(s)

Optometrists

Refractionists Ophthalmic nurses Ophthalmic assistants Primary Health Care personnel trained in Eye Health

4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department? Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period? NO

NO

5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country)
Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: (by BCVI) There were no new cases of ROP due to training with neonatal unit of main hospital in previous years More people with diabetes referred for eye examination limited number of examinations covered by NHI Belize Health Information System (BHIS) fully implemented at BCVIs 6 clinics

Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: 76

Lack of inclusion of eye health in MOHs plans and policies

What are the proposed actions to strengthen eye health services and prevention of blindness services in your country? BCVI will continue advocacy efforts What are the proposed actions to strengthen inclusive education services in your country? All children with LV have been assessed and have received the appropriate LV aid. All children who are blind have been successfully placed in their local school. However, they receive no support from the MOE. BCVI has contracted a Braille teacher for 2013 and will continue to produce Braille materials and introduce IT skills. What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country? BCVI will continue its countrywide rehabilitation programme. Special emphasis will be placed on job placement and income generation for young adults.

77

National VISION 2020 Data

Country: Dominica Year of data: 2011-2012 Country Population: 70,000 Source(s) of National V2020 data: Primary Health/ Princess Margaret Hospital Approved by VISION 2020 National Committee or MOH: Yes 1. Central Organization, Leadership and Governance
Is there a signed National Declaration in support of VISION 2020? Did your country celebrate World Sight Day or other eye health related days in this period? No

Yes Oct 11, 2012 World sight day observance theme was "The Integrated Eye Care Team Working Together to Eliminate Avoidable Blindness with a radio speech by the Minister of Health, talk shows by ophthalmologist both in Creole and English and presentation to patients attending eye clinic No No

Is there an active National Vision 2020 Committee Was there a National V2020 workshop / meeting / conference organized in the past year? Is there a designated focal person to assist the V2020 Committee and MoH? Is there a National Vision 2020 strategic framework approved by the Ministry of Health? Is your country implementing a National Vision 2020 plan? No

The Director of Primary Health Care was recommended to be the Focal Person There is a draft awaiting approval by the Ministry of Health

No

Yes

Eye care is provided free to those 18 and younger and 60 and older in the Public health sector. Cataract surgical rate over 2000 have been achieved. Opportunistic screening for glaucoma for all attending eye clinic. Glaucoma meds are provided at a subsidized cost. Diabetic fundus photography screening and 78

laser treatment are available in the public sector free of charge. Screening for retinopathy of prematurity and school vision screening have reached over 90% of target. Excellent immunization and maternal and child has resulted in elimination of blindness from measles, rubella and vitamin A deficiency. Refraction is performed for all as indicated and prescription provided for spectacles. Is eye health included in National health plans, policies and systems? What is the Governments financial contribution to Eye Health? Yes National Strategic Plan For Health 2010- 2019

There is no program based budgeting. Expenditure is through Budget for Primary Health Care and Secondary Care at the Main Hospital.

79

2. Disease Control
Cataract How many cataract surgeries were performed in the public sector in this period? How many cataract surgeries were performed in the private sector in this period? How many cataract surgeries were performed by others in this period (e.g. Cuban initiative, volunteers, etc.)? Total number of cataract surgeries for this period Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at : http://www.cehjournal.org/files/s1001.html Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country? Are glaucoma eye medications included in the subsidized drug list? Jan-Dec 2011- 142 Jan- Oct 2012- 154 None None

2011-142; 2012 154 No

Glaucoma

No

Diabetic Has a Diabetic retinopathy Services situation analysis Retinopathy been conducted in your country? Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program? Is digital photography screening available in a. public sector,

Yes Timoptic, Pilocarpine & Diamox are provided free of charge. Alphagan, Cosopt, Trusopt xalatan, Lumigan are sold at cost price which is approx.. 50% of the cost in the private pharmacies. No Yes

b. private sector

i. Yes j. Jan-Dec 2012 748 screened 96 referred 60 DR 36 No DR Sept-Oct 2012 275 screened 41 referred 20 DR 21 No DR k. Just obtained camera 80

Are diabetic patients routinely referred to ophthalmology units for examination?

Yes Numbers Not available a. Yes b. Jan-Dec 2011 PRP 26, CSME 12 Augment PRP 4 CSME 9 Jan-Oct 2012 PRP 20, CSME 6 Augment PRP 5 laser was nonoperational for 6 months c. None No No Yes Oct 2011-Nov 2012 15 premature babies screened. None required treatment Yes Neonatology screening and school health programmes. No Paediatric Ophthalmologist Not available No cataract surgeries performed Other surgeries 2011 5 2012 - 7 Yes : All patients examined are refracted as indicated and 81

Are laser treatment services available in e. public sector

b. private sector Childhood Blindness Is there any documentation on causes of childhood blindness in the country? Is there a national Retinopathy of Prematurity (ROP) prevention policy? Are there ROP screening and treatment services available? How many children were treated for ROP in this period?

Is eye care integrated into maternal and child health programs?

Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and treatment? Please provide the following information annually: 13. Total number of children examined in out-patients departments of eye health facilities 14. Total number of paediatric cataract surgeries 15. Total number of other paediatric eye surgeries

Refractive Error

Are there refractive error services available in the public sector?

spectacle prescribed Is there a school screening programme being implemented? Yes Screening is performed for all new entrants and those leaving primary school. This is part of Primary Health Care school Health Programme. Those who fail the screening criteria are referred to see the ophthalmologist. The school year 2011-2012 2505 screened 194 failed There is one finishing spectacle lab in Dominica Rotary assisted VOSH program and faith based charity groups provide spectacles to hundreds of needy persons during Ad hoc campaigns. Yes

Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker) Provide the number of spectacles dispensed per year (from public and not-for-profit sector):

Low Vision

Inclusive Services

Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age) Are Low Vision services available with 13. Trained professional(s), 14. the necessary equipment and 15. Low Vision appliances available? Please specify if in the public sector, private sector, both or none Are there any national plans for inclusive education? Are there any national plans for rehabilitation / adjustment to blindness?

1.Yes in public sector 2. No 3. No

Yes No

82

3. Human Resources
Ophthalmologists Total number of ophthalmologists in country Total number of ophthalmologists performing surgery in public sector Total number of ophthalmologists performing surgery in private sector Number of Optometrists in public sector Number of Optometrists in private sector Total number in country Total number in country Total number in country Total number trained in this period: One One None None One

Optometrists

Refractionists Ophthalmic nurses Ophthalmic assistants Primary Health Care personnel trained in Eye Health

One Two Sept 27, 2012 8-Family Nurse Practitioners 1-District Medical Doctor attended an in-service education session on V2020 programmes and Millennium Dev Goals facilitated by Ophthalmologist

4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department? Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period? No

Yes Slit lamp, laser unit, tonopen, projectors, chairs, lensemeter, operating microscope were poorly functional.

83

5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country)
Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: Upgrading of some of the eye equipment in the public sector: Laser Unit, Slit Lamp, Lensometer were purchased A non-mydriatic fundus camera is now available for screening in the private sector The first Friday of each month has been designated exclusively as an eye clinic for children especially those referred from the school vision program A successful Glaucoma Week of Activities climaxed with an exhibition and screening at the Princess Margaret Hospital May 29, 2012 a video titled Vision 2020 and Dominica: Lighting the Darkness was uploaded on You Tube at http://bouzaiproductions.weebly.com. It was an initiative of the Dominica Association of Persons with Disability and the Eye Clinic, Princess Margaret Hospital. Attendance at the 9th General Assembly of the International Agency for the prevention of Blindness in Hyderabad, India September 17-20, 2012 provided information used to guide government on vision screening for children Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: Lack of adequate financial resources from the government Despite passionate followup and presentation by the National Drug Committee to have the glaucoma medications: Trusopt, Cosopt, Alphagan and Xalatan/Lumigan included in the formulary, funds were not allocated to do so. Failure to reach the targeted number of diabetics for fundus photography approx. 3000: o Unavailability of the Ophthalmic Technician conducting the Diabetic fundus photography screening program (reassignment, vacation and sick leave). o Lack of optimal support from Primary Health Care for the diabetic screening program in protecting time when screening clinics are booked o Lack of optimal transportation to the outlying districts What are the proposed actions to strengthen eye health services and prevention of blindness services in your country? Adoption of the National Strategic Plan for Eye Care in Dominica. A new eye clinic with more space to accommodate additional services and staff. Digitalization of clinic data. Introduction of The Healthy Eyes Activity Book in Primary Schools Commencement of the Dominican Glaucoma Laser Program Reactivation of the National Prevention of Blindness Committee Removal of VAT on spectacles to make them more affordable. Improving the diabetic fundus photography screening program both in the private and public sector. What are the proposed actions to strengthen inclusive education services in your country? Ministry of Education have developed a plan of action but a partnership with the Ministry of Health has to be strengthened on that initiative. 84

What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country? Education and training of persons as Rehabilitative Officers for the Blind, especially those involved in the Yes We Care Program.

85

National VISION 2020 Data

Country: Grenada Year of data: 2011-11- 2012-11 Country Population: 108,000 Source(s) of National V2020 data: Ministry of Health Approved by VISION 2020 National Committee or MOH: 1. Central Organization, Leadership and Governance
Is there a signed National Declaration in support of VISION 2020? Did your country celebrate World Sight Day or other eye health related days in this period? Y/N - If yes, give date signed and name of Signatory Yes May 31st 2012 School children and the business community supported World sight by wearing white ribbon Yes ,monthly General monthly meeting

Yes

Is there an active National Vision 2020 Committee Was there a National V2020 workshop / meeting / conference organized in the past year? Is there a designated focal person to assist the V2020 Committee and MoH? Is there a National Vision 2020 strategic framework approved by the Ministry of Health? Is your country implementing a National Vision 2020 plan? Is eye health included in National health plans, policies and systems? What is the Governments financial contribution to Eye Health? Y/N

Y/N

Dr E. Francis Martin, Director Director Primary Health Care Email-mezzeal@gmail.com Provide an electronic copy:

Yes

Y/N

The committee meets regularly to ensure that plans are implementing and programs run smoothly. Provide reference and electronic copy of relevant policies, plans:

Provide in local currency (& USD$ official conversion) figures and % of annual Health Budget.

86

2. Disease Control
Cataract How many cataract surgeries were performed in the public sector in this period? How many cataract surgeries were performed in the private sector in this period? How many cataract surgeries were performed by others in this period (e.g. Cuban initiative, volunteers, etc.)? Total number of cataract surgeries for this period Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at : http://www.cehjournal.org/files/s1001.html Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country? Are glaucoma eye medications included in the subsidized drug list? 83 30 10

No

Glaucoma

Diabetic Has a Diabetic retinopathy Services situation analysis Retinopathy been conducted in your country? Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program? Is digital photography screening available in a. public sector, b. private sector Are diabetic patients routinely referred to ophthalmology units for examination? Are laser treatment services available in f. public sector b. private sector Childhood Blindness Is there any documentation on causes of childhood blindness in the country? Is there a national Retinopathy of Prematurity (ROP) prevention policy? Are there ROP screening and treatment services available? How many children were treated for ROP in this period? Is eye care integrated into maternal and child health programs?

No, just routine patient education from the eye clinic Yes, there is also a list of the glaucoma patients at the ministry of health No Yes

No No

Yes a. Yes 10 monthly

Yes no No, visiting surgeons provide services occasionally 6 No 87

Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and treatment? Please provide the following information annually: 16. Total number of children examined in out-patients departments of eye health facilities 17. Total number of paediatric cataract surgeries 18. Total number of other paediatric eye surgeries Are there refractive error services available in the public sector? Is there a school screening programme being implemented? Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker) Provide the number of spectacles dispensed per year (from public and not-for-profit sector): Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age) Are Low Vision services available with 16. Trained professional(s), 17. the necessary equipment and 18. Low Vision appliances available? Please specify if in the public sector, private sector, both or none Are there any national plans for inclusive education? Are there any national plans for rehabilitation / adjustment to blindness?

Refractive Error

No paediatric Ophthalmologist. Limited equipments available 950 No paediatric eye surgeries exempt for 4 emergency operations. No Yes

Yes No Not available

Yes in the private sector

Low Vision

Y/N Y/N Y/N

Inclusive Services

Yes no electronic copy Yes no electronic copy

88

3. Human Resources
Ophthalmologists Total number of ophthalmologists in country Total number of ophthalmologists performing surgery in public sector Total number of ophthalmologists performing surgery in private sector Number of Optometrists in public sector Number of Optometrists in private sector Total number in country Total number in country Total number in country Total number trained in this period: 3 2 2 0 4

Optometrists

Refractionists Ophthalmic nurses Ophthalmic assistants Primary Health Care personnel trained in Eye Health

0 1 0

4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department? Yes same is presently disrupted

Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period?

Yes

5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country)
Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: Was able to perform more cataract surgeries Also provided health information by private sponsor Was able to conduct district clinic with an ophthalmologist,(Cuban initiative)

89

Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: Lack of existing department building presently Lack of trained staff (doctors and nurses) in ophthalmology Lack of equipments and instruments to perform basic procedures Lack of advocacy due to dysfunctional national prevention of blindness society Lack of specific budgetary allocation towards eye programs What are the proposed actions to strengthen eye health services and prevention of blindness services in your country? Continue with the national prevention of blindness programs/VISION 2020 national plan Greater involvement and integration of the public/private sector in the national VISION 2020 plans More public awareness and education programs. What are the proposed actions to strengthen inclusive education services in your country? National education in regards to risk factors. Persons with risk factors (over forty years, family history) should look for an eye exam. i.e. optic disc assessment plus IOP Identify opportunities for adding basic screening methods for chronic diseases. To re-establish an allied health personnel program in ophthalmology. What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country? To reduce the causes of preventable blindness in Grenada through implementing programs of VISION 2020 which comprise of; Disease control Human resource development and The availability of infrastructure and technologies.

90

National VISION 2020 Data

Country: Guyana Year of data: 2011 Country Population: 751,223 Source(s) of National V2020 data: Situation Analysis Approved by VISION 2020 National Committee or MOH: 1. Central Organization, Leadership and Governance
Is there a signed National Declaration in support of VISION 2020? Did your country celebrate World Sight Day or other eye health related days in this period? Is there an active National Vision 2020 Committee Was there a National V2020 workshop / meeting / conference organized in the past year? Is there a designated focal person to assist the V2020 Committee and MoH? Yes Yes

Yes

Yes Yes No if yes state the focus / theme of the activity

Provide contact information: Mr. Baldeo James Chief Medex Ministry of Health Tel: 226- 1560 or 614 7922 Email: bjames@health.gov.gy Provide an electronic copy:

Is there a National Vision 2020 strategic framework approved by the Ministry of Health? Is your country implementing a National Vision 2020 plan? Is eye health included in National health plans, policies and systems? What is the Governments financial contribution to Eye Health?

Not as yet

No No

Briefly explain and provide results /progress: Provide reference and electronic copy of relevant policies, plans:

Provide in local currency (& USD$ official conversion) figures and % of annual Health Budget. G $ 96 Million / US $ 480 Thousand

91

2. Disease Control
Cataract How many cataract surgeries were performed in the public sector in this period? 575 at GPHC and 489 at Port Mourant Hospital by the Cuban team. Approximately, 650 cataract operations were performed in the private sector. 489 at Port Mourant Hospital by the Cuban team. 1714 No

How many cataract surgeries were performed in the private sector in this period?

Glaucoma

How many cataract surgeries were performed by others in this period (e.g. Cuban initiative, volunteers, etc.)? Total number of cataract surgeries for this period Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at : http://www.cehjournal.org/files/s1001.html Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country? Are glaucoma eye medications included in the subsidized drug list?

No

Yes All medications are completely free. No No

Diabetic Has a Diabetic retinopathy Services situation analysis Retinopathy been conducted in your country? Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program? Is digital photography screening available in a. public sector, b. private sector Are diabetic patients routinely referred to ophthalmology units for examination? Are laser treatment services available in g. public sector b. private sector Childhood Is there any documentation on causes of childhood Blindness blindness in the country? Is there a national Retinopathy of Prematurity (ROP) prevention policy? Are there ROP screening and treatment services available? How many children were treated for ROP in this period?

l. No m. No No. Not routine. a. No b. Yes (Data not available) No No Yes, Only screening. None

92

Is eye care integrated into maternal and child health programs? Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and treatment?

Yes. No paediatric ophthalmologists. Paediatric examination equipment is limitedly available. Data not available

Refractive Error

Please provide the following information annually: 19. Total number of children examined in outpatients departments of eye health facilities 20. Total number of paediatric cataract surgeries 21. Total number of other paediatric eye surgeries Are there refractive error services available in the public sector? Is there a school screening programme being implemented? Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker)

Yes, this is done through Eye Care Guyana/ Government. Yes Yes. Eye Care Guyana Lab produces spectacles which is priced between G$6,500-10,000 6596 spectacles were dispense for 2011 Yes

Low Vision

Provide the number of spectacles dispensed per year (from public and not-for-profit sector): Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age) Are Low Vision services available with 19. Trained professional(s), 20. the necessary equipment and 21. Low Vision appliances available? Please specify if in the public sector, private sector, both or none Are there any national plans for inclusive education? Are there any national plans for rehabilitation / adjustment to blindness?

1. Yes 2. Limited equipment 3. Extremely limited (All public sector) Yes ( Copy of the Document needed) No. Services are available but not under any formal regulation.

Inclusive Services

93

3. Human Resources
Ophthalmologists Total number of ophthalmologists in country Total number of ophthalmologists performing surgery in public sector Total number of ophthalmologists performing surgery in private sector Number of Optometrists in public sector Number of Optometrists in private sector Total number in country Total number in country 13 7 2 2 13 12 24 ( this figure is for both Ophthalmic nurses/assistants)

Optometrists

Refractionists Ophthalmic nurses

Ophthalmic assistants Primary Health Care personnel trained in Eye Health

Total number in country Total number trained in this period: 37 This training seeks to promote Eye health awareness and screening of children and adults at the community level. It will also develop the ability in the persons trained to identify and refer cases.

4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department? Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period? No No

94

5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country)
Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: Decrease in cataract surgery load ; Establishment of Vision Centres in 8 of the 10 administrative regions; Two medical doctors are on scholarships being trained as Ophthalmologists; Continuation of the BSc Optometry program started at University of Guyana Establishment of National Eye Hospital in outlying region. Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: Shortage of trained eye care personnel to reach the entire population Lack of Ophthalmic equipment in hospitals Lack of financial resources for training and to equip hospitals Available services are overburdened Services still not accessible to all

What are the proposed actions to strengthen eye health services and prevention of blindness services in your country? Train more eye care personnel at all levels; Need for more outreach activities to make services more accessible to all; Upgrade GPHC Ophthalmology Department to a tertiary level Placement of trained eye care personnel at regional centres What are the proposed actions to strengthen inclusive education services in your country? Training of teachers Provision of Learning material and equipment. What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country? Develop a national plan for rehabilitation services/ adjustment to blindness services

95

National VISION 2020 Data

Country: Haiti Year of data: 2012 Country Population: 10 000 Source(s) of National V2020 data: CNPC-Haiti Approved by VISION 2020 National Committee or MOH: Y 1. Central Organization, Leadership and Governance
Is there a signed National Declaration in support of VISION 2020? Did your country celebrate World Sight Day or other eye health related days in this period? Y 2000 Y World Glaucoma day : Television Conference and an open clinic day World Sight day : Interview on radios Y The Committee meets two times a month N

Y/N

Is there an active National Vision 2020 Committee

Was there a National V2020 workshop / meeting / conference organized in the past year? Is there a designated focal person to assist the V2020 Committee and MoH? Is there a National Vision 2020 strategic framework approved by the Ministry of Health? Is your country implementing a National Vision 2020 plan? Y/N

Y/N

Y/N

Is eye health included in National health plans, policies and systems? What is the Governments financial contribution to Eye Health?

Y/N

Provide contact information: Valery Blot (cnpcht@gmail.com, valeryblot@yahoo.fr ) Provide an electronic copy: we do have one National V2020 plan that has been shared with the MOH, but not officially approved. But now now we have a signed contract with the MOH since June 2012 recognizing our work. Briefly explain and provide results /progress: Y Human Resources : 6 residents are in ophthalmology, 3 optometrist are in training Infrastructure: 2 hospitals has been provided with equipment Provide reference and electronic copy of relevant policies, plans:

The MOH does not have a financial contribution particularly for eye care, this year 9% of the budget is allocated to health versus 5% last year. The way the government contributes is 96

by paying salary of the ophthalmologists that works in government institutions, and within those institutions they put regular nurses to work in the services. For materials, the service of ophthalmology does a requisition just like other services, and they are given only when available.

2. Disease Control
Cataract How many cataract surgeries were performed in the public sector in this period? How many cataract surgeries were performed in the private sector in this period? How many cataract surgeries were performed by others in this period ? other here are institution finance by NGO, church Total number of cataract surgeries for this period Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at : http://www.cehjournal.org/files/s1001.html Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country? 1509 96

Dont know

Glaucoma

Are glaucoma eye medications included in the subsidized drug list? Diabetic Has a Diabetic retinopathy Services situation analysis Retinopathy been conducted in your country? Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program? Is digital photography screening available in a. public sector, b. private sector Are diabetic patients routinely referred to ophthalmology units for examination? Are laser treatment services available in h. public sector (Is non in the public sector, if not please indicate) b. private sector Childhood Blindness Is there any documentation on causes of childhood blindness in the country? Is there a national Retinopathy of Prematurity (ROP) prevention policy?

We do not have a national program, but we do sensitisation on the spot No N. N

n. Y/N state number screened o. Y/N state number screened N 1 only in the private sector

No No 97

Refractive Error

Are there ROP screening and treatment services available? How many children were treated for ROP in this period? Is eye care integrated into maternal and child health programs? Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and treatment? Please provide the following information annually: 22. Total number of children examined in out-patients departments of eye health facilities 23. Total number of paediatric cataract surgeries 24. Total number of other paediatric eye surgeries Are there refractive error services available in the public sector?

No We do not have that information No No

We do not have that information

Yes, we have 3 public institutions that provide eye care. They have basic materials to the refraction and prescribe glasses (eye charts, box of glass) Y A school screening program was happening in form of a project by a partner (Iris Mundial in one locality) but there is not yet a government program for that. No we do not have one, but we plan to have one at SHAA No available

Is there a school screening programme being implemented?

Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker) Provide the number of spectacles dispensed per year (from public and not-for-profit sector): Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age) Are Low Vision services available with 22. Trained professional(s),

Y/N

Low Vision

N 98

Inclusive Services

23. the necessary equipment and 24. Low Vision appliances available? Please specify if in the public sector, private sector, both or none Are there any national plans for inclusive education?

N N

Are there any national plans for rehabilitation / adjustment to blindness?

Yes there is a plan with the Ministry of education 2011-2016 No, all the activity in that sector are within a project with NGOS

99

3. Human Resources
Ophthalmologists Total number of ophthalmologists in country Total number of ophthalmologists performing surgery in public sector Total number of ophthalmologists performing surgery in private sector Number of Optometrists in public sector Number of Optometrists in private sector Total number in country Total number in country Total number in country Total number trained in this period: 50 58 5 58 0 3 3 0 0 They trained in simple eye care for the community.

Optometrists

Refractionists Ophthalmic nurses Ophthalmic assistants Primary Health Care personnel trained in Eye Health

4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department? Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period? N

Y Lack of equipment, ancient equipments

5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country)
Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: - Signed document with the MOH in July 2012 - Participation in putting primary eye care in the curricula of health agents Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: Not enough advocacy with all actors on the field to understand the concept of blindness prevention. Lack of financial autonomy for CNPC Lack of message of education for the population 100

What are the proposed actions to strengthen eye health services and prevention of blindness services in your country? - Increase Communication - Increase the pool of persons working in eye care What are the proposed actions to strengthen inclusive education services in your country? - Training of teachers - Training school in education skills for different subject as maths... - Utilization of new logistics for education - Reinforcing education by providing more adapted equipment What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country? - Integrating activities to do screening with various institutions (e.g. HUEH, with CNPC when we do mobile clinic) - Supervision and Evaluation RFO on a regularly basis to reinforce the work.

101

National VISION 2020 Data

Country: Jamaica Date: September, 2012 Country Population: 2.706,300 (STATIN, 2011)1 Source(s) of National V2020 data: MOH Approved by VISION 2020 National Committee or MOH: Y/N 1. Central Organization, Leadership and Governance
Is there a signed National Declaration in support of VISION 2020? Did your country celebrate World Sight Day or other eye health related days in this period? Y/N - If yes, give date signed and name of Signatory Y/N if yes include a brief summary of activities Celebration 2012 to include Press release (PAHO/MOH)& local displays on diabetic eye disease Y/N if yes how frequently does the Committee meet? Small groupings of persons, each grouping (subcommittee) working on a specific strategic direction. Expect in the coming months to launch an overarching Committee, to facilitate monitoring, coordination etc. MOH actively seeking a Chairman Was there a National V2020 workshop / meeting / conference organized in the past year? Y/N if yes state the focus / theme of the activity No major workshop/meeting this year. Smaller group meetings held. Provide contact information: In the MOH, the current focal is Dr. Yasmin Williams( williamsy@moh.gov.jm) Provide an electronic copy: Draft Strategic Plan for finalization

Is there an active National Vision 2020 Committee

Is there a designated focal person to assist the V2020 Committee and MoH? Is there a National Vision 2020 strategic framework approved by the Ministry of Health? Is your country implementing a National Vision 2020 plan?

Y/N

Y/N

Y/N

Briefly explain and provide results /progress: Yes. 1) Development of policyguidelines for management of: a)Retinopathy of Prematurity 102

Is eye health included in National health plans, policies and systems?

What is the Governments financial contribution to Eye Health?

b) Programs for detecting refractive errors in Children 2) Development of a pilot project targeting diabetic retinopathy/diabetic eye disease Y/N Provide reference and electronic copy of relevant policies, plans: Dialogue ongoing for inclusion of eye health in adolescent strategic plan (refractive error in school children), safe motherhood (ROP) and PAHO/MOH Improvement of Health Information System Provide in local currency (& USD$ official conversion) figures and % of annual Health Budget. No specific budget for EYE Health, integrated in budget for primary and secondary health care service delivery

103

2. Disease Control
Cataract How many cataract surgeries were performed in the public sector in this period? All data from regional public hospitals not currently available. Data only available for patients admitted as inpatients at the Regional Hospitals (as per table attached) Not known For data from Cuba/ Jamaica Program, see table attached to this form Unable to say right now Y/N

How many cataract surgeries were performed in the private sector in this period? How many cataract surgeries were performed by others in this period (e.g. Cuban initiative, volunteers, etc.)?

Total number of cataract surgeries for this period Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at : http://www.cehjournal.org/files/s1001.html Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country? Are glaucoma eye medications included in the subsidized drug list?

Glaucoma

Y/N if yes provide a brief description Y/N if yes provide a brief explanation Glaucoma medication available from the public health facilities. Additionally all citizens can access subsidized glaucoma medications through the Governments NHF programme which supports persons with chronic diseases for access medication Y/N if yes state when the analysis was carried out. 104

Diabetic Has a Diabetic retinopathy Services situation analysis Retinopathy been conducted in your country?

Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program? Is digital photography screening available in a. public sector, Not yet b. private sector, Yes

Y/N

Are diabetic patients routinely referred to ophthalmology units for examination? Are laser treatment services available in i. public sector . Yes b. private sector Yes

Childhood Blindness

Is there any documentation on causes of childhood blindness in the country? None known Is there a national Retinopathy of Prematurity (ROP) prevention policy? Yes Are there ROP screening and treatment services available? Yes How many children were treated for ROP in this period? Data only available for Bustamante Hospital Is eye care integrated into maternal and child health programs? Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and treatment?

p. Y/N state number screened q. Y/N state number screened Unable to state Y/N state number referred a. Y/N state number treated # only currently available for Cuba Jamaica Program b. Y/N state number treated Unable to state #s Treated Y/N if yes provide electronic copy Y/N please provide electronic copy Y/N See attached table Y/N if yes, how? To some extent as part of neonatal care Y/N No pediatric ophthalmologist but equipment at Bustamante Children Hospital See attached table

Refractive Error

Please provide the following information annually: 25. Total number of children examined in out-patients departments of eye health facilities 26. Total number of paediatric cataract surgeries 27. Total number of other paediatric eye surgeries Are there refractive error services available in the public sector?

Y/N if yes provide a brief description No specific programme thrust in 105

Is there a school screening programme being implemented?

Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker)

Provide the number of spectacles dispensed per year (from public and not-for-profit sector): Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age) Are Low Vision services available with 25. Trained professional(s), 26. the necessary equipment and 27. Low Vision appliances available? Please specify if in the public sector, private sector, both or none Are there any national plans for inclusive education?

the public sector where refraction would be done as part of routine eye exam as needed Y/N if yes provide a brief description Support ongoing by NGOs. Needing coordination, Monitoring and support Y/N Definition of medium income worker unclear. Subsidy available for children through NGO (Lions Club) Data not available

Y/N No specific programme

Low Vision

Inclusive Services

Are there any national plans for rehabilitation / adjustment to blindness?

Y/N Y/N Y/N Limited access nationally. Y/N please provide electronic copy(s) Included in draft plan Y/N please provide electronic copy(s) Included in draft plan

106

3. Human Resources
Ophthalmologists Total number of ophthalmologists in country Listing of 34 0phthalmologists practising to be verified & categorized by the Jamaica Ophthalmology Association --------Listing of 15 optometrists to be verified by the Optometrists Association --------Data unavailable ----Brief description of training activity(s)

Optometrists

Total number of ophthalmologists performing surgery in public sector Total number of ophthalmologists performing surgery in private sector Number of Optometrists in public sector Number of Optometrists in private sector Total number in country Total number in country Total number in country Total number trained in this period: No specific primary care focused training this year. Previously, nurses in nurseries and on the ophthalmology service trained re guidelines for the prevention and management of ROP

Refractionists Ophthalmic nurses Ophthalmic assistants Primary Health Care personnel trained in Eye Health

4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department? Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period? Y/N

Y/N if yes what are the findings

5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country)
Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: Development of a Pilot Teleophthalmology Program for Diabetic Retinopathy 107

Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: Personnel Money

What are the proposed actions to strengthen eye health services and prevention of blindness services in your country? The development of a productive intersectoral National Vision 20/20 Committee What are the proposed actions to strengthen inclusive education services in your country? The mobilization of an effective Low Vision Subcommittee chaired by the Jamaica Society for the Blind What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country? The mobilization of an effective Low Vision Subcommittee chaired by the Jamaica Society for the Blind

ATTACHMENTS; 1) CUBA JAMAICA PROGRAMME DATA Year # Total persons Screened selected with cataract, DR, pyterygium 2092 8366 3887 876 3706 1460 # Persons diagnosed with Cataract # Cataract Surgery Done Total persons diagnosed with diabetic retinopathy # persons who had laser therapy for diabetic retinopathy 196 315 235

2012 2011 2010

730 1751 701

420 913 590

107 1603 321

2) DATA FROM THE BUSTAMANTE HOSPITAL FOR CHILDREN ITEM Diagnosed Retinopathy of Prematurity (ROP) Total persons seen in Eye Outpatient Department Total persons having Eye Surgery Year: 2010 362 Year: 2011 479

3142 88

3780 60

108

3) DISCHARGE SUMMARY DATA : Inpatients for cataract surgery 2008 2009 2010*provisional REGIONAL 2007 HOSP Kingston 138 78 6 Public Hospital Cornwall 55 78 14 18 Regional Hospital Mandeville 0 2 5 1 Regional

Reference 1) Statistical Institute of Jamaica, http:statinja.gov.jm/Demo_socialpopulation.aspx (as of May 17th 2012)

109

National VISION 2020 Data

Country: ST.KITTS AND NEVIS Year of data: 2011 Country Population: (40,120 + 12,530) 52,650 Source(s) of National V2020 data: Annual reports Approved by VISION 2020 National Committee or MOH: Y/N 1. Central Organization, Leadership and Governance
Is there a signed National Declaration in support of VISION 2020? Did your country celebrate World Sight Day or other eye health related days in this period? Y/N - If yes, give date signed and name of Signatory Y/N if yes include a brief summary of activities: A World Sight Day March and Ophthalmic Screening of Elderly at Cardin Home Y/N if yes how frequently does the Committee meet? Y/N if yes state the focus / theme of the activity:

Is there an active National Vision 2020 Committee Was there a National V2020 workshop / meeting / conference organized in the past year? Is there a designated focal person to assist the V2020 Committee and MoH? Is there a National Vision 2020 strategic framework approved by the Ministry of Health? Is your country i6mplementing a National Vision 2020 plan? Is eye health included in National health plans, policies and systems? What is the Governments financial contribution to Eye Health? Y/N

Provide contact information:

Y/N

Provide an electronic copy:

Y/N

Y/N

Briefly explain and provide results /progress: The Vision 2020 plan is being implemented at the Institutional level only Provide reference and electronic copy of relevant policies, plans: It is being included in draft policies and plans.

Provide in local currency (& USD$ official conversion) figures and % of annual Health Budget. Government expenditure is not disaggregated specifically for Programmes, therefore it is difficult to ascertain.

110

2. Disease Control
Cataract How many cataract surgeries were performed in the public sector in this period? How many cataract surgeries were performed in the private sector in this period? How many cataract surgeries were performed by others in this period (e.g. Cuban initiative, volunteers, etc.) USA Total number of cataract surgeries for this period Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at : http://www.cehjournal.org/files/s1001.html Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country? Are glaucoma eye medications included in the subsidized drug list? 36 St. Kitts

Not available 54 (by visiting Ophthalmologist in Nevis) 90 Y/N

Glaucoma

Y/N if yes provide a brief description Y/N if yes provide a brief explanation Timolol Y/N if yes state when the analysis was carried out.2011 Y/N

Diabetic Has a Diabetic retinopathy Services situation analysis Retinopathy been conducted in your country? Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program? Is digital photography screening available in a. public sector, b. private sector Are diabetic patients routinely referred to ophthalmology units for examination? Are laser treatment services available in j. public sector b. private sector Childhood Blindness Is there any documentation on causes of childhood blindness in the country? Is there a national Retinopathy of Prematurity (ROP) prevention policy

r. Y/N state number screened s. Y/N state number screened Y/N state number referred 82 a. Y/N state 19 number treated b. Y/N state number treated Y/N if yes provide electronic copy Y/N please provide electronic copy ? Plans are being developed to screen all premature infants. Y/N Children are screened by General 111

Are there ROP screening and treatment services available?

Ophthalmologist How many children were treated for ROP in this period? Is eye care integrated into maternal and child health programs? Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and treatment? Please provide the following information annually: 28. Total number of children examined in out-patients departments of eye health facilities 29. Total number of paediatric cataract surgeries 30. Total number of other paediatric eye surgeries Are there refractive error services available in the public sector? Is there a school screening programme being implemented? 01 by General Ophthalmologist Y/N if yes, how? Y/N

Refractive Error

Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker) Provide the number of spectacles dispensed per year (from public and not-for-profit sector): Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age) Are Low Vision services available with 28. Trained professional(s), 29. the necessary equipment and 30. Low Vision appliances available? Please specify if in the public sector, private sector, both or none Are there any national plans for inclusive education? Are there any national plans for rehabilitation / adjustment to blindness?

320 NONE NONE Y/N if yes provide a brief description Y/N if yes provide a brief description Screening of eight (8) year olds Y/N

N/A Y/N Annual Free Eye Screening Programme Y/N Y/N Y/N

Low Vision

Inclusive Services

Y/N please provide electronic copy(s) Y/N please provide electronic copy(s)

112

3. Human Resources
Ophthalmologists Total number of ophthalmologists in country Total number of ophthalmologists performing surgery in public sector Total number of ophthalmologists performing surgery in private sector Number of Optometrists in public sector Number of Optometrists in private sector Total number in country Total number in country Total number in country Total number trained in this period: 0 2 1 1 0 2 2 3 0 Brief description of training activity(s)

Optometrists

Refractionists Ophthalmic nurses Ophthalmic assistants Primary Health Care personnel trained in Eye Health

4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department? Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period? Y/N Adequate Y/N if yes what are the findings By corporate partners findings not available

5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country)
Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: 1. Positive response to annual free eye screening programme 2. Positive response to World Sight Day March persons presented for screening. 3. A total of 376 children, 8 year olds screened 4. Increased attendance of persons with diabetes mellitus for screening and follow-up care Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: 1. Limited staff numbers and skills 2. Limited equipment 113

What are the proposed actions to strengthen eye health services and prevention of blindness services in your country? 1. Training of personnel in Ophthalmic techniques 2. Lobby for Ophthalmologist trained in ROP/Paediatric Ophthalmology 3. Implementation of a National V2020 plan and establishment of a Nat V2020 Committee 4. Lobby for up-to-date equipment What are the proposed actions to strengthen inclusive education services in your country? Education/Sensitization programmes, utilizing the media

What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country? To improve relationship with Blind Society.

114

National VISION 2020 Data

Country: ST. LUCIA Year of data: November 2011 OCTOBER 2012 Country Population: 176,000 as of 2011 Source(s) of National V2020 data: SLBWA/MOH Approved by VISION 2020 National Committee or MOH: Yes 1. Central Organization, Leadership and Governance
Is there a signed National Declaration in support of VISION 2020? Yes Memorandum of Association between Government of St. Lucia and St. Lucia Blind Welfare Assoc. Signed on 18/10/2004 by the then Minister and Permanent Secretary of the MOH and the President of SLBWA World Sight Day and White Cane Day celebrated with sensitization sessions, free eye screening and examinations and participation in community health fairs

Did your country celebrate World Sight Day or other eye health related days in this period?

Is there an active National Vision 2020 Committee

Yes The Committee meets on a quarterly basis Was there a National V2020 workshop / meeting / Yes Four meetings were held in conference organized in the past year? the year where members shared information on activities held. During one of the meetings members were addressed by Officers of the Value Added Tax (VAT) team. VAT is now implemented in St. Lucia. Abuse of the elderly was discussed at the last meeting. Is there a designated focal Y/N Yes Nurse Juliette Joseph person to assist the V2020 Assistant Principal Nursing Officer Committee and MoH? Tel: (758) 452 2301/468 5383 communityhealthp@yahoo.com Nurse Joseph is the Co-chairperson of the Committee Is there a National Vision Y/N Yes Copy of Memorandum between 2020 strategic framework Government of St. Lucia (MOH) and SLBWA approved by the Ministry of attached Health?

115

Is your country implementing a National Vision 2020 plan? Is eye health included in National health plans, policies and systems? What is the Governments financial contribution to Eye Health?

Y/N Y/N

There is an existing Plan for the period 2010 2014 which was updated in January 2011 Yes Eye Health is one of the priority areas under National Strategic Plan for Health 2006 2011, soon to be revised

Annual subvention of EC$76,000.00 plus duty free concessions to SLBWA. Direct percentage not readily available.

2. Disease Control
Cataract How many cataract surgeries were performed in the public sector in this period? 115 Males, 386 Females and 10 children Unknown 108 Males, 175 Females and 1 child 223 Males, 561 Females, 11 child No

How many cataract surgeries were performed in the private sector in this period? How many cataract surgeries were performed by others in this period (e.g. Cuban initiative, volunteers, etc.)? Total number of cataract surgeries for this period Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at : http://www.cehjournal.org/files/s1001.html Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country?

Glaucoma

Are glaucoma eye medications included in the subsidized drug list? Diabetic Has a Diabetic retinopathy Services situation analysis Retinopathy been conducted in your country? Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program? Is digital photography screening available in a. public sector,

The Saint Lucia Glaucoma Association was formed in 2008. Currently there is an ongoing Selective Laser Trabeculoplasty Study measuring repeatability of laser treatments No No Yes

t. No u. Yes number 116

b. private sector Are diabetic patients routinely referred to ophthalmology units for examination? Are laser treatment services available in k. public sector b. private sector Childhood Blindness Is there any documentation on causes of childhood blindness in the country? Is there a national Retinopathy of Prematurity (ROP) prevention policy? Are there ROP screening and treatment services available? How many children were treated for ROP in this period? Is eye care integrated into maternal and child health programs?

unavailable Yes Approximately 3000 a. Yes 214 for retina b. Yes numbers unknown No No No None Yes Eye health is a component of developmental screening and assessment Yes by Locum Ophthalmologists. Phaco emulsification machine and sterilizer available 1. 4,078 2. 10 3. 37

Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and treatment?

Refractive Error

Please provide the following information annually: 31. Total number of children examined in out-patients departments of eye health facilities 32. Total number of paediatric cataract surgeries 33. Total number of other paediatric eye surgeries Are there refractive error services available in the public sector?

Is there a school screening programme being implemented?

Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker) Provide the number of spectacles dispensed per year (from public and not-for-profit sector):

SLBWA/ECSL as well as the Cuban Initiative provide refractive error services Ongoing services provided by SLBWA and Community Health nurses Yes at SLBWA/ECSL

1,425

117

Low Vision

Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age) Are Low Vision services available with 31. Trained professional(s), 32. the necessary equipment and 33. Low Vision appliances available? Please specify if in the public sector, private sector, both or none Are there any national plans for inclusive education?

SLBWA/ECSL and elsewhere

Yes Yes Yes at SLBWA and private sector

Inclusive Services

Yes extract from Education Sector Development Plan 2000-2005 attached No, however extract from SLBWAs Three Year Plan attached.

Are there any national plans for rehabilitation / adjustment to blindness?

118

3. Human Resources
Ophthalmologists Total number of ophthalmologists in country Total number of ophthalmologists performing surgery in public sector Total number of ophthalmologists performing surgery in private sector Number of Optometrists in public sector Number of Optometrists in private sector Total number in country Total number in country Total number in country Total number trained in this period: 25 5 5 all locums 2 2 7 3 3 1 Nurses and Community Health aides were trained

Optometrists

Refractionists Ophthalmic nurses Ophthalmic assistants Primary Health Care personnel trained in Eye Health

4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department? Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period? Yes

No

5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country)
Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: More cataract surgeries performed More persons trained in eye health at primary and tertiary level increased competency Increased participation in community health fairs early detection Greater collaboration between Government Ministries/faith based organisations and NGOs Greater access to eye health services such as screening, surgeries, supply of low vision aids etc. Increased sensitization of the public Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: 119

Limited financial and human resources Struggling economy especially with the implementation of Value Added Tax in October 2012 What are the proposed actions to strengthen eye health services and prevention of blindness services in your country? Opening of Vision Centre in the south of the island More training of volunteers Sourcing of funds Eye Health promotional activities Closer collaboration with private sector and other stakeholders What are the proposed actions to strengthen inclusive education services in your country? Review of existing Education Plan to determine the way forward What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country? Update client database system Strengthen human and financial resources

120

National VISION 2020 Data

Country: St Vincent and the Grenadines Year of data: Jan to Oct, 2012 Country Population: 110,000 Source(s) of National V2020 data: Hosp Records Approved by VISION 2020 National Committee or MOH: N 1. Central Organization, Leadership and Governance
Is there a signed National Declaration in support of VISION 2020? Did your country celebrate World Sight Day or other eye health related days in this period? Is there an active National Vision 2020 Committee Was there a National V2020 workshop / meeting / conference organized in the past year? Is there a designated focal person to assist the V2020 Committee and MoH? Is there a National Vision 2020 strategic framework approved by the Ministry of Health? Is your country implementing a National Vision 2020 plan? Is eye health included in National health plans, policies and systems? What is the Governments financial contribution to Eye Health? N N

N N N

N Y

???

121

2. Disease Control
How many cataract surgeries were performed in the public sector in this period? How many cataract surgeries were performed in the private sector in this period? How many cataract surgeries were performed by others in this period (e.g. Cuban initiative, volunteers, etc.)? Total number of cataract surgeries for this period Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at : http://www.cehjournal.org/files/s1001.html Glaucoma Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country? Are glaucoma eye medications included in the subsidized drug list? Diabetic Has a Diabetic retinopathy Services situation analysis Retinopathy been conducted in your country? Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program? Is digital photography screening available in a. public sector, b. private sector Are diabetic patients routinely referred to ophthalmology units for examination? Are laser treatment services available in l. public sector b. private sector Childhood Is there any documentation on causes of childhood Blindness blindness in the country? Is there a national Retinopathy of Prematurity (ROP) prevention policy? Are there ROP screening and treatment services available? How many children were treated for ROP in this period? Is eye care integrated into maternal and child health programs? Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and treatment? Please provide the following information annually: Cataract 54 ? 37

91 N

Y (timolol) N Y

v. N w. Y (not functional) Y a. Y aprox 120 b. N N Y Y ? (1) Y N

122

Refractive Error

34. Total number of children examined in out-patients departments of eye health facilities 35. Total number of paediatric cataract surgeries 36. Total number of other paediatric eye surgeries Are there refractive error services available in the public sector? Is there a school screening programme being implemented? Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker) Provide the number of spectacles dispensed per year (from public and not-for-profit sector): Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age) Are Low Vision services available with 34. Trained professional(s), 35. the necessary equipment and 36. Low Vision appliances available? Please specify if in the public sector, private sector, both or none Are there any national plans for inclusive education? Are there any national plans for rehabilitation / adjustment to blindness?

525 3 14 Y Y N

??? Y

Low Vision

N N N

Inclusive Services

N Y

123

3. Human Resources
Ophthalmologists Total number of ophthalmologists in country Total number of ophthalmologists performing surgery in public sector Total number of ophthalmologists performing surgery in private sector Number of Optometrists in public sector Number of Optometrists in private sector Total number in country Total number in country Total number in country Total number trained in this period: 5 2 2 1 5 3

Optometrists

Refractionists Ophthalmic nurses Ophthalmic assistants Primary Health Care personnel trained in Eye Health

Nil

4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department? Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period? Y

5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country)
Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: (not implemented) Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: (lack of resources, lack of initiative at the administrative- MoH level ) What are the proposed actions to strengthen eye health services and prevention of blindness services in your country? (Adequately equip the department, implement ongoing education programs ) 124

What are the proposed actions to strengthen inclusive education services in your country? (programs on the public media)

What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country? (equipping of the society of the blind with trained personnel and resources)

125

National VISION 2020 Data

Country: Suriname Year of data: 2012 Country Population: 540 000 Source(s) of National V2020 data: MOH Suriname ; Eye Centre Suriname AZP Approved by VISION 2020 National Committee or MOH: Yes, by MOH 1. Central Organization, Leadership and Governance
Is there a signed National Declaration in support of VISION 2020? Did your country celebrate World Sight Day or other eye health related days in this period? NO

Yes
World Sight Day 13 October 2012 was celebrated by the institute for the blinds together with the Eye Center Suirname AZP

Is there an active National Vision 2020 Committee Was there a National V2020 workshop / meeting / conference organized in the past year?

Glaucoom day 9 maart 2012

No Vision 2020 Committee Yes, organized by the institute for the blinds together with the Eye Centre Suriname AZP

Is there a designated focal person to assist the V2020 Committee and MoH? Is there a National Vision 2020 strategic framework approved by the Ministry of Health? Is your country implementing a National Vision 2020 plan? Is eye health included in National health plans, policies and systems? What is the Governments financial contribution to Eye Health?

NO

Provide contact information:

NO

Provide an electronic copy:

NO YES

Briefly explain and provide results /progress: Provide reference and electronic copy of relevant policies, plans: NHSP 2012 2016 and the OP 2012 - 2016

Provide in local currency (& USD$ official conversion) figures and % of annual Health Budget. According to the National Health Accounts 2006, the government spent 1.9% of the Total Health Expenditure (3,110,499 US $) for optical services

126

2. Disease Control
Cataract How many cataract surgeries were performed in the public sector in this period? How many cataract surgeries were performed in the private sector in this period? 2011: 3891 2011 2012 NO surgeries in the private sectors 2011 2012 No surgeries by others 2011: 3892 No

How many cataract surgeries were performed by others in this period (e.g. Cuban initiative, volunteers, etc.)? Total number of cataract surgeries for this period Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at : http://www.cehjournal.org/files/s1001.htm l Glaucoma Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country? Are glaucoma eye medications included in the subsidized drug list? Diabetic Has a Diabetic retinopathy Services situation analysis Retinopathy been conducted in your country? Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program? Is digital photography screening available in a. public sector, b. private sector Are diabetic patients routinely referred to ophthalmology units for examination?

No

YES No YES

x. YES 2011: 329 y. NO

YES numbers are not yet available because of the manual patient medical data registry (digital medical data is in progress) a. YES Eye Lite Laser: 667 JAG Laser: 653 b. NOT in private sector YES No YES 127

Are laser treatment services available in m. public sector b. private sector

Childhood Blindness

Is there any documentation on causes of childhood blindness in the country? Is there a national Retinopathy of Prematurity (ROP) prevention policy? Are there ROP screening and treatment services available?

How many children were treated for ROP in this period? Is eye care integrated into maternal and child health programs? Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and treatment?

NO Yes, paediatric ophthalmologists And equipment to perform paediatric examinations and treatment are available NO children are examined in out-patients departments of eye health facilities Total number of paediatric cataract surgeries : Pending Total number of other paediatric eye surgeries: pending Yes Yes , by the school health services and if children have problems they are referred to the GP / Eye specialists Yes

Please provide the following information annually: 37. Total number of children examined in outpatients departments of eye health facilities 38. Total number of paediatric cataract surgeries 39. Total number of other paediatric eye surgeries

Refractive Error

Are there refractive error services available in the public sector? Is there a school screening programme being implemented?

Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker) Provide the number of spectacles dispensed per year Estimates were not (from public and not-for-profit sector): available Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age) Are Low Vision services available with 37. Trained professional(s), 38. the necessary equipment and 39. Low Vision appliances available? Please specify if in the public sector, private sector, both or none Yes

Low Vision

Yes Yes Yes

128

Inclusive Services

Are there any national plans for inclusive education? Are there any national plans for rehabilitation / adjustment to blindness?

YES YES

3. Human Resources
Ophthalmologists Total number of ophthalmologists in country Total number of ophthalmologists performing surgery in public sector Total number of ophthalmologists performing surgery in private sector Number of Optometrists in public sector Number of Optometrists in private sector Total number in country Total number in country Total number in country Total number trained in this period: 0 9 9 0 1 4 (also performing in public sector) 17 18 5 Brief description of training activity(s)

Optometrists

Refractionists Ophthalmic nurses Ophthalmic assistants Primary Health Care personnel trained in Eye Health

4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department? Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period?
Yes, annually Sometimes also biannual

Yes. No problems with the equipment. There is a yearly maintenance program

5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country)
Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period:
Bilateral collaboration with the Rotterdam Oogziekenhuis since 2000: Training of ophthalmologists Introduction of new technologies

129

Establishment of EYE CARE CENTER in AZP (24 November 2009) Expeditions to the rural areas

Bilateral collaboration with Cuba: Milagro Project 2005 2009 Associate member WAEH september 2012 ( World Association of Eye Hospitals )

Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period:
Financing HCW o Ophthalmologists o Ophthalmic nurses/assistants o Community Eye Health personnel al trained in Eye Health Equipment Facilities : Mobile Eye clinic with operation theatre

What are the proposed actions to strengthen eye health services and prevention of blindness services in your country?
Cost effective modern technology Multidisciplinary well-trained teams

New building : Eye Hospital / Eye Center Ground floor : 12 doctors offices , 6 diagnostics rooms, 2 poli-clinical ORs, archive, reception First level : OR complex ( 3 ) , ward with 10 beds , offices, conference room/auditorium Scientific research

What are the proposed actions to strengthen inclusive education services in your country? Public awareness and patient education What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country?

Decentralized screening to Interior of Suriname, Nickerie , Moengo/albina Eye bus Outreach specialist care

130

National VISION 2020 Data

Country: Trinidad and Tobago Year of data: 2012 Country Population: 1.3 Million Source(s) of National V2020 data: Ministry of Health Approved by VISION 2020 National Committee or MOH:

Yes

1. Central Organization, Leadership and Governance Is there a signed National Declaration in support of Yes - If yes, give date signed and
VISION 2020? Did your country celebrate World Sight Day or other eye health related days in this period? name of Signatory Yes Activities included public awareness campaign and a walk-aton in which the Minister participated No N/A

Is there an active National Vision 2020 Committee Was there a National V2020 workshop / meeting / conference organized in the past year? Is there a designated focal person to assist the V2020 Committee and MoH? Is there a National Vision 2020 strategic framework approved by the Ministry of Health? Is your country implementing a National Vision 2020 plan? Is eye health included in National health plans, policies and systems? What is the Governments financial contribution to Eye Health? Yes

Ms Carla Ruiz Research Officer Ministry of Health, 63 park Street, Port of Spain:

No

No Yes

The Plan has not yet been developed Optometry Policy in the final stages of being developed to regulate the practice of Optometry. Vision Plan to be developed.

The Government provides a global health budget which is not disaggregated by specific areas.

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2. Disease Control
Cataract How many cataract surgeries were performed in the public sector in this period? How many cataract surgeries were performed in the private sector in this period? How many cataract surgeries were performed by others in this period (e.g. Cuban initiative, volunteers, etc.)? Total number of cataract surgeries for this period Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at : http://www.cehjournal.org/files/s1001.html Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country? Are glaucoma eye medications included in the subsidized drug list?

Yes

Glaucoma

No

Diabetic Has a Diabetic retinopathy Services situation analysis Retinopathy been conducted in your country? Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program? Is digital photography screening available in a. public sector, b. private sector Are diabetic patients routinely referred to ophthalmology units for examination? Are laser treatment services available in n. public sector b. private sector Childhood Blindness Is there any documentation on causes of childhood blindness in the country? Is there a national Retinopathy of Prematurity (ROP) prevention policy? Are there ROP screening and treatment services available? How many children were treated for ROP in this period?

Yes. Glaucoma medication is provided through the Chronic Disease Assistance Programme (CDAP) No Yes

z. No aa. Y Data not available Yes Data not available a. Yes Data not available. b. Yes Data not available Yes No Yes. This is done through the School Health Programme Data not available 132

Refractive Error

Is eye care integrated into maternal and child health programs? Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and treatment? Please provide the following information annually: 40. Total number of children examined in out-patients departments of eye health facilities 41. Total number of paediatric cataract surgeries 42. Total number of other paediatric eye surgeries Are there refractive error services available in the public sector? Is there a school screening programme being implemented?

No Y/N

Yes Yes. This is a component of the School Health Programme Yes. This is done collaboratively by the Ministries of Health and the People and Social Development Data not available

Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker)

Provide the number of spectacles dispensed per year (from public and not-for-profit sector): Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age) Are Low Vision services available with 40. Trained professional(s), 41. the necessary equipment and 42. Low Vision appliances available? Please specify if in the public sector, private sector, both or none Are there any national plans for inclusive education? Are there any national plans for rehabilitation / adjustment to blindness?

Yes. This service is provided in both public and private health institutions. Yes - Both Yes - Both Yes - Both

Low Vision

Inclusive Services

No Yes. This is being done in collaboration with the private and NGO sectors

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3. Human Resources
Ophthalmologists Total number of ophthalmologists in country Total number of ophthalmologists performing surgery in public sector Total number of ophthalmologists performing surgery in private sector Number of Optometrists in public sector Number of Optometrists in private sector Total number in country Total number in country Total number in country Total number trained in this period: 37 18 19 1 114 Data not available Data not available Data not available Data not available

Optometrists

Refractionists Ophthalmic nurses Ophthalmic assistants Primary Health Care personnel trained in Eye Health

4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department? Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period? Yes.

No

5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country)
Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: The decision by the Ministry of Health to conduct a National Eye Survey to guide the development of vision policies and plans for the national population.

Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: A shortage of qualified staff in the public health sector. Most of the vision care is currently provided in the private sector. 134

What are the proposed actions to strengthen eye health services and prevention of blindness services in your country? 1. Increase vision screening 2. Increase public health education and health promotion activities focussed on healthy lifestyles and chronic disease. 3. Recruit additional qualified staff and offer scholarships and bursaries to interested and qualified nationals What are the proposed actions to strengthen inclusive education services in your country?

What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country? The Ministry of Health is in the process of recruiting a Consultant to conduct a National Eye Survey. The results of this survey will be used to guide the development of vision policies and programmes for the national population.

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Rapid assessment of avoidable blindness survey methodology

Rapid assessment of avoidable blindness (RAAB) is a rapid survey methodology developed at the International Centre for Eye Health (ICEH). It is a population based survey of visual impairment and eye care services among people aged 50 years and over. RAAB can provide the prevalence of blindness and visual impairment, its main causes, the output and quality of eye care services, barriers, cataract surgical coverage and other indicators of eye care services in a specific geographical area.

What RAAB is not

RAAB is not a case-finding exercise: it will not provide a list of names and addresses of all people who are blind due to (for example) cataract in an area. RAAB is not a detailed blindness survey: it provides a reasonably accurate estimate of the prevalence of blindness, and the proportion that is avoidable in a geographic area. RAAB is not designed to give accurate estimates of the prevalence of specific causes of blindness and does not measure posterior segment disease in detail. RAAB focuses on people aged 50 years and above and so it does not give an estimate of childhood blindness, which is better measured through the Key Informant Method. RAAB also does not assess the need for refractive error services.

Why carry out a RAAB survey?

There are two main reasons to collect RAAB survey data on blindness and visual impairment in a community. 1. To help eye health managers develop intervention programmes for control of blindness based on a community's needs. 2. To help to monitor existing blindness control programmes and to adjust these programmes as and when required. RAAB survey data provides only some of the information needed to plan intervention programmes. A situational analysis document, which can be found at the following link, reviews all the information needed to plan for blindness control programmes at the district level https://www.iceh.org.uk/download/attachments/13571380/situationanalysis.pdf?version=1& modificationDate=1281948284000

Who can carry out a RAAB survey?

The entire process of carrying out a RAAB survey, from planning to the collection of field data, data analysis and report writing, can be conducted by local staff. Three or four teams with transport can cover the usual required sample size in a period of 4-5 weeks, including one week of training. The collection of data can be done by local ophthalmologists, residents in ophthalmology, or experienced ophthalmic assistants, together with an assistant who does not need to be medically trained. Local staff can also enter the data directly into the software package.

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Want to carry out your own RAAB survey?

Good planning and organisation are vital for success
Although RAAB has the word "rapid" in its title it is neither easy nor straightforward to undertake. If the RAAB is not undertaken carefully and to a high quality then it will give biased results which will not help with planning or monitoring and will have wasted time and money. RAABs therefore need to be planned and undertaken carefully and we strongly advise you to co-ordinate with an ICEH certified RAAB trainer when planning a RAAB. The trainer can help with the preparations for the RAAB as well as train the staff and monitor the fieldwork during its early stages. Contact details for regional trainers for RAAB are given in this document. All RAAB activities should be organised by a Survey Coordinator who starts work before the actual field survey takes place; developing the sampling frame for the survey carrying out a baseline needs assessment Selecting the clusters to be examined Recruiting survey personnel Arranging scheduling and transport & equipment logistics Organising and ensuring the quality of the staff training Managing the data - collecting survey records, managing data entry, analysis and report writing

Top tips for a successful RAAB survey Planning 1. Work with a certified RAAB trainer while planning a RAAB. 2. Do not underestimate the amount of time and effort involved in undertaking a RAAB. 3. Plan a RAAB where the information is needed to plan, monitor and/or advocate for services, working with local eye care providers. 4. The certified RAAB trainer should ensure that the sampling frame is appropriate for selecting clusters before the start of the training. 5. Don't leave things until the RAAB starts - make sure sufficient funds in place for all aspects of the RAAB (training, staff, transport etc) and that relevant authority approvals, logistics, equipment, printing, office and so on are all ready before the RAAB is started. Training 1. A RAAB certified trainer should undertake the training for RAAB. 2. The venue for the class room training part should be a simple room that has facilities for seating, projection and place for practicing vision tests. 3. All members of the survey team should attend all the training sessions. 4. The equipment that will be used in the RAAB survey should always be part of the training sessions. 5. Pre-training arrangements should include decision on where the IOV exercise and pilot RAAB survey will be done and be part of the training time table.

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Fieldwork 1. The RAAB fieldwork should start immediately after the training and should continue without long gaps. 2. The RAAB protocol should be followed, especially the examination of eligible people in their own houses. 3. The teams who will undertake the RAAB must commit for the full time duration including training and a per-diem should be agreed. 4. For team recruitment consider local customs (e.g have female team members in communities where there is such need) and make sure the team are prepared for long hours of walking in communities. Fieldwork experience is an advantage. 5. Data should be double-entered as soon as possible after data collection (ideally on the same day) to correct possible errors. This data should be backed up regularly. Reporting and service provision 1. "No Survey without Service" should be emphasized. People identified with eye problems in the survey should be referred to an appropriate service. 2. The results of the RAAB must be written up in a report and presented to the relevant stakeholders. 3. Stakeholders should be encouraged to use RAAB results to inform planning of services. 4. Advocacy after RAAB on the results to the authorities where RAAB was carried out and information sharing is absolutely important to build service delivery initiatives.

Download training materials, data analysis software and manuals

The RAAB data analysis software package includes RAAB installation software and instruction manual, IOV forms for training the fieldwork team, instructions on how to collect the survey data, RAAB survey forms and further reading. Download the RAAB package from http://www.cehjournal.org/files/s0701.html

List of regional contacts for training your RAAB trainer

Africa: Wanjiku Mathenge (ciku@email.com), Susan Lewallen (slewallen@kcco.net), Joseph Oye (joye@sightsavers.org) EMRO: Dr Jadoon (mjadoon@yahoo.com), Mansur Rabiu (mrabiu@emr-iapb.org) Europe: Hans Limburg (hlimburg@quicknet.nl), Hannah Kuper (Hannah.kuper@lshtm.ac.uk), Robert Lindfield (Robert.lindfield@lshtm.ac.uk), Sarah Polack (sarah.polack@lshtm.ac.uk) South Asia: Dr Shammana (brsham@hotmail.com)

More information

For details about ICEH certification for RAAB trainers, please contact Hannah Kuper (Hannah.kuper@lshtm.ac.uk), Robert Lindfield (Robert.lindfield@lshtm.ac.uk) or Sarah Polack (sarah.polack@lshtm.ac.uk). For details of RAABs already carried out, please contact Hans Limburg (hlimburg@quicknet.nl)

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Introduction to Low Vision

CCB Power Point Presentation Georgetown, Guyana Dec 11, 2012
By

Denise Godin CCB Regional Focal Person for Low Vision

Low Vision
Those persons who cannot have their sight fully restored. The majority have some residual vision that can be enhanced or made more useable and utilized for tasks that require vision

11/22/2012

When Medical Interventions cannot effect change in

Visual function,
Vision rehabilitation methods and devices can enhance

Functional vision

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Definition of Low Vision

Visual Acuity of less than 6/18 (20/70), but equal to or better than 3/60 (20/400), or a corresponding visual field loss in the better eye of 20 degrees
World Health Organization

Definition of Visual Acuity

VA
20/20 20/40 20/60 20/70 20/200 20/400 20/1000

Min of Arc
1 min 2 min 3 min 3.5min 10 min 20 min 50 min

WHO Definition
Normal mild LV WHO definition LV Mod LV Severe LV Profound LV Near total blindness

Visual acuity describes the loss of visual resolution (blur) Contrast is the ratio of light/dark and describes the border of the image (reduced contrast is often describes as glare)

Functional Definition of Low Vision

- <6/18 to light perception - visual field <20 degrees from fixation - potential to use vision Bangkok definition:
A person with low vision is one who has impairment of visual functioning even after treatment and/or standard refractive correction and has a visual acuity of less than 6/18 to light perception, or a visual field less than 10 degrees from the point of fixation, but who uses, or is potentially able to use vision for the planning and/or execution of a task. (WHO, 1992)

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Those persons who cannot have their sight fully restored. The majority have some residual vision that can be enhanced or made more useable and utilized for tasks that require vision.

Benefits of Low Vision

.Visual Environment -Access -Increased Awareness -Control .Acquisition of incidental visual information . Increased visual independence

Global Perspective of Blindness

Prevalence of blindness .6% in developed countries 1% in developing countries

Prevalence of Low Vision

For each blind person there are 3-3.4 with low vision Prevalence of childhood blindness is .1per 1000 1.1per 1000

Leading Causes of Blindness in the Caribbean

-cataract -Diabetic Retinopathy -Glaucoma -Uncorrected Refractive Error an d Low Vision -Childhood Blindness

Benefits of Low Vision Services

-Reduces functional impact of low vision -Facilitates child education and development -Maintains independence -Enhances quality of life -Improves life satisfaction
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Factors Affecting Low Vision Services

-Population Increasing and Ageing -Present Weakness of Eye Care Delivery -Reduction of Government Support for Health Sector/ blindness prevention -Competition of funding

Institutional Landscape
-Service Organization for the Blind -Networking -Partnership with Ministries of Health and Education -Referral System -Data Collection and Dissemination -Awareness -Training

National Low Vision Services

-Identify a National Focal Person -Network -Set Up Low Vision Clinic -Organize Referral and Follow-Up

Environment
Lighting Contrast Size Tactile

Low Vision Assessment

-Examination -Refraction -Vision Assessment

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Magnification Calculations Magnification = Dioptic Power ----------4 Example: a 20 Diopter lens is equivalent to 5X magnification 20/4) To calculate a patients initial starting magnification needs: Starting Magnification: Entering Visual Acuity -----------------------------Visual Acuity Goal Example: A patient has an entering visual acuity of 20/200 and they need to see 20/50. Initial magnification would be 4X 200/50 Near: Stand Magnifiers -Dome -Bar -Illuminated Stand Hand Magnifiers -Distance from page -Finding the distance -Increase visual field Chest Magnifiers Used for hands-free activities such as crafts, art , and writing

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CCTV/Jordy/Flipper Used for sustained reading activities such as newspapers, writing, and reverse contrast needs I Pad/ I-Pod Used for access to internet(You-Tube, music, etc) Distance
Monocular Telescope Used for reading street signs, bus numbers, spot distance tasks Full field telescopes (spectacle mounted) Place directly at the pupil centre in one eye or both used for sustained distance tasks ie: watching TV, movies. etc Bioptic Spectacle-Mounted Telescope Mobility: Can walk viewing through the carrier lens and stop and view through the telescope to view details (patient views through the carrier and tilts chin down to view through telescope when needed) Distance Electronic Magnifiers Electronic distance device with multiple working distances and magnifications

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