Innovative Approaches in the Delivery of Primary and Secondary Eye Care

This unique book will provide readers with an understanding of innovative models of delivering both primary and secondary eye care, focusing not just on providing quality care itself, but on best practices to provide and strengthen comprehensive eye care services. A wide variety of conditions will be addressed in __Innovative Approaches in the Delivery of Primary and Secondary Eye Care,__ including childhood blindness, cataract, diabetic retinopathy, age related macular degeneration, and refractive errors. Detailed descriptions of various models are presented for each condition, which are then followed by a discussion for incorporating integrated eye care services; highlighting the importance of health system approach in comprehensive eye care. Finally, this book provides detailed strategies to address the current practical challenges related to human resources in eye care, and methods to ensure financial sustainability in the delivery of comprehensive care. Each chapter is illustrated for understanding and clarity, and provides easy-to-read tables to further enrich the text. Covering existing models of delivering care, with a look to the future, __Innovative Approaches in the Delivery of Primary and Secondary Eye Care__ is designed for practicing ophthalmologists, residents, public health specialists and all other affiliated professionals dedicated to strengthening avenues of integrated, comprehensive eye care. Foreword 6 Why Do We Need Comprehensive Eye Care? 6 Preface 9 Contents 11 Contributors 13 Abbreviations 16 1: VISION 2020: Past, Present and Future 20 Prevalence of Vision Impairment and Blindness 20 Causes of Blindness and Vision Impairment 21 Universal Eye Health Coverage 22 Financing 22 Human Resources 23 Technology and Eye Health 23 The Way Forward 24 2: Prevalence and Causes of Vision Impairment and Blindness: The Global Burden of Disease 25 Introduction 25 Prevalence of Vision Impairment and Blindness 27 Changes in the Prevalence 1990–2010 27 Causes of Vision Impairment and Blindness 29 Regional Differences in Changes and Causes 30 Disability Related to Vision Loss 34 Challenges in Eye Care 35 Conclusion 36 References 37 3: Best Practice Integrated Approaches in Eye Care Service Delivery 39 Introduction 39 Primary Eye Care Attributes 40 Integrated Primary Eye Care Services Within Primary Healthcare 41 Stand-Alone Primary Eye Care Services 41 Key Informant Method (KIM) 42 Tele-Ophthalmology 42 Public-Private Partnership (PPP) 44 Subsidized Cataract Surgical Services in Latin America 45 Cataract Business Model in Guatemala 45 Cataract Outreach Services in Paraguay 45 Subsidized Cataract Surgery Business Model in Mexico 46 Integrated Secondary and Tertiary Eye Care Services: Attributes 46 Integrated District Comprehensive Eye Care Program in Pakistan 48 L V Prasad Eye Institute-Model of Holistic Eye Care 48 Aravind Eye Care System 50 Layton Rahmatullah Benevolent Trust (LRBT) -Three-Tier Network of Eye Hospitals and Clinics in Pakistan 51 Al-Shifa Trust Eye Hospitals in Pakistan 52 Conclusion 52 References 53 4: Expanding and Optimizing Human Resources for Eye Care 57 Global Need for Human Resources in Eye Health 58 Human Resource Gap and Goals of Global Action Plan 58 Planning for Human Resources for Eye Health 59 Understanding the Epidemiology of Eye Disease in the Country 59 Need by the Population 60 Legal Considerations 60 Multitude of Cadres in an Evolving Field 60 Consider HR Needs for Sustainable Service Delivery 61 Effectiveness of Our Current HReH 61 Setting Productivity Targets Where Practical 63 Defining Specific Roles and Responsibilities Within the Eye Care Team 63 Ensuring that the Eye Care Team Works Well Together 64 Having HR Plans that Enable Good Access to Service Delivery 65 Retaining Motivated and Productive Personnel 65 Training Strategies and Resources 66 Candidate Selection Matters 67 Assessment of Training Needs 67 Focus on Required Competencies 67 Array of Training Opportunities 68 Systematic Efforts to Increase Availability and Quality of Training 69 Priorities for Moving Forward 70 References 70 5: Technology and Innovation for Eye Care 74 Introduction 74 Technology for Improving Access to Eye Care Systems for Remote Screening and Diagnostics 75 Taking Visual Function Testing Beyond Primary Eye Clinics 76 Portable Anterior Segment and Cataract Diagnosis 77 Fundus Imaging for Disease Detection 77 Technology to Improve Delivery of Remote Eye Care 79 Technology to Build Capacity for Delivery of High-Quality Eye Care 81 Conclusion 83 References 83 6: Affordability and Financing for Eye Care 86 Provider Mix 87 Financing Investment Versus Operations 87 Two Case Studies: Financing of Eye Care in Vietnam and the Philippines 91 Health Insurance in Vietnam and How It Affects Eye Care Delivery 91 Health Insurance in the Philippines and How It Affects Eye Care Delivery 92 Social Impact Funding 94 Trends and Ground Realities in the African Context 94 Ground Realities in Latin America 96 Cost 97 Present Purchasing Paradigm for Ophthalmic Consumables 100 Conclusion 102 References 102 7: Innovative Approaches in the Delivery of Eye Care: Children 104 Introduction 104 Refractive Error 106 School Eye Health Programs 107 Retinopathy of Prematurity 109 Pediatric Cataract 112 Identifying Children with Cataract 113 Strategies for Prevention and Treatment 114 Low Vision Rehabilitation 116 Comprehensive Eye Care for Children 117 Conclusions 118 References 118 8: Innovative Approaches in the Delivery of Eye Care: Cataract 124 Epidemiology of Cataract: Burden and Distribution 124 Risk Factors 125 Indicators for Monitoring Cataract Surgery Programs 126 Success Stories 127 Training 134 Way Forward 136 References 137 9: Innovative Approaches in Delivery of Eye Care: Diabetic Retinopathy 143 Introduction 143 Epidemiology of Diabetic Retinopathy 144 Major Modifiable Risk Factors of Diabetic Retinopathy 144 International Council of Ophthalmology Screening Guidelines [21] 145 Diabetic Retinopathy Detection Modalities 146 Economic Burden of Vision Impairment (VI) and Blindness Secondary to Diabetes 147 Diabetic Retinopathy Screening: Innovative Approaches in the Resource-Rich and Resource-Poor Countries 148 Diabetic Retinopathy Screening Approaches in Resource-Rich Countries 149 Tele-ophthalmology Diabetic Retinopathy Screening 149 Automated Diabetic Retinopathy Detection Software 150 Optical Coherence Tomography 150 Confocal Scanning Laser Ophthalmoscopy 151 Ultrawide-Field Fundus Imaging 151 Other Imaging Modalities 151 Diabetic Retinopathy Screening Models in Resource-Poor Countries 152 Static Diabetic Retinopathy Screening Service 152 Mobile/Outreach Diabetic Retinopathy Screening Service 153 Low-Cost Measures for Diabetic Retinopathy Screening 153 Public Education 153 Improving the Access for Early Detection and Treatment 154 Primary Eye Care Clinic in Singapore: A Secondary Eye Care Service 154 Conclusions 156 References 156 10: Innovative Approaches in Delivery of Eye Care: Age-Related Macular Degeneration 162 Burden of Age-Related Macular Degeneration 162 Epidemiology and Risk Factors of Age-Related Macular Degeneration 163 Older Age 163 Smoking 164 Nutrition 165 Genetic Variants 167 Other Potential Risk Factors 168 Sunlight Exposure 168 Cardiovascular Risk Factors 168 Chronic Infection 168 Male Gender in Asian Populations 168 Heavy Alcohol Consumption 169 Risk Prediction Algorithm and Models 169 Screening for Early Signs of Age-Related Macular Degeneration 170 Drusen and Pigmentary Abnormalities 170 Reticular Drusen 171 Pachychoroid 172 Treatment of Age-Related Macular Degeneration 173 Rehabilitation of Vision Impairment due to Age-Related Macular Degeneration 174 References 174 11: Innovative Approaches in the Delivery of Eye Care: Refractive Errors (Including Presbyopia) 178 The Challenge of Refractive Errors 178 Recent and Emerging Practices for the Provision of Refractive Error Services 180 Preparing for Refractive Service Delivery 180 Refractive Error Service Delivery Models 180 Public Sector Approaches 180 District Health System 180 Hospital-Based Refraction Clinics 183 NGO/Civil Society Approaches 183 Vision Centre Models 183 Outreach Model 185 Multilevel Pyramid Models 185 Social Entrepreneur Model 187 Presbyopia and Social Entrepreneurship 187 Vision Centres and Social Entrepreneurship 188 Social Franchise 188 Private Sector Approaches 189 Independent Practice 189 Public-Private Partnerships 190 Northern Territory (NT) Aboriginal Vision Programme 190 The Use of Technology in Eye Care Service Delivery 190 Summative Statement 191 References 192 12: Assessment of Eye Health Services: A Health Systems Approach 195 Preamble 195 Health System 196 Eye Health Services 197 Assessing Eye Health Services 199 Eye Care Service Assessment Tool 200 Background Information and Country Socio-economic Indicators 200 Evidence for Advocacy and Awareness Creation 200 Enhancing Comprehensive Eye Health Services Through the WHO Health System Approach 200 Leadership and Governance 200 Eye Health Financing 200 Eye Health Workforce 201 Eye Health Service Provision 201 Essential Medicines, Medical Products and Technologies for Eye Health 201 Health Information System 201 Engagement of the Non-health Sector in the Preparation and Implementation of Policies and Plans on Eye Health and the Prevention of Vision Impairment 201 Tool for the Assessment of Diabetic Retinopathy and Diabetes Management Systems (TADDS) [7] 202 Tool for Assessment of Rehabilitation Services and Systems (TARSS) 202 Rapid Assessment of Avoidable Blindness (RAAB) [11] 203 Rapid Assessment of Refractive Errors (RARE) [10] 203 Monitoring Health Coverage and Its Implications for Eye Health 203 Health Information System and Implications for Eye Health 204 Where Does One Start 205 References 208 Index 209 Front Matter ....Pages i-xx VISION 2020: Past, Present and Future (Gullapalli N. Rao)....Pages 1-5 Prevalence and Causes of Vision Impairment and Blindness: The Global Burden of Disease (Jill Keeffe, Serge Resnikoff)....Pages 7-20 Best Practice Integrated Approaches in Eye Care Service Delivery (Muhammad Babar Qureshi, Ismat Chaudhry)....Pages 21-38 Expanding and Optimizing Human Resources for Eye Care (Suzanne S. Gilbert, Paul Courtright, Dhivya Ramasamy)....Pages 39-55 Technology and Innovation for Eye Care (Ashutosh Richhariya, Mukesh Taneja, Glenn H. Strauss, Matthew Lee Walden, Jean R. Hausheer, Van Charles Lansingh et al.)....Pages 57-68 Affordability and Financing for Eye Care (Thulasiraj Ravilla, Paul Courtright, Juan Francisco Yee Melgar, David Green)....Pages 69-86 Innovative Approaches in the Delivery of Eye Care: Children (Rohit C. Khanna, Maria Vittoria Cicinelli, Vijaya K. Gothwal, Clare Gilbert)....Pages 87-106 Innovative Approaches in the Delivery of Eye Care: Cataract (Varshini Varadaraj, Rohit C. Khanna, Nathan Congdon)....Pages 107-125 Innovative Approaches in Delivery of Eye Care: Diabetic Retinopathy (Daniel Shu Wei Ting, Ecosse Lamoureux, Tien Yin Wong)....Pages 127-145 Innovative Approaches in Delivery of Eye Care: Age-Related Macular Degeneration (Ryo Kawasaki, Yumiko Kawasaki)....Pages 147-162 Innovative Approaches in the Delivery of Eye Care: Refractive Errors (Including Presbyopia) (Kovin S. Naidoo, Pirindhavellie Govender, Jyoti Naidoo)....Pages 163-179 Assessment of Eye Health Services: A Health Systems Approach (Haroon Awan)....Pages 181-194 Back Matter ....Pages 195-200