Greek anatomy of the eye in Pakistan today

A Pakistani wall plate depicting the anatomy of the eye is described and illustrated. The picture is partly Greek (the hollow optic nerve), in part medieval Arab (the optical image on the disk), and in part modern (e.g., the refraction anomalies). A brief account is given of how Greek science passed to the Arabs and then to India. The wall plate bears witness to the pluralism in Pakistani medicine. Side by side with cosmopolitan medicine there exists the Unani Tibb, based on the Ionic-Arabic tradition.     

School eye health appraisal

School children form an important large target group which must be screened adequately for early detection of eye diseases and prevention of blindness. A total approach in a school eye health programme must include teacher orientation and health education of children in addition to screening for eye diseases. The ocular morbidity pattern in 5135 school children of Jodhpur is discussed in this paper and it is hoped that it will be an indicator to all eye care agencies to help plan their priorities in the delivery of school based eye care.     

The Duke Elder lecture: the challenge of equitable eye care in Pakistan

Purpose

Pakistan, like many other developing countries, is caught in the vicious cycle of poverty, illiteracy, violence, and disease. Right from its inception, it has been facing serious challenges of fast growing population, longevity, unemployment, wars, floods, double burden of diseases including blindness, as well as earthquakes, insurgencies, and political instability. Despite such challenges, the country has managed to reduce the burden of blindness from 1.78% in 1987-88 to 0.9% in 2003.This paper will highlight the methods used to achieve such a difficult goal.

Methods

The country used the report of the World Health Organization (WHO) temporary consultant as the initial tool for advocacy to obtain political and professional commitment. Results from the first National Blindness Survey 1987–1990 were used as baseline for development of the programme. Under the Ministry of Health, national and provincial committees with respective coordinators were constituted. To ensure access and equity, the national programme was developed on the basis of district comprehensive eye care services. The concept was carefully tested in a laboratory and then piloted in a real district before it was rolled over to the country. Strong national institutes for human resource development, research and development, and service delivery were established. A strong network of high-quality national institutes was set up and run by powerful national non-governmental organizations. The second National Blindness Survey evaluated the achievements of the programme in 2001–2003.

Conclusion

National prevalence of blindness was reduced by 100% by improving the uptake of services at the district level, especially by females.     

Attitudes and perceptions of eye care workers and health administrators regarding task sharing in screening and detection for management of diabetic retinopathy in Pakistan

Purpose: The shortage of ophthalmologists in many countries is a major barrier to timely provision of eye care. A team work approach to screen, detect and manage diabetic retinopathy (DR) could achieve greater screening coverage of people with diabetes to prevent vision loss. This study aimed to assess the attitudes and perceptions of eye care workers and health administrators regarding task sharing for management of DR.

Methods: Using purposive sampling, 121 eye and health care workers in five selected hospitals in two provinces in Pakistan were recruited. A cross-sectional survey explored the possibility for involvement of optometrists and mid-level eye care workers to share tasks with ophthalmologists for DR management and the potential outcomes of task sharing, through multiple choice and open-ended questions.

Results: Ninety-six (79%) participants–doctors (n = 56), optometrists (n = 29) and mid-level eye care workers (n = 11) responded to the survey. All participants supported task sharing in screening and detection for management of DR. There was no significant difference among the groups with respect to their positive attitude towards task sharing (p = 0.22). The majority in each group believed that the task sharing would not degrade the quality of care (p = 0.48). Two potential major outcomes of task sharing in the eye care system included the benefits for people with diabetes and potential DR and the strengthening of the health care system.

Conclusion: Task sharing among various cadres of eye care workers has the potential to improve screening coverage of people with diabetes to prevent visual loss from DR.     

Changes in eye care utilization following an eye health promotion campaign

BACKGROUND: The Vision Initiative is a public health campaign that promotes the early detection of the main causes of vision loss through regular eye examinations. Target groups are people over 50 years, with diabetes, a family history of glaucoma or age-related macular degeneration and those who have noted a change in vision. METHODS: In 2005, a range of initiatives promoted the main campaign messages using metropolitan and regional television, radio and newspapers. Campaign outcomes such as last visits to an eye specialist were evaluated comparing pre- and post-campaign data. Participation was volunteer based from randomly selected Melbourne suburbs. Recruitment was by mail. Participants were between 70 and 79 years of age. A questionnaire collected information about demographics, utilization of eye care services, general health and lifestyle. Key features of the five main eye diseases that cause vision loss in Australia were assessed. RESULTS: The percentage of people that reported to have visited an eye specialist within the last year increased significantly from 61% to 70% (P<0.001). Also the percentage of people with diabetes that reported to have a dilated fundus examination within the last 2 years increased significantly from 52% to 70% (P<0.001) and the percentage of people reporting to always wear sunglasses when going out in the sun increased significantly from 33% to 39% (P<0.001). CONCLUSIONS: Following the campaign, there was an improvement in the utilization of eye care services, especially by people with diabetes. However, other Australian public campaigns may contribute to the increased awareness of the effect of diabetes on eye health.     

蓝光与眼健康

蓝光是波长介于400 ～ 500 nm的短波长光,蓝光对视网膜细胞造成损伤的特性引起了学者广泛的关注.同时,它在调节昼夜节律、产生暗视力以及屈光发育等方面具有重要作用.蓝光是否安全？是否该从日常生活中清除？本文对蓝光的作用及安全性问题作一综述.     

Millennium development goals and eye health

In September 2000, world leaders made a commitment to build a more equitable, prosperous and safer world by 2015 and launched the Millennium Development Goals (MDGs). In the previous year, the World Health Organization and the International Agency for the Prevention of Blindness in partnership launched the global initiative to eliminate avoidable blindness by the year 2020-VISION 2020 the Right to Sight. It has focused on the prevention of a disability-blindness and recognized a health issue-sight as a human right. Both global initiatives have made considerable progress with synergy especially on MDG 1-the reduction of poverty and the reduction in numbers of the blind. A review of the MDGs has identified the need to address disparities within and between countries, quality, and disability. Noncommunicable diseases are emerging as a challenge to the MDGs and Vision 2020:0 the Right to Sight. For the future, up to and beyond 2015, there will be need for both initiatives to continue to work in synergy to address present and emerging challenges.     

Nutritional influences on eye health.

BACKGROUND: As with cardiovascular disease, nutrition and environmental intervention present new clinical practice and research opportunities in eye care. This includes maximizing health potential with food choice, the use of supplementation in high-risk and noncompliant patients, avoiding toxins such as cigarettes, and encouraging exercise. METHOD: The author provides his perspective on viewing biochemical, physiological, and epidemiological research in the context of disease prevention in both common and uncommon applications. In most cases, this approach requires food frequency intake evaluation and application of physiological optics to measure efficacy when there is an alteration in diet and/or addition of supplementation. These are details of ocular integrative medical practice that are ignored or underutilized. RESULTS: There are multiple opportunities for intervention in the age-related diseases of cataract, macular degeneration, and glaucoma. A summary of the application of nutrition to create a model for treatment of age-related macular degeneration is presented. CONCLUSIONS: Economic incentives, now lacking, are required to explore new paradigms in nutritional preventative eye care. Schools and colleges of Optometry could play a vital public health role.