.: Pakistan Institute of Community Ophthalmology :.

Pakistan Centre for Vision Sciences (PCVS)

Introduction

Blindness places an immense socioeconomic burden on the individual as well as the community. The direct economic cost of global blindness has been estimated as 25 billion US dollars per year. This figure does not include the economic resources required for the education, vocational training and social rehabilitation of a blind person. The annual cost of caring for the 2,136,00 bilaterally blind people in Pakistan has been estimated to be 38.5 billion Pakistani rupees.The magnitude of blindness and its implications have compelled the world to analyze the situation objectively. Following table depicts the comparative picture of blindness at global, regional and national levels.

	Prevalence of blindness	No of the visually impaired /Blind	Major causes of blindness
Global situation. ¹	0.7%	45 million blind 135 million with Low Vision	Cataract; 16 million, 35.5% Trachoma; 5.4 million, 12% Glaucoma; 5.2 million, 11.5%
Regional situation Eastern Mediterranean Region (EMR) ² For details ,see annexure 1	1.4% (average of 11country with available data)	5.8 million (blind)	Cataract; 3.1million, 50% Trachoma & corneal opacity; 0.8 million, 14% Glaucoma; 0.9million, 16%
National situation ³	1.78%	Bilaterally blind; 2.3 million Unilaterally blind; 3.2 million 6.3 million with low vision.	Cataract; 66.7%(of the total causes of blindness) Corneal opacities; 12.60% Refractive errors; 11.40% Glaucoma; 3.90% Other causes; 5.40%
Local situation in NWFP ⁴	1%	0.2% million	Cataract; 70% Corneal opacities; 16.60% Refractive errors; 7.5% Others; 6%

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Two thirds or more of all blindness is avoidable in that the contributing causes are preventable. World Health Organization (WHO) in collaboration with International Agency For The Prevention Of Blindness (IAPB) has taken the global initiative of eliminating avoidable blindness by the year 2020,under the Vision 2020 programme. In this programme the concept of Mid Level Eye Care Personnel (MLECP) has emerged as one of the most cost effective measures in both the establishment and strengthening of Comprehensive Eye Care (CEC). It is in this context that Pakistan Centre for Vision Sciences was established as part of Pakistan Institute of Community Ophthalmology under Khyber Institute of Ophthalmic Medical sciences with the following objectives, to meet the national, provincial and district, Human Recourse Development needs of Mid Level Eye Care Personnel:

To provide training opportunities for all cadres of Mid Level Eye Care Personnel (MLECP); who would then;

increase the coverage of essential eye care and ensure quality and equity while delivering these services;
initiate primary eye care and integrate primary eye care into primary health care;
meet the needs of refractive services of the community;

	To train some of these MLECP in specific areas of advance visual function skills, like optometry, ophthalmic technology skills, and public eye health care management skills as ophthalmic technologists to meet the needs of tertiary eye care Institutions;
	To cater for such requirements of the countries of Eastern Mediterranean Region of WHO as well as other developing countries;
	To develop standardized training programmes in modular form with standardized curricula and national /international faculty;
	To introduce a standardized system of evaluation.

In the light of experiences gained at Pakistan Institute of Community Ophthalmology, Peshawar, the Government of Pakistan will be approached through National Committee for Prevention of Blindness to:

	Replicate such Institutions in other provinces if needed,
	Devise a career structure for such mid level eye care personnel,
	Introduce and implement a national system of monitoring and evaluation of all such training programmes in the country through a national regulatory body under the Ministry of Health (MOH) Islamabad.

All the 6 provincial coordinators of Punjab, Sindh, NWFP, Baluchistan, AJK and Northern Areas have approved the curriculum. The national Leprosy, Blindness and Tuberculosis Control Board under the Ministry of Health, Pakistan have also endorsed this curriculum in a meeting held on the 26^th of October 2001 at Islamabad. This curriculum was discussed and approved by at an international forum in a workshop on such curricula in Kurat Thailand in June 2000.

References:

	Thylefous B et al. data on global blindness. WHO OMS Vol- 73, 1995, P.115-121.
	Regional situation Eastern Mediterranean Region (EMRO) WHO.
	National population –based survey 1989.
	M. Aman Khan MD, Arifa Gulab MD. And M. Daud Khan , FPAMA, Pakistan Journal of ophthalmology, Vol 10. No 2& 3, April and July 1994.

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Aims and Objectives of the training programmes at PCVS:

These courses will enable the health care personnel currently involved in delivering the existing eye care services, in the both the government & private sector, to equip themselves with the standardized knowledge required for this sensitive task.The Programmes have been designed in accordance with the strategies of the vision 2020. The programmes are aimed at providing trained human resource in the field of eye care and henceforth strengthening of the district –based comprehensive eye care Programme.

Through these training programmes are able to provide the following eye care personnel.

	Ophthalmic technicians
	Refractionist
	Orthoptists
	Optometrists
	Ophthalmic technologists
	Ophthalmic specialist nurses

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ACADEMIC COMMITTEE:

	The Rector KIOMS, (Chairman).
	Professor of Ophthalmology LRH (KIOMS wing).
	Executive Director Pakistan Institute of Community Ophthalmology.
	Director Academics, Pakistan Institute of Community Ophthalmology.
	Director Pakistan Centre for Vision Sciences, PICO.
	Deputy Registrar Academics – of the affiliating University.
	A representative of SSI, CBM, & FHF.
	01 senior Optometrist, PICO.
	01 Visiting Optometrist.
	Dean Postgraduate Medical Institute, Hayatabad Medical Complex/ a representative of the Dean.

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Course CONTENTS for the first year:
The course would be split into theory & practical modules conducted.

Module	Module Title
I-A	BASIC COMMUNITY EYE CARE FUNCTIONS
II-A	PRIMARY EYE CARE & COMMUNICATION SKILLS
III-A	BASIC EYE HEALTH MANAGEMENT FUNCTIONS
IV-A	BASIC TRAINING FUNCTIONS
V-A	BASIC TECHNICAL FUNCTIONS
VI-A	ORIENTATION WITH ADVANCED CLINICAL SKILLS
VII-A	Rehabilitation
VIII- A	Screening Programmes and Community Mobilization
XI	Islamiyat

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COURSE CONTENT FOR second year:
The second year will focus mainly on refraction (diagnosis and management of refractive errors), low vision and orthoptics. During the second year of training, the following course curriculum would be taught during the theory module;

B-I	Revision of Primary eye care &advance diseases of the eye
B-II	Introduction to ophthalmic pharmacology
B-III	Physical optics
B-III	Geometrical optics
	Visual optics (Basic)
	Advance visual functions
	Visual optics (Advance)
B-IV	Advance refraction
B-V	Basic dispensing optics
B-VI	Low vision
B-VII	Contact lenses
B-VIII	Binocular vision & orthoptics
B- IX	Screening for diabetic retinopathy & glaucoma
B-X	Rehabilitation
B-XI	Pakistan studies
B- IX	Screening for diabetic retinopathy & glaucoma
B-X	Rehabilitation
B-XI	Pakistan studies

Following timetable would be followed during the theory module:
6 days a week (Mondays to Saturdays) 8 AM to 1:30 PM

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Fo Practical work the following schedule would be followed:

	Refraction [4 months]
	Dispensing optics [2 months]
	Orthoptics [2 weeks]
	Contact lenses [ 2 weeks]
	Low vision [2 weeks]
	Community optometry [2 weeks]

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Curriculum for THIRD year (BSc. Honours):

Module		Module Title
A		Advanced Visual Function Skills
	A.1	Advance techniques in Refraction
	A.2	Orthoptics
	A.3	Contact lenses
	A.4	Low Vision
	A-5	Caring for the Blind Instructional objectives
	A-6	Rehabilitation of the visually impaired & blind
B		COURSE ON OPHTHALMIC TECHNOLOGY SKILLS
	B-1	Pharmacology
	B-2	Diagnostic procedures
	B-3

Global situation. 1

Global situation. ¹