LVP Eye Health Pyramid Glaucoma Care

Dr G. Chandrasekhar

LVPEI Eye Health Pyramid

From Screening to Management of Complex Diseases

Adv. Tertiary Tertiary Secondary Primary Community

Appropriate Available Affordable Accessible

Without Compromising Quality

PRIMARY CARE: PUTTING PEOPLE FIRST

Organizing primary-care networks

Continuity of care Bringing care closer to the people Responsibility for a well-identified population

Village Vision Complex

Integrated Secondary & Primary Eye Care
Secondary Eye Care

+
10 Vision Centres

+
100 Vision Guardians
Direct Service to 100-200 villages

Center of Excellence Four Tertiary 10+9 Secondary 89 Primary Community

Adv. Tertiary 1987 Tertiary 2003 Secondary 1992 Primary 2002 Community 2004

Community Level
(Vision Guardian)

Centre of Excellence Training centre

General awareness Refer those with problems

Service Centre
Vision Centre

Vision Guardian

Primary Care (Vision Technician)

Centre of Excellence Training centre

Service Centre
Vision Centre

History High IOP Optic nerve Van Herricks Referral

Vision Guardian

Secondary Care (Ophthalmologist)

History Slit lamp Applanation tonometry Gonioscopy Optic nerve

Centre of Excellence Training centre

Service Centre
Vision Centre

Visual fields Medical and Surgical Rx

Vision Guardian

Tertiary Care (Subspecialities)

Centre of Excellence Training centre

Service Centre
Vision Centre

Diagnosis & treatment of complicated problems Training Research

Vision Guardian

Advanced Tertiary Care (Team of Subspecialists) CENTRE OF EXCELLENCE

Centre of Excellence Training centre

Management of complex cases Training of Subspecialists and trainers Educational standards Research Advocacy Capacity building of Training Centres

Service Centre
Vision Centre

Vision Guardian

Advanced Tertiary Care (Team of CENTRE OF EXCELLENCE Subspecialists) Capacity building of

Training Centres

Centre of Excellence Training centre

Situation analysis Modification of infrastructure

Service Centre

Redesigning of physica space Equipment Training of Trainers Implementation Monitoring and evaluation

Vision Centre Vision Guardian

Village Vision Complex

Integrated Secondary & Primary Eye Care
Secondary Eye Care

+
10 Vision Centres

+
100 Vision Guardians
Direct Service to 100-200 villages

Secondary Centres Data (1998-2011)

Centre Name Mudhole Tudukurthy Adilabad Karamchedu Markapuram Kandukur Nellore Paloncha Cherukupalli Total Glaucoma OPD in OPD Trab. 1162 213108 143528 534 71603 86 84997 481 44638 303 13854 156 21987 41 20990 156 2155 30 616860 2949 Yag PI 814 377 66 109 88 5 0 6 0 1465 409 118 23 30 0 0 0 64 0 644

Glaucoma Vision Centres

April 2010 to Jan 2012 All Centers (76) Screening High IOP

Total

249160
0.68% - High IOP > 21

1709

LVPEI Eye Health Pyramid Glaucoma care

Challenges
IOP Angle Closure Disc and field damage

Glaucoma Epidemiology and Molecular Genetics Study GLEAMS

Methodology
Population based cross sectional study

Methodology
Inclusion criteria People aged 40 years and above Residents for a min 6 months Willing to participate Exclusion criteria Cannot be contacted after 3 attempts People who are immobile

The Study Plan

Vision Guardian

Vision screening

Vision Technician 1 Vision Technician 2

History, VA, Ref

FDT, HVF, SL, NMFP, ASOCT DO, IOP, Gonio

Vision Technician 1

Optometrist

Goni, dilated evaluation, OCT, Fundus photo

Results
Analysis I Agreement of Optometrists with Glaucoma Specialist Ophthalmologist in gonioscopy and Optic Disc evaluation Analysis II Diagnostic accuracy of a VG in vision screening, pupillary abnormalities and anterior chamber

Results
Analysis III Skills of a VT in Gonioscopy and image acquisition

Analysis IV Role of Imaging in POAG and PACD diagnosis

Sample Size
Gonioscopy 150 eyes with 25 PACS and 25 PAC
Optic Disc Assessment 200 eyes with 30 disc suspects and 30 glaucoma eyes

Results
Agreement between Optometrists and Glaucoma Expert

(SE) Gonioscopy (UK) Optic Disc Assessment (UK) Gonioscopy (JGB) Optic Disc Assessment (JGB) 0.92 (0.12) 0.90 (0.09) 0.84 (0.10) 0.89 (0.09)

Progress of the Project

No. of villages screened - 10 Number of subjects screened till now 2000 Data available - 1832

No. of eyes with various types of glaucoma

LVPEI Eye Health Pyramid Glaucoma care

Challenges
IOP Angle Closure Disc and field damage

The Glaucoma Continuum

Weinreb RN etal. Am J Ophthalmol 2004;138: 458-467

Shallow AC depth on Van Herrick

Corresponding ASOCT

BEST NMFP

Corresponding OCT

BEST MFP

WORST NMFP
Corresponding OCT

WORST MFP

Thank you!

L V Prasad Eye Institute

www.lvpei.org

Excellenc e

Equity

Efficienc y