Community Ophthalmology

Community Ophthalmology was described as a new discipline in medicine promoting eye health and blindness prevention through programs utilizing methodologies of public health, community medicine and ophthalmology in 1978. This new discipline was first proposed by Dr. Patricia E. Bath in 1978 after observations of epidemics rates of preventable blindness among underserved populations in urban areas in the USA as well as underserved populations in so called 3rd world countries.[1][2]

The failure of hospital based eye care to provide preventive services for at risk populations was evidenced by the high rates of blindness due to preventable causes. Moreover, government institutional based Public Health facilities were not equipped to prevent or treat the at risk populations because the system wide infrastructure lacked personnel capable of delivery of services for eye health education and eye health care.

Subspecialities of Ophthalmology

Historically, Public health Departments had staff of physicians, epidemiologists, biostatisticians, environmentalists and perhaps microbiologists. The disciplines included in Public Health Services were Maternal and Child Health, Nutrition, Family Planning, and Sanitation and Environment. Hospital and Public Health institutions viewed ophthalmology (i.e. eye care services) as a tertiary health care to be delivered solely by ophthalmologists. The basic Public Health services included pediatricians, obstetricians, gynecologists, family practice physicians, environment/sanitation specialists as well as nurses and mid-wives but no ophthalmic assistants.

Blindness

In the discipline of Community Ophthalmology, the new cadre of personnel known as eye health care workers, eye health care educators or ophthalmic assistants are trained to provide eye care and blindness prevention services at the village or door-to-door level.

For example, in villages with endemic Trachoma the eye care health workers would educate families about the importance of sanitation and hand washing and also provide access to eye drops. In areas with high rates of blindness due to cataract this cadre of personnel would educate families about the cure for blindness due to cataract with eye surgery. Changing the belief that blindness is an inevitable consequence of aging requires community eye health education about curable blindness and preventable blindness which is still so necessary in many parts of the world. Community Ophthalmology teachings include the concept of Primary Eye care which has been advocated as both as a stand alone health service as well as a new integral component of basic health services, or Public Health Services.[3]

Basic Health Services

This new concept has been shown to be a sight saving blindness prevention strategy. Since inception in 1978 programs of Community Ophthalmology have been developed worldwide. The promulgation of programs of Community Ophthalmology can be traced through programs of WHO,[4] NGO’s like AiPb,[5] and through the effort of individuals such as Professor Quarcoopome in Africa [6] and Professor Kirmani in Asia and Professor Bath worldwide.

In 2017 Dr. Bath’s role in the founding of Community Ophthalmology was recognized by MEDSCAPE as one of the "14 Women Physicians who changed the Course of American Medicine.”

## References

1. ↑ Bath PE: Blindness Prevention Through Program in Community Ophthalmology in Developing Countries. Excerpta Medica Series 442, Amsterdam, Oxford CCIII International Congress of Ophthalmology, 1913- 1915, May 1978.
2. ↑ Bath, PE. "Rationale for a program in community ophthalmology". J Natl Med Assoc 71: 145–8. PMID 423288.
3. ↑ Guide Pour Les Programmes De Prevention De Cecite, WHO, 1979
4. ↑ Report of the 11th meeting of the WHO Programme Advisory Group on the Prevention of Blindness: WHO PBL /95.51
5. ↑ American Institute for the prevention of Blindness (AiPb) www.blindnessprevention.org
6. ↑ Bath PE, Quarcoopome CO, Kirmani: Community Ophthalmology Plan for Underserved Populations. ACTA 24th International Congress of Ophthalmology, 2,13-17,1983

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