Refresher training and continuing education for para-medical ophthalmic assistants.

This paper describes a refresher training and continuing education programme in clinical and community ophthalmology for para-medical ophthalmic assistants (PMOAs) conducted by the Lions Aravind Institute of Community Ophthalmology. The course participants included 60 PMOAs working either in district hospitals, primary health centres or mobile units from the districts in Maharashtra. Each training programme was spread over 43 hours in 4 days and included lectures, practical demonstrations, and hands-on training in the outpatient, inpatient, and operation theatre of the training institution. Participants were given exposure to outreach activities in an eye camp and a satellite eye centre resembling a district hospital. The PMOAs found the training to be useful and it was seen that areas like patient counselling, instrument and equipment maintenance, and assistance in the operation theatre for newer surgical procedures which were lacking in the basic training were fulfilled in this training programme. Regional Institutes of Ophthalmology, upgraded medical colleges, and other eye-care institutions which have facilities and manpower could organise similar refresher and continuing education programmes for PMOAs so that they could be utilised more efficiently in the blindness-control activities in the country.

Risk of cataract and history of severe diarrheal disease in southern India.

A case-control study was carried out in the state of Tamil Nadu, southern India, to examine the association between the risk of visually disabling cataract and a lifetime history of severe diarrhea (including cholera). A series of 421 subjects, aged 35 to 65 years, meeting case (n = 181) and control (n = 240) eligibility criteria were enrolled from 19 rural cataract-screening camps. Ninety case-control pairs were postmatched for (reported) age (+/- 2 years), sex, and area of residence. A history of diarrhea was obtained by using an algorithm developed by other investigators in India who have reported a strong association between cataract and diarrhea. An odds ratio of 0.8 (95% confidence limits: 0.0, 3.2) was obtained from matched pairs analysis, and an odds ratio of 1.3 (95% confidence limit: 0.6, 2.7) was obtained among all subjects (n = 392) from a logistic analysis that adjusted for age, sex, occupation, area of residence, and caste. Findings of this study do not support the hypothesis of an increased risk of visually disabling cataract in persons with a positive history of severe diarrhea.

Rapid epidemiologic assessment of cataract blindness. The Aravind Rapid Epidemiologic Assessment Staff.

A major constraint to obtaining reliable information about blindness and its causes in developing countries is the limited availability of ophthalmologists for diagnosis in population-based surveys. This study in rural south India assessed the feasibility of using non-ophthalmologists to make diagnoses in a population-based survey. Ten men in their early twenties with 12 years of schooling were recruited and trained as ophthalmic assistants through a six week course in basic ophthalmology. All people aged 40 and older in households in 24 villages were enumerated and invited to have an eye examination. At a central site, 1309 subjects were independently examined by an ophthalmologist and two different ophthalmic assistants. Ophthalmic assistant cataract diagnosis is both sensitive and specific relative to the ophthalmologist's diagnosis. Sensitivity and specificity estimates were used to adjust prevalence estimates obtained from ophthalmic assistant examinations conducted at the central site as well as at the doorstep of sample households. The findings indicate that epidemiologic assessment of cataract blindness can be completed using non-ophthalmologists to diagnose cataract.

Rehabilitation of xeropthalmic children. A follow-up study in southern India.

Two hundred and seventy-five children were admitted to the Nutrition Rehabilitation Centre (NRC), Madurai in 1975; 213 had xeropthalmia and 62 showed no eye signs. All were malnourished, the largest single group being less than half their expected weight for age. A follow-up study was made both by means of recall to the NRC and by means of house visits to children of Madurai town. Less than half the total, but 55% of town children were found. The distribution of eye signs on admission in those who were later followed-up, corresponded with that in the total. Weight improved while at the NRC and also after return home. All existing cases of corneal xerosis healed but conjunctival xerosis remained in some. Major corneal damage through ulceration, keratomalacia and scars was present in 94 children at admission, 34 of these were followed-up. Four were blind and five had severely limited vision in both eyes, but useful vision was present in one or both eyes of the other 25 (73%) children. For example, of 15 children found blind in one eye, 13 had good vision in their other. The mortality among xerophthalmic children children while at the NRC was 6.6%, and among those visited later at home was 20%. Almost all mothers questioned, said they gave their children green vegetables, but apart from this very important precept, few other dietary suggestions were followed.

A nutrition rehabilitation centre for children with xerophthalmia.

A nutrition rehabilitation centre for treatment of children with xerophthalmia was established in Madurai, India. Treatment was based on provision of locally available food, rich in protein and beta-carotene and cheap enough for the families concerned to buy at home. This diet alone, with general medical treatment for other diseases, was sufficient to reverse conjunctival xerophthalmia and corneal xerosis. Children with more severe xerophthalmia received additional vitamin A. The records of 296 children followed up for between two months and three years were analysed. The results of treatment at the centre seemed as good as those produced by more expensive, and usually unobtainable, hospital treatment. Participation of the mother in buying, cooking, and sharing the food given to her child was of some educational value.