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Dr G. Chandrasekhar

Dr G. Chandrasekhar. LVP Eye Health Pyramid Glaucoma Care. LVPEI Eye Health Pyramid. From Screening to Management of Complex Diseases. Appropriate Available Affordable Accessible. Adv. Tertiary. Tertiary. Secondary. Primary. Community. Without Compromising Quality. PRIMARY CARE:

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Dr G. Chandrasekhar

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  1. Dr G. Chandrasekhar LVP Eye Health Pyramid Glaucoma Care

  2. LVPEI Eye Health Pyramid From Screening to Management of Complex Diseases • Appropriate • Available • Affordable • Accessible Adv. Tertiary Tertiary Secondary Primary Community Without Compromising Quality

  3. PRIMARY CARE: PUTTING PEOPLE FIRST • Organizing primary-care networks • Continuity of care • Bringing care closer to the people • Responsibility for a well-identified population

  4. Village Vision Complex Integrated Secondary & Primary Eye Care Secondary Eye Care + 10 Vision Centres + 100 Vision Guardians Direct Service to 100-200 villages

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

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

  7. Community Level (Vision Guardian) Centre of Excellence • General awareness • Refer those with problems Training centre Service Centre Vision Centre Vision Guardian

  8. Primary Care (Vision Technician) • History • High IOP • Optic nerve • Van Herrick’s • Referral Centre of Excellence Training centre Service Centre Vision Centre Vision Guardian

  9. Secondary Care (Ophthalmologist) • History Slit lamp • Applanation tonometry • Gonioscopy • Optic nerve • Visual fields • Medical and Surgical Rx Centre of Excellence Training centre Service Centre Vision Centre Vision Guardian

  10. Tertiary Care (Subspecialities) Centre of Excellence • Diagnosis & treatment of complicated problems • Training • Research Training centre Service Centre Vision Centre Vision Guardian

  11. Advanced Tertiary Care (Team of Subspecialists) CENTRE OF EXCELLENCE • Management of complex cases • Training of Subspecialists and trainers • Educational standards • Research • Advocacy • Capacity building of Training Centres Centre of Excellence Training centre Service Centre Vision Centre Vision Guardian

  12. Advanced Tertiary Care (Team of Subspecialists) CENTRE OF EXCELLENCE • Capacity building of • Training Centres • Situation analysis • Modification of infrastructure • Redesigning of physical space • Equipment • Training of Trainers • Implementation • Monitoring and • evaluation Centre of Excellence Training centre Service Centre Vision Centre Vision Guardian

  13. Village Vision Complex Integrated Secondary & Primary Eye Care Secondary Eye Care + 10 Vision Centres + 100 Vision Guardians Direct Service to 100-200 villages

  14. Secondary Centres Data (1998-2011)

  15. Glaucoma – Vision Centres 0.68% - High IOP > 21

  16. LVPEI Eye Health PyramidGlaucoma care Challenges IOP Angle Closure Disc and field damage

  17. Glaucoma Epidemiology and Molecular Genetics Study GLEAMS

  18. Population based cross sectional study Methodology

  19. 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 Methodology

  20. The Study Plan Vision Guardian Vision screening Vision Technician 1 History, VA, Ref Vision Technician 2 FDT, HVF, SL, NMFP, ASOCT Vision Technician 1 DO, IOP, Gonio Optometrist Goni, dilated evaluation, OCT, Fundus photo

  21. 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

  22. Analysis III Skills of a VT in Gonioscopy and image acquisition Analysis IV Role of Imaging in POAG and PACD diagnosis Results

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

  24. Agreement between Optometrists and Glaucoma Expert Results

  25. Progress of the Project • No. of villages screened - 10 • Number of subjects screened till now – 2000 • Data available - 1832

  26. No. of eyes with various types of glaucoma

  27. LVPEI Eye Health PyramidGlaucoma care Challenges IOP Angle Closure Disc and field damage

  28. The Glaucoma Continuum Weinreb RN etal. Am J Ophthalmol 2004;138: 458-467

  29. Shallow AC depth on Van Herrick Corresponding ASOCT

  30. BEST NMFP Corresponding OCT BEST MFP

  31. WORST NMFP Corresponding OCT WORST MFP

  32. Thank you! L V Prasad Eye Institute www.lvpei.org Excellence Equity Efficiency

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