COMMUNITY EYE HEALTH (CEH)

Screening

Learning Outcome Overview

COMMUNITY EYE HEALTH (CEH)
Learning Outcome	Screening
Code		CEH1
Description		Trainees must understand the basic principles of screening for disease. They must understand the local and national organisation of screening programmes for ophthalmic diseases. They must provide local screening programmes with appropriate clinical expertise.
Assessment		CbD,Portfolio and end of year 2,3/4 review/COECSA exams
Target Year of Achievement		Year ¾
Related Learning Outcomes		CEH1-CEH6
Other Links		Study Guide  3.7.1.2 below

Screening for eye disease Study Guide  

Think:

• What are the risks, limitations and benefits of screening?
• What would be the benefits of screening for diabetic retinopathy, glaucoma, cataract?
• What factors (including accessibility, personal mobility and education) may put patients off being involved in screening and how can these be minimized?
• How can patient management pathways be best organized to ensure a failsafe system?
• Why accurate disease is registers important in the context of screening?
• What is my role in the QA of screening programmes e.g. diabetic retinopathy screening?

Knowledge:

• Understanding of which diseases merit/meet criteria for screening programmes
• Which systematic screening programmes for ophthalmic conditions currently exist
• Understanding the distinction between systematic and opportunistic screening
• Organisation and importance of quality control in screening programmes
• How outcomes of screening are dealt with
• Understanding the logistics, pros cons and pitfalls of the ways of delivering a screening service to the local population
• Understanding how defects in the screening and referral pathway are identified and measured
• Knowledge of grading classification and referral criteria for the major national screening programmes including diabetic retinopathy and glaucoma screening

Activity:

• Attend and observe diabetic retinopathy screening, ROP screening and community vision screening in children

Resources:

• Epidemiology of eye diseases
• Community eye health journal
• ICEH website
• www.rcophth.ac.uk/scientific guidelines for diabetic retinopathy, retinopathy of prematurity, hydroxychloroquine, vigabatrin, management of strabismus and amblyopia
• Oxford Textbook of Medicine
• The Exeter Standards http://www.retinalscreening.nhs.uk/userFiles/File/The%20Exeter%20Standards%20v1%20-%202007-04-02.pdf#search='exeter'
• National Screening Programme for Diabetic Retinopathy Quality Standards and Service Objectives, June 2009 http://www.retinalscreening.nhs.uk/pages/default.asp?id=9&sID=80

• Diabetic retinopathy screening photo external test sets www.drseqa.org

Injury prevention

Learning Outcome Overview

COMMUNITY EYE HEALTH (CEH)
Learning Outcome	Injury prevention
Code	CEH2
Description	All trainees must be aware of available resources and information regarding eye injury prevention and promote the use of protective eyewear and occupational eye safety when appropriate
Assessment	CbD,Portfolio and end of year 2,3/4 review/COECSA exams
Target Year of Achievement	Year ¾
Related Learning Outcomes	CEH1-CEH6, BCS9
Other Links	Study Guide  3.7.2.2 below

Promote issues of injury prevention STUDY GUIDE

Think:

• What precautions would you advise for workers in chemical/glass manufacture or other types of jobs?
• What responsibilities do I have regarding safety in my workplace - for fellow staff and for patients - and what precautions should I take in this regard (environment, condition of equipment etc.)?

Knowledge:

• Occupations, leisure activities and criminal activities associated with ophthalmic injuries
• What eye protection is available and how to use it
• Principles and practice of risk management and patient safety

Resources:

• College advice on specific events e.g. solar eclipse
• www.alphatech-int.co.uk
• www.nlm.nih.gov/medlineplus/eyeinjuries.html
• http://www.prwg.co.uk/JWGrundy/occupational_vision.htm

Disease risk reduction

Learning Outcome Overview

COMMUNITY EYE HEALTH (CEH)
Learning Outcome	Disease risk reduction
Code	CEH3
Description	Trainees must be able to recognize ophthalmic diseases which are associated with systemic conditions.  They must recognize when specialist opinion is required for patients with systemic disease.  They must be aware of the ocular and systemic side effects of the drugs they prescribe including the prevention of the likely complications and side effects.
Assessment	MSF, portfolio/logbook and end of Year 2,3/4review/ exam
Target Year of Achievement	MSF, Portfolio and end of Year  2,3,4 review/ COECSA exam
Related Learning Outcomes	Year 1 (BCS1-12), CEH1-6
Other Links	Study Guide  3.7.3.2 below

Implement risk reduction strategies Study Guide

Think:

• Do I take opportunities to educate patients to enable them to maintain health and reduce risks of ophthalmic and systemic diseases?

Knowledge:

• Systemic risk factors associated with ophthalmic diseases
• Risk reduction strategies pursued in general practice e.g. hypertension, cholesterol and weight control, exercise etc
• Smoking cessation services in hospital and in community and how to access these programmes
• The risks of environmental factors such as chemical containment on ocular health (both community and individual) and how they can be mitigated
• How to prescribe medication, especially steroids, appropriately and safely

Risk of osteoporosis with steroids and how this can be minimized

Resources:

• Essential Medical Ophthalmology. A problem oriented approach. Ferris. Butterworth (2001)
• www.nlm.nih.gov/medlineplus/smokingcessation.html NIH site on smoking cessation
• http://smokefree.nhs.uk
• www.health.state.ny.us/nysdoh/osteo.fda.htm

• http://www.arthritisresearchuk.org
• Epidemiology of eye diseases
• Community eye health journal/ ICEH website

Immunization and supplementation

Learning Outcome Overview

COMMUNITY EYE HEALTH (CEH)
Learning Outcome	Immunization and supplementation
Code	CEH4
Description	Trainees must be aware of local and national immunization policies and supplementation e.g. vitamin A and be able to implement them in appropriate circumstances. They must understand the risks, benefits and limitations of immunization.
Assessment	CbD, Portfolio and end of year 2,3/4 review/COECSA exams
Target Year of Achievement	Year 3 /4
Related Learning Outcomes	CEH1-CEH6 and  BCS9.
Other Links	Study Guide  3.7.4.2 below

3.7.4.2 Promote appropriate immunisation STUDY GUIDE

Think:

• How do MCH programs impacts on childhood blindness?
• How is primary eye care linked to primary health care

Knowledge:

• Theoretical and practical aspects of antenatal care, safe delivery, immunization and nutrition in MCH programs.

Resources:           

• Local MCH protocols and guidelines
• Local Primary health care protocols and guidelines

DETERMINING MAGNITUDE AND BURDEN OF BLINDNESS/visual impairment

Learning Outcome Overview

COMMUNITY EYE HEALTH (CEH)
Learning Outcome	Determining the magnitude and burden of blindness/Visual impairment
Code	CEH5
Description	Trainees must be able to determine the prevalence and incidence of the blindness. They must be aware of the causes of avoidable blindness bearing in mind the determinants of eye diseases and blindness.  They must be able to determine the burden of the various eye disease that lead to blindness
Assessment	MSF,  presentation, Portfolio and end of year 2,3/4 review/COECSA exams
Target Year of Achievement	Year ¾
Related Learning Outcomes	CEH1-CEH6, BCS9, BCS11 and ML11
Other Links	Study Guide  3.7.5.2 below

DETERMINING MAGNITUDE AND BURDEN OF BLINDNESS/visual impairment Study Guide  

Think:

• What are the leading blinding eye diseases globally and locally in the region?
• How is the magnitude and distribution of these diseases determined?
• What do cataract backlog and cataract surgical rate mean?
• What do blind years mean?

Knowledge:

• Understanding of which diseases merit/meet public health intervention.
• The methods used to determine the prevalence of blindness for children and for adults.
• Calculation of DALYs, Blind years and the cost of blindness

• Estimation of cataract backlog and cataract surgical rate
• What RAAB and RACS mean

Activity:

• Read about surveys done on blindness, where possible participate in conducting such studies
• Do exercises on calculation of the parameters used in quantifying the blindness burden.
• Familiar yourself with your national eye care plan/strategic plan.
• Familiarize yourself with the global eye health statistics.

Resources:

• The Epidemiology of Eye Diseases edited by Gordon J. Johnson, Darwin C. Minassian, Robert Weale. Published by Chapman & Hall Medical
• Community eye health journal
• ICEH website (iceh.lshtm.ac.uk)

Developing a health promotion action plan

Learning Outcome Overview

COMMUNITY EYE HEALTH (CEH)
Learning Outcome	Developing a health promotion action plan
Code	CEH6
Description	Trainees must be able to identify eye health needs of the population.  They must recognize the impact of health beliefs, religion, culture and ethnicity.  They must be able to plan, organize and deliver quality eye care services using available resources in line with Vision 2020 plans and existing national programmes.  They must understand the cost implications and limitations.
Assessment	MSF,  presentation, Portfolio and end of year 2,3/4 review/COECSA exams
Target Year of Achievement	Year ¾
Related Learning Outcomes	CEH1-CEH6, BCS9, ML10, ML11 and ML12
Other Links	Study Guide  3.7.6.2 below

Developing a health promotion action plan STUDY GUIDE

Think:

• What are the common blinding diseases in the region (Cataract, Trachoma, Glaucoma, Childhood blindness, Diabetic Retinopathy)
• How is the magnitude and distribution of these diseases determined?
• How these diseases controlled (Primary, secondary and tertiary prevention)
• What is the role of Vision 2020 in eye health promotion?

Knowledge:

• Understanding of which diseases merit/meet public health intervention.
• Which public eye health programmes currently exist for the common blinding eye diseases?
• Understanding planning and implementation of public eye health programs

• Understanding of monitoring and evaluation of public eye health programs

Activity:

• Participate in public eye health programs (outreach and elective terms)
• Familiarise yourself with your national eye care strategic plan and the national prevention of blindness activities.

Resources:

• The Epidemiology of Eye Diseases edited by Gordon J. Johnson, Darwin C. Minassian, Robert Weale. Published by Chapman & Hall Medical
• Community eye health journals
• ICEH website (iceh.lshtm.ac.uk)
• VISION 2020 website (www.iapb.org/vision-2020)