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== Screening ==

==== Learning Outcome Overview ====
{| class="wikitable"
| colspan="3" |'''COMMUNITY EYE HEALTH (CEH)'''
|-
|'''Learning Outcome'''
| colspan="2" |

'''Screening'''
|-
| colspan="2" |Code
|CEH1
|-
| colspan="2" |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.
|-
| colspan="2" |Assessment
|

'''CbD''','''Portfolio and end of year 2,3/4 review/COECSA exams'''
|-
| colspan="2" |Target Year of Achievement
|Year ¾
|-
| colspan="2" |Related Learning Outcomes
|CEH1-CEH6
|-
| colspan="2" |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 <nowiki>http://www.retinalscreening.nhs.uk/userFiles/File/The%20Exeter%20Standards%20v1%20-%202007-04-02.pdf#search='exeter'</nowiki>
* National Screening Programme for Diabetic Retinopathy Quality Standards and Service Objectives, June 2009 <nowiki>http://www.retinalscreening.nhs.uk/pages/default.asp?id=9&sID=80</nowiki>

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

== Injury prevention ==

==== Learning Outcome Overview ====
{| class="wikitable"
| colspan="2" |'''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
* <nowiki>http://www.prwg.co.uk/JWGrundy/occupational_vision.htm</nowiki>

== Disease risk reduction ==

==== Learning Outcome Overview ====
{| class="wikitable"
| colspan="2" |'''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
* <nowiki>http://smokefree.nhs.uk</nowiki>
* www.health.state.ny.us/nysdoh/osteo.fda.htm

* <nowiki>http://www.arthritisresearchuk.org</nowiki> 
* Epidemiology of eye diseases
* Community eye health journal/ ICEH website

== Immunization and supplementation ==

==== Learning Outcome Overview ====
{| class="wikitable"
| colspan="2" |'''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 ====
{| class="wikitable"
| colspan="2" |'''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 ====
{| class="wikitable"
| colspan="2" |'''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)

COMMUNITY EYE HEALTH (CEH) - Revision history

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