Topic outline

  • Promote the value and assist in the organisation of screening for eye disease

    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 minimised?
    • How can patient management pathways be best organised to ensure a failsafe system?
    • Why are accurate disease 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:

    • Promote issues of injury prevention, especially in regard to protective eyewear

      Think:

      • What precautions would you advise for workers in chemical/glass manufacture?
      • 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:

      • Implement risk reduction strategies relating to ophthalmic and relevant systemic diseases

        Think:

        • Do I take opportunities to education 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, weight control, exercise,etc
        • Smoking cessation services in hospital and in community and how to access theses 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 minimised

        Resources:

        • Provide advice on contact lens care

          Knowledge:

          • The various contact lens types, lens hygiene and associated risks

          Activity:

          • Attend contact lens fitting clinics
          • Experience managing complications of contact lens wear

          Resources:

          • Courses on contact lensesfitting and hygiene (e.g.Institute of Optometry course)
          • Ocular Infection investigation and treatment in practice. Seal, Bron and Hay. Dunitz (1999)
          • www.ioo.org.uk (Institute of Optometry website)
          • Promote appropriate immunisation

            Think:

            • How MCH programs impacts on childhood blindness

            Knowledge:

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

            Resources:     

            • Local MCH protocols and guidelines
            • Understand the implications of investigations and therapeutics during pregnancy

              Think:

              • What advice would you give to a diabetic woman in the first trimester of her first pregnancy?
              • Which drugs might affect contraceptives?
              • Which ocular and systemic investigations can be performed safely and which should be avoided in pregnancy?
              • How would you manage a pregnant glaucoma patient?

              Knowledge:

              • Risks to eye and health in pregnancy, with respect to investigation and treatment

              Activity:

              • Remember to ask women, where appropriate, if they take a contraceptive pill
              • Where relevant, remember to ask women if they are, or could be, pregnant

              Resources:

              • Developing a health promotion action plan

                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)
                Knowledge:
                • Understanding of which diseases merit/meetpublic 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:

                • Particapate in public eye health programs (outreach and elective terms)
                Resources:
                • The Epidemiologyof 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)