2013 Caribbean V2020 Regional Meeting

Celebrating the 13th year of Vision 2020: The Right to Sight in the Caribbean
Preventing bIindness and visuaI impairment whiIe restoring sight and creating opportunities for persons whose
sight cannot be restored

Lower AII Saints Road - P.O. Box 1517 - Antigua, West Indies
TeI: 1-(268)-462-4111/462-6369/562-2216 - Fax: (268)-462-6371
E-maiI: arveI.grant@eyecarecaribbean.com; keva.richards@eyecarecaribbean.com;
frank.bowen@eyecarecaribbean.com; caroIyn.gopauI@eyecarecaribbean.com
Website: www.eyecarecaribbean.com; www.ccb1967.com www.v2020caribbean.com

2013 ANNUAL MEETING OF VISION 2020
COMMITTEES - REPRESENTATIVES FOR
THE CARIBBEAN

AGENDA

VENUE: The Legacy Suite, Pegasus HoteI, Kingston, Jamaica
Tuesday 3
rd
& Wednesday 4
th
Dec, 2013

CHAIR: ArveI Grant, CEO, CCB-Eye Care Caribbean

This meeting is being impIemented with the technicaI and financiaI support of:

1
AGENDA
2013 ANNUAL MEETING OF VISION 2020 COMMITTEES -
REPRESENTATIVES FOR THE CARIBBEAN

Purpose of the meeting:
! This meeting will provide a platform for sharing, learning and networking and will
strengthen links between V2020 Committees and persons involved in eye health.
! Participants will become familiar with perspectives from other areas and will be
exposed to new thinking, technologies and opportunities that can be used to benefit
eye health service delivery in their countries.
! The meeting will pay particular attention to Diabetic Retinopathy one of the most
prevalent causes of blindness in the Caribbean, and to discussing WHO's Towards
Universal Eye Health: a Global Action Plan 2014-2019

DAY ONE: Tuesday 3
rd
December, 2013
START TIME: 8.15 am to 5.00 pm

OPENING SESSION
8:15 - 8:30 Getting seated and meeting your
neighbors

8:30 - 8:40 CaII to order and weIcome
Moment of Meditation
ArveI Grant,
CEO, CCB-Eye Care Caribbean
Meeting Chair
8:40 - 8:50 RoIe caII of deIegates Keva Richards,
Vision 2020 Project Manager,
CCB-Eye Care Caribbean
Doc. 1: List of Delegates; page 9
8:50 - 9:00 House-keeping matters and
questions for cIarification
Conrad Harris,
Director Of Programmes,
Jamaica Society for the Blind

SETTING THE CONTEXT
9:00 - 9:15 Address by the InternationaI Agency
for the Prevention of BIindness
Dr Pizzarello will open the meeting and
discuss APB's World Sight Day 2013
Report
Dr Louis PizzareIIo (MD,MPH)
Chairman for the North American
Region of the International Agency
for the Prevention of Blindness
(IAPB)
Doc. 2: Towards Universal Eye
Health (WSD 2013 Report); page 11

2
9:15 - 9:30 Towards UniversaI Eye HeaIth:
GIobaI Action PIan 2014-2019
What is new, what is different and what
the Global Action Plan aims to achieve -
plus an overview of the plan's Vision,
Goal, Purpose, Objectives and Actions.
(NOTE: More detailed sessions on the
Global Action Plan and its
implementation will be held on Day 2)
Dr Juan CarIos SiIva (MD, MPH)
Regional Advisor - Visual Health
PAHO
Doc. 3: WHA66.4 - Endorsement of
Global Action Plan 2014-19; page
31
Doc. 4: Towards Universal Eye
Health: a Global Action Plan 2014-
2019 (Draft); page 33
9:30 - 9:40 Strategic Framework for V2020 -
Caribbean Region (2010)
Recap on ndicators and Priorities of the
current Framework for the Caribbean
Dr Juan CarIos SiIva
Doc. 5: Strategic Framework for
V2020 (Caribbean Region); page 49
9:40 - 9:50 DeIivering V2020 in the Caribbean
(EC Contract No. DCI-NSA PVD / 2009
/ 222-937)
Progress to date and planned actions
PhiIip Hand,
Programme Manager (Caribbean),
Sightsavers;
Doc. 6: Session Presentation; page
71
9:50 - 10:05 Keynote Address Hon. Dr. Fenton Ferguson CD
DDS MP Minister of HeaIth,
Jamaica
(or his representative)
10:05 - 10:15 Q & A on aII Presentations FaciIitated by ArveI Grant

10:15 - 10:45 COFFEE BREAK

STATUS OF V2020: THE RIGHT TO SIGHT
10:45 - 1:00
(Session
continues after
Iunch)

The Status of V2020: The Right to
Sight in participating countries
Each national delegation is invited to
present for up to 15 minutes:
! Antigua & Barbuda
! Barbados
! Belize
! Commonwealth of Dominica;
! Grenada
! Guyana (The Republic)
! Haiti (The Republic)
! Jamaica
! St. Kitts & Nevis
! St. Lucia

FaciIitated by Dr Juan CarIos
SiIva
3

1:00 - 2:00

LUNCH BREAK (Own Account)

2:00 - 2:45 ! St. Vincent & The Grenadines
! Suriname (The Republic)
! Trinidad & Tobago (The Republic)

2:45 - 2:55 RegionaI AnaIysis Keva Richards
2:55 - 3:05 Q & A ArveI Grant

3:05 - 3:35

COFFEE BREAK

IMPLEMENTING V2020 PROGRAMMES - DISEASE CONTROL
3.35 - 4.00 Diabetic Retinopathy
An overview of Diabetic Retinopathy
including a presentation of findings and
recommendations from the 2013 Diabetic
Retinopathy Situation Analyses from
Antigua, Belize and Jamaica
Dr MichaeI Eckstein,
MB BS MD DO FRCOphth
Consultant Vitreoretinal
Surgeon
Clinical Lead Sussex Diabetic
Retinopathy Screening
Programme
Brighton and Sussex
University Hospital, UK
Doc. 7: Situation Analysis of
Diabetic Retinopathy Services
in Antigua; page 73
in Belize; page 96
in Jamaica; page 114
4:00 - 4:15 The Queen EIizabeth Diamond JubiIee
Trust
An introduction to The Queen Elizabeth
Diamond Jubilee Trust and its work on
avoidable blindness across the
Commonwealth. Potential next steps for
the Trust's involvement in a potential
diabetic retinopathy programme in the
Caribbean.
Dr Andrew Cooper
Director of Programmes
The Queen Elizabeth Diamond
Jubilee Trust

Doc. 10: About The Queen
Elizabeth Diamond Jubilee
Trust; page 135
4:15 - 4:35 Caribbean Diabetic Retinopathy
Programme Concept
ntroduction of a Regional Diabetic
Retinopathy Programme Concept Paper
followed by a plenary discussion

ArveI Grant
Doc. 11: Caribbean Diabetic
Retinopathy Programme
Concept Paper; page 139
4
4:35 - 4:45 Group Work Objectives
Defining Groups

PhiIip Hand
4:45 - 5:45 Group Work Activity 1

Three groups wiII address one topic
each:
Group 1 Topic:
! Developing a Diabetic
Retinopathy Programme Who
(key players) How (process)
When (timelines)

Group 2 Topic:
! Learning from others
incorporating regional and global
best practice and experience into
programme design.

Group 3 Topic:
! Barriers and solutions
exploring challenges to
introducing screening and
treatment policy frameworks and
to influencing behavior change.

Group 1:
Facilitator:
! Joan McLeod-Omawale,
PhD, MBA - Director LAC
Program, ORBIS
International
Resource Person:
! Dr Andrew Cooper
Rapporteurs:
! Philip Hand
Doc. 12: Group Work Activity 1
Group 1; page 154

Group 2:
Facilitator
! Dr Shailendra Sugrim
Resource Person:
! Dr Michael Eckstein
Rapporteurs:
! Charles Vandyke
Group 2; page 155

Group 3:
Facilitator
! Dr Juan Carlos Silva
Resource Person:
! Charles O Pierce,
MBBS MRCOphth
Research Registrar,
Ophthalmology,
University of
Southampton, UK
Rapporteurs:
! Keva Richards
Group 3; page 156

5:45 - 6:15 Presentation of Group Work Activity 1 FaciIitated by ArveI Grant

5
DAY TWO: Wednesday 4
th
December, 2012
8.30 am to 4.30 pm

V2020 PLANNING
Purpose of this Session:
! Provide participants with an overview of the current strategies to prevent blindness in
the world and in the Region.
! Assess strengths, weaknesses, opportunities and threats on the implementation of
the Prevention of Blindness and Visual Impairment Plan approved by the PAHO
governing bodies in 2009.
! Discuss national level implementation of WHO's Towards Universal Eye Health:
Global Action Plan 2014-2019, approved by the World Health Assembly in 2013.

8:30 - 8:45 PAHO PIan for the Prevention of
BIindness approved by Ministers of
HeaIth in 2009.
Progress and Challenges
Juan CarIos SiIva
Regional Advisor
Visual Health PAHO
Doc. 15: PAHO action plan 2009;
page 157
8:45 - 9:00 WHO Action PIan on AvoidabIe
BIindness 2014-2019
Overview
Juan CarIos SiIva
Regional Advisor
Visual Health PAHO
9:00 - 9:10 Group Work Objectives
Defining Groups
PhiIip Hand
9:10 - 10:15 Group Work Activity 2

Groups 1:
! SWOT analysis on the
implementation of national eye
health plans
! How to improve implementation of
national plans

Group 2:
! SWOT analysis on National V2020
Committee function, stakeholder
participation, leadership and
communications.
! How to improve effectiveness of
V2020 Committees

Group 1:
Facilitator:
! Joan McLeod-Omawale
Resource Person:
! To be determined
Rapporteurs:
! Keva Richards
Group 1; page 172

Group 2:
Facilitator
Resource Person:
! Nurse Juliette Joseph
Asst. Principal Nursing
Officer, representing
Ministry of Health, St
Lucia.
Rapporteurs:
! Philip Hand
Group 2; page 173
6
10:15 - 10:45 Coffee break
10:45 - 11:15
Presentations and discussion of Group
Work Activity 2
Facilitated by Juan Carlos
Silva
11:15 - 12:30
Group Work Activity 3
Group 1 Topics:
! How to include Retinopathy of
Prematurity (ROP) in national
Neonatal policies and plans
! How to include Diabetic Retinopathy
in national Non-Communicable
Disease and Diabetes Policies and
Plans
! How to include Cataract Surgery in
the national health information
systems

Group 2 Topics:
! How to include Refractive Error in
school children in National Ministry of
Education policies
! How to include Primary Eye Care in
Primary Health Care
! How to resource and implement
national eye health surveys

Group 1:
Facilitator:
! Joan McLeod-Omawale
Resource Person:
! To be determined
Rapporteurs:
! Philip Hand
Doc. 18: Group Work Activity
3 Group 1; page 174

Group 2:
Facilitator
Resource Person:
! Nurse Juliette Joseph
Rapporteurs:
! Keva Richards
Doc. 19: Group Work Activity
3 Group 2; page 175
12:30 - 1:00 Presentations and discussion of Group
Work Activity 3
Facilitated by Juan Carlos
Silva
1:00 - 2:00 LUNCH (Own Account)

NOTE: Arvel Grant will resume as meeting chair for the afternoon sessions
2:00 - 2:20 DeveIoping the Guyana Eye Care
Strategic Framework
Dr Shailendra Sugrim discussed the process
of framework development in Guyana
Dr ShaiIendra Sugrim
Consultant Ophthalmologists,
& Glaucoma Specialists,
Georgetown Public Hospital,
Guyana.
Doc. 20: Developing the
Guyana Eye Care Strategic
Framework; page 176
Doc. 21: Guyana Eye Care
Strategic Framework; page
179

7
2:20 - 3.10 PIenary Discussion:
Engaging non-heaIth sectors in
deveIoping and impIementing eye
heaIth/prevention of visuaI impairment
poIicies and pIans
The Universal Eye Health: Global Action
Plan 2014-2019 proposes that Health
Ministries identify and engage other sectors,
such as those under Ministries of Education,
Finance, Welfare and Development, when
developing and implementing eye health
policies and plans.
This discussion will explore:
! How this has or can happen
! What are the common areas of interest
! What are the potential benefits
! What challenges may be expected
Chaired by Arvel Grant
Rapporteur Conrad Harris
Doc. 4: Objective 3 of the
Global Action Plan; page 43

3:10 - 3:30

COFFEE BREAK

RESEARCH - GLAUCOMA & DIABETIC RETINOPATHY KAP STUDIES
3:30 - 4:00 GIaucoma & Diabetic Retinopathy KAP
studies
Update on studies to be undertaken in
Barbados, Guyana, Jamaica and St Lucia
Dr Dawn Grosvenor
Consultant Ophthalmologist,
& Glaucoma Specialists&
Principal Investigator-
Barbados
Doc. 21: Abstract for CCB
Conference Presentation on
Caribbean Glaucoma KAP
Study; page 204

CharIes O Pierce MBBS
MRCOphth
Research Registrar,
Ophthalmology, University of
Southampton, UK
Doc. 22: Abstract summary
of the (DRKAP) study; page
205

4:00- 4:20 Patient Ied GIaucoma Action Group from
the MandeviIIe area

Dr. CeIeste Chambers
4:20 - 4:30 CIosing Remarks (end of Meeting) ArveI Grant

8
"#$% &' ()")*+%)$

,&- %)..#%&./ ,+0) &' &.*+,#1+%#&, ()")*+%)$ ,+0)$
1 Antigua & Barbuda ChieI Executive OIIicer, Caribbean Council Ior the Blind Arvel Grant
2 Antigua & Barbuda Operations & Lab Services Manager, Caribbean Council
Ior the Blind
Carolyn Gopaul
3 Antigua & Barbuda V2020 Project Manager, Caribbean Council Ior the Blind Keva Richards
4 Antigua & Barbuda Statistician, Ministry oI Health St. Clair Soleyn
5 Antigua & Barbuda Permanent Secretary, Ministry oI Health Edson Joseph
6 Barbados Consultant Ophthalmologist, Queen Elizabeth Hospital Dr. Dawn Grosvenor-Blackman
7 Barbados Vitreo Retinal Specialist Dr. Charles Pierce
8 Barbados Ministry oI Health Kevamae Belgrave
9 Barbados Vitreo Retinal Specialist, Ministry oI Health Sherwin Gaskin
10 Belize Programme Director, Belize Council Ior the Visually
Impaired
Leolyn Garcia
11 Belize Executive Director, Belize Council Ior the Visually
Impaired
Joan Musa
12 Dominica District Medical OIIicer, Ministry oI Health Dr. Charlotte Jeremy-CuIIy
13 Dominica The Diabetic Retinopathy Screening Programme, The
Commonwealth OI Dominica
Nanda Matthew
14 Grenada ChieI Medical OIIicer, Ministry oI Health Dr. George Mitchell
15 Guyana Chairman (National V2020 Committee), Ministry oI
Health
Dr. Shailendra Sugrim
16 Guyana National Programme Manager, CCB-Eye Care Guyana Charles Vandyke
17 Haiti Coordinator, CNPC-Haiti Dr. Valery Blot
18 Haiti Ophthalmologist, International Child Care Dr. Mike Maingrette
19 Jamaica Acting Regional Technical Director, Southern Regional
Health Authority
Beverley Wright
20 Jamaica Theatre Nurse, Mandeville Eye Clinic Nurse Joyce Gooden

9
21 Jamaica Ophthalmologist (Glaucoma Specialist), Mandeville Eye
Clinic
Dr. Celeste Chambers
22 Jamaica National V2020 Programme Manager, Jamaica Society Ior
the Blind
Conrad Harris
23 Jamaica Executive Director, Jamaica Society Ior the Blind Lola Marson
24 Jamaica Regional Maintenance Manager, Caribbean Council Ior the
Blind
Henry Latty
22 St. Kitts & Nevis Director Institutional Nursing Services, Ministry oI Health Mrs. Sonia Daly-Finley
22 St. Kitts & Nevis StaII Nurse, Ministry oI Health Mrs. Loiuse Williams
23 St. Lucia Assistant Principal Nursing OIIicer, Ministry oI Health Nurse Juliette Joseph
24 St. Lucia Executive Director, St. Lucia Blind WelIare Association Anthony Avril
25 St. Lucia V2020 Programme Manager, Eye Care St. Lucia/SLBWA Emma Bernard-Joseph
26 St. Vincent & The Grenadines Senior Registrar, Ministry oI Health, Wellness &
Environment
Dr. Orly Adams
27 St. Vincent & The Grenadines Registrar, Ministry oI Health, Wellness & Environment Dr. Rosmond Adams
28 Suriname Eye Specialist, Eye Care Centre at Academic Hospital
Paramaribo
Michael Rayanto Siban
29 Suriname Director oI National Foundation Ior Blind Care Suriname Natasia Hanenberg-Agard
30 Trinidad & Tobago Primary Care OIIicer 1, Ministry oI Health Dr. Sharon Lackan
31 Caribbean Programme Manager, Sightsavers Philip Hand
32 Regional Advisor, Visual Health, Pan American Health
Organisation (PAHO)
Dr. Juan Carlos Silva
33 Director LAC Program, ORBIS International, USA Joan McLeod-Omawale
34 Chairman Ior the North American Region oI the
International Agency Ior the Prevention oI Blindness
Dr. Louis Pizzarello
35 Eye and Ear Care Health Programme Coordinator, CBM Marie Joseph
36 Clinical Lead Sussex Diabetic Retinopathy Screening
Programme, Brighton & Sussex Univ. Hospital
Dr. Mike Eckstein
37 Director oI Programmes, The Queen Elizabeth Diamond
Jubilee Trust
Dr. Andrew Cooper
38 Regional Coordinator, Brien Holden Vision Institute Vivien Ocampo

1a
11
12
13
14
15
16
17
18
19
2a
21
22
23
24
25
26
27
28
29
3a

SIXTY-SIXTH WORLD HEALTH ASSEMBLY WHA66.4
Agenda item 13.4 24 May 2013
Towards universal eye health: a global action plan
20142019

The Sixty-sixth World Health Assembly,
Having considered the report and draft global action plan 20142019 on universal eye health;
1

Recalling resolutions WHA56.26 on elimination of avoidable blindness and WHA62.1 and
WHA59.25 on prevention of avoidable blindness and visual impairment;
Recognizing that the global action plan 20142019 on universal eye health builds upon the
action plan for the prevention of avoidable blindness and visual impairment for the period 20092013;
Recognizing that globally, 80% of all visual impairment can be prevented or cured and that
about 90% of the worlds visually impaired live in developing countries;
Recognizing the linkages between some areas of the global action plan 20142019 on universal
eye health and efforts to address noncommunicable diseases and neglected tropical diseases;
1. ENDORSES the global action plan 20142019 on universal eye health;
2. URGES Member States:
(1) to strengthen national efforts to prevent avoidable visual impairment including blindness
through, inter alia, better integration of eye health into national health plans and health service
delivery, as appropriate;
(2) to implement the proposed actions in the global action plan 20142019 on universal eye
health in accordance with national priorities, including universal and equitable access to
services;
(3) to continue to implement the actions agreed by the World Health Assembly in resolution
WHA62.1 on prevention of blindness and visual impairment and the action plan for the
prevention of blindness and visual impairment for the period 20092013;
(4) to continue to support the work of the WHO Secretariat to implement the current action
plan up to 2013;

1
Document A66/11.
31
WHA66.4

2
(5) to consider programme and budget implications related to implementation of this
resolution within the context of the broader programme budget;
3. REQUESTS the Director-General:
(1) to provide technical support to Member States for the implementation of the proposed
actions in the global action plan 20142019 on universal eye health in accordance with national
priorities;
(2) to further develop the global action plan 20142019 on universal eye health in particular
with regard to the inclusion of universal and equitable access to services;
(3) to continue to give priority to the prevention of avoidable visual impairment, including
blindness, and to consider allocating resources for the implementation of the global action
plan 20142019 on universal eye health;
(4) to report to the Seventieth and Seventy-third World Health Assemblies, in 2017 and 2020
respectively, through the Executive Board, on progress in implementing the action plan.

Eighth plenary meeting, 24 May 2013
A66/VR/8

= = =
32
- 68 -

ANNEX 2
Universal eye health: a global action plan 20142019
1

[A66/11 28 March 2013]
1. In January 2012 the Executive Board reviewed progress made in implementing the action plan
for the prevention of avoidable blindness and visual impairment for the period 20092013. It decided
that work should commence immediately on a follow-up plan for the period 20142019, and requested
the Director-General to develop a draft action plan for the prevention of avoidable blindness and
visual impairment for the period 20142019 in close consultation with Member States and
international partners, for submission to the World Health Assembly through the Executive Board.
2

The following global action plan was drafted after consultations with Member States, international
partners and organizations in the United Nations system.
VISUAL IMPAIRMENT IN THE WORLD TODAY
2. For 2010, WHO estimated that globally 285 million people were visually impaired, of whom
39 million were blind.
3. According to the data for 2010, 80% of visual impairment including blindness is avoidable. The
two main causes of visual impairment in the world are uncorrected refractive errors (42%) and cataract
(33%). Cost-effective interventions to reduce the burden of both conditions exist in all countries.
4. Visual impairment is more frequent among older age groups. In 2010, 82% of those blind
and 65% of those with moderate and severe blindness were older than 50 years of age. Poorer
populations are more affected by visual impairment including blindness.
BUILDING ON THE PAST
5. In recent resolutions, the Health Assembly has highlighted the importance of eliminating
avoidable blindness as a public health problem. In 2009, the World Health Assembly adopted
resolution WHA62.1, which endorsed the action plan for the prevention of avoidable blindness and
visual impairment. In 2012, a report noted by the Sixty-fifth World Health Assembly and a discussion
paper described lessons learnt from implementing the action plan for 20092013. The results of those
findings and the responses received to the discussion paper were important elements in the development
of this action plan. Some of the lessons learnt are set out below.
(a) In all countries it is crucial to assess the magnitude and causes of visual impairment and
the effectiveness of services. It is important to ensure that systems are in place for monitoring
prevalence and causes of visual impairment, including changes over time, and the effectiveness
of eye care and rehabilitation services as part of the overall health system. Monitoring and

1
See resolution WHA66.4.
2
See decision EB130(1).
33
ANNEX 2 69

evaluating eye care services and epidemiological trends in eye disease should be integrated into
national health information systems. Information from monitoring and evaluation should be
used to guide the planning of services and resource allocation.
(b) Developing and implementing national policies and plans for the prevention of avoidable
visual impairment remain the cornerstone of strategic action. Some programmes against eye
diseases have had considerable success in developing and implementing policies and plans,
however, the need remains to integrate eye disease control programmes into wider health care
delivery systems, and at all levels of the health care system. This is particularly so for human
resource development, financial and fiscal allocations, effective engagement with the private
sector and social entrepreneurship, and care for the most vulnerable communities. In increasing
numbers, countries are acquiring experience in developing and implementing effective eye
health services and embedding them into the wider health system. These experiences need to be
better documented and disseminated so that all countries can benefit from them.
(c) Governments and their partners need to invest in reducing avoidable visual impairment
through cost-effective interventions and in supporting those with irreversible visual impairment
to overcome the barriers that they face in accessing health care, rehabilitation, support and
assistance, their environments, education and employment. There are competing priorities for
investing in health care, nevertheless, the commonly used interventions to operate on cataracts
and correct refractive errors the two major causes of avoidable visual impairment are highly
cost effective. There are many examples where eye care has been successfully provided through
vertical initiatives, especially in low-income settings. It is important that these are fully
integrated into the delivery of a comprehensive eye care service within the context of wider
health services and systems. The mobilization of adequate, predictable and sustained financial
resources can be enhanced by including the prevention of avoidable visual impairment in
broader development cooperative agendas and initiatives. Over the past few years, raising
additional resources for health through innovative financing has been increasingly discussed but
investments in the reduction of the most prevalent eye diseases have been relatively absent from
the innovative financing debate and from major financial investments in health. Further work on
a costbenefit analysis of prevention of avoidable visual impairment and rehabilitation is
needed to maximize the use of resources that are already available.
(d) International partnerships and alliances are instrumental in developing and
strengthening effective public health responses for the prevention of visual impairment.
Sustained, coordinated international action with adequate funding has resulted in impressive
achievements, as demonstrated by the former Onchocerciasis Control Programme, the African
Programme for Onchocerciasis Control and the WHO Alliance for the Global Elimination of
Trachoma by the year 2020. VISION 2020: The Right to Sight, the joint global initiative for the
elimination of avoidable blindness of WHO and the International Agency for the Prevention of
Blindness, has been important in increasing awareness of avoidable blindness and has resulted
in the establishment of regional and national entities that facilitate a broad range of activities.
The challenge now is to strengthen global and regional partnerships, ensure they support
building strong and sustainable health systems, and make partnerships ever more effective.
(e) Elimination of avoidable blindness depends on progress in other global health and
development agendas, such as the development of comprehensive health systems, human
resources for health development, improvements in the area of maternal, child and reproductive
health, and the provision of safe drinking-water and basic sanitation. Eye health should be
included in broader noncommunicable and communicable disease frameworks, as well as those
addressing ageing populations. The proven risk factors for some causes of blindness
(e.g. diabetes mellitus, smoking, premature birth, rubella and vitamin A deficiency) need to be
continuously addressed through multisectoral interventions.
34
70 SIXTY-SIXTH WORLD HEALTH ASSEMBLY

(f) Research is important and needs to be funded. Biomedical research is important in
developing new and more cost-effective interventions, especially those that are applicable in
low-income and middle-income countries. Operational research will provide evidence on ways
to overcome barriers in service provision and uptake, and improvements in appropriate cost-
effective strategies and approaches for meeting ever-growing public health needs for improving
and preserving eye health in communities.
(g) Global targets and national indicators are important. A global target provides clarity on
the overall direction of the plan and focuses the efforts of partners. It is also important for
advocacy purposes and evaluating the overall impact of the action plan. National indicators help
Member States and their partners to evaluate progress and plan future investments.
GLOBAL ACTION PLAN 20142019
6. The vision of the global action plan is a world in which nobody is needlessly visually impaired,
where those with unavoidable vision loss can achieve their full potential, and where there is universal
access to comprehensive eye care services.
7. The global action plan 20142019 aims to sustain and expand efforts by Member States, the
Secretariat and international partners to further improve eye health and to work towards attaining the
vision just described. Its goal is to reduce avoidable visual impairment
1
as a global public health problem
and to secure access to rehabilitation services for the visually impaired. The purpose of the action plan is
to achieve this goal by improving access to comprehensive eye care services that are integrated into
health systems. Further details are provided in Appendix 1. Five principles and approaches underpin the
plan: universal access and equity, human rights, evidence-based practice, a life course approach, and
empowerment of people with visual impairment. Further details are provided in Appendix 2.
8. Proposed actions for Member States, international partners and the Secretariat are structured
around three objectives (see Appendix 3):
Objective 1 addresses the need for generating evidence on the magnitude and causes of visual
impairment and eye care services and using it to advocate greater political and financial
commitment by Member States to eye health.
Objective 2 encourages the development and implementation of integrated national eye health
policies, plans and programmes to enhance universal eye health with activities in line with
WHO`s Iramework Ior action Ior strengthening health systems to improve health outcomes.
2

Objective 3 addresses multisectoral engagement and effective partnerships to strengthen eye
health.
Each of the three objectives has a set of metrics to chart progress.

1
The term 'visual impairment includes moderate and severe visual impairment as well as blindness.

'Blindness is
defined as a presenting visual acuity of worse than 3/60 or a corresponding visual field loss to less than 10 in the better eye.
'Severe visual impairment is deIined as a presenting visual acuity of worse than 6/60 and equal to or better than 3/60.
'Moderate visual impairment is deIined as a presenting visual acuity in therange Irom worse than 6/18 to 6/60 (Definition
of visual impairment and blindness. Geneva, World Health Organization, 2012.) The action plan uses the term 'visual
impairment. Also, see the ICD update and revision platIorm 'Change the deIinition oI blindness.
2
Everybodys business. strengthening health systems to improve health outcomes. WHOs framework for action.
World Health Organization. Geneva, 2007.
35
ANNEX 2 71

9. There are three indicators at the goal and purpose levels to measure progress at the national
level, although many Member States will wish to collect more. The three indicators comprise: (i) the
prevalence and causes of visual impairment; (ii) the number of eye care personnel; and (iii) cataract
surgery. Further details are provided in Appendix 4.
Prevalence and causes of visual impairment. It is important to understand the magnitude
and causes of visual impairment and trends over time. This information is crucial for resource
allocation, planning, and developing synergies with other programmes.
Number of eye care personnel, broken down by cadre . This parameter is important in
determining the availability of the eye health workforce. Gaps can be identified and human
resource plans adjusted accordingly.
Cataract surgical service delivery. Cataract surgical rate (number of cataract surgeries
performed per year, per million population) and cataract surgical coverage (number of
individuals with bilateral cataract causing visual impairment, who have received cataract
surgery on one or both eyes). Knowledge of the surgery rate is important for monitoring
surgical services for one of the leading causes of blindness globally, and the rate also provides
a valuable proxy indicator for eye care service provision. Where Member States have data on
the prevalence and causes of visual impairment, coverage for cataract surgery can be
calculated; it is an important measure that provides information on the degree to which
cataract surgical services are meeting needs.
10. For the first of these indicators there is a global target. It will provide an overall measure of the
impact of the action plan. As a global target, the reduction in prevalence of avoidable visua l
impairment by 25% by 2019 from the baseline of 2010 has been selected for this action plan.
1
In
meeting this target, the expectation is that greatest gains will come through the reduction in the
prevalence of avoidable visual impairment in that portion of the population representing those who are
over the age of 50 years. As described above, cataract and uncorrected refractive errors are the two
principal causes of avoidable visual impairment, representing 75% of all visual impairment, and are
more frequent among older age groups. By 2019, it is estimated that 84% of all visual impairment will
be among those aged 50 years or more. Expanding comprehensive integrated eye care services that
respond to the major causes of visual impairment, alongside the health improvement that can be
expected to come from implementing wider development initiatives including strategies such as the
draft action plan for the prevention and control of noncommunicable diseases 20132020, and global
efforts to eliminate trachoma suggest the target, albeit ambitious, is achievable. In addition, wider
health gains coming from the expected increase in the gross domestic product in low-income and
middle-income countries will have the effect of reducing visual impairment.
2

1
The global prevalence of avoidable visual impairment in 2010 was 3.18%. A 25% reduction means that the
prevalence by 2019 would be 2.37%.
2
According to the International Monetary Fund, by 2019 the average gross domestic product per capita based on
purchasing power parity will grow by 24% in low-income and lower-middle-income countries, by 22% in upper-middle-
income countries, and by 14% in high-income countries.
36

7
2

A
N
N
E
X

2

APPENDIX 1
VISION, GOAL AND PURPOSE
VISION
A world in which nobody is needlessly visually impaired, where those with unavoidable vision loss can achieve their full pote ntial, and where there is universal access to
comprehensive eye care services
Goal Measurable indicators
1
Means of verification Important assumptions
To reduce avoidable visual impairment as
a global public health problem and secure
access to rehabilitation services for the
visually impaired
2

Prevalence and causes of visual
impairment
Global target: reduction in prevalence of
avoidable visual impairment by 25% by
2019 from the baseline of 2010
Collection of epidemiological data at national
and subnational levels and development of
regional and global estimates
Human rights conventions
implemented, equity across all
policies achieved, and people with
visual impairment fully empowered
Sustained investment achieved by
the end of the action plan
Purpose
To improve access to comprehensive eye
care services that are integrated into
health systems
Number of eye care personnel per million
population
Cataract surgical rate
Reports summarizing national data provided
by Member States
Services accessed fully and
equitably by all populations
1
See also Appendix 4.
2
The objective oI the Secretariat`s programme Ior the prevention oI blindness was 'to prevent and control major avoidable causes oI blindness and to make essential eye care
available to all . the long-term target being to reduce national blindness rates to less than 0.5%, with no more than 1% in individual communities, Formulation and management oI national
programmes for the prevention of blindness. Geneva, World Health Organization, 1990 (document WHO/PBL/90.18).
37

A
N
N
E
X

2

7
3

APPENDIX 2
CROSS-CUTTING PRINCIPLES AND APPROACHES
Universal access and equity Human rights Evidence-based practice Life course approach Empowerment of people with
blindness and visual
impairment
All people should have equitable
access to health care and
opportunities to achieve or
recover the highest attainable
standard of health, regardless of
age, gender or social position
Strategies and interventions for
treatment, prevention and
promotion must be compliant
with international human rights
conventions and agreements
Strategies and interventions for
treatment, prevention and
promotion need to be based on
scientific evidence and good
practice
Eye health and related policies,
plans and programmes need to
take account of health and social
needs at all stages of the life
course
People who are blind or who
have low vision can participate
fully in the social, economic,
political and cultural aspects of
life
38

7
4

S
I
X
T
Y
-
S
I
X
T
H

W
O
R
L
D

H
E
A
L
T
H

A
S
S
E
M
B
L
Y

APPENDIX 3
OBJECTIVES AND ACTIONS
Objective 1 Measurable indicators Means of verification Important assumptions
Evidence generated and used to advocate
increased political and financial
commitment of Member States for eye
health
Number of Member States that have
undertaken and published prevalence
surveys during the past five years by
2019
Number of Member States that have
completed and published an eye care
service assessment over last five years
in 2019
Observation of World Sight Day reported
by Member States
Epidemiological and economic
assessment on the prevalence and causes
of visual impairment reported to the
Secretariat by Member States
Eye care service assessment and cost
effectiveness research results used to
formulate national and subnational
policies and plans for eye health
Reports of national, regional and global
advocacy and awareness-raising events
Advocacy successful in increasing
investment in eye health despite the
current global financial environment and
competing agendas
Actions for Objective 1 Proposed inputs from Member States Inputs from the Secretariat Proposed inputs from international
partners
1.1 Undertake population-based surveys
on prevalence of visual impairment and
its causes
Undertake surveys in collaboration with
partners, allocating resources as required
Publish and disseminate survey results,
and send them to the Secretariat
Provide Member States with tools for
surveys and technical advice
Provide estimates of prevalence at
regional and global levels
Advocate the need for surveys
Identify and supply additional resources
to complement governments` investments
in surveys
1.2 Assess the capacity of Member
States to provide comprehensive eye care
services and identify gaps
Assess eye care service delivery,
allocating resources as required.
Assessments should cover availability,
accessibility, affordability, sustainability,
quality and equity of services provided,
including costeffectiveness analysis of
eye health programmes
Collect and compile data at national
level, identifying gaps in service
provision
Publish and disseminate survey results,
Provide Member States with tools for eye
care service assessments and technical
advice
Publish and disseminate reports that
summarize data provided by Member
States and international partners
Advocate the need for eye care service
assessments
Support Member States in collection and
dissemination of data
Identify and supply additional resources
to complement governments` investments
in eye care service assessments
39

A
N
N
E
X

2

7
5

and report them to the Secretariat
1.3 Document, and use for advocacy,
examples of best practice in enhancing
universal access to eye care
Identify and document successful
interventions and lessons learnt
Publish results and report them to the
Secretariat
Develop tools and provide them to
Member States along with technical
advice
Collate and disseminate reports from
Member States
Advocate the need to document best
practice
Support Member States in documenting
best practice and disseminating results
Identify additional resources to
complement governments` investments
National eye health policies, plans and
programmes for enhancing universal eye
health developed and/or strengthened and
implemented in line with WHO`s
framework for action for strengthening
health systems in order to improve health
outcomes
Number of Member States reporting the
implementation of policies, plans and
programmes for eye health
Number of Member States with an eye
health/prevention of blindness
committee, and/or a national prevention
of blindness coordinator, or equivalent
mechanism in place
Number of Member States that include
eye care sections in their national lists of
essential medicines, diagnostics and
health technologies
Number of Member States that report the
integration of eye health into national
health plans and budgets
Number of Member States that report a
national plan that includes human
resources for eye care
Number of Member States reporting
evidence of research on the cost
effectiveness of eye health programmes
Reports that summarize data provided by
Member States
Policies, plans and programmes have
sufficient reach for all populations
Services accessed by those in need
4a

7
6

S
I
X
T
Y
-
S
I
X
T
H

W
O
R
L
D

H
E
A
L
T
H

A
S
S
E
M
B
L
Y

partners
2.1 Provide leadership and governance
for developing/updating, implementing
and monitoring national/subnational
policies and plans for eye health
Develop/update national/subnational
policies, plans and programmes for eye
health and prevention of visual
impairment, including indicators and
targets, engaging key stakeholders
Secure inclusion of primary eye care into
primary health care
Establish new and/or maintain the
existing coordinating mechanisms
(e.g. national coordinator, eye
health/prevention of blindness
committee, other national/subnational
mechanisms) to oversee implementation
and monitoring/evaluating the policies,
plans and programmes
Provide guidance to Member States on
how to develop and implement national
and subnational policies, plans and
programmes in line with the global action
plan
Provide Member States with tools and
technical advice on primary eye care, and
evidence on good leadership and
governance practices in developing,
implementing, monitoring and evaluating
comprehensive and integrated eye care
services
Establish/maintain global and regional
staff with responsibility for eye
health/prevention of visual impairment
Establish country positions for eye
where strategically relevant and resources
allow
Advocate national/subnational leadership
for developing policies, plans and
programmes
Support national leadership in identifying
the financial and technical resources
required for implementing the
policies/plans and inclusion of primary
eye care in primary health care
Secure funding for key positions in the
Secretariat at headquarters, regional and
country levels
2.2 Secure adequate financial resources
to improve eye health and provide
comprehensive eye care services
integrated into health systems through
national policies, plans and programmes
Ensure funding for eye health within a
comprehensive integrated health care
service
Perform costbenefit analysis of
prevention of avoidable visual
impairment and rehabilitation services
and conduct research on the cost
effectiveness of eye health programmes
to optimize the use of available resources
Provide tools and technical support to
Member States in identifying cost
effective interventions and secure the
financial resources needed
Advocate at national and international
levels for adequate funds and their
effective use to implement
national/subnational policies, plans and
programmes
Identify sources of funds to complement
national investment in eye care services
and costbenefit analyses
41

A
N
N
E
X

2

7
7

2.3 Develop and maintain a sustainable
workforce for the provision of
comprehensive eye care services as part
of the broader human resources for health
workforce
Undertake planning of human resources
for eye care as part of wider human
resources for health planning, and human
resources for eye health planning in other
relevant sectors
Provide training and career development
for eye health professionals
Ensure retention strategies for eye health
staff are in place and being implemented
Identify, document and disseminate best
practice to the Secretariat and other
partners with regard to human resources
in eye health
Provide technical assistance as required
Collate and publish examples of best
practice
Advocate the importance of a sustainable
eye health workforce
Support training and professional
development through national
coordination mechanisms
Provide support to Member States in
collection and dissemination of data
2.4 Provide comprehensive and equitable
eye care services at primary, secondary
and tertiary levels, incorporating national
trachoma and onchocerciasis elimination
activities
Provide and/or coordinate universal
access to comprehensive and equitable
eye care services, with emphasis on
vulnerable groups such as children and
the elderly
Strengthen referral mechanisms, and
rehabilitation services for the visually
impaired
Establish quality standards and norms for
eye care
Provide WHO`s existing tools and
technical support to Member States
Advocate the importance of
comprehensive and equitable eye care
services
Support local capacity building for
provision of eye care services, including
rehabilitation services in line with
policies, plans and programmes through
national coordination mechanisms
Monitor, evaluate and report on services
provided in line with national policies,
plans and programmes through national
coordination mechanisms
2.5 Make available and accessible
essential medicines, diagnostics and
health technologies of assured quality
with particular focus on vulnerable
groups and underserved communities,
and explore mechanisms to increase
affordability of new evidence-based
technologies
Ensure existence of a national list of
essential medical products, national
diagnostic and treatment protocols, and
relevant equipment
Ensure the availability and accessibility
of essential medicines, diagnostics and
health technologies
Provide technical assistance and tools to
support Member States
Advocate the importance of essential
medicines, diagnostics and health
technologies
Provide essential medicines, diagnostics
and health technologies in line with
national policies
42

7
8

S
I
X
T
Y
-
S
I
X
T
H

W
O
R
L
D

H
E
A
L
T
H

A
S
S
E
M
B
L
Y

2.6 Include indicators for the monitoring
of provision of eye care services and their
quality in national information systems
Adopt a set of national indicators and
targets, including those on rehabilitation,
within the national information systems
Periodically collect, analyse and interpret
data
Report data to the Secretariat
Provide technical support to Member
States by including national indicators
and targets in national health systems
Collate and disseminate data reported by
Member States annually
Advocate the importance of monitoring
using nationally agreed indicators
Provide financial and technical support
for collection and analysis of national and
subnational data
Multisectoral engagement and effective
partnerships for improved eye health
strengthened
Number of Member States that refer to a
multisectoral approach in their national
eye health/prevention of blindness
policies, plans and programmes
The WHO Alliance for the Global
Elimination of Trachoma by the Year
2020, African Programme for
Onchocerciasis Control, and
Onchocerciasis Elimination Program for
the Americas deliver according to their
strategic plans
Number of Member States that have eye
health incorporated into relevant poverty-
reduction strategies, initiatives and wider
socioeconomic policies
Number of Member States reporting eye
health as a part of intersectoral
collaboration
Reports from Member States received
and collated by the Secretariat
Receipt of annual reports and
publications from partnerships
Non-health sectors invest in wider
socioeconomic development
43

A
N
N
E
X

2

7
9

partners
3.1 Engage non-health sectors in
developing and implementing eye
policies and plans
Health ministries identify and engage
other sectors, such as those under
ministries of education, finance, welfare
and development
Report experiences to the Secretariat
Advise Member States on specific roles
of non-health sectors and provide support
in identifying and engaging non-health
sectors
Collate and publish Member States`
experiences
Advocate across sectors the added value
of multisectoral work
Provide financial and technical capacity
to multisectoral activities (e.g. water and
sanitation)
Provide support to Member States in
collecting and disseminating experiences
3.2 Enhance effective international and
national partnerships and alliances
Promote active engagement in, and where
appropriate, establish partnerships and
alliances that harmonize and are aligned
with national priorities, policies, plans
and programmes
Identify and promote suitable
mechanisms for intercountry
collaboration
Where appropriate, participate in and
lead partnerships and alliances, including
engaging other United Nations entities,
that support, harmonize and are aligned
with Member States` priorities, policies,
plans and programmes
Facilitate and support establishment of
intercountry collaboration
Promote participation and actively
support partnerships, alliances and
intercountry collaboration that harmonize
and are aligned with Member States`
priorities, policies, plans and programmes
3.3 Integrate eye health into poverty-
reduction strategies, initiatives and wider
socioeconomic policies
Identify and incorporate eye health in
relevant poverty-reduction strategies,
initiatives and socioeconomic policies
Ensure that people with avoidable and
unavoidable visual impairment have
access to educational opportunities, and
that disability inclusion practices are
developed, implemented and evaluated
Write and disseminate key messages for
policy-makers
Advise Member States on ways to
include eye health/prevention of visual
impairment in poverty-reduction
strategies, initiatives and socioeconomic
policies
Advocate the integration of eye health
into poverty-reduction strategies,
initiatives and socioeconomic policies
44

8
0

S
I
X
T
Y
-
S
I
X
T
H

W
O
R
L
D

H
E
A
L
T
H

A
S
S
E
M
B
L
Y

APPENDIX 4
NATIONAL INDICATORS FOR PREVENTION OF AVOIDABLE BLINDNESS AND VISUAL IMPAIRMENT
1. Prevalence and causes of visual impairment
Purpose/rationale To measure the magnitude of visual impairment including blindness and monitor progress in eliminating avoidable blindness and in
controlling avoidable visual impairment
Definition Prevalence of visual impairment, including blindness, and its causes, preferably disaggregated by age and gender
Preferred methods of data
collection
Methodologically sound and representative surveys of prevalence provide the most reliable method. Additionally, the Rapid
Assessment of Avoidable Blindness and the Rapid Assessment of Cataract Surgical Services are two standard methodologies for
obtaining results for people in the age group with the highest prevalence of visual impairment, that is, those over 50 years of age
Unit of measurement Prevalence of visual impairment determined from population surveys
Frequency of data collection At national level at least every five years
Source of data Health ministry or national prevention of blindness/eye health coordinator/committee
Dissemination of data The Secretariat periodically updates the global estimates on the prevalence and causes of visual impairment
2. Number of eye care personnel by cadre
2.1 Ophthalmologists
Purpose/rationale To assess availability of the eye health workforce in order to formulate a capacitydevelopment response for strengthening national
health systems. Ophthalmologists are the primary cadre that deliver medical and surgical eye care interventions
Definition Number of medical doctors certified as ophthalmologists by national institutions based on government -approved certification criteria.
Ophthalmologists are medical doctors who have been trained in ophthalmic medicine and/or surgery and who evaluate and treat
diseases of the eye
collection
Registers of national professional and regulatory bodies
45

A
N
N
E
X

2

8
1

Unit of measurement Number of ophthalmologists per one million population
Frequency of data collection Annually
Limitations The number does not reflect the proportion of ophthalmologists who are not surgically active; clinical output (e.g. subspecialists);
performance; and quality of interventions. Unless disaggregated, the data do not reflect geographical distribution
Source of information Health ministry or national prevention of blindness/eye health coordinator/committee
Dissemination of data The Secretariat annually issues a global update based on the national data provided by Member States
2.2 Optometrists
Purpose/rationale To assess availability of the eye health workforce in order to formulate a capacity-development response for strengthening national
health systems. In an increasing number of countries, optometrists are often the first point of contact for persons with eye diseases
Definition Number of optometrists certified by national institutions based on government -approved certification criteria
collection
Registers of national professional and regulatory bodies
Unit of measurement Number of optometrists per one million population
Limitations The number does not denote performance, especially the quality of interventions to reduce avoidable blindness. There is a wid e
variability in knowledge and skill of optometrists from one nation to another because curricula are not standardized
Numbers do not reflect the proportion of ophthalmic clinical officers, refractionists and other such groups who in some countries
perform the role of optometrists where this cadre is short staffed or does not exist
46

8
2

S
I
X
T
Y
-
S
I
X
T
H

W
O
R
L
D

H
E
A
L
T
H

A
S
S
E
M
B
L
Y

2.3 Allied ophthalmic personnel
Purpose/rationale To assess availability of the eye health workforce in order to formulate a capacity-development response for strengthening national
health systems. Allied ophthalmic personnel may be characterized by different educational requirements, legislation and practice
regulations, skills and scope of practice between countries and even within a given country. Typically, allied ophthalmic personnel
comprise opticians, ophthalmic nurses, orthoptists, ophthalmic and optometric assistants, ophthalmic and optometric technicians, vision
therapists, ocularists, ophthalmic photographer/imagers, and ophthalmic administrators
Definition Numbers of allied ophthalmic personnel comprising professional categories, which need to be specified by a reporting Member State
collection
Compilation of national data from subnational (district) data from government, nongovernmental and private eye care service p roviders
Unit of measurement Number of allied ophthalmic personnel per one million population
Limitations The numbers do not denote performance, especially the quality of interventions to reduce avoidable blindness. There is a wide
variability in knowledge and skill. These data are useful for monitoring of progress in countries over time but they cannot be reliably
used for intercountry comparison because of variation in nomenclature
3. Cataract surgical service delivery
3.1 Cataract surgical rate
Purpose/rationale The rate can be used to set national targets for cataract surgical service delivery. It is also often used as a proxy indicator for general eye
care service delivery. Globally, cataract remains the leading cause of blindness. Visual impairment and blindness from cataracts are
avoidable because an effective means of treatment (cataract extraction with implantation of an intraocular lens) is both safe and
efficacious to restore sight. The cataract surgical rate is a quantifiable measure of cataract surgical service delivery.
Definition The number of cataract operations performed per year per one million population
collection
Government health information records, surveys
47

A
N
N
E
X

2

8
3

Unit of measurement Number of cataract operations performed per one million population
Frequency of data collection Annually at national level. In larger countries it is desirable to collate data at subnational level
Limitations This indicator is meaningful only when it includes all cataract surgeries performed in a country, that is, those performed within the
government and nongovernmental sectors
Comments For calculations, use official sources of population data (United Nations)
3.2 Cataract surgical coverage
Purpose/rationale To assess the degree to which cataract surgical services are meeting the need
Definition Proportion of people with bilateral cataract eligible for cataract surgery who have received cataract surgery in one or both eyes (at 3/60
and 6/18 level)
collection
Calculation using data from methodologically sound and representative prevalence surveys. Additionally, calculation using data from
the Rapid Assessment of Avoidable Blindness and the Rapid Assessment of Cataract Surgical Services, which are two standard
methodologies to obtain results for people in the age group with the highest prevalence of blindness and visual impairment due to
cataract, that is, those over 50 years of age
Unit of measurement Proportion
Frequency of data collection Determined by the frequency of performing a national/district study on the prevalence of blindness and visual impairment and their
causes
Limitations Requires population-based studies, which may be of limited generalization
Comments Preferably data are disaggregated by gender, age, and urban/rural location or district
Dissemination of data The Secretariat periodically issues updates

48
"#$%#&'%()*)+*
#,-"%.//+

S1kA1LGIC IkAMLWCkk ICk VISICN 2020: 1nL
kIGn1 1C SIGn1

CAkI88LAN kLGICN

An AML8lCAn PLAL1P C8CAnlZA1lCn
WC8Lu PLAL1P C8CAnlZA1lCn
vlSlCn 2020

8arbados
2010

49
"#$%#&'%()*)+*
#,-"%.//+

S1kA1LGIC IkAMLWCkk ICk VISICN 2020: 1nL
kIGn1 1C SIGn1

CAkI88LAN kLGICN

AN AMLkICAN nLAL1n CkGANI2A1ICN
WCkLD nLAL1n CkGANI2A1ICN
VISICN 2020

8arbados
2010

5a
"#$%#&'%()*)+*
#,-"%.//+
iii
CCn1Ln1S

ACknCWLLuCLMLn1

AC8Cn?MS

ln18CuuC1lCn

1. ulSLASL CCn18CL Anu 8LvLn1lCn Cl vlSuAL lMAl8MLn1....................... 4

1.1 8LuuCL 8LlnunLSS Anu vlSuAL lMAl8MLn1 ln AuuL1S
1.1.1 8educe caLaracL bllndness.................... ....................... 4
1.1.2 8educe bllndness from dlabeLlc reLlnopaLhy..................................3
1.1.3 8educe bllndness due Lo open-angle glaucoma ( CAC)...........................7
1.1.4 8educe vlsual dlsablllLy due Lo uncorrecLed refracLlve errors ln adulLs.................. 7

1.2 8LuuCL 8LlnunLSS Anu vlSuAL lMAl8MLn1 ln CPlLu8Ln
1.2.1 8educLlon of Lhe prevenLable & of LreaLable causes of chlldhood bllndness............... 8
1.2.2 8educe vlsual dlsablllLy by deLecLlng and LreaLlng uncorrecLed refracLlve errors ln school chlldren.9

1.3 8LuuCL 1PL 8u8uLn Cl 8LlnunLSS Anu vlSuAL lMAl8MLn1 ln 1PL CLnL8AL CuLA1lCn
1.3.1 Lnhance vlslon relaLed quallLy of llfe for people wlLh funcLlonal low vlslon................10
1.3.2. lncluslve servlces.......................... .......................11

2. L?L CA8L S?S1LMS
2.1 CLn18AL C8CAnlZA1lCn, LLAuL8SPl Anu CCvL8nAnCL...................13
2.2 L?L CA8L WC8klC8CL................................. ........13
2.3 MLulCAL 8CuuC1S Anu 1LCPnCLCC?.................... ...........14
2.4 L?L CA8L lnlC8MA1lCn S?S1LMS Anu MCnl1C8lnC .......................14

3. L?L CA8L 8CMC1lCn, u8LlC LuuCA1lCn & AuvCCAC?
3.1. AuvCCAC? ..................................... ............... 13
3.2. u8LlC AWA8LnLSS Anu LuuCA1lCn .....................................13

8l8LlCC8AP?

AnnLx 1

51
"#$%#&'%()*)+*
#,-"%.//+
1
ACkCNMS

C8M ChrlsLoffel 8llnden Mlsslon
CC8 Carlbbean Councll for Lhe 8llnd
lA8 lnLernaLlonal Agency for Lhe revenLlon of 8llndness
lCLL lnLernaLlonal CenLre for Lye Care LducaLlon
lCLvl lnLernaLlonal Councll for LducaLlon of eop le wlLh vlsual
lnCC lnLernaLlonal non CovernmenLal CrganlzaLlons
MoP MlnlsLry of PealLh
MoL MlnlsLry of LducaLlon
nCuC non-governmenLal uevelopmenL CrganlzaLlon
CAC Cpen Angle Claucoma
CSWl CphLhalmologlcal SocleLy of Lhe WesL lndles
AAC an Amerlcan AssoclaLlon of CphLhalmology
APC an Amerlcan PealLh CrganlzaLlon
8L revenLlon of 8llndness
LC rlmary Lye Care
PC rlmary PealLh Care
8C 8eLlnopaLhy of remaLurlLy
unC8u unlLed naLlons ConvenLlon on Lhe 8lghLs of ersons wlLh ulsablllLles
W8u World 8llnd unlon
WPC World PealLh CrganlzaLlon

52
"#$%#&'%()*)+*
#,-"%.//+
2

ACkNCWLLDGLMLN1

1he valuable flnanclal supporL provlded by CC8, Slg hLsavers, C8M and Lhe an Amerlcan PealLh CrganlzaLlon,
8eglonal Cfflce of Lhe World PealLh CrganlzaLlon, whlch made posslble Lhe servlces assessmenL, Lhls meeLlng
and documenL ls graLefully acknowledged.

1he organlzaLlons parLlclpaLlng ln Lhe consulLaLlon conslsLed on Lhe MlnlsLry of PealLh of uomlnlca, MlnlsLry of
PealLh of Crenada, MlnlsLry of PealLh Cuyana, MlnlsLry of PealLh of !amalca, MlnlsLry of PealLh of SL vlncenL,
Lye Care Cuyana, Carlbbean CpLomeLrlsLs AssoclaLlon, SocleLe PaiLlenne u'Alde aux Aveugles (SPAA), naLlonal
revenLlon of 8llndness CommlLLee of PalLl, !amalca SocleLy for Lhe 8llnd, SL Lucla 8llnd Welfare AssoclaLlon,
CC8-Lye Care Carlbbean, SlghLsavers, C8M, C88lS lnLernaLlonal, Pelp Age lnLernaLlonal, lnLernaLlonal Agency
for Lhe revenLlon of 8llndness-lA8, CperaLlon LyeslghL, lnLernaLlonal CenLer for Lye Care LducaLlon and Lhe
an Amerlcan PealLh CrganlzaLlon-APC-WPC.

1he meeLlng parLlclpanLs conslsLed on Pazel Shllllngford-8lckeLLs, !oan McLeod-Cmawale, uave uuncan, !ullan
Mckoy-uavls, Luclne Ldwards, narlne Slngh, Charles vandyke, Ava-Cay 1lmberlake, eLer Ackland, aL
lerguson, nelson 8lvera, !lllla 8lrd, nlgel SL 8ose, Conrad Parrls, AnLhony Avrll, hlllp Pand, Arvel CranL, lrank
8owen, keva 8lchards, kaLhy 8arreLL, Cavln Penry, 8achelle noelsalnL, 8eglnald aul, MarLln 8uppenLhal, !uan
Carlos Sllva.

53
"#$%#&'%()*)+*
#,-"%.//+
3
IN1kCDUC1ICN

8llndness and low vlslon are a publlc healLh proble m LhroughouL Lhe world, Lhls ls why Lhe World PealLh
CrganlzaLlon (WPC) and Lhe lnLernaLlonal Agency for Lhe revenLlon of 8llndness (lA8) LogeLher wlLh nCCs
have launched vlSlCn 2020 - Lhe global lnlLlaLlve f or Lhe ellmlnaLlon of avoldable bllndness. 1hls ln lLlaLlve LhaL
brlngs LogeLher governmenLs, WPC, lnLernaLlonal and naLlonal nCCs, as well as assoclaLlons of professl onals ln
eye care, alms Lo deLermlne global, reglonal and naLlonal plans of acLlon ln prevenLlon of avoldable b llndness
and lncluslve servlces. ln Lhe Carlbbean vlSlCn 2020 was offlclally launched ln 1rlnldad-1obago ln Apr ll 2000.

1he World PealLh CrganlzaLlon's llfLy-SlxLh World PealLh Assembly approved 8esoluLlon WPA36.26, whlch
requesLed Lhe ulrecLor Lo sLrengLhen WPC's collaboraLlon wlLh Member SLaLes on Lhe Clobal lnlLlaLlve f or Lhe
LllmlnaLlon of Avoldable 8llndness. ln 8esoluLlon W PA39.23, Lhe llfLy-nlnLh World PealLh Assembly reafflrmed
lLs commlLmenL Lo glve prlorlLy Lo Lhe prevenLlon of bllndness. 1he 144Lh Sesslon of Lhe an Amerlcan PealLh
CrganlzaLlon - APC LxecuLlve CommlLLee recommended LhaL Lhe ulrecLlng Councll adopL a resoluLlon as a way
Lo bolsLer reglonal and naLlonal efforLs Lo reach Lhe objecLlves of Lhe lan of AcLlon for Lhe revenLlon of
Avoldable 8llndness and vlsual lmpalrmenL. ln SepLe mber 2009 Lhe 49Lh APC ulrecLlng Councll - WPC 61sL
Sesslon of Lhe 8eglonal CommlLLee approved Lhe prevenLlon of bllndness plan of acLlon and passed Lhe
resoluLlon (Annex 1).

ln Lhe year 2002 a vlSlCn 2020 sLraLeglc plan was developed for Lhe Carlbbean reglon Lhrough a serles of ln-
house dlscusslons ln APC, as well as Lhrough meeLl ngs wlLh member sLaLes, Lhe lA8, naLlonal and
lnLernaLlonal non-governmenLal organlzaLlons and sc lenLlflc socleLles. ln Lhe Carlbbean, APC, lmplemenL Lhe
vlSlCn 2020 lnlLlaLlve ln alllance wlLh Lhe lA8, SlghLsavers, Carlbbean Councll for Lhe 8llnd-CC8, C8M, C88lS
and Lhe lCLL. SlgnlflcanL progress has been achleved ln Lhe Carlbbean ln Lhe prevenLlon of avoldable bllndness,
and access Lo eye care servlces has been lncreaslng ln mosL counLrles worklng ln Lhls lnlLlaLlve.

Cn uecember 1sL 2009 APC, CC8, SlghLsavers, C8M, C88lS and all Carlbbean vlslon 2020 parLners organlzed a
meeLlng ln 8arbados Lo revlew and updaLe Lhe vlslon 2020 Carlbbean lan LhaL was produced ln Lhe year 2002.
1hls new sLraLeglc framework for vlSlCn 2020 ln Lhe Carlbbean 8eglon was prepared uLlllzlng a very
parLlclpaLory meLhodology LhaL lncluded consulLaLlon wlLh several MlnlsLrles of PealLh of Lhe Lngllsh speaklng
counLrles, naLlonal and lnLernaLlonal parLners and lncorporaLed Lhe sLraLegles of Lhe lan of AcLlon on Lhe
revenLlon of Avoldable 8llndness and vlsual lmpalr menL approved by Lhe APC 49Lh ul8LC1lnC CCunClL ln
2009. 1hls sLraLeglc framework serves as a guldellne Lo supporL counLrles and sLakeholders ln prlorl Ly seLLlng
and objecLlves developmenL, lL does noL preLend Lo be a norm and each counLry may adapL lL Lo lLs own
reallLles, prlorlLles and resources. Lach prlorlLy esLabllshed by a counLry should uLlllze a prlmary healLh care
approach and have a referral sysLem avallable for quallLy care for every condlLlon.
54
"#$%#&'%()*)+*
#,-"%.//+
4

1. DISLASL CCN1kCL AND kLVLN1ICN CI VISUAL IMAIkMLN1

1he mosL prevalenL causes of bllndness ln Lhe Carlbbean are non-operaLed caLaracL and glaucoma, followed by
dlabeLlc reLlnopaLhy and uncorrecLed refracLlve errors. Chlldhood bllndness ls noL as prevalenL, buL l s a maln
cause of bllndlng years ln Lhe populaLlon. An lmpor LanL percenLage of bllndness ln Lhe Carlbbean reglon ls
avoldable (prevenLable or curable). CaLaracL and dl abeLlc reLlnopaLhy can be cured wlLh relaLlvely lnexpenslve
surglcal LreaLmenLs, refracLlve errors are correcLable wlLh slmple opLlcal devlces, and prevenLlve sLraLegles and
effecLlve referral sysLems can reduce Lhe burden of chlldhood bllndness. 1he appllcaLlon of new Lechno logy can
be used ln fuLure Lo lmprove Lhe deLecLlon and LreaLmenL of glaucoma.

1.1 kLDUCL 8LINDNLSS AND VISUAL IMAIkMLN1 IN ADUL1S

1.1.1 keduce Cataract b||ndness
ln LaLln Amerlca and Lhe Carlbbean, caLaracL (opaclflcaLlon of Lhe lens) ls Lhe mosL prevalenL cause of bllndness,
caLaracL surgery has been shown Lo be one of Lhe mosL cosL-effecLlve of all healLh care lnLervenLlons. MosL
caLaracLs are age-relaLed and cannoL be prevenLed, buL caLaracL surgery wlLh lnserLlon of an lnLraocul ar lens
(lCL) ls hlghly effecLlve, provldlng almosL lmmedlaLe vlsual rehablllLaLlon.

Magn|tude of rob|em
1he resulLs of Lhe 8arbados Lye SLudy show LhaL 12 of people 40-84 years old have vlsual lmpalrmenL or vlsual
aculLy worse Lhan 6/12 (normal value 6/6"# 1hree percenL (3) have severe vlsual lmpalrmenL worse Lhan 6/60
and mosL have caLaracL or lens opaclLles, Lhus demonsLraLlng LhaL mosL vlsual lmpalrmenL ln Lhls popul aLlon ls
assoclaLed wlLh lens opaclLles.

Issues
! lnadequaLe publlc awareness of caLaracL and how lL can be recLlfled wlLh a sLralghLforward surglcal
procedure, leadlng Lo low demand for servlces.
! numerous barrlers beLween needs and servlces, lncludlng poor avallablllLy and accesslblllLy and hlgh c osLs.
! Lvldence of good vlslon ouLcomes lacklng afLer surgery.
! lnsufflclenL lnformaLlon on ouLpuLs and ouLcomes ln publlc secLor, prlvaLe secLor and bllaLeral cooperaLlon
lnlLlaLlves.

Lxpected Cutcome
! rovlde caLaracL surglcal servlces aL a raLe adequaLe Lo ellmlnaLe Lhe backlog of caLaracL, aL a prlce LhaL ls
affordable for all people, boLh rural and urban and wlLh hlgh success raLe ln Lerms of vlsual ouLcome.

!"#$#%&' )*+,#-% .#" /&01&" 2+)+&%
! Make naLlonal assessmenLs of caLaracL surglcal servlces, lncludlng avallablllLy, access, affordablllLy and
quallLy, as well as collecLlon and managemenL of lnformaLlon and daLa.
! Measure prevalence of caLaracL bllndness, deLermlne servlces coverage level and ldenLlfy barrlers Lo access
ln selecLed counLrles.
! uevelop counLry and dlsLrlcL-speclflc caLaracL servlce plans wlLh measurable LargeLs LhaL address equlLy
(avallablllLy, accesslblllLy, affordablllLy) and quallLy of servlces.
! Lnsure eye healLh servlces are lnLegraLed lnLo a prlmary healLh care sysLem Lo deLecL and refer people wlLh
eye dlseases.
! uevelop a human resources developmenL plan for caLaracL surglcal servlces.
! romoLe hlgh-quallLy surgery and ensure saLlsfacLory vlsual ouLcomes and paLlenL saLlsfacLlon.
! uevelop approprlaLe communlcaLlon sLraLegles for Lhe LargeL populaLlon- vlz. adulLs 30 years and older.

!"#$#%&' )*+,#-% .#" #"3)-,4)+,#-% %5$$#"+,-3 672789 :;:; )*+,<,+,&%
55
"#$%#&'%()*)+*
#,-"%.//+
5
! rovlde Lechnlcal cooperaLlon for Lhe deslgn of 8apld AssessmenL of Avoldable 8llndness (8AA8) and
slmllar sLudles.
! uevelop a slLuaLlon analysls of caLaracL surglcal servlces aL reglonal and naLlonal levels.
! AdvocaLe and provlde Lechnlcal cooperaLlon for developmenL and lmplemenLaLlon of naLlonal caLaracL
plans.
! Moblllze resources wlLh reglonal and lnLernaLlonal parLners.

Ind|cators
! 8each a caLaracL surglcal raLe (CS8) of 2,000 per 1 mllllon populaLlon per year ln Lhe majorlLy of
counLrles by Lhe year 2014. (See 1able 2 below)

! 4 counLrles uLlllzlng a caLaracL ouLcomes monlLorlng Lool/sysLem ln 2014.

1ab|e 2. Car|bbean Cataract Surg|ca| kate, ear 2009
Country opu|at|on CSk year 2010 1arget 2014
1housands
AnLlgua 88 1343 1800
8ahamas 342 2300 3000
8arbados 236 2001 2300
8ellze 307 1648 2000
uomlnlca 67 1746 2000
Crenada 104 1062 1300
Cuyana 762 1700 2000
PalLl 10,033 440 1000
!amalca 2719 1000 1300
SL Lucla 172 843 1300
SL vlncenL 109 1066 1300
1rlnldad 1339 2600 3000

1.1.2 keduce the preva|ence of b||ndness from d|abet|c ret|nopathy
ulabeLes causes weakenlng of Lhe blood vessels ln Lhe body. 8eLlnal blood vessels are parLlcularly suscepLlble
and weakenlng of Lhese blood vessels, accompanled by sLrucLural changes ln Lhe reLlna, ls Lermed as dlabeLlc
reLlnopaLhy. ulabeLlc reLlnopaLhy ls sympLomless ln lLs early sLage and eye examlnaLlons/screenlng ls Lhe only
way Lo ldenLlfy affecLed people Lo prevenL Lhem from golng bllnd. Lvldence-based LreaLmenL ls avallable Lo
slgnlflcanLly reduce Lhe rlsks of bllndness and of moderaLe vlslon loss. Cllnlcal sLudles spannlng mor e Lhan 30
years have shown LhaL approprlaLe LreaLmenL wlLh laser can reduce Lhe rlsks by more Lhan 90.

Magn|tude of the prob|em
1he prevalence of dlabeLes among adulLs ln LaLln Amerlca and Lhe Carlbbean varles from counLry Lo counLry.
More Lhan 73 of paLlenLs who have had dlabeLes melllLus for more Lhan 20 years wlll have some form of
dlabeLlc reLlnopaLhy. AfLer 13 years of dlabeLes, approxlmaLely 2 of people become bllnd, and abouL 10
develop severe vlsual lmpalrmenL. ln 8arbados, 18 of persons of Afrlcan descenL beLween Lhe ages of 40 and
84, reporL havlng a hlsLory of dlabeLes melllLus, among people wlLh dlabeLes 30 has dlabeLlc reLlnopaLhy 8.6
56
"#$%#&'%()*)+*
#,-"%.//+
6
of dlabetics have clinically significant macular edema and 1 has prollferaLlve dlabeLlc reLlnopaLhy needlng
laser LreaLmenL.

Issues
! lnadequaLe medlcal managemenL and conLrol of dlabeLes.
! lnadequaLe developmenL of deLecLlon and referral sysLems.
! lnsufflclenL publlc awareness relaLlng Lo cause and prevenLlon of bllndness due Lo dlabeLes.
! lnsufflclenL awareness and knowledge of PC pracLlLloners, general physlclans and lnLernlsLs regardlng
Lhelr role ln Lhe prevenLlon of bllndness due Lo dl abeLes.
! LlmlLed number of ophLhalmologlsLs wlLh Lralnlng ln dlagnosls and LreaLmenL of dlabeLlc reLlnopaLhy.
! lnadequaLe Lechnologlcal lnfrasLrucLure ln Lhe heal Lh servlces.
! oor resourclng and low capaclLy of naLlonal dlabeL es assoclaLlons.

Lxpected Cutcome
! CounLrles lmplemenLlng early deLecLlon, referral and LreaLmenL for dlabeLlc reLlnopaLhy

!"#$#%&' )*+,#-% .#" /&01&" 2+)+&%
! lnLegraLe bllndness prevenLlon sLraLegles lnLo naLlonal dlabeLes programs and ensure Lhelr
lncorporaLlon lnLo non communlcable chronlc dlsease s programs of Lhe MlnlsLrles of PealLh.
! Lncourage sLraLegles for prevenLlon, early deLecLlon and effecLlve LreaLmenL of dlabeLes and
hyperLenslon, whlch wlll prevenL compllcaLlons LhaL lead Lo bllndness.
! uevelop publlc awareness programs Lo LargeL groups LhaL are aL hlgh rlsk.
! LsLabllsh referral sysLems from servlces for dlabeLlcs Lo Lhe ophLhalmologlc servlces.
! LsLabllsh screenlng servlces uslng dlglLal phoLography Lo deLecL and refer LreaLable dlabeLlc
reLlnopaLhy.
! Lnsure laser LreaLmenL servlces for dlabeLlc reLlnopaLhy are avallable, accesslble and affordable.

!"#$#%&' )*+,#-% .#" #"3)-,4)+,#-% %5$$#"+,-3 672789 :;:; )*+,<,+,&%
! erform a slLuaLlon analysls of Lhe managemenL of dlabeLlc reLlnopaLhy ln Lhe 8eglon as a basellne for
plannlng and advocacy.
! ConducL naLlonal assessmenLs of servlces for dlabeLlc reLlnopaLhy ln selecLed counLrles.
! uevelop educaLlon packages and Lralnlng programs for Lhe general publlc and healLh care provlders.
! uevelop conLlnulng medlcal educaLlon programs for ophLhalmologlsLs and opLomeLrlsLs.
! SupporL counLrles ln Lhe developmenL of screenlng programs and laser servlces for ulabeLlc
8eLlnopaLhy.
! LsLabllsh reglonal proLocols and managemenL guldell nes
! LsLabllsh an lnLer-counLry referral sysLem for LreaLmenL accordlng Lo an esLabllshed proLocol.
! ulabeLes AssoclaLlons playlng a lead role ln awareness ralslng and prevenLlon of bllndness due Lo
dlabeLes.

Ind|cators
! SlLuaLlon analysls conducLed ln flve selecLed counL rles by Lhe year 2014.
! AL leasL Lhree of Lhe selecLed counLrles lnLegraLe early deLecLlon and LreaLmenL programs for dlabeLlc
reLlnopaLhy lnLo non-communlcable chronlc dlseases programs by Lhe year 2014.
! lncrease Lhe number of counLrles wlLh dlglLal phoLograph screenlng and laser LreaLmenL programs
from 1 Lo 4 by Lhe year 2014.

1.1.3 keduce the |nc|dence of b||ndness due to open-ang|e g|aucoma (CAG) |n h|gh-r|sk groups
CAC ls a major publlc healLh problem ln Lhe Afro-Carlbbean populaLlon, where lL ls a major cause of vl sual loss
and Lhe leadlng cause of lrreverslble bllndness. vl slon 2020 programs need Lo lnclude mechanlsms for
57
"#$%#&'%()*)+*
#,-"%.//+
7
glaucoma deLecLlon and LreaLmenL for hlgh-rlsk segmenLs of Lhe populaLlon, lncludlng persons of Afrlca n
descenL ln Lhe Carlbbean populaLlon, persons over 40 years of age, and lndlvlduals wlLh a famlly hlsLory of
glaucoma.

Cpen Angle Claucoma prevalence ln Afro-Carlbbean people over 40 years of age ls over 7 and lncreases wlLh
age. ln Lhe 8arbados Lye SLudy, CAC affecLed 1 ln 11 Afro-Carlbbeans older Lhan 30 years of age, reachlng a
prevalence of 1 ln 6 ln Lhose over 70 years. AbouL 2 of lndlvlduals over 40 years are bllnd and, of LhaL
percenLage, one-Lhlrd are bllnd due Lo CAC.

Issues
! Plgh dlsease frequency.
! very llmlLed avallablllLy of senslLlve and speclflc screenlng meLhods aL reasonable cosL.
! SllenL naLure of Lhe dlsease.
! LaLe deLecLlon and poor compllance.
! Plgh cosL of medlcaLlon.
! Lack of publlc awareness abouL need for people over 40 years of age Lo geL eyes checked for glaucoma.

Lxpected Cutcome
! SLrengLhen naLlonal programs for deLecLlon and LreaLmenL of glaucoma ln segmenLs of Lhe populaLlon
wlLh rlsk facLors as ouLllned ln naLlonal eye care plans.

!"#$#%&' )*+,#-% .#" /&01&" 2+)+&%
! lnclude glaucoma deLecLlon as an lnLegral parL of comprehenslve eye examlnaLlons for persons over 40
years of age.
! Lnsure LhaL eye care unlLs are have Lhe capaclLy (equlpmenL & P8) Lo provlde glaucoma dlagnosls and
LreaLmenL.
! lncrease awareness among Lhe general populaLlon of Lhe lmporLance of regular eye examlnaLlons and
glaucoma screenlng for Lhose over age 40, as well of oLher rlsk facLors for glaucoma.
! rovlde affordable LreaLmenLs and medlcaLlons.

!"#$#%&' )*+,#-% .#" #"3)-,4)+,#-% %5$$#"+,-3 672789 :;:; )*+,<,+,&%
! uLlllze avallable epldemlologlc lnformaLlon Lo promoLe early deLecLlon and LreaLmenL ln counLrles ln
hlgh-rlsk groups.
! uLlllze besL pracLlces Lo promoLe and deslgn publlc awareness programs and lnLervenLlons.
! Moblllze Lechnlcal and flnanclal resources Lo sLrengLhen naLlonal eye care servlces ln glaucoma
deLecLlon and LreaLmenL
! 1raln professlonals Lo lmplemenL exlsLlng evldence- based proLocols.

Ind|cators
! lncreaslng from 3 Lo 6 Lhe number of counLrles carrylng ouL glaucoma communlLy awareness programs
by Lhe year 2014.
! A reglonal procuremenL and dlsLrlbuLlon sysLem for affordable glaucoma medlcaLlons
! number of counLrles lncludlng glaucoma eye medlcaLl ons ln subsldlzed drug llsL and encouraglng
pracLlLloners Lo use lL

1.1.4. keduce v|sua| d|sab|||ty by detect|ng and treat|ng uncorrected refract|ve errors |n adu|ts
1he 8arbados Lye SLudles found hlgh prevalence of myopla and hyperopla ln adulLs. MosL adulLs over 30 years
of age suffer presbyopla.

!"#$#%&' )*+,#-% .#" /&01&" 2+)+&%
58
"#$%#&'%()*)+*
#,-"%.//+
8
! lnclude refracLlon ln a comprehenslve eye examlnaLlon Lo ldenLlfy specLacles requlremenLs ln adulLs.
! lncrease publlc awareness Lhrough lnformaLlon, educaLlon, and communlcaLlon sLraLegles.

!"#$#%&' )*+,#-% .#" #"3)-,4)+,#-% %5$$#"+,-3 672789 :;:; )*+,<,+,&%
! romoLe and supporL screenlng and refracLlve errors correcLlon ln adulLs, lncludlng presbyopla.

1.2. kLDUCL 8LINDNLSS AND VISUAL IMAIkMLN1 IN CnILDkLN

1.2.1 keduct|on of the preventab|e causes and of treatab|e causes of ch||dhood b||ndness.

As Lhe causes of 8llndness ln chlldren dlffer from Lhose ln adulLs, dlfferenL conLrol measures are needed,
chlldrens' eye problems need Llmely aLLenLlon or Lhey may become lrreverslbly bllnd, speclflc experLlse and
equlpmenL are requlred. Whlle daLa ls llmlLed, Lhe followlng causes of chlldhood bllndness has belng reporLed
ln Lhe Carlbbean 8eglon: 8eLlnopaLhy of remaLurlLy (8C) , caLaracL and glaucoma ln chlldren have been
reporLed ln some counLrles, corneal scarrlng (Lhe drylng ouL and scarrlng of Lhe ouLer eye because of vlLamln A
deflclency) ls noL common and has been reporLed ln a few counLrles. Powever, vlsual lmpalrmenL from Lrauma
ls commonly reporLed ln !amalca, especlally among boys.

Issues
! lnsufflclenL daLa abouL Lhe causes or magnlLude of chlldhood bllndness and vlsual lmpalrmenL ln Lhe
Carlbbean.
! Lack of pollcles LhaL supporL lncluslon of an eye c are componenL ln MaLernal & Chlld PealLh programs.
! lnsufflclenL awareness and knowledge among pedlaLrlclans, obsLeLrlclans, general physlclans and healLh
personnel abouL Lhelr role ln prevenLlon of chlldren's vlsual lmpalrmenL and bllndness.
! lnsufflclenL lnvolvemenL of general ophLhalmologlsL s ln prevenLlon of chlldhood bllndness programs.

Lxpected Cutcome
rovlde servlces Lo deLecL and LreaL chlldren wlLh 8eLlnopaLhy of remaLurlLy, congenlLal caLaracL, congenlLal
glaucoma and corneal ulcer or scarrlng, and oLher non-bllndlng eye problems, such as sLrablsmus, Lrauma,

!"#$#%&' )*+,#-% .#" /&01&" 2+)+&%
! lnLegraLe chlldhood bllndness prevenLlon wlLh early dlagnosls, evaluaLlon and LreaLmenL lnLo all naLlonal
maLernal and chlld healLh plans and pollcles.
! Assess Lhe maln causes of bllndness and vlsual lmpalrmenL ln chlldren ln Lhe Carlbbean as a base for
fuLure plannlng.
! romoLe deLecLlon of eye dlseases and eye problems as parL of Lhe naLlonal pollcles ln maLernal and
chlld healLh.
! rovlde ocular prophylaxls of newborns Lo prevenL neonaLal conjuncLlvlLls Lhrough uLlllzaLlon of
ovldone lodlne.
! 8educe bllndness ln premaLure bables due Lo reLlnopaLhy of premaLurlLy
revenLlon of bllndness due Lo 8C ls planned on Lhree levels:
a) rlmary prevenLlon: reduce Lhe lncldence of 8C Lhrough lmproved prenaLal and neonaLal care.
b) Secondary prevenLlon: early ldenLlflcaLlon of severe cases of 8C ln premaLure bables ln neonaLal
care Lhrough regular examlnaLlon of Lhose deemed Lo be hlgh-rlsk by skllled ophLhalmologlsLs and
Llmely LreaLmenL wlLh laser or cryoLherapy of severe 8C
c) 1erLlary prevenLlon: resLore useful vlslon ln chlldren wlLh reLlnal compllcaLlons Lhrough vlLreoreL lnal
surgery and/or offer rehablllLaLlon.
! romoLe sysLems, neLworks and proLocols for safe neonaLal care, adequaLe referral, and follow-up.
! LlaboraLe and promoLe naLlonal guldellnes and mlnlmum accepLable sLandards.
! Lnsure Lhe avallablllLy of Lhe necessary equlpmenL for prlmary prevenLlon, examlnaLlon and LreaLmenL.
59
"#$%#&'%()*)+*
#,-"%.//+
9
! lmprove Lhe quallLy of avallable lnformaLlon on neonaLal care.

!"#$#%&' )*+,#-% .#" #"3)-,4)+,#-% %5$$#"+,-3 672789 :;:; )*+,<,+,&%
! CollecL and analyze lnformaLlon on causes of chlldh ood bllndness ln school chlldren who are bllnd
uLlllzlng Lhe approprlaLe documenLaLlon.
! ConducL naLlonal assessmenLs of needs and resources for 8C programs.
! Crganlze reglonal and naLlonal workshops Lo lncrease awareness.
! Crganlze reglonal and naLlonal Lralnlng programs for professlonals (obsLeLrlclans, pedlaLrlclans, nurses,
and ophLhalmologlsLs).
! romoLe Lhe uLlllzaLlon of reglonal guldellnes on neonaLal care and 8C programs.
! SupporL counLrles ln Lhe developmenL of 8C servlces
! Crganlze a referral pedlaLrlc ophLhalmology cenLer

Ind|cators
! uocumenLaLlon on causes of chlldhood bllndness ln s chool chlldren who are bllnd ln Lhe Carlbbean.
! lncrease Lhe number of counLrles LhaL have a naLlonal 8C prevenLlon pollcy from 1 Lo 4 by Lhe year
2014.
! number of counLrles LhaL are lmplemenLlng an eye care componenL ln maLernal and chlld care programs.
! number of counLrles wlLh capaclLy (pedlaLrlc orlenLed ophLhalmologlsLs and equlpmenL) ln LerLlary
faclllLy Lo perform pedlaLrlc caLaracL, 8C examlnaLlons and LreaLmenL, and oLher bllndlng and non-
bllndlng chlldren's eye condlLlons.

1.2.2 keduce v|sua| d|sab|||ty by detect|ng and treat|ng uncorrected refract|ve errors |n schoo| ch||dren

Accordlng Lo epldemlologlc sLudles ln LaLln Amerlca APC-WPC esLlmaLes LhaL abouL 7 of school chlldren
may requlre specLacles for correcLlon of refracLlve errors.
1he sLeps ln Lhe provlslon of refracLlon servlces are as follows:
(a) Screen|ng: ldenLlflcaLlon of lndlvlduals wlLh poor vlslon whl ch can be lmproved by correcLlon.
(b) Lye exam|nat|on: Lo evaluaLe Lhe condlLlon of Lhe eye and ldenLlfy coexlsLlng paLhologles
requlrlng care.
(c) kefract|on: deLermlne whaL correcLlon ls requlred.
(d) D|spens|ng: provlde and supply approprlaLe correcLlve eyeglasses.
(e) Io||ow-up: ensure compllance wlLh prescrlpLlon, care of Lhe eyeglasses, repalr or subsLlLuLlon
of specLacles, lf needed.

Issues
! no daLa avallable on need for specLacles ln school chlldren.
! no daLa avallable on besL pracLlces on refracLlve errors programs ln schools chlldren.
! ulfferenL prlorlLles and crlLerla ln eye care programs for school chlldren ln Lhe dlfferenL counLrles.
! Lack of pollcles LhaL lnclude an eye care componenL ln school healLh programs.
! Small number of ophLhalmologlc and opLomeLry servlces LhaL dlagnose refracLlve errors ln school chlldren
of low soclo-economlc sLaLus.
! SpecLacles ofLen Loo expenslve for Lhe majorlLy of paLlenLs.
! lnadequaLe collaboraLlon beLween healLh and educaLl on sLakeholders.
! Lack of parenL's awareness and commlLmenL Lo comply.

Lxpected Cutcome
! revenLlon of vlsual lmpalrmenL and bllndness due L o uncorrecLed refracLlve errors ln school chlldren by
lnLegraLlng eye healLh lnLo pollcles and pracLlce l n healLh and educaLlon secLors.

6a
"#$%#&'%()*)+*
#,-"%.//+
10
!"#$#%&' )*+,#-% .#" /&01&" 2+)+&%
! uevelop naLlonal guldellnes for Lhe deLecLlon and L reaLmenL of refracLlve errors, Laklng lnLo accounL
naLlonal reallLles.
! LsLabllsh screenlng durlng Lhe flrsL school level and durlng Lhe slxLh grade.
! uevelop and follow plloL refracLlve error programs Lo ldenLlfy and dlssemlnaLe besL pracLlces.
! romoLe refracLlve error servlces and provlslon of specLacles ln Lhe publlc secLor for school chlldren,
adulLs and any person ln need
! lncrease avallablllLy and affordablllLy of eyeglasses and faclllLaLe Lhelr producLlon Lhrough Lhe
esLabllshmenL of low-cosL laboraLorles.
! lncrease publlc awareness Lhrough lnformaLlon, educaLlon, and communlcaLlon sLraLegles.

!"#$#%&' )*+,#-% .#" #"3)-,4)+,#-% %5$$#"+,-3 672789 :;:; )*+,<,+,&%
! romoLe Lhe uLlllzaLlon of Lhe reglonal gulde ln refracLlve errors programs.
! SLandardlze Lechnology: screenlng klL and affordabl e lnsLrumenLs.
! uevelop advocacy plan for healLh and educaLlonal auLhorlLles.
! romoLe a sLudy ln refracLlve error correcLlon needs for school chlldren.
! SupporL developmenL of low cosL specLacle producLlon and dlsLrlbuLlon sysLems.

Ind|cators
! lncrease Lhe number of counLrles lmplemenLlng a naLlonal sLandard refracLlve errors program as parL
of naLlonal eye care pollcles and plans from 2 Lo 7 by Lhe year 2014.
! lncrease ln Lhe specLacle labs produclng affordable, quallLy specLacles

1.3. kLDUCL 1nL IMAC1 CI 8LINDNLSS AND VISUAL IMAIkMLN1 IN 1nL GLNLkAL CULA1ICN

1.3.1 Lnhance v|s|on re|ated qua||ty of ||fe for peop|e w|th funct|ona| |ow v|s|on.
Low-vlslon servlces are almed aL people who have resldual vlslon LhaL can be used and enhanced by spec lflc
alds. Low vlslon ls currenLly deflned as 'vlsual ac ulLy of < 6/18 down Lo and lncludlng 3/60 ln Lhe be LLer eye',
from all causes.

lL ls esLlmaLed LhaL for every Lhousand people, 17 has low vlslon, of Lhose abouL 6 could beneflL from low vlslon
lnLervenLlons.

Lxpected outcome
rovlde comprehenslve low-vlslon servlces for persons who are bllnd or severely vlsually lmpalred lnLegraLlng
cllnlcal eye care, rehablllLaLlon and educaLlonal servlces ln each counLry.

Issues
! lnadequaLe governmenL pollcy for vlsual rehablllLaLlon.
! LlmlLed publlc and eye care professlonals' awareness of low vlslon.
! lnsufflclenL professlonal servlces and Lechnlcal experLlse ln Lhls speclalLy.
! lnsufflclenL affordable opLlcal devlces for assessmenL and prescrlpLlon.
! lnsufflclenL rehablllLaLlon and educaLlonal servlce s for people wlLh low vlslon.
! lnsufflclenL adapLed Leachlng maLerlals and Lechnol ogles for sLudenLs wlLh low vlslon.

!"#$#%&' )*+,#-% .#" /&01&" 2+)+&%
! uevelop naLlonal pollcles on comprehenslve low-vlsl on care.
! LsLabllsh low-vlslon servlces aL Lhe naLlonal level ln publlc faclllLles.
! romoLe early ldenLlflcaLlon of all chlldren and adulLs who are lrrevocably bllnd severely vlsually
lmpalred and ensure LhaL an effecLlve referral sysLem ls ln place.
61
"#$%#&'%()*)+*
#,-"%.//+
11
! LsLabllsh unlLs LhaL can provlde comprehenslve low vlslon servlces, uLlllzlng Lechnlclans ln opLomeLry
Lo perform low vlslon examlnaLlons, assess and counsel paLlenLs, prescrlbe opLlcal devlces and provlde
lnsLrucLlon ln devlce use.
! romoLe low vlslon servlces for chlldren as early as posslble Lhrough an lnLegraLed sysLem of cllnlcal
and pedagoglc servlces.

!"#$#%&' )*+,#-% .#" #"3)-,4)+,#-% %5$$#"+,-3 672789 :;:; )*+,<,+,&%
! Crganlze low-vlslon courses aL reglonal and naLlonal congresses of ophLhalmology.
! romoLe Lhe esLabllshmenL of resource cenLers for Lhe Lralnlng of Lralners, currlcula sLandardlzaLlon,
and Lechnology developmenL.
! SupporL Lhe organlzaLlon of low-vlslon cenLers ln underserved counLrles currenLly wlLhouL such
servlces.
! uevelop a sysLem Lo make low-vlslon alds affordable.
! AdvocaLe for naLlonal lnLer-secLoral pollcles and plans for lncluslve educaLlon and for rehablllLaLlon
programs for persons who are bllnd
! 1raln low-vlslon Leams (eye care, low-vlslon Lherapy, rehablllLaLlon, educaLlon, and soclal servlces).
! CreaLe reglonal or naLlonal fundlng bases for Lhe purchase of devlces
! uevelop speclflc conLlnulng educaLlon programs ln l ow vlslon care for exlsLlng/avallable personnel.

Ind|cator
! lncrease Lhe number of counLrles wlLh low-vlslon servlces from 3 Lo 6 by Lhe year 2014.

1.3.2. Inc|us|ve serv|ces
Chlldren who are bllnd should have access Lo lnclus lve educaLlon and supporLlve servlces, adulLs who are bllnd
requlre rehablllLaLlon (adjusLmenL Lo bllndness) pr ograms Lo sLrengLhen Lhelr emoLlonal and soclal capablllLles,
as well as Lralnlng ln dally llvlng skllls, orlenLa Llon moblllLy skllls, and vocaLlonal Lralnlng. lnso far as lL ls feaslble,
lncluslve educaLlon and adjusLmenL Lo bllndness ser vlces should be supporLed by access Lo adapLlve alds,
lncludlng devlces for readlng and wrlLlng, whlLe canes, adapLed domesLlc alds, and low-vlslon appllanc es and
Lechnologles.

Issues
! lnadequaLe governmenL pollcy for vlsual rehablllLaLlon.
! lnsufflclenL rehablllLaLlon and educaLlonal servlce s for people wlLh low vlslon and bllndness.
! lnsufflclenL adapLed Leachlng maLerlals and Lechnol ogles.

Lxpected outcome
LducaLlon and 8ehablllLaLlon servlces avallable for persons wlLh bllndness or vlsual dlsablllLy.

!"#$#%&' )*+,#-% .#" /&01&" 2+)+&%
! LeglslaLlon and pollcles approved/enacLed LhaL supporL lmplemenLaLlon of Lhe un ConvenLlon on Lhe
8lghLs of ersons wlLh ulsablllLles unC8u (Slgned ln 2009)
! naLlonal ulsablllLy lan ls approved and lmplemenLe d by Lhe CovernmenL (MoL and MoP)
! Lnsurlng avallablllLy and accesslblllLy of lncluslv e servlces (8ehablllLaLlon, educaLlon and soclal servlces)
! LducaLlon and soclal servlces deparLmenL ls sLrengLhened Lo provlde expanded servlce dellvery for chlldren
and adulLs who are bllnd.
! MoL provldes sufflclenL supporL Lo meeL Lhe educaLl onal needs of bllnd and vl sLudenLs.

!"#$#%&' )*+,#-% .#" #"3)-,4)+,#-% %5$$#"+,-3 672789 :;:; )*+,<,+,&%
! AdvocaLe for lncluslve servlces ln every counLry.
! CoordlnaLe efforLs among nCCs Lo resource soclal and educaLlon servlces.
! Make avallable affordable Lechnlcal equlpmenL and speclal supplles for bllnd and vlsually lmpalred.
62
"#$%#&'%()*)+*
#,-"%.//+
12
! ConducL a reglon wlde slLuaLlon assessmenL on rehablllLaLlon and educaLlon servlces for persons who ar e
bllnd.

Ind|cator
! number of counLrles LhaL are lmplemenLlng naLlonal plans for lncluslve educaLlon and adjusLmenL Lo
bllndness by 2014.
63
"#$%#&'%()*)+*
#,-"%.//+
13

2. LL CAkL SS1LMS

2.1 Centra| Crgan|zat|on, Leadersh|p and Governance

Lxpected outcome: rovlde leadershlp and governance LhaL ensures an effecLlve and equlLable eye care
sysLem.
lnvolves ensurlng sLraLeglc pollcy comblned wlLh coallLlon bulldlng, Lhe provlslon of approprlaLe regulaLlons,
lncenLlves and accounLablllLy.

keg|ona| and Nat|ona| Strategy
! Lnsure naLlonal sLraLeglc pollcy framework.
! Lncourage naLlonal CommlLLee and a local erson for Lhe revenLlon of 8llndness LhaL wlll asslsL Lhe
mlnlsLry of healLh, educaLlon and oLher naLlonal auLhorlLles and organlzaLlons ln Lhe developmenL of
regulaLlons and plans and Lhe lmplemenLaLlon and mo nlLorlng of programs.
! SupporL Lhe lmplemenLaLlon of Lhe plan.
! keep updaLed lnformaLlon on vlSlCn 2020 lmplemenLaLlon aL all levels.
! romoLe neLworklng and capaclLy bulldlng.

2.2 Lye Care Workforce

Issues
! lnsufflclenL ophLhalmology and opLomeLry Lralnlng programs ln Lhe reglon, resulLlng ln an lnadequaLe
number of quallfled professlonals ln ophLhalmology, opLomeLry and allled healLh personnel.
! ln Lhe Carlbbean Lhe surglcal producLlvlLy per ophLhalmologlsL ls low, ln parL because several cllnlcal
ophLhalmologlsLs do noL perform surgery. CLhers work ln prlvaLe pracLlce and llmlL Lhelr servlces Lo
paLlenLs who can afford Lhelr fees.
! ln many counLrles prlmary eye care ls noL yeL lmplemenLed.

Lxpected outcome: Pave a well-performlng healLh workforce falr and efflclenL Lo achleve Lhe besL eye care
ouLcomes posslble glven avallable resources and clrcumsLances. 1here are sufflclenL numbers and mlx of sLaff,
falrly dlsLrlbuLed, Lhey are compeLenL and producLlve.

! Crganlze new ophLhalmology and opLomeLry Lralnlng programs ln Lhe 8eglon and sLrengLhen Lhose LhaL
exlsL.
! Lxpand numbers of mld level personnel such as refracLlonlsLs, ophLhalmlc asslsLanLs and low vlslon
Lechnlclans ln Lhe dellvery of eye care ln Lhe Carlbbean.
! ldenLlfy and or Lraln sub-speclallsLs ln pedlaLrlc ophLhalmology and reLlnal servlces lncludlng Lhe necessary
referral sysLem for Lhe esLabllshed referral servlces.
! 1raln prlmary healLh care (PC) workers ln prlmary eye care aL Lhe naLlonal level.
! LsLabllsh Lhe producLlvlLy norms for key resources (for example caLaracL surgerles per ophLhalmologlsL per
year).
! uevelop conLlnulng educaLlonal programs.
! uevelop manpower for equlpmenL malnLenance repalr, low cosL specLacle producLlon and eye drops
preparaLlon.

Ind|cators
! number of counLrles reachlng Lhe mlnlmum raLlo seL of one acLlve ophLhalmlc surgeon per 30,000
populaLlons.
! number of counLrles reachlng Lhe mlnlmum raLlo seL of one acLlve opLomeLrlsL per 30,000 populaLlons.
64
"#$%#&'%()*)+*
#,-"%.//+
14
! number of counLrles reachlng Lhe mlnlmum raLlo seL of one acLlve ophLhalmlc nurse per 30,000
populaLlons
! number of counLrles havlng an acLlve LC servlce lnLegraLed Lo Lhe PC servlce.
! number of counLrles wlLh neLwork of malnLenance Lechnlclans avallable coverlng all hosplLals ln counLr y
by 2014.
! lncrease Lhe number of counLrles havlng specLacles lab Lechnlclans from 3 Lo 6.

2.3. Med|ca| roducts and 1echno|og|es

Issues
! LlmlLed avallablllLy of affordable consumables.
! LlmlLed producLlon of specLacles and medlcaLlons.
! underuLlllzaLlon of equlpmenL due Lo lack of skllls .
! LlmlLed governmenL undersLandlng of eye care equlpmenL managemenL.

Lxpected outcome:
1o ensure an opLlmal supply of approprlaLe, hlgh-quallLy, affordable equlpmenL, lnsLrumenLs, consumabl es
essenLlal for Lhe dellvery of eye care servlces.

keg|ona| and nat|ona| Strategy
! romoLe Lhe uLlllzaLlon of small lnclslon caLaracL surgery.
! roduce and/or dlsLrlbuLe affordable consumables.
! rovlde pracLlLloners, mlnlsLrles of healLh, hosplLals and cllnlcs wlLh lnformaLlon on good quallLy an d
affordable approprlaLe Lechnology.
! Lnsure avallablllLy of specLacles, ophLhalmlc suppl les and equlpmenL aL cosLs approprlaLe Lo local
economles.
! rovlde Lralnlng Lo supporL sLaff ln malnLalnlng and repalrlng ophLhalmlc equlpmenL.

2.4. Lye Care Informat|on Systems and Mon|tor|ng

Issues
! lnsufflclenL daLa on ouLpuLs and ouLcomes of servlc es Lo supporL plannlng, monlLorlng, advocacy and
reporLlng.

Lxpected outcomes:
lnclude eye care ln Lhe naLlonal plannlng, healLh and educaLlon lnformaLlon sysLem.
erlodlc lnformaLlon avallable on Lhe slLuaLlon and Lrends on eye care dellvery ln Lhe Carlbbean.

keg|ona| and nat|ona| Strategy
! ldenLlfy mechanlsms Lo lnclude eye care ln Lhe presenL PealLh ManagemenL lnformaLlon sysLem.
! uevelop daLa managemenL sysLems for eye care: daLa collecLlon, compllaLlon, reporLlng and analysls
! ueflne how analysls and dlsLrlbuLlon of lnformaLlon wlll be carrled ouL.
! ueflne procedures for annual, mld-Lerm and flnal revlew of Lhe sLraLegy lmplemenLaLlon.
! ldenLlfy feedback mechanlsms for varlous levels of sLaff.
65
"#$%#&'%()*)+*
#,-"%.//+
15

3. LL CAkL kCMC1ICN, U8LIC LDUCA1ICN & ADVCCAC
AbouL 80 of bllndness ls avoldable: lL elLher resulLs from condlLlons LhaL could have been prevenLed or
condlLlons LhaL may have belng successfully LreaLed Lo resLore slghL. lL ls necessary LhaL hlgh rlsks groups have
adequaLe lnformaLlon Lo ensure Lhey look for servlces Lo deLecL and LreaL eye problems and LhaL Lhey lncrease
compllance on follow-up and LreaLmenLs. 1he alm of eye care promoLlon and publlc educaLlon ls Lo lmprove
knowledge, aLLlLudes, moLlvaLlon and acLlon for hlgh rlsk groups and healLh auLhorlLles.

1he promoLlon of eye healLh as parL of Lhe naLlonal healLh pollcy ls, lnvarlably, a necessary prerequlslLe for a
naLlonal rogram for Lhe revenLlon of 8llndness. 1hls fosLers publlc awareness, leads Lo socleLal
responslveness and parLlclpaLlon and faclllLaLes co-ordlnaLlon of acLlvlLles carrled ouL by varlous parLners, such
as non-governmenLal organlzaLlons, Lhe prlvaLe secLor and Lhe governmenL lLself.

3.1. Advocacy
Lxpected Cutcomes
! lncreased pollLlcal commlLmenL ln all counLrles Lo lnclude eye healLh ln Lhe naLlonal healLh plans.
! lncreased commlLmenL of professlonal socleLles Lo reglonal and naLlonal eye care programs.

! MlnlsLrles of PealLh are acqualnLed wlLh Lhe APC and WPC resoluLlons ln prevenLlon of bllndness.
! SLrengLhen naLlonal daLa-gaLherlng capablllLles, Lo faclllLaLe reglonal collecLlon of epldemlologlcal and
servlce dellvery lnformaLlon and allow dlsaggregaLlon of daLa by gender and age.
! LsLabllsh and keep currenL a reglsLer of all known persons wlLh vlsual dlsablllLy.
! romoLe epldemlologlcal and servlce dellvery assessmenLs.
! arLlclpaLe ln ophLhalmlc reglonal professlonal soc leLles' meeLlng.
! romoLe eye care professlonals gaLherlng reglonally and sub-reglonally for conLlnulng medlcal educaLlo n
and eye care plannlng.
! romoLe v2020 / revenLlon of 8llndness CommlLLees gaLherlng reglonally for cross learnlng, sklll sharlng
and collaboraLlon.
! ubllsh papers ln reglonal sclenLlflc journals.
! AdvocaLe for Lhe lncluslon of crlLlcal eye care ln Lhe naLlonal healLh lnformaLlon sysLems.
! Cbserve Lhe second 1hursday of CcLober every year as World SlghL uay.
! CelebraLe any day Lo promoLe speclflc Loplcs.

Ind|cators
! number of counLrles celebraLlng Lhe World SlghL uay and relaLed days each year.
! lncrease Lhe number of counLrles lmplemenLlng a naLlonal vlslon 2020 plan from 6 Lo 10 by 2014.
! number of counLrles lncludlng eye healLh servlces ln Lhe naLlonal healLh plan from 4 Lo 8 by 2014.

3.2 ub||c awareness and educat|on

Lxpected outcome: lncreased publlc knowledge and uLlllzaLlon of eye care servlces.

! Assess Lhe basellne daLa ln knowledge, bellefs, aLLlLudes and acLlons of Lhe populaLlon ln regard Lo e ye
care.
! uevelop a communlcaLlon program lncludlng prlnLed and audlo-vlsual maLerlals.
! uLlllse general healLh and eye healLh professlonals Lo creaLe publlc awareness.

Ind|cators
! lncrease Lhe number of counLrles lmplemenLlng an eye care publlc awareness program.
66
"#$%#&'%()*)+*
#,-"%.//+
16
! lncrease Lhe number of people uslng eye care servlces by 30 over 3 years
67
"#$%#&'%()*)+*
#,-"%.//+
17
8l8LlCC8AP?

1. World PealLh CrganlzaLlon. vlslon 2020 1he 8lghL Lo SlghL: Clobal lnlLlaLlve for Lhe ellmlnaLlon of
avoldable bllndness, AcLlon lan 2006-2011. Ceneva, SwlLzerland: 2007.
2. an Amerlcan PealLh CrganlzaLlon. lorLy-nlnLh ulrecLlng Councll, 61sL Sesslon of Lhe 8eglonal
CommlLLee. WashlngLon uC, APC, 2009 (8esoluLlon Cu49/19).
3. an Amerlcan PealLh CrganlzaLlon. PealLh ln Lhe Amerlcas. PealLh condlLlons and 1rends. Ccular
PealLh. 8eglonal volume. APC: WashlngLon uC,2007:141-142. Avallable aL:
hLLp://www.paho.org/PlA/homelng.hLml. Accessed: lebruary 17, 2010.
4. vlslon 2020. LaLln Amerlcan 8eglon. Avallable aL:
hLLp://www.vlslon2020.org/maln.cfm?1ype=WLlLA&objecLld=2812. Accessed !anuary 13. 2010.
3. losLer A, 8esnlkoff S. 1he lmpacL of vlslon 2020 on global bllndness. Lye 2003, 19:1133-1133.
6. CllberL C, losLer A. Chlldhood bllndness ln Lhe conLexL of vlSlCn 2020-L he rlghL Lo slghL. 8ull World
PealLh Crg 2001,79:227-232.
7. ?orsLon u. 1he global lnlLlaLlve vlslon 2020: 1he r lghL Lo slghL chlldhood bllndness. CommunlLy Lye
PealLh 1999,12:44-43.
8. Llmburg P, 8arrla l, Comez , Sllva !C, losLer A. 8evlew of recenL surveys on 8llndness and vlsual
lmpalrmenL ln LaLln Amerlca. 8r !.CphLhalmol 2008,92,313-319.
9. ongo gulla L, Carrln 8, Luna W, Sllva !C, Llmburg P. Ceguera por caLaraLa en personas mayores de
30 anos en una zona semlrrural del norLe del eru. an Am ! ubllc PealLh 2003,17:387-393.
10. 8elLranena l, Casasola k, Sllva !C, Llmburg P. CaLaracL bllndness ln four reglons ln CuaLemala-resulLs
of a populaLlon-based survey. CphLhalmology 2007,114:1338-1363.
11. nano ML, nano Pu, Muglca !M, Sllva !C, MonLana C, Llmburg P. 8apld assessmenL of vlsual
lmpalrmenL due Lo caLaracL and caLaracL surglcal servlces ln urban ArgenLlna. CphLhalmlc Lpldemlol
2006,13:191-197.
12. Lduardo LelLe ArleLa C, nlcollnl uelgado AM, !ose nk, 1emporlnl L8, Alves M8, de Carvalho Morelra
lllho u. 8efracLlve errors and caLaracL as causes of vlsual lmpalrmenL ln 8razll. CphLhalmlc Lpldemlol
2003,10:13-22.
13. Pernndez Sllva !8, 8lo M, adllla C. 8esulLados del 8ACSS en cludad de la Pabana, Cuba, 2003. 8ev
Cubana CfLalmol 2006:19:1-9.
14. uuerksen 8, Lanslngh v. vlslon 2020 ln LaLln Amerlca. CaLaracL 8efracL Surg 1oday. May 2007. 64-67.
13. Sllva !C, 8aLeman !8, ConLreras l. Lye dlsease and care ln LaLln Amerlca and Lhe Carlbbean. Survey
CphLhalmol 2002,47:267-274.
16. Llmburg P, Sllva !C, losLer A. CaLaracL ln LaLln Amerlca: flndlngs from nlne recenL surveys. 8ev anam
Salud ubllca 2009,23:449-433.
17. uuerksen 8, Llmburg P, Carron !L, losLer A. CaLaracL bllndness ln araguay-resulLs of a naLlonal
survey. CphLhalmlc Lpldemlol 2003,10:349-337.
18. Lanslngh vC, 8esnlkoff S, 1lngley-kelley k, nano ML, MarLens M, Sllva !C, uuerksen 8, CarLer M!.
CaLaracL surgery raLes ln laLln amerlca: a four-year longlLudlnal sLudy of 19 counLrles CphLhalmlc
Lpldemlol. 2010 Mar,17(2):73-81.
19. Chlrlboga l. ?aruqul-Lcuador: An ongolng dlsLrlcL vlSlCn 2020 programme. CommunlLy Lye PealLh
2003,18:96.
20. Maul L, 8arroso S, Munoz S8, SperduLo 8u, Lllweln L8. 8efracLlve error sLudy ln chlldren: resulLs from
La llorlda, Chlle: Am ! CphLhalmol 2000,129:443-434.
21. Sauerbrey M. 1he Cnchocerclasls LllmlnaLlon rogram for Lhe Amerlcas (CLA). Ann 1rop Med
araslLol 2008,102:1:23-29.
22. ArleLa CL, de Cllvelra ul, Luplnaccl A, novaes , accola M, !ose nk, Llmburg P. CaLaracL remalns an
lmporLanL cause of bllndness ln Camplnas, 8razll. CphLhalmlc Lpldemlol 2009,16:38-63.
23. Salomao S, MlLsuhlro M, 8elforL 8. vlsual lmpalrmenL and bllndness: an overvlew of prevalence and
causes ln 8razll. An Acad 8ras Clenc 2009,81:339-349.
68
"#$%#&'%()*)+*
#,-"%.//+
18
Annex 1

PAN AMERCAN HEALTH ORGANZATON
WORLD HEALTH ORGANZATON

0123 456./7589 /":8/5'
;*<2 $.$$5"8 "= 7-. 6.95"8,' /">>577..

Washington, D.C., USA, 28 September-2 October 2009

CD49/19 (Eng.)
Annex B
ORIGINAL: ENGLISH

!"#!#$%& "%$#()*+#,

PLAN OF ACTION ON THE PREJENTION OF AJOIDABLE BLINDNESS
AND JISUAL IMPAIRMENT

*-% ./01 &+"%2*+,3 2#),2+(4

Having reviewed Document CD49/19 Plan of Action on the Prevention of Avoidable
Blindness and Jisual Impairment;

Recalling Resolution WHA56.26 oI the World Health Assembly on the elimination oI
avoidable blindness;

Noting that visual disability is a prevalent problem in the Region and is related to poverty and
social marginalization;

Aware that most oI the causes oI blindness are avoidable and that treatments available are
among the most successIul and cost-eIIective oI all health interventions;

Acknowledging that preventing blindness and visual impairment relieves poverty and
improves opportunities Ior education and employment; and

Appreciating the eIIorts made by Member States in recent years to prevent avoidable
blindness, but mindIul oI the need Ior Iurther action,

69
"#$%#&'%()*)+*
#,-"%.//+
19
"%$#(5%$6

1. To approve the Plan oI Action on the Prevention oI Avoidable Blindness and Visual
Impairment.

2. To urge Member States to:

(a) establish national coordinating committees to help develop and implement national
blindness prevention plans;

(b) include prevention oI avoidable blindness and visual impairment in national
development plans and goals;

(c) advance the integration oI prevention oI blindness and visual impairment in existing
plans and programs Ior primary health care at the national level, ensuring their
sensitivity to gender and ethnicity;

(d) support the mobilization oI resources Ior eliminating avoidable blindness;

(e) encourage partnerships between the public sector, nongovernmental organizations,
private sector, civil society, and communities in programs and activities that promote the
prevention oI blindness; and

(I) encourage intercountry cooperation in the areas oI blindness and visual impairment
prevention and care.

3. To request the Director to:

(a) support the implementation oI the Plan oI Action on the Prevention oI Avoidable
Blindness and Visual Impairment;

(b) maintain and strengthen PAHO Secretariat`s collaboration with Member States on the
prevention oI blindness; and

(c) promote technical cooperation among countries and the development oI strategic
partnerships in activities to protect ocular health.

7a
11/22/2013
1
Sightsavers
Delivering V2020 in the Caribbean

Promoting Vision 2020: The Right to Sight to eliminate avoidable
blindness through capacity building in Guyana, Haiti, Jamaica,
St. Lucia and the Caribbean Region

!"#$%$
A Partnership between
This project is funded by the European Union
With technical support from PAHO and Brien Holden Vision Institute
Sightsavers
Project Overview

Total Funding:
5,429,856 (73.67% from European Commission)

Duration:
January 2010 December 2014

Countries covered:
Guyana, Haiti, Jamaica, St. Lucia, Caribbean Region

Project objectives:
Reduce prevalence of blindness
Strengthen collaboration and coordination
Build capacity of partners and V2020 Committees

Sightsavers
Project Update
RESULT / ACTIVITIES PROGRESS TO DATE
Strengthen partner
capacities, systems
and processes
All project partners benefited from staff
support, computer and accounting systems
development, training and mentoring
Support development,
implementation and
review of National
Eye Health Plans with
mentoring and
support for V2020
Committees
Project supports data collection which
facilitates review of progress against Regional
V2020 Framework indicators
Partners contributing to development and
implementation of V2020 Plans & Strategic
Frameworks in project countries
Partners and project contributed to disease
control workshops in Jamaica (LV, RE, DR)
Supporting V2020 Committee development
and activities
Support for Regional V2020 Committees
meetings
Sightsavers
Project Update
Human Resource
Development

9 Ophthalmology residents in training
15 Optometry students in training plus
project providing inputs to support 67 others
8 Refractionists completed training -
course also provided inputs to support 4
Refractionists funded by Government of
Antigua & Barbuda
784 PHC workers trained
88 Low Vision Counselors trained
6 Low Vision Specialists trained
4 Spectacle Lab Techs trained
Continuous support to University of
Guyana Optometry and Refractionist courses
71
11/22/2013
2
Sightsavers
Project Update
Infrastructure
Development

5 Operating theatres
Guyana (Linden & GPHC)
Haiti (St. Nicholas & Eliazar Germain)
Jamaica (Mandeville Eye Clinic)
7 Vision Centres
Guyana x 4
Haiti x 2
Jamaica x 1
4 Spectacle Labs
Guyana, St. Lucia (Upgrade of equipment)
Jamaica, Antigua (new labs)
Bio-med Technician Training Lab
Equipment in-situ
Sightsavers
Project Update
Communications

CCB website links Members and partners
and provides information on eye health and
social inclusion.
Newsletters, bulletins, press releases and
human interest stories produced regularly
Over 40 videos produced which reinforce
messaging from other media and advocate
for policy development, social inclusion of
visually impaired persons and prevention of
avoidable blindness
Support to special events such as World
Sight Day, Glaucoma Day and Health Fairs
IEC materials & KAP Studies under
development
Project learning documented and shared
Sightsavers
Planned activities 2014 include:
Support to National V2020 Committees and for Regional V2020
Meeting 2014
Awareness activities & distribution of communication materials
Graduation of Optometry Students at University of Guyana
Scholarships for up to 11 Refractionists
Training LV Specialists and LV Counsellors
Training Maintenance Techs, Lab Techs , Dispensing Techs and
PHC workers
Surfacing Lab and Maintenance Lab (CCB Antigua)
Operating Theatres (Haiti & St. Lucia)
Vision Centre & Spectacle Lab (SHAA, Haiti)
Vision Centres in Jamaica (3) and St Lucia (1)
KAP Studies focus on Glaucoma, DR and Cataract
Sightsavers
Delivering V2020 in the Caribbean
We look forward to your continued
support and involvement
72

SI1UA1ICNAL ANALSIS CI
DIA8L1IC kL1INCA1n
SLkVICLS IN AN1IGUA

M|chae| Lckste|n M8 8S MD DC IkCCphth
ConsulLanL vlLreoreLlnal Surgeon
Cllnlcal Lead Sussex ulabeLlc 8eLlnopaLhy Screenlng rogramme
8rlghLon and Sussex unlverslLy PosplLal

Iune - Iu|y 2013

Supported by
73
Contents

AcknowledgemenLs page 3
Acronyms page 4
Alms of SlLuaLlon Analysls / CbjecLlves page 3
8ackground - ulabeLlc 8eLlnopaLhy page 6
MagnlLude of Lhe problem age 6
Cenerallsed lssues page 7
AnLlgua - SlLuaLlon Analysls page 8
8egulaLlons, ollcles & lans page 8
Puman 8esources, lnfrasLrucLure & LqulpmenL page 8
Servlce uellvery, SysLems & roLocols page 10
Servlce ouLpuLs page 11
Awareness of PealLh Care ersonnel page 11
AchlevemenLs, 8esL racLlce and ConsLralnLs page 12
8ecommendaLlons page 14
Summary page 17
8eferences page 18
Appendlx: page 21
ulabeLlc reLlnopaLhy daLa collecLlon form

74

3
Acknow|edgements
1he Carlbbean Councll for Lhe 8llnd-Lye Care Carlbbean and SlghLsavers are graLeful
for Lhe Lechnlcal and flnanclal supporL recelved from Lhe an-Amerlcan PealLh
CrganlsaLlon (APC) when plannlng and lmplemenLlng Lhl s slLuaLlon analysls.
We exLend our Lhanks Lo ur Mlchael LcksLeln for underLaklng Lhls slLuaLlon analysls
and for hls conLlnued conLrlbuLlon Lo Lhe developmenL of dlabeLlc reLlnopaLhy
programmes ln Lhe Carlbbean.
We are graLeful Lo Lhe followlng who Look parL ln Lhe dlscusslons ln AnLlgua:
Mr Ldson !oseph, ermanenL SecreLary PealLh
ur 8honda Sealey-1homas, Chlef Medlcal Cfflcer
Mr Sean uesChamps, Chlef LxecuLlve Cfflcer, MounL SL !ohn's Medlcal CenLre
ur Alvln Ldwards, Medlcal ulrecLor (CphLhalmologlsL), aL MounL SL !ohn's Medlcal
CenLre
ur CrlLLa Zacharlah, Medlcal Cfflcer of PealLh
ur Leyland owell - Medlcal Cfflcer of lnsLlLuLlons
ur Affle Charles-8arLon - ulsLrlcL Medlcal Cfflcer
ur eLro MlLchell -ulsLrlcL Medlcal Cfflcer
ur Sonja WesLe-Cllkes - Medlcal Cfflcer
ur !ames knlghL - Medlcal Cfflcer
ur 8ose Masslah - Medlcal Cfflcer
ur Pelen Maklnde - Medlcal Cfflcer
ur Saravana SabahamaLl - Medlcal Cfflcer
ur 8asheda Wllllams - Medlcal Cfflcer
ur ?amlry Luso lerran - Medlcal Cfflcer
ur !enelle Allen, CpLomeLrlsL, MounL SL. !ohn's Medlcal CenLre
Ms !uanlLa !ames, AnLlgua and 8arbuda ulabeLes AssoclaLlon
Mr Colln C'keefe, SLaLlsLlclan/Pead, PealLh lnfo ulvlslon
Mr Clarence llgrlm, SuperlnLendenL, Clarevue PosplLal
Mr AlLon lorde, MasLer - llennes lnsLlLuLe
Mrs Llnora Warner, rlnclpal nurslng Cfflcer
Mrs Avls !onas, CommunlLy nuLrlLlon Cfflcer
Mr SL. Clalr Soleyn, rojecL uevelopmenL Cfflcer
Mr Alfred ALhlll, ulrecLor of harmaceuLlcal Servlces
nurse Pampson - uepuLy SuperlnLendenL of ubllc PealLh nurses
Ms Carolyn Copaul, Carlbbean Councll for Lhe 8llnd-Ly e Care Carlbbean
Mr lrank 8owen, Carlbbean Councll for Lhe 8llnd-Lye Care Carlbbean
Mr Arvel CranL- CLC, Carlbbean Councll for Lhe 8llnd-Lye Care Carlbbean
Mr hlllp Pand - rogramme Manager (Carlbbean), SlghLsavers
75

4
Acronyms

M8S Medlcal 8eneflLs Scheme
nCC non-governmenLal organlsaLlon
u8 ulabeLlc 8eLlnopaLhy
MCP MlnlsLry of PealLh
76

5
A|m of the S|tuat|on Ana|ys|s
1o conducL a slLuaLlonal analysls of Lhe avallable s ervlces and referral sysLems
for screenlng and LreaLmenL of dlabeLlc reLlnopaLhy and awareness of dlabeLlc
reLlnopaLhy among medlcal offlcers and dlabeLlc paL lenLs ln AnLlgua.

Cbject|ves
1. ldenLlfy naLlonal regulaLlons, pollcles or plans on prevenLlon of bllndness
due Lo dlabeLlc reLlnopaLhy and lLs lnLegraLlon lnL o naLlonal non-
communlcable dlseases or dlabeLes conLrol programs and pollcles.
2. Assess human resources and lnfrasLrucLure avallable for referral,
LreaLmenL and managemenL of dlabeLlc reLlnopaLhy, lncludlng access Lo
and use of fundus cameras and approprlaLe laser sysLems.
3. Assess dlabeLlc reLlnopaLhy servlces dellvery, eye care sysLems and
screenlng proLocols aL Lhe naLlonal level.
4. Assess dlabeLlc reLlnopaLhy servlces ouLpuLs on Lhe prevlous year,
number of dlabeLlcs undergolng eye examlnaLlons and LreaLmenL.
3. Assess Lhe awareness of healLh care personnel on dlabeLlc reLlnopaLhy.
6. Lxplore major achlevemenLs, besL pracLlces and major consLralns and
barrlers.
7. Make recommendaLlons on fuLure acLlons, objecLlves and acLlvlLles
requlred Lo sLrengLhen dlabeLlc reLlnopaLhy programs aL Lhe naLlonal
level, wlLh an emphasls on:
uevelopmenL & use of LreaLmenL proLocols
Screenlng and referral
MonlLorlng and LreaLmenL
77

6
8ackground D|abet|c ket|nopathy
1he mosL prevalenL causes of bllndness ln Lhe Carlbbean are non-operaLed
caLaracL and glaucoma, followed by dlabeLlc reLlnopaLhy and uncorrecLed
refracLlve errors.
Cne of Lhe maln objecLlves of Lhe currenL !"#$"%&'( *#$+%,-#. /-# 012123 45%
6'&5" "- !'&5" 78$#'99%$: 6%&'-:; ls Lo reduce Lhe prevalence of bllndness from
dlabeLlc reLlnopaLhy.
ulabeLlc reLlnopaLhy ls sympLomless ln lLs early sLages and eye examlnaLlons /
screenlng are Lhe only way Lo ldenLlfy affecLed people Lo prevenL Lhem from
golng bllnd. Screenlng ls hlghly effecLlve as LreaLmenL of Lhe pre-sympLomaLlc
sLaLe ls cheaper and more beneflclal Lhan LreaLlng sympLomaLlc paLlenLs.
Cllnlcal sLudles over Lhe lasL 30 years have shown LhaL approprlaLe LreaLmenL
wlLh laser can reduce Lhe rlsks by more Lhan 90 and LhaL Lhls LreaLmenL ls a
very efflclenL and susLalnable use of resources.

Clobally 330 mllllon people have dlabeLes. AbouL 90 mllllon may have dlabeLlc
reLlnopaLhy. AbouL 1:12 dlabeLlcs over Lhe age of 40 has vlslon LhreaLenlng
reLlnopaLhy. 1he lncldence and prevalence ls lncreaslng aL a dramaLlc raLe due
malnly Lo publlc healLh lssues relaLed Lo changes l n dleL and reduced physlcal
acLlvlLy.
1he populaLlon of Lhe Lngllsh speaklng Carlbbean ls 3.3 mllllon. 1he reglon ls
exLremely dlverse geographlcally, eLhnlcally and economlcally. Mass Lourlsm
and valuable cash crops enrlch some counLrles whereas oLher areas have
vlrLually no Lourlsm, few valuable exporLs and large-scale emlgraLlon
parLlcularly of Lhelr younger populaLlon. 8ecause dlabeLes affecLs eLhnlc
groups dlfferenLly, boLh prevalence flgures and Lhe amounL of acLual dlabeLlc
eye dlsease varles slgnlflcanLly LhroughouL Lhe reglon. 1he level of ophLhalmlc
experLlse, equlpmenL and Lechnlcal supporL also varl es very wldely.
1he prevalence of dlabeLes among adulLs ln LaLln Amerlca and Lhe Carlbbean
varles from counLry Lo counLry. ln 8arbados, 18 of persons of Afrlcan descenL
beLween Lhe ages of 40 and 84, reporL havlng a hlsLory of dlabeLes, among
people wlLh dlabeLes 30 have dlabeLlc reLlnopaLhy. 9 of dlabeLlcs have
cllnlcally slgnlflcanL macular oedema and 1 have advanced dlabeLlc
reLlnopaLhy.

78

7
Genera||sed Issues
lnadequaLe medlcal managemenL and conLrol of dlabeLes.
lnadequaLe developmenL of deLecLlon and referral sysLems.
lnsufflclenL publlc awareness relaLlng Lo cause and prevenLlon of vlsual loss
due Lo dlabeLes.
lnsufflclenL awareness and knowledge of rlmary PealLh Care (PC)
pracLlLloners, general physlclans and lnLernlsLs regardlng Lhelr role ln Lhe
prevenLlon of bllndness due Lo dlabeLes.
LlmlLed number of ophLhalmologlsLs wlLh useful expe rlence ln dlagnosls
and LreaLmenL of dlabeLlc reLlnopaLhy.
lnadequaLe Lechnologlcal lnfrasLrucLure ln Lhe heal Lh servlces.
oor resourclng and low capaclLy of naLlonal dlabeL es assoclaLlons.
1he !"#$"%&'( *#$+%,-#. /-# 012123 45% 6'&5" "- !'&5" 78$#'99%$: 6%&'-:;
proposes a number of acLlons for organlzaLlons supporL lng vlSlCn 2020
acLlvlLles, one of whlch ls Lo conducL naLlonal asse ssmenLs of servlces for
dlabeLlc reLlnopaLhy ln selecLed counLrles. 1he ouL puLs of Lhese naLlonal level
assessmenLs wlll enable organlzaLlons supporLlng vlS lCn 2020 acLlvlLles Lo
supporL counLrles ln Lhe developmenL of screenlng programs and servlces for
dlabeLlc reLlnopaLhy and Lo supporL developmenL of educaLlon packages and
Lralnlng programs for Lhe general publlc and healLh care provlders.
lL ls ln Lhls conLexL LhaL Lhe an Amerlcan PealLh CrganlsaLlon (APC), Lhe
Carlbbean Councll for Lhe 8llnd - Lye Care Carlbbean (CC8) and SlghLsavers
collaboraLed wlLh MlnlsLrles of PealLh and naLlonal organlzaLlons supporLlng
vlSlCn 2020 acLlvlLles ln AnLlgua, 8ellze and !amalca Lo assess Lhe currenL
slLuaLlon ln relaLlon Lo servlces and referral sysLems for screenlng and
LreaLmenL of dlabeLlc reLlnopaLhy and awareness of dlabeLlc reLlnopaLhy
among medlcal offlcers and dlabeLlc paLlenLs.

79

8
AN1IGUA S|tuat|on Ana|ys|s
AnLlgua ls an lsland ln Lhe Leeward lsland group ln Lhe Carlbbean. lLs
populaLlon was around 80,000 aL Lhe 2011 Census. Cver 1/3
rd
of Lhe
populaLlon llve ln Lhe maln Lown of SL !ohn's. 1he eLhnlc mlx of Lhe lsland ls
predomlnanLly black Afrlcan (91) wlLh small populaLlons of mlxed race (4),
whlLe (2) and oLhers. AnLlgua ls a geographlcally small counLry wlLh a
relaLlvely good LransporL lnfrasLrucLure.

kegu|at|ons, o||c|es & |ans
<=%:"'/> :$"'-:$? #%&@?$"'-:AB C-?'('%A -# C?$:A -: C#%D%:"'-: -/ 9?':=:%AA
=@% "- ='$9%"'( #%"':-C$"5> $:= '"A ':"%&#$"'-: ':"- :$"'-:$? :-:E
(-++@:'($9?% ='A%$A%A -# ='$9%"%A (-:"#-? C#-&#$+A $:= C-?'('%A
1here ls no formallsed dlabeLlc screenlng programme and aL presenL, no
naLlonal pollcy or plan for dlabeLlc reLlnopaLhy or for eye dlsease ln general.
1here ls no prevalence daLa for dlabeLes or dlabeLlc reLlnopaLhy ln AnLlgua.
1here ls no dlabeLlc reglsLer.
uslng daLa from oLher surroundlng counLrles wlLh sl mllar eLhnlc mlxes Lhe
esLlmaLed prevalence of dlabeLes should be around 12-13 ln Lhe populaLlon
aged over 40. (8ef 2,3,3,6)
1hls esLlmaLes a dlabeLlc populaLlon of abouL 6000 of whom 2000 are llkely Lo
have dlabeLlc reLlnopaLhy and 400 of whlch mlghL beneflL from laser
LreaLmenL.
AlmosL all medlcaLlon ls avallable Lhrough Lhe Medlcal 8eneflLs Scheme (M8S).
aLlenLs ellglble for Lhls scheme have a unlque medlcal beneflL number and
Lhls ls a way Lo poLenLlally capLure more accuraLe daLa. AL presenL Lhere ls no
means Lo do Lhls buL Lhere ls hope LhaL a sophlsLlca Led smarL card" may be
lnLroduced, whlch wlll allow deLalled analysls of p aLlenL lnLeracLlon wlLh
governmenL healLh servlces.
AL presenL because paLlenLs do noL use any unlque l denLlfler, lL ls dlfflculL Lo
capLure paLlenL eplsodes and upLake of servlces as well as prescrlpLlons of
lnsulln and oLher dlabeLlc drugs.

8a

9
numan kesources, Infrastructure & Lqu|pment
!""#"" %&'() *#"+&*,#" ()- .)/*("0*&,0&*# (1(.2(32# /+* *#/#**(24
0*#(0'#)0 ()- '()(5#'#)0 +/ -.(3#0., *#0.)+6(0%74 .),2&-.)5 (,,#"" 0+
()- &"# +/ /&)-&" ,('#*(" ()- (66*+6*.(0# 2("#* "7"0#'"8
1here ls a well-esLabllshed and effecLlve model of prlmary care.
1here are 26 small healLh cllnlcs and 8 healLh cenLres (Cray's larm, SL. !ohn's,
!ohnson's olnL, !ennlngs, 8rowne's Avenue, All SalnLs, Clare Pall, 8lshopsgaLe
SLreeL and ares) LhroughouL Lhe lsland, plus Lhe Pannah 1homas PosplLal ln
8arbuda. 1here are 17 Medlcal Cfflcers and ulsLrlcL Medlcal Cfflcers wlLhln
CommunlLy PealLh Servlces. 1here are Medlcal Cfflcers ln Lhe large healLh
cenLres (of whlch Lhere are slx) on a dally basls. ul sLrlcL Medlcal Cfflcers vlslL
Lhe smaller cllnlcs weekly. ulsLrlcL Medlcal Cfflcers cover larger geographlc
areas and prlmarlly see chlldren and Lhe elderly. 1here ls nurslng sLaff aL all of
Lhe cllnlcs and healLh cenLers on a dally basls.
Medlcal Cfflcers and ulsLrlcL Medlcal Cfflcers refer paLlenLs Lo MounL SL !ohn's
Medlcal CenLre ln SL !ohn's. 1hls ls Lhe only publlcally owned hosplLal ln Lhe
counLry. lL ls a modern hosplLal and appears Lo be well run. aL lenLs Lake Lhe
referral from Lhe medlcal offlcers Lo Lhe hosplLal and organlse an appolnLmenL
for phoLography or cllnlc. aLlenLs reLurn agaln on anoLher day for Lhe
appolnLmenL. lf laser LreaLmenL ls requlred lL musL be organlsed dlrecLly wlLh
Lhe prlvaLe ophLhalmology cllnlcs.
1here ls an esLabllshed Medlcal 8eneflLs Scheme (M8S) ln AnLlgua whlch
means LhaL ellglble paLlenLs do noL need Lo pay for Lhelr vlslL Lo Lhe healLh
cenLres. 1he vasL majorlLy of people LhaL are resldenL ln AnLlgua have access Lo
Lhe M8S. lL ls funded by conLrlbuLlons made by employers and employees.
Cnce a person becomes ellglble Lhey remaln so even lf no longer worklng.
Chlldren, Lhe elderly and persons dlagnosed wlLh cer Laln chronlc dlseases
lncludlng dlabeLes are ellglble for beneflLs from M8S. 1he only groups LhaL are
noL ellglble are recenL mlgranLs who are noL worklng.
Cnce referral ls made Lo Lhe hosplLal Lhe paLlenL musL pay a conLrlbuLlon for
Lhelr cllnlc appolnLmenL and for any LreaLmenL. 1hl s paymenL ls made up fronL
and Lhey are Lhen able Lo apply for a proporLlon of L hls Lo be refunded by Lhe
M8S aL a laLer daLe.
1here are 2 ophLhalmologlsLs ln Lhe counLry boLh based ln SL !ohns. 1hey work
mosLly ln Lhe prlvaLe secLor ln Lhelr own cllnlcs buL each does a sesslon ln
MounL SL !ohn's PosplLal alLernaLlng every lrlday. 8oLh ophLhalmologlsLs are
able Lo see, assess and LreaL dlabeLlc reLlnopaLhy wlLh laser.
81

10
1here ls one opLomeLrlsL who also does sesslonal wor k ln Lhe hosplLal and
operaLes Lhe dlglLal camera. 1here are oLher opLomeLrlsLs who only work ln
Lhe prlvaLe secLor. 1hey mosLly refer paLlenLs prlvaLely.
1here are 4 refracLlonlsLs who have been recenLly Lralned ln Lhe one year
8efracLlonlsL 1echnlques Course aL Lhe unlverslLy of Cuyana wlLh supporL from
CC8 and Lhe MlnlsLry of PealLh. 1hey are now ready Lo begln work ln four of
Lhe large healLh cenLres. 1he requlred space has been allocaLed and ls belng
converLed and equlpped for Lhelr use. lL ls esLlmaLed LhaL Lhey wlll begln work
ln Lhe second half of 2013.
1here ls a small dlabeLlc assoclaLlon based ln SL !ohn's wlLh abouL 60 members
of whlch 12 are regular aLLendees aL meeLlngs. 1hey currenLly do noL have an
acLlve paLlenL educaLlon programme and are shorL of resources.
AL presenL Lhere ls llLLle lf any ophLhalmlc equlpmenL ln Lhe healLh cenLres.
Cnce Lhe refracLlonlsLs begln work lL ls hoped LhaL Lhere wlll be baslc
equlpmenL Lo check Lhe fronL and back of Lhe eye.
1here ls on-golng dlscusslon as Lo wheLher dlglLal cameras could be lnsLalled ln
Lhese 4 healLh cenLres.
1here ls one modern dlglLal camera ln MounL SL !ohns Medlcal CenLre eye
deparLmenL. 1hls was purchased uslng charlLable funds. An opLomeLrlsL
operaLes lL.
1here are Lwo modern funcLlonlng lasers ln Lhe prlvaLe cllnlcs of Lhe
ophLhalmologlsLs. 1here ls no laser avallable ln L he hosplLal.
1here are no faclllLles for vlLreo-reLlnal surgery and paLlenLs who requlre Lhls
usually go Lo 8arbados. 1hls LreaLmenL ls someLlmes parL funded by Lhe
CovernmenL dependlng on need.

Serv|ce De||very, Systems & rotoco|s
!""#"" -.(3#0., *#0.)+6(0%7 "#*1.,#" -#2.1#*74 #7# ,(*# "7"0#'" ()-
",*##).)5 6*+0+,+2" (0 0%# )(0.+)(2 2#1#28
ulabeLlc paLlenLs seen ln healLh cenLres may be asked Lo go for screenlng
phoLos. A referral ls made for Lhls and lL ls up Lo Lhe paLlenL Lo organlse lL aL
Lhe hosplLal. 1here ls no screenlng programme as such and no way of
capLurlng how many paLlenLs are referred and how many acLually aLLend.
Cnce Lhe phoLo ls Laken lL ls assessed by Lhe opLomeLrlsL and lf Lhere ls
slgnlflcanL paLhology a referral ls made Lo Lhe ophL halmologlsL. lf Lhere ls no
slgnlflcanL paLhology Lhen Lhe paLlenL mlghL be asked Lo re-aLLend Lhe nexL
82

11
year for repeaL dlglLal phoLos. no record ls kepL of Lhose asked Lo re-aLLend
and wheLher Lhey have or noL. no rellable lnformaLlon ls avallable Lo
deLermlne how many dlabeLlcs are regularly screened. 1here ls no formal
feedback sysLem back Lo Lhe referrlng docLors and nurses ln Lhe healLh cenLres.
1hose paLlenLs requlrlng laser musL organlse Lhls l n Lhe prlvaLe secLor. 1he Lwo
ophLhalmologlsLs carry Lhls LreaLmenL ouL. no deLalled records are readlly
avallable of Lhe numbers and Lypes of laser LreaLmenLs performed and no audlL
daLa ls avallable. Laser fees are beLween 730-1000$LC.
1reaLmenL proLocols are loosely based around Lhe esLabllshed Amerlcan
Academy of CphLhalmology guldellnes.
1he hosplLal ls ln Lhe process of procurlng an elec Lronlc paLlenL record and
managemenL sysLem. 1hls wlll help Lo ldenLlfy dlabeLlc paLlenLs and whaL
LreaLmenLs Lhey recelve wlLhln Lhe hosplLal. lL wlll noL be llnked Lo Lhe healLh
cllnlcs or Lhe prlvaLe cllnlcs.

Serv|ce outputs
!""#"" -.(3#0., *#0.)+6(0%7 "#*1.,#" +&06&0" +) 0%# 6*#1.+&" 7#(*4 )&'3#*
+/ -.(3#0.," &)-#*5+.)5 #7# #9('.)(0.+)" ()- 0*#(0'#)08
1here ls no daLa avallable on servlce ouLpuL or robus L daLa on Lhe number of
dlabeLlcs undergolng eye examlnaLlons or belng referred lnLo secondary care.
1he ueparLmenL of PealLh lnformaLlon does geL monLhly reLurns from healLh
cllnlcs and Lhls records Lhe number of dlabeLlcs seen. lL does noL say why Lhey
were seen or whaL Lype of dlabeLes Lhey have. 8ecause Lhere ls no unlque
paLlenL ldenLlfler Lhe same paLlenL may be counLed agaln each Llme Lhey are
seen.
1here ls a log kepL of all dlglLal phoLographlc lmages Laken aL Lhe hosplLal.
Some buL noL all have a commenL as Lo Lhe reason for Lhe phoLos such as
dlabeLes and dlabeLlc reLlnopaLhy. AbouL 1100 phoLos were Laken lasL year
(2012) and Lhe opLomeLrlsL esLlmaLes LhaL abouL 70 of Lhese were for
dlabeLlc reLlnopaLhy. 1here ls no daLa on Lhe grade of dlabeLlc reLlnopaLhy
seen, Lhe number referred Lo Lhe ophLhalmologlsL and Lhe number LhaL were
LreaLed. 1here ls no daLa LhaL shows how many paLlenLs LhaL were referred for
LreaLmenL acLually wenL ahead wlLh lL.

Awareness of nea|th Care ersonne|
!""#"" 0%# (:(*#)#"" +/ %#(20% ,(*# 6#*"+))#2 +) -. (3#0., *#0.)+6(0%78
83

12
1here was a good undersLandlng amongsL nurslng and medlcal sLaff of Lhe
publlc healLh lssues surroundlng dlabeLes such as Lhe causaLlve role played by
dleL and llfesLyle. 1here was also a good undersLandlng of Lhe lmporLance of
blood sugar and blood pressure conLrol ln reduclng L he lncldence of
reLlnopaLhy. ManagemenL of dlabeLes wlLhln Lhe heal Lh cenLres was good and
Lhey reporLed LhaL healLh educaLlon was avallable and approprlaLe. 1here was
good and free access Lo lnsulln and oLher dlabeLlc dr ugs. 1he only lssue
reporLed was LhaL dlabeLlc paLlenLs who are noL on lnsulln couldn'L geL a
supply of glucosLlcks Lo monlLor Lhelr sugar. 1hese have Lo be purchased.
lnsulln dependanL dlabeLlcs on Lhe oLher hand can g eL Lhese free Lhrough M8S.

Ach|evements, 8est ract|ce and Constra|nts
;962+*# '(<+* (,%.#1#'#)0"4 3#"0 6*(,0.,#" ()- '(<+* ,+)"0*(.)0" ()-
3(**.#*"F

Major ach|evements and best pract|ce
1he MlnlsLry of PealLh ls aware of Lhe lncreaslng prevalence of dlabeLes and
dlabeLlc reLlnopaLhy and Lhe lmporLance of early LreaLmenL and screenlng.
1hey are engaged ln Lhe dlscusslon process and appear amenable Lo Lhe
lnLroducLlon of schemes deslgned Lo reduce Lhe poLenLlal burden of vlsual
lmpalrmenL due Lo dlabeLlc reLlnopaLhy.
1he Carlbbean Councll for Lhe 8llnd, ln parLnershlp wlLh SlghLsavers, are an
acLlve nCC supporLlng Lhe developmenL of eye healLh programmes ln AnLlgua.
1here ls already a good neLwork of prlmary healLh cllnlcs wlLh well-Lralned and
moLlvaLed sLaff.
1here ls an acLlve publlc healLh educaLlon programme and paLlenLs wlLh
dlabeLes should have access Lo lnformaLlon abouL Lhe effecLs of dlabeLes and
how besL Lo manage lL.
1here are 2 ophLhalmologlsLs ln Lhe counLry who are able Lo LreaL dlabeLlc
reLlnopaLhy wlLh laser.
1here are now 4 Lralned refracLlonlsLs who are abouL Lo sLarL work ln 4 of Lhe
larger healLh cenLres. 1hls means LhaL Lhere ls poLenLlal for Lhem Lo operaLe
fundus cameras and Lo check for dlabeLlc reLlnopaLhy as parL of Lhelr workload.
A refracLlonlsL wlLh slmllar Lralnlng ls already worklng successfully ln !amalca.
lnsulln and oLher dlabeLlc and hyperLenslve drugs are almosL unlversally freely
avallable alLhough supply and avallablllLy can some Llmes be an lssue.

84

13
Major constra|nts and barr|ers
Data
1here ls very llLLle daLa avallable on Lhe number of dlabeLlcs ln Lhe
populaLlon or Lhe number wlLh dlabeLlc relaLed dlseases such as
reLlnopaLhy. aLlenLs are noL requlred Lo use a unlque ldenLlfler and lL ls noL
posslble Lo Lrack Lhem Lhrough Lhe sysLem or ensure feedback Lo Lhe
referrlng cllnlcs.
1here ls no daLa avallable on raLes of referral for reLlnopaLhy or numbers of
paLlenLs LhaL fall Lo aLLend appolnLmenLs or laser. 1hls makes plannlng
servlces for Lhe fuLure more dlfflculL.
Infrastructure
1here ls currenLly no naLlonal eye healLh plan/framework for AnLlgua.
LsLabllshmenL of a commlLLee Lo oversee lmplemenLaLlon of a plan mlghL
be beneflclal.
no dlabeLlc screenlng programme ls ln place aL Lhe prlmary levels of Lhe
healLh servlce.
no esLabllshed paLhway for managemenL of dlabeLlc eye dlsease exlsLs.
ersonne|
uemand on prlmary care nurses and docLors ls hlgh. Cllnlcs are very busy
and Lhere ls llLLle Llme for healLh educaLlon.
1here are no Lralned nurses ln eye care
1here ls no ophLhalmologlcal assessmenL avallable ln a prlmary care seLLlng
Access Lo nuLrlLlonlsLs and healLh educaLlon experLlse ls very llmlLed
Lxpense
AlLhough prlmary care may be free, Lhere are Lhen fees for any furLher
servlce ln secondary care. 1here ls a fee for Laklng a dlglLal lmage ln Lhe
hosplLal and for aLLendlng an eye cllnlc. 1here ls L hen a slgnlflcanL fee for
any laser LreaLmenL LhaL would need Lo be done ln Lhe prlvaLe secLor. 1hls
ls llkely Lo be a major dlslncenLlve. 1here ls no daLa Lo show how many
paLlenLs fall Lo follow Lhrough wlLh Lhelr phoLogra phy, hosplLal and laser
appolnLmenLs. lL ls posslble Lo geL some of Lhls fee refunded Lhrough Lhe
Medlcal 8eneflLs Scheme buL paLlenLs need Lo pay Lhe full amounL up fronL.
Lducat|on]comp||ance
aLlenL compllance wlLh medlcaLlon Lo conLrol dlabeLes and blood pressure
ls poor and Lhls leads Lo lncreased eye and oLher sysLemlc compllcaLlons.
aLlenL educaLlon could be lmproved furLher. ClucomeLers and LesL sLrlps
85

14
Lo monlLor blood sugars are noL freely avallable for non lnsulln dlabeLlcs .
1hls means LhaL lL ls dlfflculL for paLlenLs Lo mon lLor Lhelr dleL and blood
sugars. 1hls almosL cerLalnly leads Lo lncreased morbldlLy.

kecommendat|ons
=(># *#,+''#)-(0.+)" +) /&0&*# (,0.+)"4 +3<#,0.1#" ()- (,0.1.0.#"
*#?&.*#- 0+ "0*#)50%#) -.(3#0., *#0.)+6(0%7 6*+5*('" (0 0%# )(0.+)(2
2#1#24 :.0% () #'6%("." +)@
! A#1#2+6'#)0 B &"# +/ 0*#(0'#)0 6*+0+,+2"
! C,*##).)5 ()- *#/#**(2
! =+).0+*.)5 ()- 0*#(0'#)0
1. LsLabllsh a commlLLee Lo oversee Lhe developmenL of a naLlonal Lye PealLh
lan LhaL could posslbly be lncorporaLed lnLo Lhe naLlonal PealLh lan. 1hls
would ald fuLure plannlng and coordlnaLlon of eye se rvlces.

2. Conslder lnvesLlng ln furLher local lnlLlaLlves Lo lmprove healLh educaLlon
speclflcally for dlabeLes and dlabeLlc reLlnopaLhy. 1hls should lnclude
educaLlon abouL Lhe effecLs of dlabeLes on Lhe body, blood glucose conLrol
and monlLorlng, dleL and blood pressure conLrol. lL should also lnclude
lnformaLlon abouL Lhe avallablllLy of servlces, dlagnosls and LreaLmenL
paLhway and LreaLmenL procedures.

3. 8esource and organlse more schemes Lo educaLe prlmary care physlclans,
communlLy nurses, hosplLal docLors and nurses abouL dlabeLes and dlabeLlc
eye dlsease.

4. lmproved daLa collecLlon ls requlred. 1he followlng lnformaLlon would be
very helpful ln plannlng a susLalnable model of care :
AccuraLe recordlng of all dlabeLlcs presenLlng Lo healLh cllnlcs, preferably
uslng a unlque paLlenL ldenLlfler. 1he mosL obvlous way would be Lo use
Lhe smarL card sysLem LhaL ls under conslderaLlon and lf Lhls does noL
happen Lo use naLlonal soclal securlLy numbers.
8ecord all referrals Lo secondary care from prlmary care for dlabeLlc
screenlng
8ecord all dlglLal phoLographs Laken for dlabeLlc reLl nopaLhy ln a
separaLe daLabase aLLached Lo Lhe camera or ln Lhe same locaLlon as Lhe
camera.
8ecord all paLlenLs asked Lo reLurn for dlglLal screenlng and Lo send
remlnder leLLers or moblle phone LexLs.
86

15
8ecord all dlabeLlc lasers performed, preferably wlLh a Llmellne beLween
orlglnal referral, Llme seen ln secondary care and LreaLmenL.

S. lmprove formal feedback sysLem Lo Lhe referrlng docLors and nurses ln Lhe
prlmary care healLh cenLres. 1hls could be a leLLer glven Lo Lhe paLlenL Lo
Lake back or a leLLer posLed back Lo Lhe healLh cenLre. 1hls could preferably
also be done by e mall lf all healLh cenLres were able Lo access Lhe
lnformaLlon.

6. Make avallable a solld sLaLe dlode or frequency doubled ?AC laser Lo LreaL
dlabeLlc reLlnopaLhy Lo be used ln MounL SL !ohn's Medlcal CenLre. 1hls
should have a malnLenance conLracL aLLached Lo lL as well as guaranLeed
Lralnlng for Lhe ophLhalmologlsLs who wlll use lL. 1hls should make lL more
affordable and accesslble Lo paLlenLs and make lL easler Lo monlLor and
conLrol Lhe process. 1he enLlre paLlenL paLhway from dlagnosls Lo
LreaLmenL would essenLlally Lhen be wlLhln unlLs owned by Lhe publlc.

7. lnLroduce a naLlonal dlabeLlc screenlng and LreaLmenL programme
8ecause of lLs small populaLlon and slze lL should b e posslble Lo develop a
screenlng programme ln AnLlgua. 1here are a number of posslble
mechanlsms:
a. 1he preferred opLlon ls Lo use Lhe four refracLlonlsLs LhaL are due Lo
be posLed Lo four major healLh cenLres. Lach cenLre could have a
dlglLal fundus camera. lmages Laken by Lhe camera can be senL
elecLronlcally Lo Lhe opLomeLrlsL or ophLhalmologls Ls ln MounL SL
!ohn's Medlcal CenLre. AlLernaLlvely and preferably Lhe refracLlonlsLs
could be Lralned Lo read Lhe phoLographs aL Lhe Llme Lhey are Laken.
Lvery seL of phoLos ls Lhen glven a refer" or noL refer" grade
dependlng on Lhe severlLy of Lhe reLlnopaLhy. lf Lhey are noL referred
Lhey are Lold Lo reLurn ln a year for repeaL phoLos. lf Lhey are referred
Lhen elLher Lhey could be seen by an ophLhalmologlsL ln a cllnlc aL
MounL SL !ohn's Medlcal CenLre and LreaLed preferably Lhe same day
(one sLop) or alLernaLlvely glven an appolnLmenL Lo reLurn for laser.
CLher healLh cenLres would refer dlabeLlc paLlenLs for annual phoLos
Lo one of Lhe four cenLres wlLh a refracLlonlsL. ln Lhls way every
dlabeLlc paLlenL ls able Lo geL annual dlglLal phoLos . 1he geographlc
locaLlon of Lhe 4 cenLres means LhaL all paLlenLs should be able Lo
access Lhe servlce aL leasL aL one cenLre wlLhouL Loo much dlsrupLlon.

b. lollow Lhe referral sysLem buL use Lhe lasers ln Lhe prlvaLe secLor
already avallable as parL of a publlc/prlvaLe parLnershlp.
87

16
CphLhalmologlsLs would agaln make Lhe declslon wheL her Lo LreaL or
noL and organlse laser appolnLmenLs ln Lhelr prlvaLe cllnlcs. 1hese
would be pald for Lhrough Medlcal 8eneflLs or aL leasL heavlly
subsldlsed.

c. 8efer all dlabeLlc paLlenLs Lo Lhe camera aL MounL SL !ohn's Medlcal
CenLre wlLh a Llme and daLe glven Lo each paLlenL for Lhelr screenlng
phoLo. 1he opLomeLrlsL makes a refer" or noL refer" declslon aL Lhe
Llme Lhe phoLo ls Laken. 8efer declslons are senL Lo Lhe
ophLhalmologlsLs and paLlenLs are senL a laser appol nLmenL aL Lhe
hosplLal or lf Lhere ls no laser Lhen Lo Lhe prlvaLe lasers as parL of a
publlc /prlvaLe parLnershlp. 1he dlsadvanLages of L hls scheme are LhaL
paLlenLs need Lo Lravel for Lhelr phoLos and one opLomeLrlsL has Lo
Lake all of Lhe phoLographs and do Lhe gradlng. 1he Lake up raLe ls
llkely Lo be lower. lL also relles heavlly on Lhe presence of slngle
opLomeLrlsL who may leave or may noL have Llme Lo do Lhe work. lL
mlghL be feaslble Lo Lraln a refracLlonlsL Lo work l n Lhe hosplLal
alongslde Lhe opLomeLrlsL and Lo Lake on some of Lhese
responslblllLles.

Summary
WlLh Lhe rlslng prevalence of dlabeLes and dlabeLlc eye dlsease ln Lhe
Carlbbean lL ls essenLlal Lo lnLroduce screenlng and LreaLmenL programmes Lo
Lackle Lhe problem. AnLlgua has Lhe ablllLy and deslre Lo lnLroduce an effecLlve
dlabeLlc reLlnopaLhy screenlng and LreaLmenL servlce.
Some of Lhe recommended changes can be lnLroduced relaLlvely qulckly and
some may Lake longer. SLrong and producLlve collaboraLlon beLween Lhe
MlnlsLry of PealLh, nCC's, Lhe prlvaLe secLor and research lnsLlLuLlons wll l play
an lmporLanL role ln Lackllng dlabeLes and dlabeLlc reLlnopaLhy ln AnLlgua and
LhroughouL Lhe Carlbbean.

88

17
kLILkLNCLS

1 Arch CphLhalmol. 1993 Aug,111(8):1064-70.
Comparlson of dlabeLlc reLlnopaLhy deLecLlon by cllnlc al examlnaLlons and
phoLograph gradlngs. 8arbados (WesL lndles) Lye SLudy Croup.
SchachaL A, Pyman L, Leske MC, Connell AM, Plner C, !avornlk n, Alexander !.
Wllmer Lye lnsLlLuLe, !ohns Popklns unlverslLy School of Medlclne, 8alLlmore, Md

2 CphLhalmology. 1999 CcL,106(10):1893-9.
ulabeLlc reLlnopaLhy ln a black populaLlon: Lhe 8arbados Ly e SLudy.
Leske MC, Wu S?, Pyman L, Ll x, Pennls A, Connell AM, SchachaL A.
ueparLmenL of revenLlve Medlclne, unlverslLy Medlcal CenLer aL SLony 8rook, new
?ork 11794-8036, uSA.

3 ulabeL Med. 1999 CcL,16(10):873-83.
ulabeLes ln Lhe Carlbbean: resulLs of a populaLlon surv ey from Spanlsh 1own,
!amalca.
Wllks 8, 8oLlml C, 8enneLL l, Mclarlane-Anderson n, kaufman !S, Anderson SC,
Cooper 8S, Crulckshank !k, lorresLer 1.
1roplcal MeLabollsm 8esearch unlL, unlverslLy of Lhe WesL lndles, Mona, !amalca

4 8MC 8es noLes. 2011 !un 13,4:199.
Are prlmary care pracLlLloners ln 8arbados followlng dlabeLes guldellnes? - a charL
audlL wlLh comparlson beLween publlc and prlvaLe care secLors.
Adams C, CarLer AC.
laculLy of Medlcal Sclences, unlverslLy of Lhe WesL lndles, Cave Plll Campus, SL,
Mlchael, 8arbados.

3 ulabeLes Care. 2012 Mar,33(3):336-64. Clobal prevalence and major rlsk facLors of
?au !W eL al
CenLre for Lye 8esearch AusLralla, unlverslLy of Melbourne, 8oyal vlcLorlan Lye and
Lar PosplLal, Melbourne, vlcLorla, AusLralla.

6 ulabeLes Care. 2012 Apr,33(4):738-40. revalence of dlabeLes and lnLermedlaLe
hyperglycemla among adulLs from Lhe flrsL mulLlnaLlonal sLudy of noncommunlcable
dlseases ln slx CenLral Amerlcan counLrles: Lhe CenLral Amerlca ulabeLes lnlLlaLlve
(CAMul).
8arcelo A, eL al
Chronlc ulseases, an Amerlcan PealLh CrganlzaLlon, WashlngLon, ulsLrlcL of
Columbla, uSA. barceloa[paho.org

7 LoS Cne. 2012,7(6):e39608. dol: 10.1371/journal.pone.0039608. Lpub 2012 !un 27.
LLhnlc varlaLlon ln Lhe prevalence of vlsual lmpalrmenL ln people aLLendlng dlabeLlc
reLlnopaLhy screenlng ln Lhe unlLed klngdom (u8lvL uk).
Slvaprasad S, CupLa 8, Culllford MC, uodhla P, Mann S, nagl u, Lvans !.
89

18
Laser and 8eLlnal 8esearch unlL, klng's College PosplLal nPS loundaLlon 1rusL,
London, unlLed klngdom.

8 ulabeLes Care. 2013 leb,36(2):336-41LLhnlc dlfferences ln Lhe prevalence of dlabeLlc
reLlnopaLhy ln persons wlLh dlabeLes when flrsL presenLlng aL a dlabeLes cllnlc ln
SouLh Afrlca.
1homas 8L, ulsLlller L, Luzlo Su, Chowdhury S8, Melvll le v!, kramer 8, Cwens u8.
ulabeLes 8esearch Croup, Swansea unlverslLy, Wales, unlLed klngdom

9 CphLhalmlc Lpldemlol. 2012 uec,19(6):414-9. dol: 10.3109/09286386.2012.716893.
SLraLegles of dlglLal fundus phoLography for screenlng dlabeLlc reLlnopaLhy ln a
dlabeLlc populaLlon ln urban Chlna.
ulng !, Zou ?, Llu n, !lang L, 8en x, !la W, Snelllngen 1, ChongsuvlvaLwong v, Llu x.
Sekwa Lye PosplLal, 8eljlng, Chlna.

10 CphLhalmology. 2012 uec 1. pll: S0161-6420(12)00861-3. dol:
10.1016/j.ophLha.2012.09.002. [Lpub ahead of prlnL]
1he CosL-uLlllLy of 1elemedlclne Lo Screen for ulabeLlc 8eLlnopaLhy ln lndla.
8achapelle S, Legood 8, Alavl ?, Llndfleld 8, Sharma 1, kuper P, olack S.
ueparLmenL of revenLlve CphLhalmology, Sankara neLhralaya, vlslon 8esearch
loundaLlon, Chennal 1amll nadu, lndla.

11 WesL lndlan Med !. 2012 !ul,61(4):372-9.
naLlonal healLh surveys and healLh pollcy: lmpacL of Lhe !amalca PealLh and LlfesLyle
Surveys and Lhe 8eproducLlve PealLh Surveys.
lerguson 1S, 1ulloch-8eld Mk, Cordon-SLrachan C, PamllL on , Wllks 8!.
Lpldemlology 8esearch unlL, 1roplcal Medlclne 8esearch lnsLlLuLe, 1he unlverslLy of
Lhe WesL lndles, klngsLon 7, !amalca.

12 Mlddle LasL Afr ! CphLhalmol. 2013 !an-Mar,20(1):36-60. lmprovlng dlabeLlc
reLlnopaLhy screenlng ln Afrlca: paLlenL saLlsfacLlon wlLh LeleophLhalmology versus
ophLhalmologlsL-based screenlng.
kurjl k, klage u, 8udnlsky C!, uamjl kl.
College of Medlclne, unlverslLy of SaskaLchewan, SaskaLoon, SaskaLchewan, Canada.

13 ulabeL Med. 2013 !an 19. dol: 10.1111/dme.12119. [Lpub ahead of prlnL]
revalence of dlabeLlc reLlnopaLhy ln 1ype 2 dlabeLes ln developlng and developed
counLrles.
8uLa LM, Magllano u!, Lemesurler 8, 1aylor P8, ZlmmeL Z, Shaw !L.
8aker lul PearL and ulabeLes lnsLlLuLe, Melbourne, vlc, AusLralla.

14 Am ! CphLhalmol. 2011 leb,131(2):192-4.e1. dol: 10.1016/j.ajo.2010.10.014.
ulabeLlc reLlnopaLhy ln Lhe developlng world: how Lo approach ldenLlfylng and
LreaLlng underserved populaLlons.
lrledman uS, All l, kourglalls n.

9a

19
13 8ural 8emoLe PealLh. 2003 CcL-uec,3(4):330.
ulabeLlc reLlnopaLhy screenlng model for rural populaLl on: awareness and screenlng
meLhodology.
8anl k, 8aman 8, Agarwal S, aul C, uLhra S, Margabandhu C, SenLhllkumar u,
kumaramanlckavel C, Sharma 1.
Sankara neLhralaya, Chennal, 1amllnadu, lndla.

16 ulabeLes 8es Clln racL. 2013 !an 30 Are recommended sLandards for dlabeLes care
meL ln CenLral and SouLh Amerlca? A sysLemaLlc revlew.
Mudallar u, klm WC, klrk k, 8ouse C, narayan kM, All M.
School of Medlclne, Lmory unlverslLy, ALlanLa, CA, uSA.

91

20
ALNDIk
D|abet|c ret|nopathy data co||ect|on form:

D|abet|c ket|nopathy Data Co||ect|on Iorm

PealLh mlnlsLers from Lhe reglon approved by resoluLlon Cu49.811 ln 2009 Lhe
AcLlon lan for Lhe revenLlon of 8llndness and vls ual lmpalrmenL urglng
Member SLaLes Lo develop naLlonal sLraLegles and plans Lo prevenL bllndness
and vlsual lmpalrmenL due Lo dlabeLlc reLlnopaLhy.
ln response Lo Lhe prevlous resoluLlon, Lhls quesLl onnalre has been developed
Lo charL Lhe progress made by Member SLaLes on Lhe plan and Lo esLabllsh a
basellne daLa for fuLure servlces plannlng and developmenL.

1. Nat|ona| Data
CounLry /ulsLrlcL/MunlclpallLy:

CounLry opulaLlon:

?ear of daLa:

Source(s) of daLa:

uaLe when daLa collecLlon began

uaLe of daLa collecLlon compleLlon:

LsLlmaLed number of dlabeLlcs ln Lhe
counLry:

ls Lhere a dlabeLlc reglsLer
?/n
number of reglsLered ulabeLlcs ln Lhe
counLry

ls Lhere an acLlve dlabeLlc assoclaLlon
?/n
ls prlmary eye care lnLegraLed ln prlmary
healLh care

?/n

2. Centra| Crgan|zat|on, Leadersh|p and Governance
ls early deLecLlon (dlabeLlcs screenlng and referral)
lnLegraLed ln Lhe naLlonal non-communlcable
chronlc dlseases program by a pollcy, plan or
resoluLlon?
?/n - lf yes, glve daLe slgned and
name of SlgnaLory
92

21
ls Lhere a naLlonal pollcy on screenlng and
LreaLmenL of dlabeLlc reLlnopaLhy?
?/n CommenLs
uoes Lhe counLry has a u8 cllnlcal guldellne? ?/n CommenLs
ls Lhere an esLabllshed screenlng program for
dlabeLlc reLlnopaLhy?
?/n CommenLs
nLA1n IINANCING ICk DIA8L1IC kL1INCA1n IN1LkVLN1ICNS
rlmary Care lease check
CovernmenL
naLlonal PealLh lnsurance
Secondary Care
CovernmenL
naLlonal PealLh lnsurance
CuL of pockeL
rlvaLe healLh care lnsurance
Soclal welfare
lree for paLlenLs

3. numan kesources
CphLhalmologlsLs
# of CphLhalmologlsLs Lralned Lo LreaL
dlabeLlc reLlnopaLhy ln publlc secLor:

# of CphLhalmologlsLs Lralned Lo LreaL
dlabeLlc reLlnopaLhy ln prlvaLe secLor:

CphLhalmlc
Lechnlclans
# of ophLhalmlc Lechnlclans Lralned Lo
screen dlabeLlc reLlnopaLhy

CphLhalmlc nurses 1oLal number
CphLhalmlc
asslsLanLs
1oLal number ln counLry
PC personnel
Lralned ln LC and
managlng- referrlng
dlabeLlc paLlenLs
1oLal number Lralned ln u8 ln Lhe
lasL 3 years:
8rlef descrlpLlon of Lralnlng
acLlvlLy(s)
PealLh ulsLrlcL nurses
Lralned ln LC and
managlng dlabeLlc
paLlenLs
1oLal number Lralned ln u8 ln Lhe
lasL 3 years:
8rlef descrlpLlon of Lralnlng
acLlvlLy(s)
lP and physlclans
Lralned ln managlng
-referrlng dlabeLlc
paLlenLs
1oLal number Lralned ln u8 Lhe lasL 3
years:

4. Infrastructure
# of healLh cenLers
# of dlsLrlcL hosplLals
# ulsLrlcL PosplLals wlLh eye deparLmenL (name Lhe dlsLrlcLs)
93

22
# rlvaLe and nCC PosplLals wlLh eye deparLmenL
# of ubllc CuL-aLlenL CphLhalmology unlLs:
# of CphLhalmologlc rlvaLe Cfflces:
# of ubllc fundus cameras:
# of rlvaLe fundus cameras:
# of worklng argon lasers avallable ln publlc secLor
# of worklng argon lasers avallable ln Lhe prlvaLe secLor
ls a revenLlve malnLenance programme lmplemenLed ln
each hosplLal wlLh an ophLhalmology deparLmenL?
?/n

Pas an assessmenL of avallablllLy and adequacy of
equlpmenL aL eye healLh faclllLles been carrled ouL ln Lhls
perlod?

?/n - lf yes whaL are Lhe
flndlngs

S. Serv|ces De||very
Pas a ulabeLlc reLlnopaLhy servlces slLuaLlon analysls
been conducLed ln your counLry?
?/n - lf yes sLaLe when Lhe analysls
was carrled ouL.
ls early deLecLlon (dlabeLlcs screenlng and referral)
lnLegraLed ln Lhe naLlonal healLh sysLems?
?/n Lxplaln
ls dlglLal phoLography screenlng avallable ln
a. publlc secLor,
b. prlvaLe secLor

a. ?/n - sLaLe number screened
b. ?/n - sLaLe number screened
Are dlabeLlc paLlenLs rouLlnely referred Lo
ophLhalmology unlLs for examlnaLlon?
?/n - sLaLe number referred

Are laser LreaLmenL servlces avallable ln
a. publlc secLor
b. prlvaLe secLor

a. ?/n - sLaLe number LreaLed
b. ?/n - sLaLe number LreaLed

6. rogram |nformat|on on the prev|ous year
# of dlabeLlc paLlenLs screened wlLh dlglLal fundus phoLographs
# of paLlenLs' fundus phoLos screened by CphLhalmolog lsL
# of dlabeLlc paLlenLs referred by CphLhalmlc 1echnlclan Lo Lhe
ophLhalmologlsL

# of dlabeLlc paLlenLs who aLLended Lhe u8 eye cllnlc: llrsL vlslL or
noncompllanL follow-up paLlenLs

# of dlabeLlc paLlenLs dlagnosed wlLh dlabeLlc reLlnopaLhy aL Lhe u8 eye
cllnlc

# of dlabeLlc paLlenLs LreaLed wlLh Laser for Lhe flrsL Llme
# of dlabeLlc paLlenLs recelvlng augmenLaLlon of laser LreaLmenL.
94

23

7. ua||tat|ve assessment (relaLed Lo Lhe eye healLh acLlon plan and/or
sLraLeglc framework for counLry)
uescrlbe Lhe major achlevemenLs and besL pracLlces ln lmplemenLlng Lhe dlabeLlc
reLlnopaLhy program:

CuLllne Lhe major consLralns and barrlers ln lmplemenLl ng Lhe dlabeLlc reLlnopaLhy program:

WhaL are Lhe proposed acLlons Lo sLrengLhen Lhe dlabeLlc reLlnopaLhy program:

95

DIA8L1IC kL1INCA1n
SLkVICLS IN 8LLI2L


Iune - Iu|y 2013

Supported by

96
Contents

Acronyms page 4
8ellze - SlLuaLlon Analysls page 8
Summary page 13
8eferences page 16
Appendlx: page 19

97

3
Acknow|edgements
1he an-Amerlcan PealLh CrganlsaLlon (APC), Carlbbean Councll for Lhe
8llnd-Lye Care Carlbbean and SlghLsavers exLend our Lhanks Lo ur Mlchael
LcksLeln for underLaklng Lhls slLuaLlon analysls and for hls conLlnued
conLrlbuLlon Lo Lhe developmenL of dlabeLlc reLlnopaLhy programmes ln Lhe
Carlbbean.
We would also llke Lo Lhank Lhe 8ellze Councll for L he vlsually lmpalred for
Lhelr supporL and Lhe MlnlsLry of PealLh for Lhelr cooperaLlon ln permlLLlng Lhls
slLuaLlon analysls Lo Lake place.
We are graLeful Lo Lhe followlng who Look parL ln Lhe dlscusslons ln 8ellze:
ur ue Coslo, APC W8 8ellze
ur !orge olanco, uepuLy ulrecLor of PealLh Servlces, MlnlsLry of PealLh
!oan Musa, LxecuLlve ulrecLor, 8ellze Councll for Lhe vlsually lmpalred
AnLhony CasLlllo, resldenL, 8ellze ulabeLlc AssoclaLlon
ur PoLchandanl , Llderly aLlenL hyslclan
8uLh !aramlllo, naLlonal PealLh lnsurance 8ep
ur naLalla CasLlllo, Ag, naLlonal PealLh lnsurance Manager
ur karl !ones, rlmary Care hyslclan naLlonal PealLh lnsurance &
MlnlsLry of PealLh
Leolyn Carcla, 8Cvl CpLomeLrlsL and rogramme Manager
Carla Ayres Musa, 8Cvl CommunlcaLlon Cfflcer
!oan Samuels, 8Cvl 8ehab ConsulLanL
lreddy nlcholson, 8Cvl CpLomeLrlsL
!ackle Craham, 8Cvl LC Manager
CllfLon 8orland, 8Cvl Senlor Lab 1echnlclan
ur Zory erez, 8Cvl CphLhalmologlsL
!ohn ascoe, 8Cvl l1 volunLeer
98

4
Acronyms

8Cvl 8ellze Councll for Lhe vlsually lmpalred
8PlS 8ellze PealLh lnformaLlon SysLem
nLC naLlonal Lye Cllnlc
nPl naLlonal PealLh lnsurance
99

5
reLlnopaLhy among medlcal offlcers and dlabeLlc paL lenLs ln 8ellze.

Cbject|ves
barrlers.
1aa

6
refracLlve errors.

acLlvlLy.
reLlnopaLhy.

1a1

7
Genera||sed Issues
due Lo dlabeLes.
1he !"#$"%&'( *#$+%,-#. /-# 012123 45% 6'&5" "- !'&5" 78$#'99%$: 6%&'-:;

1a2

8
8LLI2L S|tuat|on Ana|ys|s
8ellze ls locaLed on Lhe Carlbbean coasL of CenLral Amerlca. lL ls bordered on
Lhe norLh by Mexlco, Lo Lhe souLh and wesL by CuaLemala and Lo Lhe easL by
Lhe Carlbbean Sea. lLs malnland ls abouL 290 km long and 110 km wlde. ln
general, 8ellze ls consldered Lo be a CenLral Amerlcan and Carlbbean naLlon
wlLh sLrong Lles Lo Lhe enLlre LaLln Amerlcan and Carlbbean reglon. lL ls
dlvlded lnLo slx dlsLrlcLs, Corazol, Crange Walk, 8ellze ulsLrlcL, Cayo, SLann
Creek and 1oledo.
1he LoLal populaLlon ls around 330,000 (2009 census) and 1/3rd llve ln 8ellze
ClLy. 1he populaLlon over 40 ls esLlmaLed Lo be abouL 80,000. lL has Lhe lowesL
populaLlon denslLy ln CenLral Amerlca. 8ellze ls among Lhe mosL raclally and
eLhnlcally dlverse counLrles ln Lhe world. 1he maln eLhnlc groups are Lhe
MesLlzo, Creole, keLchl, ?ucaLec and Mopan Mayas, Carlfunas and LasL
lndlans.

<=%:"'/> :$"'-:$? #%&@?$"'-:AB C-?'('%A -# C?$:A -: C#%D%:"'-: -/ 9?':=:%AA
=@% "- ='$9%"'( #%"':-C$"5> $:= '"A ':"%&#$"'-: ':"- :$"'-:$? :-:E
(-++@:'($9?% ='A%$A%A -# ='$9%"%A (-:"#-? C#-&#$+A $:= C-?'('%A
A naLlonal Lye PealLh lan for 8ellze 2010-2014 was publlshed ln 2010.
SLraLeglc ulrecLlon 2.2 calls for a reducLlon ln Lhe prevalence of bllndness
from dlabeLlc reLlnopaLhy". AmongsL Lhe ouLcomes expecLed are:
1 lnLegraLlon of bllndness prevenLlon sLraLegles lnLo naLlonal dlabeLes
and chronlc dlseases programs
2 lmproved publlc awareness programs
3 lmproved referral of paLlenLs wlLh dlabeLes Lo eye care provlders
4 AdopL esLabllshed lnLernaLlonal cllnlcal guldelln es
3 lmplemenLaLlon of dlglLal phoLography Lo deLecL and refer LreaLable
reLlnopaLhy
1he publlc healLh sysLem does noL have an ophLhalmology servlces programme
or unlL. 8ellze Councll for Lhe vlsually lmpalred ( 8Cvl) was esLabllshed ln 1981
and provldes prlmary and secondary eye care servlces and rehablllLaLlon
servlces. Slnce 1998 Lhe MlnlsLry of PealLh has had an agreemenL wlLh 8Cvl
and Lhe Llons Club Lo provlde ophLhalmlc servlces on lLs behalf.
1hls ls done Lhrough a naLlonal Lye Cllnlc (nLC) ln 8ellze ClLy. 8Cvl operaLes
flve prlmary eye care cllnlcs LhroughouL Lhe counLry. Lach cllnlc has Lhe
servlces of an opLomeLrlsL, ophLhalmlc asslsLanL and rehablllLaLlon fleld offlcer.
1a3

9
ln 2011 a LoLal of 767 cllnlcs were held counLrywlde and 11,764 people were
examlned. 1here ls no charge for aLLendlng Lhe cllnlc and an appolnLmenL ls
noL requlred.
1here ls no dlabeLes reglsLry ln 8ellze and no naLlonal sLaLlsLlcs avallable on eye
healLh. 8Cvl has a paLlenL daLabase recordlng all vl slLs and LreaLmenLs
performed. 1hls lnformaLlon ls glven Lo Lhe MCP buL does noL appear Lo be
lnLegraLed lnLo Lhe 8ellze PealLh lnformaLlon SysLem (8PlS). naLlonal PealLh
lnsurance (nPl) cllnlcs have Lhelr own elecLronlc paLlenL record sysLem and
submlL monLhly reLurns Lo Lhe MCP.
8eLween 2003 and 2006 a naLlonal survey was performed whlch showed an
average adulL prevalence raLe for dlabeLes of 13 (17.6 women, 8.8 men).
Cverall 40 of Lhose wlLh dlabeLes were undlagnosed prlor Lo Lhe survey. 1he
hlgh prevalence raLes are llkely Lo be assoclaLed wlLh Lhe facL LhaL 44
populaLlon have a 8Ml >30 (cllnlcally obese). 23 of paLlenLs who presenLed
for eye examlnaLlon ln 2012 aL nLC had dlabeLes. 138 people are reglsLered
bllnd due Lo dlabeLes on Lhe 8Cvl reglsLer.
8ased on populaLlon esLlmaLes Lhere should be abouL 43,000 dlabeLlcs ln
8ellze. up Lo 13,000 are llkely Lo have slgnlflcanL dlabeLlc reLlnopaLhy and up
Lo 2,300 of Lhese are llkely Lo beneflL from laser LreaLmenL.

!""#"" %&'() *#"+&*,#" ()- .)/*("0*&,0&*# (1(.2(32# /+* *#/#**(24
0*#(0'#)0 ()- '()(5#'#)0 +/ -.(3#0., *#0.)+6(0%74 .),2&-.)5 (,,#"" 0+
()- &"# +/ /&)-&" ,('#*(" ()- (66*+6*.(0# 2("#* "7"0#'"8

Referral infrastructure
aLlenLs are assessed by a 8Cvl opLomeLrlsL ln Lhe 3 prlmary eye care cllnlcs.
1hey are able Lo manage slmple eye problems and do a comprehenslve eye
examlnaLlon and refracLlon. 1here ls no charge for Lhese examlnaLlons. Many
paLlenLs wlll be prescrlbed glasses made by 8Cvl. 1he lncome from Lhls offseLs
some of Lhe cosL of Lhe examlnaLlons.
Cnward referral for secondary care can be done elLher elecLronlcally uslng
8PlS or as a wrlLLen referral. 8eferrals are usually made Lo Lhe naLlonal Lye
Cllnlc (nLC) ln 8ellze ClLy or occaslonally Lo a prlv aLe ophLhalmologlsL. 1he
walLlng Llme Lo be seen ls dependenL on Lhe urgency of Lhe case and when
vlslLlng ophLhalmologlsLs are avallable aL Lhe nLC.
CuLpaLlenL dlabeLes cllnlcs run aL a number of gover nmenL and nPl cllnlcs.
1here are no jolnL ophLhalmology/dlabeLes cllnlcs and no formal process of
1a4

10
lnLer-referral. Ceneral physlclans and C's run Lhese cllnlcs. 8eferrals can be
made Lo 8Cvl uslng Lhe 8PlS or as a paper referral.

Human Resources
1here are 4 opLomeLrlsLs and 3 ophLhalmlc asslsLanLs worklng ln 8Cvl's
prlmary care cllnlcs.
ln secondary care Lhere ls currenLly one permanenL general ophLhalmologlsL
from Cuba who does noL perform surgery. 1he nLC ls mosLly rellanL on forelgn
Leams/lndlvlduals, usually from Lhe uSA, Lo provlde speclallsL servlces. 8Cvl
have been forLunaLe recenLly Lo have a reLlred senlor Amerlcan
ophLhalmologlsL who spends abouL four monLhs of eac h year aL Lhe nLC. Whlle
he ls avallable Lhey are able Lo provlde a comprehenslve servlce. When he ls
noL presenL 8Cvl Lry Lo coordlnaLe oLher vlslLs from overseas ophLhalmologlsLs.
1here are lnevlLably perlods when no speclalLy servlces are avallable.
1here are 3 full Llme prlvaLe ophLhalmologlsLs who have Lhelr own cllnlcs and
surglcal faclllLles. 1helr fees resLrlcL access buL Lwo of Lhem do see a number of
nPl paLlenLs under an agreemenL.

Non-Governmental organisations
1he MeLhodlsL Church has an occaslonal eye cllnlc ln Corozal dlsLrlcL uslng
vlslLlng docLors and nurses.

Other human resources
1here ls one Lralned eye nurse who works for 8Cvl. 1here ls one nuLrlLlonlsL
who works ln MCP cllnlcs buL ls noL normally lnvolv ed wlLh Lhe dlabeLlc
referrals.

Equipment
8Cvl have one fully funcLlonlng modern dlode laser. 1hls ls moblle and can be
used ln dlsLrlcL cllnlcs. 1he vlslLlng Amerlcan ophLhalmologlsL also has hls own
laser ln Lhe cllnlc. All of Lhe prlvaLe ophLhalmologlsLs have funcLlonlng lasers.
1here are adequaLe numbers of sllL lamp mlcroscopes and lndlrecL
ophLhalmoscopes ln all cllnlcs.
1here are no dlglLal fundus cameras aL presenL ln 8ellze.
1here are adequaLe supplles of dllaLlng drops ln all cllnlcs
1here ls no vlLreo-reLlnal faclllLy ln 8ellze and paLlenLs would need Lo go Lo
CuaLemala, 8arbados or Lhe uSA. 1here ls Lhe occaslonal vlslLlng
1a5

11
ophLhalmologlsL who provldes a vlLreo-reLlnal servlce, buL lL ls unllkely Lo be of
greaL beneflL or susLalnable ln any way.

!""#"" -.(3#0., *#0.)+6(0%7 "#*1.,#" -#2.1#*74 #7# ,(*# "7"0#'" ()-
",*##).)5 6*+0+,+2" (0 0%# )(0.+)(2 2#1#28
1here ls no formal screenlng programme ln 8ellze. aLlenLs are referred for
eye assessmenL on an ad hoc basls.
1he nPl cllnlcs have a dlabeLes managemenL proLocol G$:$&':& H'$9%"%A ':
I#'+$#> 8$#% ': J%?'K% 12L2". 1hls suggesLs LhaL all dlabeLlcs are referred Lo an
ophLhalmlc unlL annually for eye examlnaLlon. CLher governmenL cllnlcs have
been Lold Lo follow a slmllar proLocol. aLlenLs sho uld have Lhe opLlon of golng
Lo 8Cvl or one of Lhe prlvaLe ophLhalmologlsLs for Lhls. 1hls examlnaLlon ls
provlded free or aL low cosL dependlng on Lhe age of Lhe paLlenL and where
Lhey llve.
Cnce dlabeLlc paLlenLs are seen ln a 8Cvl cllnlc Lhey are asked Lo conLlnue
comlng for regular annual follow up so LhaL Lhey can be fully assessed and
checked for dlabeLlc eye dlsease.

Serv|ce outputs
!""#"" -.(3#0., *#0.)+6(0%7 "#*1.,#" +&06&0" +) 0%# 6*#1.+&" 7#(*4 )&'3#*
+/ -.(3#0.," &)-#*5+.)5 #7# #9('.)(0.+)" ()- 0*#(0'#)08
ln 2012 8Cvl examlned 1000 paLlenLs wlLh dlabeLes counLrywlde (700 ln 8ellze
ClLy and 300 aL dlsLrlcL cllnlcs) and performed 241 laser LreaLmenLs.
1here ls no meanlngful daLa avallable from MCP, nPl or prlvaLe cllnlcs buL
because many paLlenL lnLeracLlons are recorded on Lhe 8PlS, lL ls llkely LhaL
more lnformaLlon could be pulled from Lhe sysLem gl ven adequaLe resources.

!""#"" 0%# (:(*#)#"" +/ %#(20% ,(*# 6#*"+))#2 +) -. (3#0., *#0.)+6(0%78
All of Lhe docLors lnLervlewed agreed LhaL lack of paLlenL educaLlon was a
major lssue. 1here are dlabeLlc falrs, leafleLs, healLh educaLors, well Lralned
prlmary care nurses and Lhe wlll Lo lmprove paLlenL educaLlon. Lack of
resources and culLural reslsLance Lo Lake on lnformaLlon are slgnlflcanL facLors.
Cllnlcs are Loo busy Lo have much Llme Lo sLarL educaLlng Lhe majorlLy of
paLlenLs. 1he 8ellze ulabeLlc AssoclaLlon has 130 reglsLered members. lLs role
1a6

12
ls Lo educaLe members and Lhe general publlc as well as Lo collaboraLe wlLh
MCP ln creaLlng awareness of healLhy llfesLyle, provlde free educaLlon and
LesLlng equlpmenL Lo chlldren. lLs members all come from 8ellze ClLy. 1hey
have regular meeLlngs wlLh guesL speclallsL speakers buL aLLendance ls
someLlmes poor.

;962+*# '(<+* (,%.#1#'#)0"4 3#"0 6*(,0.,#" ()- '(<+* ,+)"0*(.)0" ()-
3(**.#*"F

Cver Lhe lasL 13 years 8Cvl have Lransformed eye care ln 8ellze. 1hey have
fllled Lhe vacuum creaLed by llmlLed resources and lnvesLmenL ln governmenL
provlslon of eye servlces. 1hey are now Lhe only provlder of comprehenslve
eye care and Lhe governmenL essenLlally conLracL Lhem Lo provlde affordable
naLlonal eye care.
AL Lhe prlmary care level Lhey offer refracLlon, free eye examlnaLlons and
LreaLmenL of caLaracL, glaucoma and dlabeLlc reLlnopaLhy. 1here ls no formal
dlabeLlc reLlnopaLhy screenlng and no susLalnable model of LreaLmenL for Lhls
lncreaslng problem.
1here ls good prlmary care across Lhe counLry wlLh well-Lralned and moLlvaLed
nurses. Access Lo drugs lncludlng lnsulln and oral hypoglycaemlc agenLs ls
generally good and Lhese are ofLen avallable free or aL low cosL.
1here ls an excellenL elecLronlc paLlenL managemenL sysLem (8PlS) LhroughouL
Lhe publlc healLh secLor. Lach paLlenL has a unlque ldenLlfler (naLlonal securlLy
number) and lnLeracLlons wlLh healLh professlonals ln all healLh cllnlcs are
recorded. aLlenL records, Lhelr medlcaLlons and prevlous and fuLure
appolnLmenLs are easlly accesslble ln Lhe hosplLals and cllnlcs. 1hls should also
make lL posslble Lo geL a loL of lnformaLlon on morbldlLy assoclaLed wlLh
dlabeLes and drug prescrlpLlons for dlabeLlc paLlenLs.
8ellze ls a poor counLry wlLh 41 of Lhe populaLlon l lvlng aL or below Lhe
poverLy llne. AlLhough Lhe road lnfrasLrucLure ls falrly good, publlc LransporL
can be dlfflculL and expenslve.
uesplLe lmprovemenLs ln healLh educaLlon mosL dlabeLlc paLlenLs sLlll presenL
Lo Lhe eye cllnlcs when Lhey lose vlslon ln Lhelr only remalnlng seelng eye. 8y
Lhls Llme lL ls usually Loo laLe Lo sLablllse or lmprove vlslon.
1a7

13
ManagemenL of dlabeLes ln general ls problemaLlc. aLlenLs culLurally reslsL
seeklng healLhcare and ofLen refuse Lo regularly Lake medlcaLlon, especlally
lnsulln. 1here ls a llmlLed supply of glucose monlLo rlng equlpmenL and Lhe LesL
sLrlps requlred.
SpeclallsL ophLhalmlc care for Lhe managemenL of dl abeLlc reLlnopaLhy
presenLly relles on vlslLlng ophLhalmologlsLs. 8Cvl aLLracLs many volunLeers.
Some volunLeers also come lnLo Lhe counLry wlLhouL Lhe knowledge of 8Cvl.
1hls means LhaL Lhere may be dupllcaLlon of servlces or LhaL supporL ls noL
evenly dlsLrlbuLed and avallable LhroughouL Lhe year.

kecommendat|ons
=(># *#,+''#)-(0.+)" +) /&0&*# (,0.+)"4 +3<#,0.1#" ()- (,0.1.0.#" *#?&.*#-
0+ "0*#)50%#) -.(3#0., *#0.)+6(0%7 6*+5*('" (0 0%# )(0.+)(2 2#1#24 :.0% ()
#'6%("." +)@
! A#1#2+6'#)0 B &"# +/ 0*#(0'#)0 6*+0+,+2"
! C,*##).)5 ()- *#/#**(2
! =+).0+*.)5 ()- 0*#(0'#)0
1. 8ellze ls llkely Lo beneflL from Lhe lnLroducLlon of a naLlonwlde dlabeLlc
screenlng servlce. lL has a hlgh prevalence of dlabeLes, whlch ls lncreaslng.
ulabeLlc reLlnopaLhy ls a slgnlflcanL problem wlLh l lLLle or no faclllLy Lo LreaL
advanced dlsease. lL already has Lhe lnfrasLrucLure Lo LreaL dlabeLlc
reLlnopaLhy once dlagnosed.
lL has a sophlsLlcaLed naLlonal elecLronlc paLlenL r ecord and paLlenL
managemenL sysLem. lLs populaLlon ls relaLlvely small and Lhere ls a good
LransporL lnfrasLrucLure allowlng access Lo LreaLmenL and screenlng.
lL has, ln 8Cvl, an esLabllshed and respecLed organlsaLlon LhaL can organlse
and malnLaln a screenlng programme and coordlnaLe LreaLmenL. 8Cvl has
jusL puL ln a granL Lo 1he Llons for equlpmenL and L ralnlng LhaL would
enable lL Lo lnLroduce jusL such a programme. 1he programme model would
be:
! have a number of flxed non-mydrlaLlc dlglLal fundus cameras aL 3 or 4
locaLlons LhroughouL Lhe counLry lncludlng nLC ln 8 ellze ClLy. 1hese
would all be based ln 8Cvl cllnlcs and operaLed by L echnlclans who are
already worklng ln Lhe cllnlcs.
! An opLomeLrlsL or posslbly a Lralned Lechnlclan woul d revlew Lhe
lmages. 1hey would make a declslon on each lmage seL as Lo wheLher
LhaL paLlenL needs referral or noL (referral grade). lf no referral were
necessary Lhe paLlenL would be asked Lo reLurn for phoLos ln a years
Llme. lf referral ls necessary an appolnLmenL would be generaLed elLher
ln nLC or aL a reglonal cllnlc.
1a8

14
! 1he ophLhalmologlsL would have access Lo Lhe lmages and would have
faclllLles Lo do laser boLh ln dlsLrlcL eye cllnlcs wlLh a moblle laser or ln
nLC wlLh a flxed laser.
! 1he lmages would be sLored locally on hard drlves and also backed up
onLo a cenLral server based ln nLC. aLlenLs would be able Lo vlew Lhelr
prevlous lmages aL each vlslL. 1hls ls a very powerful educaLlonal Lool as
paLlenLs can see how Lhelr reLlnopaLhy ls progresslng. lL has been shown
LhaL Lhls can have a dramaLlc effecL on how Lhey manage Lhelr dlabeLes
and blood pressure conLrol.
! 1he dlglLal lmages would also show up oLher dlseases such as glaucoma
and hyperLenslon. AnoLher referral paLhway would be lnLroduced Lo
manage Lhese paLlenLs.
! 1echnlclans and opLomeLrlsLs would need Lo be Lralned Lo Lake Lhe
lmages and Lo grade Lhem. lL mlghL be posslble for Lhem Lo underLake
Lhe ClLy and Cullds Lralnlng requlred for screeners/graders ln Lhe uk for
Lhelr naLlonal screenlng programme. 1hls ls vlewed as a gold sLandard
lnLernaLlonally.

2. Cnce Lhe programme was runnlng lL would beneflL from a permanenL
ophLhalmologlsL ln Lhe counLry who ls Lralned Lo un derLake Lhe LreaLmenL
of reLlnopaLhy as well as general ophLhalmology.

3. 1here ls a Cuban ophLhalmologlsL already ln counLry L haL could be Lralned
Lo use Lhe laser.

4. Serlous LhoughL should be glven Lo Lralnlng a 8ellzean naLlonal ln
ophLhalmology who would be able Lo LreaL reLlnopaLhy and offer a
comprehenslve general ophLhalmology servlce. 1hls would requlre supporL
from Lhe MCP and ls an asplraLlon and longer Lerm goal.

3. 8Cvl would beneflL from a slngle person employed Lo lnlLlaLe Lhe
programme and oversee lL unLll esLabllshed.

1a9

15
Summary
Lackle Lhe problem. 8ellze has Lhe ablllLy and desl re Lo lnLroduce an effecLlve
MlnlsLry of PealLh, nCC's, Lhe prlvaLe secLor and research lnsLlLuLlons wlll play
an lmporLanL role ln Lackllng dlabeLes and dlabeLlc reLlnopaLhy ln 8ellze and

11a

16
kLILkLNCLS


ulabeLlc reLlnopaLhy ln a black populaLlon: Lhe 8arbados Lye SLudy.
?ork 11794-8036, uSA.

3 ulabeL Med. 1999 CcL,16(10):873-83.
!amalca.

4 8MC 8es noLes. 2011 !un 13,4:199.
Adams C, CarLer AC.
Mlchael, 8arbados.

?au !W eL al

(CAMul).
8arcelo A, eL al

111

17

SouLh Afrlca.





counLrles.


112

18
meLhodology.


113

DIA8L1IC kL1INCA1n
SLkVICLS IN IAMAICA


Iune - Iu|y 2013

Supported by

114
Contents

Acronyms page 4
!amalca - SlLuaLlon Analysls page 8
Summary page 18
8eferences page 19
Appendlx: page 22

115

3
Acknow|edgements
1he an-Amerlcan PealLh CrganlsaLlon (APC), Carlbbean Councll for Lhe
8llnd-Lye Care Carlbbean and SlghLsavers exLend our Lhanks Lo ur Mlchael
LcksLeln for underLaklng Lhls slLuaLlon analysls and for hls conLlnued
conLrlbuLlon Lo Lhe developmenL of dlabeLlc reLlnopaLhy programmes ln Lhe
Carlbbean.
We would also llke Lo Lhank Lhe !amalca SocleLy for Lhe 8llnd for Lhelr supporL
and Lhe MlnlsLry of PealLh for Lhelr cooperaLlon ln permlLLlng Lhls slLuaLlon
analysls Lo Lake place.
We are graLeful Lo Lhe followlng who Look parL ln Lhe dlscusslons ln !amalca:
ur ?asmln Wllllams, ulrecLor PealLh Servlces SupporL and MonlLorlng, MlnlsLry
of PealLh
ur uenlse uuncan-Coffe, ulrecLor PealLh Servlces lannlng and lnLegraLlon,
MlnlsLry of PealLh
ur 1amu uavldson, AcLlng ulrecLor of Chronlc ulsease and lnjurles revenLlon
unlL, MlnlsLry of PealLh
ur 8 WrlghL, 1echnlcal ulrecLor, SouLhern 8eglonal PealLh AuLhorlLy
ur Angela MaLLls, ConsulLanL CphLhalmologlsL, klngsLon ubllc PosplLal
ur Cordon 8oboLham, ConsulLanL CphLhalmologlsL, klng sLon ubllc PosplLal
ur M LelghLon, ConsulLanL CphLhalmologlsL, klngsLon ubllc PosplLal
ur Marlene uay, ConsulLanL CphLhalmologlsL, Mandevllle 8eglonal PosplLal
ur Cavln Penry, ConsulLanL CphLhalmologlsL, Mandevllle 8eglonal PosplLal
ur ukule Cabrlel, hyslclan wlLh dlabeLlc lnLeresL, Mandevllle 8eglonal
PosplLal
ur Claudlne Creen, ConsulLanL CphLhalmologlsL, Cornwall 8eglonal PosplLal
ur eLerkln, 8esldenL, Cornwall 8eglonal PosplLal
ur rasad, Senlor 8esldenL, Cornwall 8eglonal PosplLal
ur ScarleLL, Senlor 8esldenL, Cornwall 8eglonal PosplLal
Mr Cwen 8ernard, LxecuLlve ulrecLor, !amalca ulabeLes AssoclaLlon
Mr Conrad Parrls, rogramme ulrecLor, !amalca SocleLy for Lhe 8llnd
Mr Penry LaLLy, Carlbbean Councll for Lhe 8llnd, MalnLenance Manager
116

4
Acronyms

kP klngsLon ubllc PosplLal
nPl naLlonal PealLh lund
S8PA SouLhern 8eglonal PealLh AuLhorlLy
117

5
reLlnopaLhy among medlcal offlcers and dlabeLlc paL lenLs ln !amalca.

Cbject|ves
barrlers.
118

6
refracLlve errors.

acLlvlLy.
reLlnopaLhy.

119

7
Genera||sed Issues
due Lo dlabeLes.
1he !"#$"%&'( *#$+%,-#. /-# 012123 45% 6'&5" "- !'&5" 78$#'99%$: 6%&'-:;

12a

8
IAMAICA S|tuat|on Ana|ys|s
1he lsland of !amalca lles 90 mlles souLh of Cuba an d 120 mlles wesL of PalLl. lL
has an area of abouL 4000 square mlles and ls Lhe largesL lsland ln Lhe
CommonwealLh Carlbbean. !amalca has an esLlmaLed populaLlon of jusL over
2.7 mllllon of whlch 830,000 are aged over 40. AlmosL 1/3 of Lhe populaLlon
llve ln or around Lhe caplLal clLy, klngsLon.
1he counLry ls dlvlded lnLo four reglons (SouLh Las L, SouLhern, WesLern, norLh
LasL) and fourLeen parlshes.
1he prlvaLe and publlc secLor, as well as Lhe !amalca/Cuba Lye Care
programme and a few lnLernaLlonal non-CovernmenLal CrganlzaLlons, provlde
eye care servlces ln !amalca. 1here are four ophLhalmlc cenLres ln Lhe counLry
LhaL cover 3 reglons: klngsLon ubllc PosplLal, unlverslLy PosplLal of Lhe WesL
lndles klngsLon, Mandevllle 8eglonal PosplLal and Cornwall 8eglonal PosplLal
ln MonLego 8ay. 1he only area of Lhe counLry wlLh no publlc secLor ophLhalmlc
faclllLy ls Lhe norLh LasL reglon.

<=%:"'/> :$"'-:$? #%&@?$"'-:AB C-?'('%A -# C?$:A -: C#%D%:"'-: -/ 9?':=:%AA
=@% "- ='$9%"'( #%"':-C$"5> $:= '"A ':"%&#$"'-: ':"- :$"'-:$? :-:E
(-++@:'($9?% ='A%$A%A -# ='$9%"%A (-:"#-? C#-&#$+A $:= C-?'('%A
1here ls a urafL naLlonal Lye PealLh lan for !amalca. WlLhln Lhe plan are
speclflc recommendaLlons wlLh regard Lo dlabeLlc reLlnopaLhy. SLraLeglc
ulrecLlon number 2 calls for a reducLlon of adulL bllndness from dlabeLlc eye
dlsease". 1he LargeL ls Lo lnLroduce an efflclenL and effecLlve dlglLal
phoLography screenlng programme ln aL leasL 2 of Lhe 4 healLh reglons by 2013
Lo faclllLaLe early deLecLlon and LreaLmenL of u8".
1here ls also a urafL acLlon plan for Lhe prevenLlon of avoldable bllndness and
vlsual lmpalrmenL 2014-19. Cne of Lhe alms ls Lo puL ln place a healLh
lnformaLlon sysLem LhaL wlll adequaLely capLure Lhe causes of vlsual
lmpalrmenL and Lhe effecLlveness of Lhe eye care servlce dellvery ln boLh Lhe
publlc and prlvaLe secLors".
ln 2012 Lhe MlnlsLry of PealLh publlshed naLlonal g uldellnes for dlabeLlc
managemenL. Cne of Lhese guldellnes ls Lo recommend annual screenlng of
eyes for dlabeLlc reLlnopaLhy".
!amalca has carrled ouL Lwo comprehenslve naLlonal healLh surveys. 1hls work
comes from Lhe Lpldemlology 8esearch unlL, (unlverslLy of WesL lndles,
klngsLon). 1hese surveys have documenLed low raLes of LreaLmenL and
121

9
conLrol for chronlc non-communlcable dlseases lnclu dlng dlabeLes desplLe
major pollcy lnlLlaLlves". 1he survey ln 2008 lndlc aLed a 7.8 prevalence of
dlabeLes among Lhe 13-74 year olds. 1hls ls probabl y nearer 10-12 ln Lhose
over 40. A prevlous random populaLlon survey from Spanlsh 1own, !amalca
gave an overall prevalence of ulabeLes as 13.4.
1here are 26,000 paLlenLs reglsLered as dlabeLlc ln Lhe reLurns from healLh
cenLres LhroughouL Lhe counLry. WlLh dlabeLlc prevalence around 12, Lhe
expecLed number of dlabeLlcs ln Lhe !amalcan populaLlon over 40 (830,000)
would be 102,000. Cf Lhese 34,000 would be expecLed Lo have reLlnopaLhy
and 6000 mlghL need or beneflL from laser.
PealLh care ln !amalca has been free of cosL slnce Aprll 2008 wlLh Lhe AbollLlon
of user lees ollcy. aLlenLs wlLh chronlc dlseases are ellglble for a naLlonal
PealLh lund (nPl) card, whlch enLlLles Lhem Lo free medlcaLlon as well as a
glucomeLer lf dlabeLlc. lL does noL lnclude Lhe gl ucose LesLlng sLrlps requlred
Lo monlLor blood sugars. 1here ls ofLen a shorLage of drugs and ln reallLy lL may
someLlmes be necessary Lo purchase drugs lncludlng lnsulln prlvaLely. Some
relmbursemenL may be posslble Lhrough Lhe nPl.
Laser LreaLmenL ls free aL klngsLon ubllc PosplLal (kP). lL ls subsldlsed aL Lhe
unlverslLy PosplLal buL remalns expenslve for Lhe average !amalcan of whom
20 llve aL or below Lhe poverLy llne.
1here ls dlscusslon wlLhln CovernmenL aL presenL Lo declde wheLher Lo
relnLroduce a user fee for healLh servlces. 1he advanLages of Lhls would be Lo
recoup some funds and also Lo reduce Lhe sLraln on servlces. 1he numbers of
paLlenLs accesslng secondary care lncreased slgnlflcanLly afLer Lhe abollLlon of
user fees. 1hls has meanL lncreased walLlng Llmes for mosL servlces and an
unsusLalnable demand.

!""#"" %&'() *#"+&*,#" ()- .)/*("0*&,0&*# (1(.2(32# /+* *#/#**(24
0*#(0'#)0 ()- '()(5#'#)0 +/ -.(3#0., *#0.)+6(0%74 .),2&-.)5 (,,#"" 0+
()- &"# +/ /&)-&" ,('#*(" ()- (66*+6*.(0# 2("#* "7"0#'"8

Referral infrastructure
1here ls a formallsed referral sysLem beLween prlmary and secondary care.
aLlenLs are glven a referral sllp, whlch Lhey need Lo Lake Lo a hosplLal. An
appolnLmenL ls Lhen generaLed ln an eye cllnlc. 1he walLlng Llme for a cllnlc
appolnLmenL ls beLween 3 and 12 monLhs. lf Lhey are seen ln Mandevllle
8eglonal PosplLal or Cornwall 8eglonal PosplLal and requlre laser LreaLmenL a
122

10
furLher referral ls glven Lo Lhem Lo Lake Lo klngsLon. 1hey are Lhen assessed
agaln ln an eye cllnlc ln klngsLon and an appolnLmenL fo r laser ls glven Lo Lhem
lf requlred. 1he walL for Lhe laser cllnlc ln klngsLon may be anoLher four Lo slx
monLhs. A paLlenL may Lherefore walL anyLhlng beLween 6 and 24 monLhs
beLween belng seen ln prlmary care and geLLlng laser LreaLmenL. lL ls
esLlmaLed LhaL aL leasL half of all paLlenLs referred for laser never geL Lhe
LreaLmenL because Lhey do noL make or aLLend Lhelr appolnLmenLs.
CphLhalmologlsLs esLlmaLe LhaL up Lo 40 of paLlenL s wlll declde Lo have Lhelr
laser LreaLmenLs done prlvaLely once Lhey have been seen ln Lhe hosplLal and
dlagnosed wlLh LreaLable dlabeLlc reLlnopaLhy. 1hls LreaLmenL ls llkely Lo be
performed wlLhln a few weeks.

Primary Care
!amalca has a comprehenslve prlmary care sysLem. 1here are 317 healLh
cenLres, whlch are of 3 levels. Level 1 ls essenLlally a flrsL ald posL whereas
levels 4 and 3 offer speclalLy cllnlcs wlLh prlmary care physlclans and
speclallsLs. Lach of Lhe 14 arlshes has aL leasL one level 4 or 3 cllnlc. AL
presenL no ophLhalmologlsLs, opLomeLrlsLs or refracLlonlsLs work ln Lhese
cllnlcs. rlmary care physlclans are noL Lralned ln eye care.
1here are 13 reglsLered prlvaLe opLomeLrlsLs ln Lhe counLry and perhaps
anoLher 13 pracLlclng wlLhouL reglsLraLlon.
8eferrals Lo ophLhalmology mosLly come from healLh cenLres and
opLomeLrlsLs.

Secondary Care
CphLhalmologlsLs ln four CovernmenL hosplLals:
klngsLon ubllc hosplLal has 4 ConsulLanL CphLhalmo loglsLs.
unlverslLy PosplLal of Lhe WesL lndles (klngsLon) has 4 ConsulLanL
CphLhalmologlsLs (Lhere ls a fee for servlce ln Lhls hosplLal).
Mandevllle 8eglonal PosplLal has 2 ConsulLanL CphLh almologlsLs.
Cornwall 8eglonal PosplLal (MonLego 8ay) has 1 Cons ulLanL
ophLhalmologlsL.
Alongslde Lhe ConsulLanLs are beLween 10 and 13 more junlor
ophLhalmologlsLs and resldenLs Lralnlng ln ophLhalmology.

CphLhalmologlsLs ln Lhe prlvaLe secLor:
1here are aL leasL 10 ophLhalmologlsLs ln klngsLon who work only ln Lhe
prlvaLe secLor. 1here are abouL a furLher 10 prlvaLe ophLhalmologlsLs who
123

11
work elsewhere ln Lhe counLry. All Lhe ophLhalmologlsLs who work ln
governmenL / unlverslLy hosplLals also do prlvaLe work.

Jamaica/Cuba Eye care programme
1hls programme was seL up ln SepLember 2003 and has conLlnuously evolved.
lL ls run by Cuban ophLhalmologlsLs and supporL sLa ff. ln AugusL 2010 dlabeLlc
reLlnopaLhy screenlng and LreaLmenL was lncorporaLed lnLo Lhelr programme
for Lhe flrsL Llme. 1hls ls run auLonomously and wlLhouL Lhe lnvolvemenL of Lhe
local ophLhalmologlsLs.

Non-Governmental organisations
SupporL ls provlded by a number of nCC's lncludlng L he Carlbbean Councll for
Lhe 8llnd (CC8), Llons club, !amalca ulabeLlcs AssoclaLlon and vlslLlng forelgn
Leams. 1hese elLher supporL governmenL lnsLlLuLlons, offer reduced fees for
servlces or provlde occaslonal vlslLlng Leams LhaL provlde faclllLles for
examlnaLlons and LreaLmenLs. 1he Carlbbean Councll for Lhe 8llnd ls currenLly
playlng a major role ln Lhe developmenL of eye healLh servlces wlLh Lhe
SouLhern 8eglonal PealLh AuLhorlLy as parL of a 10 year parLnershlp. lL ls also
preparlng Lo enLer lnLo a slmllar parLnershlp wlLh Lhe norLh-LasLern PealLh
reglon.

Other human resources
1here ls one Lralned refracLlonlsL ln Mandevllle 8eglonal PosplLal supporLed
and Lralned by CC8. 1here are 2 Lralned ophLhalmlc nurses. no opLomeLrlsLs
work ln hosplLals and Lhere are no ophLhalmlc Lechnl clans.

Equipment
1here are no worklng dlglLal fundus cameras ln Lhe !amalcan publlc hosplLals aL
presenL. 1here was no lndlcaLlon LhaL any were avallable and used ln Lhe
prlvaLe secLor.
AL Lhe Llme of Lhls analysls Lhere was one funcLlonl ng dlode laser ln klngsLon
ubllc PosplLal. 1he laser aL Lhe unlverslLy Pospl Lal was noL worklng buL was
due Lo be repalred. 1here was no laser ln Mandevllle and Lhe laser ln Cornwall
8eglonal PosplLal was beyond repalr and had noL wor ked for several years.
1here are esLlmaLed Lo be beLween 13 and 20 funcLlonlng lasers ln Lhe prlvaLe
secLor and mosL rlvaLe ConsulLanLs have Lhelr own.
1he !amalca/Cuban eye care programme has one funcLlonlng and well-
malnLalned laser based ln Lhelr own faclllLy ln klngsLon.
124

12
1here were adequaLe faclllLles and equlpmenL Lo assess Lhe eye for dlabeLlc
reLlnopaLhy aL all cenLres vlslLed. Some of Lhe sllL lamp mlcroscopes were old
buL enough were worklng ln each unlL Lo allow cllnlc s Lo funcLlon. Some
ConsulLanLs had Lo brlng Lhelr own lnsLrumenLs from Lhelr prlvaLe cllnlcs such
as ophLhalmoscopes and lenses. Cllnlc space was ofLe n crowded buL all unlLs
made Lhe mosL of Lhe space allocaLed Lo Lhem. 1he eye deparLmenL ln
Mandevllle 8eglonal PosplLal has jusL moved Lo a ref urblshed more spaclous
faclllLy. Cornwall 8eglonal PosplLal has Lhe mosL llmlLed space and has Lhe
leasL equlpmenL.
1he unlverslLy PosplLal ln klngsLon offers a llmlLed vlLreo-8eLlnal servlce,
whlch ls able Lo offer LreaLmenL for advanced dlabeLlc reLlnopaLhy. 1he walLlng
Llmes are long and Lhere ls a fee for servlce. ln reallLy very few dlabeLlc
paLlenLs have Lhe opporLunlLy Lo have surgery.

!""#"" -.(3#0., *#0.)+6(0%7 "#*1.,#" -#2.1#*74 #7# ,(*# "7"0#'" ()-
",*##).)5 6*+0+,+2" (0 0%# )(0.+)(2 2#1#28
1here ls no esLabllshed dlabeLlc reLlnopaLhy screenlng or LreaLmenL servlce.
1he naLlonal PealLh lund (nPl) organlses communlLy screenlng for dlabeLes
and oLher dlseases. 1hls ls managed Lhrough Lhe !amalca ulabeLes AssoclaLlon.
CuLreach Leams check blood pressure, blood sugars, do LCC's and do baslc
vlslon LesLs. lL ls esLlmaLed LhaL 40,000 paLlenLs were screened lasL year
(2012). 8ecause dlabeLlc reLlnopaLhy does noL usually affecL vlslon unLll Lhere
ls slgnlflcanL dlsease Lhls programme wlll noL be useful for reLlnopaLhy
screenlng.
1he !amalca/Cuba programme also screen ln some areas. no daLa ls avallable
on numbers screened or locallLy of Lhe areas screened. 1he dlsLrlcL hosplLal eye
unlLs are noL lnvolved ln Lhe organlsaLlon of Lhese and do noL parLlclpaLe ln Lhe
programme or LreaL paLlenLs referred ln from Lhe programme. aLlenLs are
managed back ln klngsLon aL a Cuban managed faclllL y.

Serv|ce outputs
!""#"" -.(3#0., *#0.)+6(0%7 "#*1.,#" +&06&0" +) 0%# 6*#1.+&" 7#(*4 )&'3#*
+/ -.(3#0.," &)-#*5+.)5 #7# #9('.)(0.+)" ()- 0*#(0'#)08
1here ls very llmlLed daLa avallable. 1he !amalca/Cuba Lye care programme
has done 806 dlabeLlc lasers slnce 2010. ln 2012 lL carrled ouL 1766 dlabeLlc
reLlnopaLhy consulLaLlons and 233 laser LreaLmenLs.
125

13
klngsLon ubllc PosplLal carrles ouL around 730 laser LreaLmenLs a year. Some
of Lhese wlll be on Lhe same paLlenL so lL ls dlffl culL Lo know how many
lndlvlduals are geLLlng LreaLmenL.

!""#"" 0%# (:(*#)#"" +/ %#(20% ,(*# 6#*"+))#2 +) -. (3#0., *#0.)+6(0%78
1here ls a naLlonal dlabeLlc educaLlon programme and a lay dlabeLes educaLor
programme. 1here are 3 healLh educaLors per parlsh buL Lhey malnly Leach
sexual healLh educaLlon.
CphLhalmologlsLs do presenLaLlons abouL dlabeLlc ey e dlsease aL prlmary care
docLor meeLlngs buL all agreed LhaL Lhe frequency of Lhese could be lncreased
and more efforL Lo reach more docLors and nurses could be made.

;962+*# '(<+* (,%.#1#'#)0"4 3#"0 6*(,0.,#" ()- '(<+* ,+)"0*(.)0" ()-
3(**.#*"F

!amalca ls a large Carlbbean counLry wlLh varled Lerraln and llmlLed LransporL
lnfrasLrucLure. lL ls flndlng lL dlfflculL Lo cope wlLh Lhe demands on lLs freely
accesslble healLh care sysLem. 1he MlnlsLry of PealLh ls aware of Lhe
lmporLance of dlabeLes and dlabeLlc reLlnopaLhy. 1here ls a good neLwork of
prlmary healLh cllnlcs LhroughouL Lhe counLry wlLh well-Lralned and moLlvaLed
sLaff.
1here are many hlghly moLlvaLed ophLhalmologlsLs who work ln Lhe publlc
secLor, ofLen ln dlfflculL and demandlng clrcumsLances. 1hey work efflclenLly
and provlde Lhe very besL care LhaL Lhey are able Lo wlLh Lhe llmlLed resources
LhaL Lhey have.
ln Mandevllle Lhe eye unlL has recenLly moved Lo a larger and well equlpped
bulldlng supporLed by CC8 and SlghLsavers. Cnce Lhe move ls compleLe and
Lhe LheaLres are funcLlonlng lL wlll be able Lo provlde an upgraded servlce and
hopefully reduce walLlng Llmes.
ln klngsLon, kP has an excellenL ophLhalmlc Leam provldlng Lhe majorlLy of
Lhe dlabeLlc reLlnopaLhy managemenL ln Lhe counLry. lL has Lhe only
funcLlonlng laser, whlch ls used efflclenLly.
126

14
Cornwall PosplLal ln MonLego 8ay has a very energeLlc and moLlvaLed Leam
who make use of Lhelr llmlLed resources Lo provlde Lhe besL care Lhey can.
1here ls good daLa avallable on Lhe number of dlabeL lcs ln Lhe populaLlon from
Lwo comprehenslve naLlonal healLh surveys performed by Leams from Lhe
unlverslLy of Lhe WesL lndles, klngsLon.
1he !amalca Cuban eye care programme has run a screenlng and LreaLmenL
programme LhaL has enabled a few Lhousand people Lo be screened and a few
hundred LreaLed.
1here ls a llmlLed vlLreo-reLlnal servlce based aL Lhe unlverslLy PosplLal, whlch
ls able Lo LreaL severe dlabeLlc reLlnopaLhy. 1hls LreaLmenL ls only parLly
subsldlsed.

Genera|
1here ls no flnallsed and approved naLlonal Lye Peal Lh lan alLhough lL
does exlsL ln drafL form. A furLher efforL should be made Lo flnallse Lhls and
Lo geL lL approved. 1he naLlonal Lye PealLh lan would be a very useful
Lool Lo enable beLLer plannlng and coordlnaLlon of eye healLh acLlvlLles
lncludlng dlabeLlc eye dlsease LhroughouL Lhe counL ry.
Infrastructure
no naLlonwlde dlabeLlc screenlng programme ls ln pl ace and Lhere ls no
esLabllshed paLhway for managemenL of dlabeLlc eye dlsease.
1he !amalca / Cuba eye care programme runs a screenlng and LreaLmenL
programme buL lL ls unllkely Lo be susLalnable. 1he programme has had
beneflLs buL lL has noL lnLegraLed wlLh servlces wl Lhln !amalca and has noL
formed Lles wlLh ophLhalmology unlLs. lL ls run as an auLonomous unlL.
1here are poLenLlal effecLs on Lralnlng !amalcan CphLhalmologlsLs as Lhey
are geLLlng less experlence and lL ls percelved as a LhreaL by some local
ophLhalmologlsLs. 1he programme ls cosLly for !amal ca and Lhere ls a sLrong
posslblllLy LhaL lL wlll be run down as Lhe LradlLlo nal core fundlng from
venezuela ls reduced. lL ls lmporLanL Lo have a servlce ln place LhaL can
Lake over, lf and when Lhe programme ends.
Data
1here ls no appreclable daLa avallable on prevalence of reLlnopaLhy, raLes
of referral for reLlnopaLhy or numbers of paLlenLs LhaL fall Lo aLLend hosplLal
appolnLmenLs or laser LreaLmenLs.

127

15
ersonne|
1here are plenLy of Lralned ophLhalmologlsLs Lo run a screenlng and
LreaLmenL programme buL few personnel aL a more junlor level who are
avallable Lo Lake on some of Lhe responslblllLles. 1here are no Lralned
refracLlonlsLs aparL from one ln Mandevllle and very few Lralned ophLhalmlc
nurses. 8ecause ophLhalmology ls noL vlewed as a speclallsL area Lhere ls no
upward moblllLy for nurses and nurses roLaLe Lhrough ophLhalmology every
6 monLhs. CpLomeLrlsLs only work ln Lhe prlvaLe secLor.
Lxpense
ln Lheory boLh prlmary and secondary healLh care ls free aL Lhe polnL of
dellvery. 1he major llmlLaLlon ls noL access Lo Lhe servlce buL avallablllLy of
resources. 1he demands on all servlces lncreased slgnlflcanLly afLer fees for
servlces were removed ln 2008.
Lducat|on]comp||ance
aLlenL compllance wlLh medlcaLlon Lo conLrol dlabeLes and blood pressure
ls poor and Lhls leads Lo lncreased eye and oLher sysLemlc compllcaLlons.
aLlenL educaLlon could be lmproved furLher. 1he prevalence of
hyperLenslon, whlch ls a slgnlflcanL rlsk facLor for severe dlabeLlc
reLlnopaLhy, ls as hlgh as 23 ln Lhe over 40's.
aLlenLs wlLh reLlnopaLhy are seen aL a laLe sLage ofLen when Lhe vlslon ln
Lhelr only seelng eye ls affecLed. 1hls ls due Lo l ack of educaLlon and llmlLed
access Lo resources.

kecommendat|ons
=(># *#,+''#)-(0.+)" +) /&0&*# (,0.+)"4 +3<#,0.1#" ()- (,0.1.0.#" *#?&.*#-
0+ "0*#)50%#) -.(3#0., *#0.)+6(0%7 6*+5*('" (0 0%# )(0.+)(2 2#1#24 :.0% ()
#'6%("." +)@
! A#1#2+6'#)0 B &"# +/ 0*#(0'#)0 6*+0+,+2"
! C,*##).)5 ()- *#/#**(2
! =+).0+*.)5 ()- 0*#(0'#)0
1. 1here ls a deflnlLe need for a comprehenslve screenlng and LreaLmenL
programme for dlabeLlc reLlnopaLhy. !amalca has a hlgh prevalence of
dlabeLes and dlabeLlc reLlnopaLhy. AlLhough Lhere l s llmlLed daLa, all
ophLhalmologlsLs agreed LhaL dlabeLlc paLlenLs made up beLween 20 and
23 of Lhelr cllnlcs. A comprehenslve screenlng and LreaLmenL programme
for dlabeLlc reLlnopaLhy would flrsLly free up Lhe ophLhalmologlsLs Lo see
and LreaL oLher problems. aLlenLs wlLh mlld or no reLlnopaLhy would noL
need Lo come Lo cllnlcs. Secondly lL would enable paLlenLs wlLh slgnlflcanL
reLlnopaLhy Lo geL LreaLed more qulckly wlLh beLLer vlsual ouLcomes.

128

16
2. A furLher efforL should be made Lo flnallse Lhe naLlonal Lye PealLh lan and
Lo geL lL approved. 1hls would be a very useful Lool Lo enable beLLer
plannlng and coordlnaLlon of eye healLh acLlvlLles lncludlng dlabeLlc eye
dlsease LhroughouL Lhe counLry.

3. lncrease Lhe amounL of Leachlng and Lralnlng of nurses and docLors so LhaL
Lhey are more aware of Lhe rlsks of dlabeLlc eye dlsease. nCC's mlghL be
able Lo help supporL Lhls.

4. A general revlew of currenL daLa managemenL pracLlces relaLlng Lo dlabeLlc
reLlnopaLhy ls recommended wlLh a vlew Lo lmprovlng and enhanclng
avallablllLy of daLa on prevalence, referral raLes, paLlenL aLLendance, eLc.

S. 1here ls a need Lo lncrease Lhe number of refracLlonlsLs or equlvalenL
Lralned personnel Lo underLake screenlng and referral as approprlaLe.

6. lL ls hlghly deslrable Lo seL up a screenlng programme ln !amalca. 1he
problem ls noL lack of CphLhalmologlsLs buL lack of equlpmenL and Lhe
lnfrasLrucLure Lo organlse and malnLaln a dlabeLlc screenlng programme.
Some unlLs have beLLer faclllLles Lhan oLhers. 1he unlL aL kP has Lhe mosL
sLaff and has a funcLlonlng laser. Mandevllle has a hlsLory of supporL from
CC8, whlch has enabled Lhem Lo employ a refracLlonlsL and move lnLo new
faclllLles. 1hey have no laser buL have Lhe space for one and also Lhe ablllLy
Lo malnLaln lL.
1he ldea of runnlng a slngle naLlonal programme woul d be very amblLlous.
lL would be more sLralghLforward Lo conslder seLLlng up 3 smaller reglonal
programmes ln klngsLon, Mandevllle and MonLego 8ay. 1he vasL majorlLy of
Lhe populaLlon should be able Lo access one of Lhese pr ogrammes. Lach
programme would need a dlglLal camera and access Lo a laser. 1he
programmes could run ln dlfferenL ways Lo sulL Lhe dlfferenL populaLlons:
k|ngston:
use a slngle non-mydrlaLlc camera based wlLhln Lhe hosplLal cllnlc and
run by a refracLlonlsL. 1he S8PA has nomlnaLed 4 candldaLes Lo be
Lralned as 8efracLlonlsLs.
8eferrals come ln dlrecLly from healLh cllnlcs and opLomeLrlsLs. 1he
camera could be used for reLlnopaLhy screenlng aL a seL Llme every
weekday. Cnce lnformed, paLlenLs would be able Lo have phoLos Laken
on any day and noL have Lo walL for a booked appolnLmenL.
1he lmages would be assessed lmmedlaLely by a refracLlonlsL and a
refer" or non refer" declslon made. lf Lhe paLlenL had a refer grade
129

17
Lhen an appolnLmenL would be glven Lo Lhe paLlenL for a
laser/assessmenL cllnlc when Lhe paLlenL could be assessed and LreaLed
aL Lhe same sesslon. lf a non refer" grade ls made Lhen Lhe paLlenL ls
asked Lo reLurn ln 1 year for repeaL phoLos.
All grades would need Lo be recorded and a reglsLer kepL of Lhose
LreaLed and Lhose due Lo be revlewed. lf resources were avallable
paLlenLs could be conLacLed by LexL message on Lhelr moblle phones Lo
remlnd Lhem Lo reLurn for annual phoLos.
Mandev|||e:
SLarL wlLh a slngle non-mydrlaLlc camera LhaL could remaln ln Lhe
hosplLal. 1hls could be expanded Lo esLabllsh slmll ar servlces ln each of
Lhe 3 parlsh hosplLals ln Lhe reglon, expandlng ouL ward Lo lnclude Lypes
4 & 3 healLh cenLres as resources become avallable.
1he lmages could be Laken and assessed by a Lralned healLh professlonal
such as a refracLlonlsL. 1hey would look aL Lhe lmage and grade lL as
refer or non-refer.
A llsL of paLlenLs wlLh a refer grade could be senL Lo Lhe hosplLal and
appolnLmenLs generaLed for a cllnlc for Lhem Lo be seen and LreaLed lf
necessary. AppolnLmenLs could be senL ouL as a LexL message on moblle
phones.
1hls scheme would requlre a laser, whlch would be slLuaLed ln Lhe eye
unlL ln Mandevllle. ConsulLanLs and Lralnees could have a roLa Lo run an
assessmenL and LreaLmenL cllnlc. 1he hope would be LhaL Lhe majorlLy of
paLlenLs would be able Lo access care as Lhey dld noL have far Lo Lravel
and Lhe LreaLmenL could be free or subsldlsed. A moblle servlce ls
posslble buL llkely Lo be more expenslve, parLlcularly lf Lralned
refracLlonlsLs were avallable aL some hosplLals and healLh cenLres.

Montego 8ay:
1he Cornwall hosplLal has a slmllar caLchmenL popula Llon Lo LhaL of
Mandevllle (approx. 300,000). lL covers a large geographlc area and has
Lo LreaL paLlenLs from Lhe norLheasL reglon where Lhere ls no
ophLhalmlc unlL. A screenlng and LreaLmenL programme ls feaslble and
agaln would requlre a slngle non-mydrlaLlc camera and a laser, based ln
Lhe eye unlL. AL presenL Lhe condlLlons are cramped and Lhe cllnlc ls
shared wlLh oLher speclalLles. More space would need Lo be found for
Lhe efflclenL operaLlon of Lhe cllnlc lf screenlng and laser LreaLmenL was
Lo be done.
1he lmages would need Lo be assessed and graded by Lhe person Laklng
Lhem. lf a refer grade was made, Lhe unlL ln Cornwall 8eglonal PosplLal
13a

18
would need Lo organlse an appolnLmenL ln a comblned assessmenL and
LreaLmenL cllnlc. 1he paLlenL could be conLacLed wl Lh a LexL message.
lf a non refer" grade ls made Lhe paLlenL ls asked Lo reLurn ln a year for
more phoLos.
1hls programme would requlre Lhe mosL lnvesLmenL and Lralnlng. Cnce
esLabllshed, slmllar screenlng servlces could be seL up ln each of Lhe
parlsh hosplLals ln Lhe reglon, expandlng ouLward L o lnclude Lype 4 & 3
healLh cenLres as resources become avallable.
A moblle camera movlng Lo a number of dlfferenL healLh cenLres aL
speclflc Llmes ls also feaslble buL agaln llkely Lo be more expenslve.

1he lnLroducLlon of Lhese programmes could be sLaggered. lL mlghL be
reasonable Lo sLarL ln klngsLon and Mandevllle and Lhen begln ln MonLego
8ay once Lhe programmes had been shown Lo work efflclenLly ln Lhe lnlLlal
locaLlons. ln Lhe meanLlme resources, supporL and Lralnlng could be
dlrecLed Lo Lhe Cornwall PosplLal.

Summary
Lackle Lhe problem. !amalca has Lhe ablllLy and deslre Lo lnLroduce an effecLlve
MlnlsLry of PealLh, nCC's, Lhe prlvaLe secLor and research lnsLlLuLlons wll l play
an lmporLanL role ln Lackllng dlabeLes and dlabeLlc reLlnopaLhy ln !amalca and

131

19
kLILkLNCLS


ulabeLlc reLlnopaLhy ln a black populaLlon: Lhe 8arbados Ly e SLudy.
?ork 11794-8036, uSA.

3 ulabeL Med. 1999 CcL,16(10):873-83.
!amalca.

4 8MC 8es noLes. 2011 !un 13,4:199.
Adams C, CarLer AC.
Mlchael, 8arbados.

?au !W eL al

(CAMul).
8arcelo A, eL al

132

20

SouLh Afrlca.





counLrles.


133

21
meLhodology.


134

!"#$% '() *$))+ ,-./0")%( 1.02#+3 4$".-)) '5$6%
1|e ueen L||zabet| L|amono !ub||ee 1ust |s a c|a|tab|e ounoat|on estab||s|eo |n 2012 to
ma| ano ce|ebate le Majesty 1|e ueen's 60-yea cont|but|on to t|e Commonwea|t|.
1|e 1ust |as ece|veo oonat|ons om govenments, coooate oatnes, tusts, ounoat|ons,
commun|ty gouos ano |no|v|oua|s om acoss t|e Commonwea|t|. lts m|ss|on |s to en|c| t|e
||ves o oeoo|e om a|| bac|gounos w|t||n t|e Commonwea|t|, ano |ts oogammes w||| wo| |n
a|||ance towaos e||m|nat|ng avo|oab|e b||noness ano to emoowe a new geneat|on o young
|eaoes.
v|t| a |ve yea t|meame |n w||c| to oe||ve successu| oogammes, t|e 1ust's a|m |s to |eave
a |ast|ng |egacy, owneo by t|e w|o|e Commonwea|t|, to |onou le Majesty 1|e ueen.
l| no out moe by v| s| t| ng www. j ub| | eet| bute. og.
7#$%( 8)03)56(.9
?oung oeoo|e ae oten ove|oo|eo ano t|e| cont|but|on, enegy ano s||||s not su|c|ent|y
|anesseo w|t||n nat|ona| ano g|oba| oeve|ooment agenoas. v|t| 60 o |ts ooou|at|on unoe
t|e age o 30, young oeoo|e ma|e uo moe t|an |a| o t|e Commonwea|t|'s ooou|at|on, ano
|nvest|ng |n t|e| ootent|a| |s c|t|ca| |n |e|o|ngaooess t|e c|a||enges o t|e 21st centuy.
1|e 1ust's oogamme on yout| |eaoes||o a|ms to emoowe a geneat|on o young |eaoes, ano
ceate moe ooootun|t|es o young oeoo|e |n evey Commonwea|t| county.
An awaos sc|eme o young |eaoes acoss t|e Commonwea|t| w||| ecogn|se exceot|ona| young
oeoo|e ano |e|o t|em to oeve|oo ut|e. Cants w||| a|so be oov|oeo o yout|-|eo oojects ano
ogan|sat|ons acoss t|e Commonwea|t|, ocus|ng on a ange o |ssues om t|e ecent|y aoooteo
Commonwea|t| C|ate.
!:#.30"-) "-.+3+)66
L|g|ty oecent o b||noness |s avo|oab|e. C|oba||y,an est|mateo 28S m||||on oeoo|e ae v|sua||y
|moa|eo, |nc|uo|ng 39 m||||on oeoo|e w|o ae b||no. 1|ee ae aooox|mate|y 31 m||||on oeoo|e |n
t|e wo|o w|o ae neeo|ess|y b||no.
1|e 1ust's Avo|oab|e u||noness oogamme a|ms to ma|e s|gn||cant oogess towaos eso|v|ng
t||s majo |ssue ac|ng t|e Commonwea|t|, by se|z|ng t|e ooootun|ty to cont|bute to t|e goa|s
135

set by v|s|on 2020, t|e g|oba| |n|t|at|ve to e||m|nate t|e ma|n causes o avo|oab|e b||noness
wo|ow|oe. 1|e oogamme w||| tac||e t|ee soec||c o|seases ano |ea|t| |ssues ||n|eo to
avo|oab|e b||noness - b||no|ng tac|oma, o|abet|c et|nooat|y ano et|nooat|y o oematu|ty -
ano |t w||| suooot t||s w|t| a seoaate, oveac||ng oogamme t|at oeve|oos e||ows||os,
eseac| ano tec|no|ogy |n t|e eye cae secto acoss t|e Commonwea|t|.
;-.+3.+< %50=(#20
Aooot|ng t|e vo|o lea|t| Cgan|sat|on-enooseo SAlLstategy (Sugey, Ant|b|ot|cs, lac|a|
c|ean||ness ano Lnv|onmenta| |moovement) t|e 1ust w||| wo| |n a|||ance w|t| oatnes
towaos e||m|nat|ng b||no|ng tac|oma |n two count|es |n A|ca - lenya ano Ma|aw| - ano
s|gn||cant|y eouce |ts oeva|ence |n uo to s|x ot|e Commonwea|t| count|es.
1|e oogamme w||| uno: sugey, t|e o|st|but|on o ant|b|ot|cs oonateo by l|ze to teat ano
oevent act|ve |nect|on, |n|t|at|ves to encouage ac|a| c|ean||ness to oevent o|sease
tansm|ss|on, ano wo| to |moove access to c|ean wate souces ano san|tat|on.
1.0")%.= >)%.+#90%(?
1|e oogamme |s cuent|y suooot|ng some eseac| to aooa|se t|e o|eent mooe|s t|at ae
cuent|y be|ng useo to aooess o|abet|c et|nooat|y |n lno|a. 1|e |no|ngs om t||s w||| be s|aeo
w|oe|y, to |e|o tac||e t|e |ssue |n ot|e Commonwea|t| count|es ano wo|ow|oe.
1|e oogamme w||| ocus on Sout| As|a, t|e Ca|bbean ano sevea| lac||c ls|ano nat|ons, to
oeve|oo ano |mo|ement soec|a||st sceen|ng ano teatment to oevent oeoo|e om go|ng b||no.
>)%.+#90%(? #@ A5)20%$5.%?
As et|nooat|y o oematu|ty |s causeo by g|v|ng too muc| oxygen to oematue bab|es, w||c|
esu|ts |n b||no|ng et|na| oetac|ment, t||s stano o t|e 1ust's oogamme w||| suooot t|e
oeve|ooment o a nat|ona| o|an to |moove neonata| cae |n lno|a, w||c| |as t|e ||g|est numbe
o oe-tem b|t|s |n t|e wo|o.
1||s oogamme |s be|ng oes|gneo to |nc|uoe t|e ootent|a| o eo||cat|on by ot|es to aooess
et|nooat|y o oematu|ty |n ot|e Commonwea|t| count|es.
B)--#C6(.96D 5)6)05=( 0+3 %)=(+#-#<?
1|oug| e||ows||os ano eseac|, t|e 1ust a|ms to oeve|oo exoet|se |n eye cae ano stengt|en
|ea|t| systems acoss t|e Commonwea|t|. 1|e 1ust w||| a|so |nvest |n new |nnovat|ve
tec|no|og|es t|at w||| enab|e eye cae to be oe||veeo o a act|on o t|e cuent cost.
lt |s |ooeo t|at t||s oogamme w||| |eao to a evo|ut|on |n aooab|e ano ||g|-qua||ty eye cae
acoss t|e Commonwea|t| ano beyono.
136

E#C C) C#5F
1|e 1ust wo|s w|t| t|e u|| comm|tment o govenments to oeve|oo nat|ona| stateg|es o eac|
o ou Commonwea|t| ocus count|es.
lo |ts gant ma||ng 1|e 1ust wo|s ooact|ve|y, se|ect|ng soec|a||st oatnes w|o ae best-
o|aceo to oe||ve t|e 1ust's oogammes, ano |nv|t|ng t|em to aoo|y o uno|ng.
Cnce a oatne |as been se|ecteo by t|e 1ust to aoo|y o uno|ng, t|e 1ust w||| wo|
co||aboat|ve|y w|t| t|e se|ecteo oatnes, to jo|nt|y oeve|oo a |ve-yea oogamme o wo|. 1|e
o||ow|ng actos ae t|en ta|en |nto caeu| cons|oeat|on by t|e 1ust beoe gants ae
awaoeo:
'() G5<0+.60%.#+H
1. !"#$%&'&($) Annua| Accounts ano govenance oeta||s w||| be scut|n|seo, to ensue t|at
t|e oatne |s |nanc|a||y souno ano |as aoooo|ate ooceoues |n o|ace to manage a
gant. L|ves|ty |s a |ey assessment acto.
2. *"++',"%'-."&) 1|e oatne must oemonstate a w||||ng ano exoe|ence o co||aboat|ng
w|t| ot|es, ano a comm|tment to s|a|ng |ean|ng extena||y about successes ano
a||ues.
'() A5#<5022) #5 A5#I)=%H
3. /0-0'+1 ",2$(-.#$3: 1|e a|ms o t|e ooject must meet t|e 1ust's object|ves. 1|e ooject
|tse| s|ou|o |ave c|ea ovea|| object|ve, ano |ave an aoooo|ate taget o t|e numbes
o oeoo|e w|o w||| be |e|oeo by t|e wo|.
4. 456$&7.-0%$: A|| ooject exoeno|tue must be e||g|b|e o C|c|a| Leve|ooment Ass|stance
(CLA).
S. /"&.-"%.&81 '&71 $#'+0'-."&: 1|e ooooseo ooject must |ave a oe|neo ovea|| |moact
taget, soec||c outcomes to be ac||eveo (o|eence to |no|v|oua|s, commun|t|es,
ogan|sat|ons o oo||c|es), ano oeta||s o |ow suc| c|anges w||| be mon|toeo ano
eva|uateo. Leta||s o oovety eouct|on s|ou|o be oov|oeo w|ee ooss|b|e.
6. 45.-13-%'-$89: lnomat|on oeta|||ng |ow t|e wo| can cont|nue toen|c| oeoo|e's ||ves |n
t|e Commonwea|t| ate t|e uno|ng oe|oo |s como|eteo ano/o |ow utue uno|ng w|||
be secueo must be oov|oeo. 1||s must be g|ven caeu| cons|oeat|on at t|e o|ann|ng
stage.
/. :+'&&.&8) 1|e ooject oooosa| must |nc|uoe a c|ea o|an o t|e ent|e uno|ng oe|oo.
8. ;$&$<.(.'%.$3) 1|e 1ust equ|es ev|oence o |ow t|e v|ews o bene|c|a|es, |nc|uo|ng
econom|ca||y o|saovantageo ano mag|na||seo oeoo|e, |ave been ta|en |nto account.
Lv|oence o neeo |s a|so equ|eo.
137

ClAl8MAl: 1lL 81 lCl Sl8 !Cll MA!C8 lC Cl
18bS1LLS: lAMALLSl SlA8MA, CCMMClvLAL1l SLC8L1A8?-CLlL8AL |
1lL 81 8LvL 8 81 lCl 8lClA8L ClA818LS lCvC | ALAl lA8lL8 | 1lL 81 lCl Sl8 Cl8lS1CllL8 CLlL1 lCvC CuL |
1lL LC8L lllC Cl LC1lub8? CuL | 1lL 81 lCl 1lL LC8L 8CuL81SCl Cl lC81 LLLLl l1 CCMC lCl l8SL |
1lL 81 lCl 1lL uA8ClLSS SCC1LAlL Cl AS1lAL C | 1lL 81 lCl 1lL uA8ClLSS lCCC Cl lL11LL1lC8lL
18LASb8L8: !Cll A SlLlCL CuL LL
2S Lcc|eston l|ace | Lonoon | Sv1v 9ll | 1e|: -44 (0) 20/ 2S9 9020 |www.jub||eet|bute.og
8eg|steeo C|a|ty |n Lng|ano ano va|es (no: 114S640)
9. *'6'(.-9: 1|e oatne must be ab|e to oemonstate t|at |t |as su|c|ent caoac|ty to
unoeta|e t|e wo|, ano t|at |t w||| |ave a oos|t|ve |moact on |ea|t| systems.
10. =.3>3)1A u|| |s| ana|ys|s must be ta|en |nto account ano m|t|gateo o.
11. ;078$-) A oeta||eo buoget w|t| gooo va|ue o money |s equ|eo. 1|e 1ust w||| a|so
exam|ne t|e |nanc|a| ooceoues ano management stuctue o t|e ooject.
Management ano oves|g|t costs s|ou|o not noma||y exceeo 10.
12. *""%7.&'-."&) A|| oojects s|ou|o be ca|eo out |n cooo|nat|on w|t| t|e M|n|sty o
lea|t| ano ot|e aoooo|ate agenc|es.
13. *"??0&.('-."&3) 1|ee s|ou|o be a c|ea |ntena| ano extena| commun|cat|on o|an o
t|e wo|.

138

Carlbbean ulabeLlc
8eLlnopaLhy rogramme

ConcepL aper

1hls concepL paper has been developed by 1he Carlbbean Councll for Lhe 8llnd -
Lye Care Carlbbean, wlLh Lhe an Amerlcan PealLh CrganlsaLlon (APC), C88lS and
SlghLsavers.
1hls paper, whlch ouLllnes a poLenLlal ulabeLlc 8eL lnopaLhy rogramme focuslng on
Carlbbean CommonwealLh counLrles, was submlLLed Lo 1he Cueen LllzabeLh
ulamond !ubllee 1rusL ln SepLember 2013. 1he 1rusL's 8oard of 1rusLees responded
poslLlvely Lo Lhe paper and requesLed LhaL furLher dlscusslons Lake place, Lo see
how Lhe plans could be furLher developed lnLo a full fundlng proposal.
139
Carlbbean ulabeLlc 8eLlnopaLhy rogramme ConcepL aper age 2 of 13

Car|bbean D|abet|c ket|nopathy rogramme Concept aper

Introduct|on
347 mllllon people worldwlde have dlabeLes and Lhe World PealLh CrganlsaLlon projecLs LhaL
dlabeLes wlll be Lhe 7Lh leadlng cause of deaLh ln 2030. ulabeLes MelllLus ls llsLed among Lhe
leadlng causes of deaLh ln Lhe Carlbbean and a number of populaLlon based sLudles have
documenLed Lhe hlgh prevalence of Lhe dlsease.
More Lhan 73 of ulabeLes MelllLus paLlenLs experlence some form of ulabeLlc 8eLlnopaLhy and
Lhe eye dlsease ls esLlmaLed Lo be responslble for 4.8 of all cases of bllndness. Lvldence-based
LreaLmenL can reduce Lhe rlsk of vlslon loss from ulabeLlc 8eLlnopaLhy by >90. MosL
CommonwealLh counLrles ln Lhe Carlbbean have no naLlonal dlabeLlc screenlng and LreaLmenL
programme.

Crgan|sat|ons Invo|ved & Capac|t|es
Car|bbean Counc|| for the 8||nd ] Lye Care Car|bbean (CC8) - 8eglonal coordlnaLlon,
programmaLlc and flnanclal granL managemenL, monlLorlng, communlcaLlons, programme
plannlng and lmplemenLaLlon.
Ck8IS - programme plannlng, Lechnlcal experLlse, Lralnlng, carrylng ouL
assessmenLs/revlews, monlLorlng aL reglonal and/ or naLlonal levels
an Amer|can nea|th Crgan|sat|on(AnC) - programme plannlng, Lechnlcal supporL,
advocacy, reglonal coordlnaLlon, monlLorlng aL reglonal and or naLlonal level,
CC8, AnC and Ck8IS wlll collaboraLe Lo organlse and faclllLaLe reglonal meeLlngs and Lo
manage programme agreemenLs wlLh naLlonal governmenLs / MlnlsLrles of PealLh
CC8 Member Agenc|es - naLlonal level advocacy, acLlvlLy plannlng & lmplemenLaLl on

Work|ng w|th:
M|n|str|es of nea|th - MlnlsLrles of PealLh wlll be requesLed Lo nomlnaLe a programme
coordlnaLor / focal person. A naLlonal level rogramme ManagemenL CommlLLee wlll also
be requlred Lo gulde Lhe process whlch should lnclude MCP sLaff, e.g. rlmary PealLh Care
ulrecLor, CphLhalmologlsL, PealLh Servlces Manager, non-Communlcable ulseases
rogramme Manager, PealLh romoLlons Manager and Lhe Chlef Medlcal Cfflcer. 1hls
managemenL commlLLee would llalse wlLh CC8 aL reglonal level and wlll work closely wlLh
Lhe naLlonal v2020 / revenLlon of 8llndness commlLLee aL naLlonal level
nea|th Informat|on Departments - AlLhough Lhe scope of Lhese deparLmenLs varles from
counLry Lo counLry, engagemenL wlll be prlmarlly focused on publlc healLh communlcaLlons
acLlvlLles and may also lnclude developmenL of healLh lnformaLlon sysLems.
Nat|ona| D|abetes Assoc|at|ons - where Lhey exlsL, wlll be lnvolved ln naLlonal level
consulLaLlons and coordlnaLlon and publlc awareness acLlvl Lles.
Nat|ona| V2020 ] revent|on of 8||ndness Comm|ttees as Lhe role of Lhese CommlLLees
lncludes coordlnaLlon of all eye healLh programmlng aL naLlonal level and developmenL,
monlLorlng and revlew of naLlonal eye healLh plans and frameworks, Lhey wlll be a key
sLakeholder.
1ra|n|ng |nst|tut|ons - wlll be lnvolved ln provlslon of Lralnlng Lo varlous cadres and
esLabllshlng a reglonal programme Lo Lraln screeners
kesearch |nst|tut|ons]expert|se - Lhe programme wlll faclllLaLe knowledge, ALLlLude and
racLlce and oLher sLudles relaLlng Lo ulabeLlc 8eLlnopaLhy Lo supporL programmlng and
publlc awareness acLlvlLles.
Moorf|e|ds Lye nosp|ta| - Lhere ls Lhe poLenLlal Lo collaboraLe wlLh Moorflelds Lye PosplLal
ln Lhe developmenL of daLa managemenL sysLems.
14a

Cvera|| rogramme Cbject|ve
8educe Lhe lncldence of bllndness due Lo ulabeLlc 8eLl nopaLhy ln CommonwealLh counLrles of
Lhe Carlbbean

rogramme Cverv|ew
rogramme |ocat|on Car|bbean Commonwea|th Countr|es

Countr|es and keg|ons of nASL 1:
a potent|a| programme AnLlgua & 8arbuda
8ellze
uomlnlca
!amalca (SouLhern 8eglon)
nASL 2:
!amalca (WesLern and SouLh LasL 8eglon)
SL klLLs & nevls
SL Lucla
SL vlncenL & Lhe Crenadlnes
Cuyana
8arbados
nASL 3:
8ahamas
Crenada

roposed durat|on S years commenc|ng Iu|y 2014

1he programme w||| focus on the fo||ow|ng key areas:
8eglonal guldellnes developmenL
naLlonal programme proposal developmenL, programme managemenL proLocols and
LreaLmenL and referral proLocols
Advocacy Lo lnclude deLecLlon and LreaLmenL of dlabeLlc reLlnopaLhy as parL of Lhe nCus
naLlonal pollcles and plans.
Advocacy Lo llnk each naLlonal programme wlLh nCus deparLmenL aL Lhe MoP, dlabeLes
assoclaLlon eLc.
Puman resource developmenL
lnfrasLrucLure developmenL
aLlenL screenlng and LreaLmenL
aLlenL educaLlon
8esearch

1h|s programme w||| adopt a phased approach, whereby:
hase 1 counLrles/reglons wlll begln esLabllshmenL of screenlng, LreaLmenL and educaLlon
programmes as soon as posslble. 1hese counLrles have already compleLed slLuaLlon analysls
and have adequaLe levels of human resources and lnfrasLrucLure ln place Lo supporL sLarL up.
lnLroducLlon of screenlng and LreaLmenL ln Lhese counLrles wlll be phased, e.g. by reglon or
healLh faclllLy, Lo ensure approaches can be LesLed, wlLh learnlng conLrlbuLlng Lo evenLual roll-
ouL Lo oLher reglons and faclllLles.
hase 2 counLrles wlll begln wlLh a SlLuaLlon Analysls and are llkely Lo have some human
resource and lnfrasLrucLure requlremenLs ln place, enabllng screenlng, LreaLmenL and
educaLlon programmes Lo begln ln year 2 or 3.
141

hase 3 counLrles - currenL sLaLus unknown. Wlll need Lo begln wlLh slL uaLlon analysls and
llkely Lo need lncreased levels of human resource and lnfrasLrucLure developmenL. AL presenL
Loo llLLle lnformaLlon ls avallable Lo make any programmaL lc proposlLlons.

8y the end of the programme hase 1 & 2 countr|es w||| have estab||shed:
A pollcy framework for screenlng and LreaLlng dlabeLlc reLlnopaLhy ln Lhe Carlbbean
A paLhway for managemenL of dlabeLlc reLlnopaLhy and oLher vlslon relaLed compllcaLlons
arlslng from dlabeLes and dlabeLlc reLlnopaLhy ln each counLry
AdequaLe human resource levels wlLhln Lhe publlc heal Lh sysLem (CovernmenL/nCC) Lo
manage and lmplemenL a susLalnable dlabeLlc reLlnopaLhy screenlng and LreaLmenL
programme (screeners / refracLlonlsLs / opLomeLrlsLs / ophLhalmologlsLs/ blo-med
Lechnlclans, )
lnfrasLrucLure Lo faclllLaLe screenlng and LreaLmenL (publlc healLh faclllLles and equlpmenL)
lmproved daLa managemenL sysLems aL naLlonal and reglonal level

hase 3 countr|es, lf evenLually lncluded, are llkely Lo have compleLed a slLuaLlon analysls and
developed a programme plan and Lhe necessary proLocols. 1hese counLrles wlll be unlquely
placed Lo learn from lmplemenLaLlon ln oLher counLrles and also beneflL from Lhe Lralnlng
lnfrasLrucLure developed.

At reg|ona| |eve| the programme w||| have estab||shed:
A body of evldence, Lhrough research ln Lhe areas of dlabeLes, dlabeLlc reLlnopaLhy,
assoclaLed dlabeLlc eye dlseases, low vlslon and dlabeLl c relaLed bllndness, Lo supporL
advocacy, plannlng and healLh lnformaLlon acLlvlLles
A 8eglonal forum Lo promoLe lnformaLlon and sklll sharlng and dlssemlnaLlon of besL pracLlce
A Lralnlng programme for screeners whlch meeLs lnLernaLlonal sLandards
A range of culLurally relevanL lnformaLlon, LducaLlon & CommunlcaLlon maLerlals Lo lnclude
lnformaLlon on ulabeLlc 8eLlnopaLhy, lnformaLlon for dl abeLlcs on screenlng, lnformaLlon for
healLh professlonal (prlnLed, audlo and oLher formaLs)

rob|ems to be addressed
1he populaLlon of Lhe Carlbbean CommonwealLh counLrle s ls 6.37 mllllon. 1he reglon ls exLremely
dlverse geographlcally, eLhnlcally and economlcally. 8ecause dlabeLes affecLs eLhnlc groups
dlfferenLly, boLh prevalence flgures and Lhe amounL of acLual dlabeLlc eye dlsease varles
slgnlflcanLly LhroughouL Lhe reglon. 1he level of ophLhalmlc experLlse, equlpmenL and Lechnlcal
supporL also varles very wldely.
WlLh Lhe rlslng prevalence of dlabeLes and dlabeLlc eye dlsease ln Lhe Carlbbean lL ls essenLlal Lo
lnLroduce screenlng and LreaLmenL programmes Lo Lackle Lhe problem. 1he prevalence of
dlabeLes among adulLs ln LaLln Amerlca and Lhe Carlbbean varles from counLry Lo counLry.
ln 8arbados, 18 of persons of Afrlcan descenL beLween Lhe ages of 40 and 84, reporL havlng
a hlsLory of dlabeLes, among people wlLh dlabeLes 30 have dlabeLlc reLlnopaLhy. 9 of
dlabeLlcs have cllnlcally slgnlflcanL macular oedema and 1 have advanced dlabeLlc
reLlnopaLhy.
A !amalcan survey ln 2008 lndlcaLed a 7.8 prevalence of dlabeLes among Lhe 13-74 year
olds. 1hls ls probably nearer 10-12 ln Lhose over 40. A prevlous random populaLlon survey
from Spanlsh 1own, !amalca gave an overall prevalence of dlabeLes as 13.4.
A 2013 slLuaLlon analysls from AnLlgua esLlmaLes a dlabeLlc populaLlon of abouL 6000, of
whom 2000 are llkely Lo have dlabeLlc reLlnopaLhy and 400 of whlch mlghL beneflL from laser
LreaLmenL.
142

uomlnlca SLep Survey 2008 ldenLlfled LhaL prevalence of dlabeLes melllLus ln Lhe 13-64 age
group was 17.7 (approx 7,370 persons)
MosL CommonwealLh counLrles ln Lhe Carlbbean have no naLlonal dlabeLlc screenlng and
LreaLmenL programme.

8enef|c|ar|es
8eneflclarles of a Carlbbean ulabeLlc 8eLlnopaLhy rogramme wlll lnclude people wlLh dlabeLes,
Lhose aL rlsk, Lhelr famllles, healLh professlonals and healLh servlce provlders.
1he populaLlon of all counLrles lncluded ln Lhls prop osal ls 3,037,130. 1he average dlabeLes
prevalence ( of populaLlon ages 20 Lo 79) of counLrles lncluded ls 12. 1hls would assume
approx 603,000 of Lhe LoLal populaLlon have dlabeLes. Cf Lhese 30, (181,300 people), are llkely
Lo have ulabeLlc 8eLlnopaLhy.
uue Lo Lhe presenL lack of sLaLlsLlcal lnformaLlon lL l s dlfflculL Lo esLabllsh LargeL beneflclary
numbers.
LsLabllshlng llsLs of persons wlLh dlabeLe s who are belng LreaLed aL lndlvldual healLh care faclllLl es
wlll help Lo esLabllsh more accuraLe flgures. ln addlL lon, and where Lhey exlsL, naLlonal dlabeLlcs
reglsLers wlll also be used Lo gulde plannlng and seLLlng LargeLs aL naLlonal and reglonal level.

A||gnment to 1he ueen L||zabeth D|amond Iub||ee 1rust Cbject|ves
1hls programme wlll enable Lhe 1rusL Lo work wlLh Carl bbean experLlse Lo develop cosL-effecLlve
programmes for screenlng and LreaLlng dlabeLlc reLlnopaLhy whlch wlll uLlllze modern
Lechnologles.
ubllc secLor eye healLh professlonals' skllls wlll be developed ln up Lo 10 counLrles whl ch wlll
sLrengLhen healLh sysLems and conLrlbuLe Lo dellvery of susLalnable dlabeLlc reLlnopaLhy
screenlng and LreaLmenL programmes.
ubllc educaLlon programmes wlll lmprove healLh seeklng behavlour and conLrlbuLe Lo an
lmproved quallLy of llfe for people llvlng ln Carlbbe an CommonwealLh counLrles.

rogramme Approach:
AL naLlonal level, ulabeLlc 8eLlnopaLhy programmes wlll be lnLegraLed lnLo exlsLlng healLh
dellvery sysLems. Servlces wlll be developed or sLrengLhened ln exlsLlng publlc healLh
faclllLles, wlLh servlce dellvery personnel predomlnanLly belng MlnlsLry of PealLh employees.
CounLrles wlLh programmes already underway (uomlnlca) wlll be asslsLed Lo demonsLraLe
success, scale up ln underserved areas, sLrengLhen dellvery and work wlLh oLher governmenLs
and non-governmenLal organlsaLlons Lo share experLlse Lo supporL developmenL of new
programmes.
CounLrles whlch have compleLed slLuaLlon analysls wlll be asslsLed Lo sLrengLhen exlsLlng
servlces and/or lnLroduce, on a phased basls, new servlces ln llne wlLh recommendaLlons and
collaboraLlvely developed naLlonal plans.
CounLrles wlLh no programmes or where levels of screenlng and LreaLmenL are noL know wlll
be asslsLed Lo conducL slLuaLlon analysls Lo esLabllsh b asellnes and ouLllne plans Lo elLher
lnLroduce plloL programmes or sLrengLhen exlsLlng servlces. lloLs wlll be scaled up over Lhe
programme years.
rlmary and secondary publlc healLh faclllLles wlll be equlpped, on a phased basls, Lo screen,
refer and record daLa. ln mosL cases flxed servlces wlll be developed ln preference Lo
underLaklng ouLreach acLlvlLles.
Secondary and/or LerLlary level faclllLles wlll be equlpped, on a phased basls, Lo screen, LreaL
and record daLa.
143

LxlsLlng 8efracLlonlsLs wlll be Lralned as screeners.
1he exlsLlng 8achelor of Sclence ln CpLomeLry course aL Lhe unlverslLy Cf Cuyana wlll be
sLrengLhened and personnel from parLlclpaLlng counLrles wlll be Lralned as CpLomeLrlsLs, ln
order Lo sLrengLhen and expand deLecLlon, Lhereby allowlng CphLhalmologlsLs Lo focus on
LreaLmenL.
A cadre of CpLomeLrlsLs Lralned ln CommunlLy CpLomeLry and oLher publlc healLh dlsclpllnes
wlll be Lralned as Lralners Lo supporL dellvery of a course ln ulabeLlc 8eLlnopaLhy Screenlng, ,
whlch wlll be esLabllshed ln Lhe Carlbbean and wlll meeL lnLernaLlonal sLandards.
8lo-medlcal Lechnlclans, preferably Lhose currenLly ln Lhe employ of MCP, wlll be Lralned Lo
lnsLall, malnLaln and repalr equlpmenL for screenlng and LreaLmenL.
Culdellnes for screenlng and LreaLmenL of ulabeLlc 8eLlnopaLhy wlll be developed or adopLed.
A shorL Lralnlng program wlll be glven Lo parLlclpaLlng ophLhalmologlsLs Lo examlne, deLecL
and LreaL dlabeLlc reLlnopaLhy.
LxlsLlng Lralned ophLhalmologlsLs wlll provlde LreaLmenL, oLher quallfled ophLhalmologlsLs wlll
underLake fellowshlps.
A managemenL commlLLee wlll be esLabllshed Lo oversee and coordlnaLe Lhe programme
1he Carlbbean Councll for Lhe 8llnd wlll manage Lhe pr ogramme aL reglonal and sub-reglonal
level.
MlnlsLrles of PealLh wlll asslgn a programme manager / coordlnaLor aL naLlonal level.
1he programme wlll llase wlLh PealLh lnformaLlon ueparLmenLs and ulabeLlc AssoclaLlons Lo
develop awareness and educaLlon maLerlals LargeLlng general publlc, dlabeLlcs and healLh
professlonals.
1he programme wlll llase wlLh ulabeLlc AssoclaLlons Lo supporL developmenL of dlabeLlc
reglsLers.
uevelopmenL-adopLlon of eye healLh lnformaLlon sysLems Lo faclllLaLe sLorage, reLrleval and
remoLe revlew, dlagnosls and LreaLmenL of dlabeLlc reLlnopaLhy cases
A reglonal forum wlll be esLabllshed Lo promoLe lnformaLlon and sklll sharlng and
dlssemlnaLlon of besL pracLlce. ldeally Lhls should lnc lude parLlclpanLs and donors from Lhe
1rlnldad and 1obago ulabeLlc 8eLlnopaLhy rogramme, represenLaLlve from relaLed
programmes ln Lhe reglon and global Lechnlcal experLlse.
Lessons wlll also be drawn from case sLudles, assessmenLs and evaluaLlons whlch wlll be
publlshed and wldely dlssemlnaLed.

Mon|tor|ng & Lva|uat|on Cverv|ew
A 8eglonal rogramme ManagemenL CommlLLee wlLh parLlclpaLlon of CC8, C88lS and APC
wlll be esLabllshed Lo oversee and coordlnaLe - Lhls wlll lnclude responslblllLles for
monlLorlng.
naLlonal level rogramme ManagemenL CommlLLees wlll also be esLabllshed Lo supporL
lmplemenLaLlon and monlLorlng.
Mld-Lerm and flnal evaluaLlons wlll be carrled ouL by exLernal experLlse.
AssessmenLs of lndlvldual healLh faclllLles wlll be c arrled ouL Lo ensure mlnlmum
requlremenLs are meL (skllls, equlpmenL, procedures, reporLlng).
CuarLerly naLlonal reporLs on screenlng and LreaLmenL wlll be submlLLed Lo reglonal level and
complled (breakdown by gender, age, screened, LreaLed, referred, eLc).
llnanclal and narraLlve reporLs wlll need Lo be coordlnaLed and submlLLed Lo 1he Cueen
LllzabeLh ulamond !ubllee 1rusL every slx monLhs.

144

Susta|nab|||ty
MlnlsLry of PealLh sLaff, healLh professlonals and dl abeLes assoclaLlons wlll be lnvolved from
Lhe ouLseL, l.e. aL SlLuaLlon Analysls sLage, and Lhey wlll Lhen conLlnue Lo be lnvolved Lhrough
plannlng, lmplemenLaLlon and monlLorlng acLlvlLles. 1hl s wlll ensure Lhelr conLlnued
lnvolvemenL ln declslon maklng processes and promoLe local ownershlp.
ersonnel Lo be Lralned (screeners, refracLlonlsLs, opLomeLrlsLs, blo-med Lechnlclans and
ophLhalmologlsLs) wlll predomlnanLly be employed and n omlnaLed by MlnlsLrles of PealLh.
1hey wlll be salarled by MlnlsLrles of PealLh and pr ospecLs for reLenLlon are good.
1reaLmenL servlces wlll be esLabllshed ln publlc healL h faclllLles. ubllc healLh faclllLles wlll
also be able Lo provlde equlpmenL and supplles for bloo d sugar monlLorlng. A cosL recovery
sysLem should be negoLlaLed lnLo dlabeLlc reLlnopaLhy programme relaLed agreemenLs wlLh
MlnlsLrles of PealLh wlLh parL of any lncome generaLed by dlabeLlc reLlnopaLhy servlces
dedlcaLe Lo consumable requlred Lo keep Lhe servlce operaLlonal.
naLlonal rogramme CoordlnaLors / focal persons wlll be MCP employees and naLlonal level
programme managemenL and coordlnaLlon wlll rely heavlly on MlnlsLry of PealLh sLaff and
represenLaLlves of naLlonal organlsaLlons. 1hls wlll promoLe ownershlp aL counLry level.

145

Nat|ona| Informat|on hase 1

Country Lqu|p C|ass 1 Lqu|p C|ass 2 ] 3 1ra|n Lducat|on Data ] Comments
n
A
S
L

1

AN1IGUA
ulabeLes prevalence ( of
populaLlon ages 20 Lo 79)
- 12.83
4 vlslon cenLres wlLh
fundus camera, Lable
and chalrs plus paLlenL
recllnlng chalr equlpped
wlLh ophLhalmlc arm
and baslc refracLlve
sysLem & sllL lamp
where relevanL
CompuLer/lapLop
1 laser and
supporL sysLems
4 exlsLlng refracLlonlsLs
ln screenlng Lechnlques
8lo-med Lech (laser,
camera, eLc.

!"#$%&' )%*
+,)-)%"./"/01*-*
2/.,$-$3- 13 "%*$#
PealLh educaLlon as
per 8ecs 2 & 3 of
AnLlgua u8 SlLuaLlon
Analysls 2013
Work wlLh MCP
and MS!MC Lo
lmprove daLa
managemenL re
eye healLh ln
general. 1hls could
be mapped ouL
wlLhln a naLlonal
Lye PealLh lan
8LLI2L
- 17.37
need Lo esLabllsh lnpuLs from Llons funded
u8 rogramme Lo undersLand whaL
complemenLary equlpmenL and P8u may
be requlred
3 personnel and 4
opLomeLrlsLs ln
screenlng Lechnlques
1 ophLhalmologlsL ln
laser LreaLmenL
camera, eLc.
8ellze wlll sLarL a
u8 programme ln
2013 or 2014 -
need Lo llalse wlLh
8Cvl Lo esLabllsh
lnpuLs requlred
DCMINICA
- 9.03
Carry our formal assessmenL of exlsLlng
uomlnlca u8 programme Lo esLabllsh key
learnlng polnLs, besL pracLlce and currenL
servlce dellvery gaps - plan lnpuLs based
on Lhls assessmenL.
Already has
CphLhalmologlsLs
compeLenL ln laser plus
Lralned u8 programme
sLaff
uocumenL and
publlsh besL pracLlce
from exlsLlng
naLlonal u8
screenlng and
LreaLmenL
programme

146

IAMAICA (Southern
keg|on)
- 13.97

3 parlsh hosplLals wlLh
wlLh ophLhalmlc arm
sysLem & sllL lamp
where relevanL
compuLer/lapLop

1 laser and
supporL sysLems
(Mandevllle)

vlslon CenLre
equlpmenL plus
fundus camera,
paLlenL recllnlng
chalr,
compuLer/lapLop
(Mandevllle)
3 refracLlonlsLs ln
screenlng Lechnlques
(based on exlsLlng
Lralned refracLlonlsL
and 4 Lo be Lralned ln
2013/14)
camera, eLc.
!"#$%&' )%*
+,)-)%"./"/01*-
2/.,$-$3- 13 "%*$#
As per 8ec 3
SlLuaLlon Analysls
2013 - lncrease
awareness of nurses
and docLors re rlsks
of dlabeLlc eye
dlsease

Work wlLh MCP and
healLh lnformaLlon
deparLmenL on
naLlonal and/or
reglonal publlc
awareness
campalgns.

oLenLlal Lo also
work wlLh ulabeLes
Assoc on awareness
LargeLlng dlabeLlcs
As per 8ec 4
SlLuaLlon Analysls
2013 - A general
revlew of currenL
daLa managemenL
pracLlces relaLlng
Lo dlabeLlc
reLlnopaLhy ls
recommended wlLh
a vlew Lo
lmprovlng and
enhanclng
avallablllLy of daLa
on prevalence,
referral raLes,
paLlenL
aLLendance, eLc.

147

Nat|ona| Informat|on hase 2

Country Lqu|p C|ass 1 Lqu|p C|ass 2 ] 3 1ra|n Lducat|on Data
n
A
S
L

2

IAMAICA (Western
keg|on)
- 13.97

wlLh ophLhalmlc arm
sysLem & sllL lamp
where relevanL
compuLer/lapLop
1 laser and supporL
sysLems (Cornwall)
4 personnel as
screeners - Lo be
upgraded Lo
8efracLlonlsLs (1 year
course)
CphLhalmologlsL Lo be
Lralned Lo LreaL wlLh
laser (fellowshlp)
camera, eLc.
As per SouLhern
8eglon
As per SouLhern
8eglon
IAMAICA (Southeast
keg|on)
- 13.97

wlLh ophLhalmlc arm
sysLem & sllL lamp
where relevanL
compuLer/lapLop
2 laser and supporL
sysLems (2 LerLlary
hosplLals)
7 personnel as
screeners - Lo be
upgraded Lo
course)
camera, eLc.
!"#$%&' )%*
+,)-)%"./"/01*-
2/.,$-$3- 13 "%*$#

S1 kI11S & NLVIS
- 8.69
2 healLh cenLres ln SL
klLLs Lo be deslgnaLed
as screenlng faclllLles
and equlpped wlLh ful l
seL of vC equlpmenL
1 laser and supporL
sysLems ln maln
publlc hosplLal
3 personnel as
screeners - Lo be
upgraded Lo
LducaLlon llkely Lo
LargeL healLh
professlonals,
dlabeLlcs and
general publlc
v2020 8eporL 2012
lndlcaLes LhaL a
ulabeLlc
reLlnopaLhy
Servlces slLuaLlon
148

plus fundus camera,
paLlenL recllnlng chalr,
compuLer/lapLop
1 healLh cenLre ln nevls
Lo be deslgnaLed as
screenlng faclllLy and
equlpped wlLh full seL
of vC equlpmenL plus
fundus camera, paLlenL
recllnlng chalr,
compuLer/lapLop
course)
camera, eLc.

4-5 61--*78$91* %"#$%&'
)%* % :/9$#3.$3-
$.,"/'$&
+,)-)%"./"/01*-*
2/.,$-$3- -/ ;*$ "%*$#
analysls was
carrled ouL ln 2011

S1. LUCIA
- 8.37
2 healLh cenLres Lo be
deslgnaLed as screenlng
faclllLles and equlpped
wlLh fundus camera
and oLher relevanL
lnpuLs plus
compuLer/lapLop (Lye
Care SL & vleux lorL)

vlcLorla PosplLal
Lo be deslgnaLed
as screenlng
faclllLy and
equlpped wlLh full
seL of vC
equlpmenL plus
fundus camera,
paLlenL recllnlng
chalr,
compuLer/lapLop
Lqulp Lye Care SL.
Lucla Lo serve as
a LreaLmenL
cenLre wlLh laser
and supporL
sysLems
laser (fellowshlp)
LxlsLlng refracLlonlsLs
Lo be Lralned as
screeners
new refracLlonlsLs Lo
be Lralned 8lo-med
Lech (laser, camera,
eLc.
SlLuaLlon Analysls
requlred (noLe
naLlonal eye healLh
plan 2008-12
lndlcaLes 9000
persons on SL
dlabeLlcs reglsLer)
S1 VINDLN1 & 1nL
GkLNADINLS
- 8.93
ueslgnaLe hosplLal ln
CeorgeLown as a
screenlng cenLres. 8oll
ouL Lo one or 2 on
oLher famlly lslands
Lqulp
CphLhalmology
ueparLmenL
ln klngsLown
CovernmenL
laser (fellowshlp)
camera, eLc.
noLe: SL. vlncenL
and Lhe Crenadlnes
PealLh lnformaLlon
SysLem (SvCPlS)
has already been
149

based on experlence of
flrsL cenLres

hosplLal Lo serve as
screenlng faclllLy
and LreaLmenL
cenLre wlLh laser
and supporL
sysLems
4 personnel as
screeners - Lo be
upgraded Lo
course)
lmplemenLed and
ls belng used aL 36
faclllLles
GUANA
- 16.99
Cn a phased basls,
deslgnaLe 9 exlsLlng
vlslon cenLres as
screenlng faclllLles and
equlp wlLh fundus
camera, paLlenL
recllnlng chalr,
compuLer/lapLop
! CeorgeLown
! ulamond
! WesL uemerara
! Lenora
! Malchoney
! Suddle
! new AmsLerdam or
orL MoranL
! Skeldon
! Llnden
Cn a phased basls,
deslgnaLe and equlp
4 maln reglonal
hosplLals as
LreaLmenL cenLres,
wlLh laser and
supporL sysLems
! Llnden
! CeorgeLown
! orL MoranL
! Suddle
4 CphLhalmologlsL
(one from each
reglonal hosplLal) Lo
be Lralned Lo LreaL
wlLh laser (fellowshlp)
12 exlsLlng
refracLlonlsLs Lo be
Lralned as screeners
uevelop an on-golng
Lralnlng of screeners
course as parL of Lhe
emerglng Lralnlng
programmes for
8efracLlonlsLs and
CpLomeLrlsLs aL
unlverslLy Cf Cuyana
(uslng Lhe ClLy and
Cullds course as Lhe
LemplaLe)
4 8lo-med Lech (laser,
camera, eLc.
needs Lo Lake lnLo
accounL
programme belng
developed wlLh
asslsLance of C88lS
and ensure any
programme plans
or lnpuLs
complemenL
8Ak8ADCS
- 12.71
Cn a phased basls,
deslgnaLe olycllnlcs as
screenlng faclllLles and
equlp wlLh fundus
camera, paLlenL
recllnlng chalr,
camera, eLc.
? personnel as
screeners - Lo be
upgraded Lo
lnfo from 2010 eye
healLh SlLuaLlon
Analysls:
1 reLlnal
speclallsL & ?AC
laser aL CLP.
15a

compuLer/lapLop (noLe
Lhere are 8 governmenL
polycllnlcs - lL may noL
be necessary Lo
esLabllsh all as
screenlng faclllLles)
course)

1 reLlnal
speclallsL and 3
lasers ln prlvaLe
secLor.
All 19
ophLhalmologlsLs
Lralned Lo LreaL
u8
1 fundus camera
ln prlvaLe secLor
no naLlonal u8
screenlng
programme
no naLlonal
dlabeLlcs reglsLer
no referral or
LreaLmenL daLa
avallable
1kINIDAD & 1C8AGC
- 13.03
1rlnldad and 1obago PealLh Sclences lnlLlaLlve (ln parLne rshlp wlLh !ohns Popklns, uWl, MCP and oLher mlnlsLr les) have
a ulabeLes CuLreach rogramme whlch recenLly (2013) launched a u8 screenlng programme, Lralnlng phoLographers and
graders ln an lnLenslve week-long Lralnlng programme led by rofessor uavld Cwens of Cardlff unlverslLy School of
Medlclne and Swansea unlverslLy.
1he programme also plans Lo esLabllsh a CenLre of Lxcell ence Lo lnclude an ophLhalmologlsL and also Lraln prlmary healLh
care workers and opLomeLrlsLs ln dlabeLlc care.
A comprehenslve sLudy of people wlLh dlabeLes and Lhe healLh care servlces Lhey recelve has also been compleLed under
Lhls programme.
Whlle mosL acLlvlLy seems Lo be ln Lhe SouLh WesL 8eglon lL looks llke 1&1 has a slgnlflcanL programme under way and we
would assume lf Lhe model ls successful lL wlll be e xpanded Lo cover Lhe counLry.
CollaboraLlon wlLh Lhls programme ls hlghly recommended Lo share learnlng, skllls and besL pracLlce.

151

Nat|ona| |nformat|on hase 3

Country Lqu|p C|ass 1 Lqu|p C|ass 2 ] 3 1ra|n Lducat|on Data
n
A
S
L

3

8AnAMAS
- 12.40
8ahamas has a ulabeLes AssoclaLlon
and MCP has a dlabeLlc nuLrlLlon
programme - oLher lnformaLlon
hard Lo esLabllsh so no real way of
ouLllnlng any Lype of plan.
GkLNADA
- 8.78
ulabeLlc AssoclaLlon esLabllshed.
no oLher lnfo avallable.

opu|at|on & reva|ence |nfo:

Country op
D|abetes preva|ence ( of popu|at|on ages 20 to
79)
AnLlgua 88,000 12.83
8ahamas 342,000 12.4
8arbados 279,000 12.71
8ellze 322,130 17.37
uomlnlca 79,000 9.03
Crenada 103,000 8.78
Cuyana 761,000 16.99
!amalca 2,721,000 13.97
SL klLLs 32,000 8.69
SL Lucla 171,000 8.37
SL
vlncenL
119,000
8.93
1C1AL S,037,130 Average - 12.03
opu|at|on stats -
hLLp://en.wlklpedla.org/wlkl/Member_sLaLes_of_Lhe_Commonwe
alLh_of_naLlons

reva|ence stats -
hLLp://daLaLoplcs.worldbank.org/hnp/Loplc/non-communlc able-
dlseases

152

Notes:
153

Group 1 V2020 Committees Meeting
Tuesday 3rd December, 2013

Time allocation: Group Work 1hr
Feedback Presentation 10mins

Developing a Diabetic Retinopathy Programme

Presentations and documentation made available to meeting participants has
provided an outline for a potential Diabetic Retinopathy Programme focusing on
Caribbean Commonwealth countries.
A Concept Note has been developed as a first step. Interested stakeholders can
now begin the process of developing this concept further to reach a stage where a
detailed, evidence based and robust funding proposal can be submitted to the
Queen Elizabeth Diamond Jubilee Trust.

Objective of Group Work:
Identify Who (key players) How (process) When (timelines)

Group 1 is invited to discuss the following, with rapporteurs providing key
points in a 10 minute plenary feedback session:
1. Who are the key actors likely to be at national, regional and international level to
ensure development of a detailed, evidence based and robust funding proposal?
2. What are the key stages likely to be in the proposal development process and what
are the associated timelines?
3. What resources will be required throughout the proposal development process?

GROUP 1
FACILITATOR:
Joan McLeod-Omawale
RAPPORTEUR:
Philip Hand
RESOURCE PERSON:
Dr Andrew Cooper

Group 1
154



Learning from others incorporating regional and global
best practice and experience into programme design

A Concept Note has been produced as a first step in the development of a potential
Diabetic Retinopathy Programme focusing on Caribbean Commonwealth countries.
If stakeholders are to undertake a process of developing this concept further, to
reach a stage where a detailed, evidence based and robust funding proposal can be
submitted to the Queen Elizabeth Diamond Jubilee Trust, best practice and the
experiences of others will have to be given due consideration.

Objective of Group Work:
Identify ways of incorporating regional and global best practice and
experience into diabetic retinopathy programme design.

1. What national, regional and/or international diabetic retinopathy service delivery
and training programmes can we learn from?
2. How do we identify reliable, efficient, cost-effective technologies for DR service
delivery which suit the Caribbean context?
3. How do we ensure programme design has meaningful input from diabetics and their
representative associations?

GROUP 2
FACILITATOR:
Dr Shailendra Sugrim
RAPPORTEUR:
Charles Vandyke
RESOURCE PERSON:
Dr Michael Eckstein

Group 2
155



Barriers and solutions exploring challenges to introducing
screening and treatment policy frameworks and to influencing
behavior change.

A Concept Note has been produced as a first step in the development of a potential
Diabetic Retinopathy Programme focusing on Caribbean Commonwealth countries.
If stakeholders are to undertake a process of developing this concept further they
will need to demonstrate a thorough understanding of how policy can guide service
provision and how the programme can influence real behaviour change in the
growing diabetic population.

Objective of Group Work: Identify challenges and possible
solutions to introducing diabetic retinopathy screening and
treatment policy frameworks and to influencing behavior change.

1. What diabetes or diabetic retinopathy policies, procedures and/or quality standards
currently exist which could be adopted or adapted for Caribbean countries?
2. Identify 3 barriers and 3 possible solutions to integration of existing diabetic
retinopathy policies, procedures and standards at national level.
3. On average 12% of the population aged 20 to 79
1
in Caribbean Commonwealth
countries have diabetes. Identify 3 barriers to influencing behavior change in this
large section of the population and outline 3 possible solutions.

GROUP 3
FACILITATOR:
Dr Juan Carlos Silva
RAPPORTEUR:
Keva Richards
RESOURCE PERSON:
Charles O Pierce

1
This is based on the average Diabetes prevalence (% of population ages 20 to 79) for 11 Caribbean Commonwealth
countries - http://datatopics.worldbank.org/hnp/topic/non-communicable-diseases
Group 3
156

PAN AMERICAN HEALTH ORGANIZATION
WORLD HEALTH ORGANIZATION

49th DIRECTING COUNCIL
61st SESSION OF THE REGIONAL COMMITTEE


Provisional Agenda Item 4.15 CD49/19 (Eng.)
22 July 2009
ORIGINAL: ENGLISH

PLAN OF ACTION ON THE PREVENTION OF AVOIDABLE
BLINDNESS AND VISUAL IMPAIRMENT

Introduction

1. In 1979, the Pan American Health Organization (PAHO) Directing Council
approved Resolution CD26.R13 requesting the Director to support governments in the
elaboration of national plans on the prevention of blindness. The regional strategy
document Prevention of Blindness in the Americas (CD34/9) was approved by the
34th Directing Council in 1989. The World Health Organizations Fifty-Sixth World
Health Assembly approved Resolution WHA56.26, which requested the Director to
strengthen WHOs collaboration with Member States on the Global Initiative for the
Elimination of Avoidable Blindness. In Resolution WHA59.25, the Fifty-Ninth World
Health Assembly reaffirmed its commitment to give priority to the prevention of
blindness. Resolution CD47.R1 of the 47th Directing Council urges Member States to
adopt national policies to prevent disability. PAHOs Strategic Plan 2008-2012 (Official
Document No. 328) includes visual impairment and blindness in one of the expected
results. By acknowledging at the global level and in Latin America and the Caribbean
that prevention of blindness and eye care are already priorities, it now becomes necessary
for the coming years to revise and reaffirm the regional objectives regarding the
prevention of blindness.

2. In June 2009, the 144th Session of the Executive Committee recommended that
the Directing Council adopt a resolution as a way to bolster regional and national efforts
to reach the objectives of the Plan of Action for the Prevention of Avoidable Blindness
and Visual Impairment.

157
CD49/19 (Eng)
Page 2

Background

3. Several blindness surveys conducted by PAHO in recent years have demonstrated
that the prevalence of blindness and visual impairment is more than twice as high among
rural and poor populations and that the coverage and quality of eye care services is very
low compared to those among the more wealthy urban areas. In many countries, it is
estimated that for every one million persons, 5,000 are blind and 20,000 are visually
impaired; at least two-thirds of these are attributable to treatable conditions.
1
Visual
impairment and associated disability can lead to discrimination and exclusion, and can
become a cause of poverty. Reducing blindness and visual impairment relieves poverty,
improves opportunities for education and employment of the population, and further
reduces health inequities.

4. Ocular health interventions are achievable, measurable, and cost-effective; in
order to prevent cases of blindness and visual disability in the Region, a full range of
services must be offered which seeks to increase access to eye health services for rural
residents and indigenous groups, women, and segments of the population that are
economically and socially marginalized. In Latin America and the Caribbean, prevention
of blindness and proper eye care already are priorities in many countries. Significant
progress has been achieved in the prevention of avoidable blindness, and access to eye
care services has been increasing in most countries that have received support from
PAHO, international partners, and bilateral cooperation in the development of their
national eye care plans.
2

5. This regional plan of action document was prepared utilizing a very participatory
methodology that included both national and international partners and incorporated the
input of various working groups organized by different countries linked with the global
program at WHO and with the regional programs and plans of diabetes, neonatal care,
health of older persons, and neglected diseases.

Analysis

6. Blindness poses a serious public health, social, and economic problem for the
Regions Member States. Globally, up to 80% of blindness is avoidable: it either results
from conditions that could have been prevented or conditions that may be successfully
treated to restore sight. In spite of international efforts made to date, the burden of
blindness may increase in the future due to population growth and aging. At the country

1
Silva-JC; Bateman-J.B; Contreras F: Eye disease and care in Latin America and the Caribbean. Survey of
Ophthalmology 47(3):267-274; May-June 2002.
2
Pan American Health Organization. Health in the Americas. Health Conditions and Trends. Ocular
Health. Regional Volume. pp.141-142, Washington DC, 2007 at:
http://www.paho.org/HIA/homeing.html.
158
CD49/19 (Eng)
Page 3

level, ministries of health need to develop national ocular health plans, implement these
programs, mobilize the necessary resources to strengthen the supply of eye care services,
and integrate eye care into national health systems and primary health care services, in
order to ensure access to quality eye care by the entire population.

7. Five conditions have been identified as immediate priorities in Latin America.
Cataract is responsible today for close to 50% of global blindness. The prevalence of
blindness in the population aged 50 years and older varies from 2.3% to 3% in national
surveys; it is higher among women than among men;
3
in urban areas of Argentina, it is
1.4%,
4
and it is nearly 4% in rural areas of Peru and Guatemala.
5,6
The proportion of
blindness due to cataract in persons age 50 years and older varied from 39% in the urban
areas of Argentina and Brazil to about 65% in the rural areas of Guatemala and Peru.
National assessments revealed that close to 60% of blindness is due to cataract. Eye care
services coverage for eyes with severe visual impairment is close to 80% in
well-developed urban areas, but it is under 10% in rural and remote areas. Cataract
surgery can be one of the most cost-effective of all health interventions.

8. The prevalence of diabetes among adults in Latin America and the Caribbean
varies from country to country. More than 75% of patients who have had diabetes
mellitus for more than 20 years will have some form of diabetic retinopathy. After
15 years of diabetes, approximately 2% of people become blind, and about 10% develop
severe visual impairment.
7
In Barbados, 18% of persons of African descent between the
ages of 40 and 84, report having a history of diabetes mellitus; among people with
diabetes 30% have diabetic retinopathy and 1% has proliferative diabetic retinopathy. In
the Barbados Eye Studies, open-angle glaucoma (OAG) prevalence in the
Afro-Caribbean population over age 40 years is more than 7%, approximately 2% of
individuals over age 40 are blind and, of that percentage, one-third of the blindness is due
to OAG. Therefore, OAG is a major public health problem in the Afro-Caribbean
population, where it is a major cause of visual loss and the leading cause of irreversible
blindness.
8

3
Limburg H, Barria von-Bischhoffshausen F, Gomez P, Silva JC, Foster A. Review of recent surveys on
blindness and visual impairment in Latin America. Br J Ophthalmol. 2008 Mar;92:315-9.
4
Nano ME, Nano HD, Mugica JM, Silva JC, Montana G, Limburg H. Rapid assessment of visual
impairment due to cataract and cataract surgical services in urban Argentina. Ophthalmic Epidemiology
2006 Jun; 13(3):191-197.
5
Pongo Aguila L, Carrin R, Luna W, Silva JC, Limburg H. Ceguera por catarata en personas mayores de
50 aos en una zona semirural del norte del Per. Rev Panam Salud Pblica 2005; 17(5/6): 387-931.
6
Beltranena F, Casasola K, Silva JC, Limburg H. Cataract blindness in 4 regions of Guatemala: results of
a population-based. Survey. Ophthalmology. 2007 Aug;114(8):1558-63.
7
World Health Organization: Prevention of Blindness from Diabetes Mellitus. Geneva: WHO, 2006.
8
Pan American Health Organization. Technology and Health Services Delivery. Health Services
Organization Series: Eye Diseases in people 40-84. The Barbados Eye Studies: A summary report.
Washington ,DC: PAHO; 2006. (THS/OS/06).
159
CD49/19 (Eng)
Page 4

9. About 3% of the worlds blind population are children. However, because
children have a lifetime of blindness ahead of them, the number of blind person years
resulting from blindness starting in childhood is second only to cataract.
9
In Latin
America and the Caribbean, an estimated 42,000 infants with a birthweight of less than
1,500 g require screening for retinopathy of prematurity (ROP), and 4,300 need treatment
every year. If left untreated, 50% of these babies will become blind.
10
Neonatal
conjunctivitis may represent a risk for blindness in newborns. Good vision is vitally
important for education, and screening at school age is recommended. A study in Chile
revealed that more than 7% of children could benefit from the provision of proper
eyeglasses.
11
The incidence of myopia is higher among 1115-year-olds, and this is the
highest priority age group for interventions in refractive errors.
12
Congenital cataract is a
defect associated with congenital rubella syndrome (CRS). Between 1998 and 2008, the
rubella elimination initiative reduced the number of cases by 98% and is preventing some
6,000 cataracts cases annually in children.

10. Despite major advances in eye care, there is a significant number of persons in all
age groups who cannot have their sight fully restored. The majority of these have some
residual vision that can be enhanced or made more useable and utilized for tasks that
require vision. Low-vision services are aimed at people who have residual vision that can
be used and enhanced by specific aids. The benefits of low-vision care include reduction
of the functional impact of vision loss, facilitation of child education and development,
maintenance of independence and productive activity and enhancement of quality of life.

11. Best practices of the PAHO Prevention of Blindness Program include: developing
national epidemiologic assessments that proved to be a very strong advocacy tool to
secure the necessary political support; giving priority to measurable, cost-effective, and
sustainable interventions, developing international partnerships and alliances with Sight
Savers International, Caribbean Council for the Blind, CBM, International Agency for the
Prevention of Blindness (IAPB), VISION 2020, and academic and research institutions
sharing the same vision, thereby establishing a collective knowledge base and improving
the use of resources and promoting at the national level, partnerships among
governments, donors, civil society, and the private and nonprofit sectors. The
collaboration and partnership around the VISION 2020 global initiative for the
elimination of avoidable blindness, proved to be very effective at the regional and
national level. Bilateral cooperation such as Operacin Milagro from Cuba is

9
Rahi JS, Gilbert CE, Foster A, et al. Measuring the burden of childhood blindness. Br J Ophthalmol
1999;83(4):387-8.
10
Zin A. Reducing Blindness in Premature Babies. Vision For Children; A global overview of Blindness,
Childhood and Vision 2020 The Right To Sight. 2007.
11
Maul E, Barroso S. et. all. (2000) Refractive error study in children: results from La Florida, Chile: Am
J Ophthalmol. Apr; 129(4): 445-54.
12
Mutti DO, Zadnik K, Adams AJ. Myopia. The nature versus nurture debate goes on. Invest Ophthalmol
Vis Sci 1996;37:952-7.
16a
CD49/19 (Eng)
Page 5

substantially increasing cataract surgical services coverage and rising eye care awareness
in several countries.

Goals and Objectives

GOAL 1: REDUCE BLINDNESS AND VISUAL IMPAIRMENT IN ADULTS

Objective 1.1: Reduce cataract blindness
In Latin America and the Caribbean, cataract (opacification of the lens) is the single most
important cause of blindness; cataract surgery has been shown to be one of the most
cost-effective of all health care interventions. Most cataracts are age-related and cannot
be prevented, but cataract surgery with insertion of an intraocular lens (IOL) is highly
effective, providing almost immediate visual rehabilitation.

Indicators
Increase the number of countries that conducted a Rapid Assessment of Cataract
Surgical Services (RACSS) or a Rapid Assessment of Avoidable Blindness
(RAAB) from 9 to 14 by the year 2013.

Reach a cataract surgical rate (CSR) of 2,000 per 1 million population per year in
the majority of countries by the year 2013.

Proposed actions for Member States

1.1.1 Make national assessments of cataract surgical services, including of their
availability, access, affordability, and quality, as well as of their collection and
management of information data.
1.1.2 Measure prevalence of cataract blindness, determine services coverage level, and
identify barriers to access in selected countries.
1.1.3 Develop district-specific cataract service plans with measurable targets that
address equity (availability, accessibility, affordability) and quality of services.
1.1.4 Establish a primary eye care system to detect and refer eye diseases and educate
the population in basic eye care and prevention of blindness.
1.1.5 Develop a human resources development plan for cataract surgical services.
1.1.6 Promote high-quality surgery and ensure satisfactory visual outcomes and patient
satisfaction.
1.1.7 Develop appropriate communication strategies for the target population.

Proposed actions for the Secretariat

1.1.8 Provide technical cooperation for the design of Rapid Assessment of Avoidable
Blindness (RAAB) studies.
161
CD49/19 (Eng)
Page 6

1.1.9 Develop a situation analysis of cataract surgical services at the regional and
national levels.
1.1.10 Advocate and provide technical cooperation in the development and
implementation of national cataract plans.
1.1.11 Mobilize resources with international partners.

Objective 1.2: Reduce the prevalence of blindness from diabetic retinopathy
Evidence-based treatment is available to significantly reduce the risks for blindness and
for moderate vision loss. Clinical studies spanning more than 30 years have shown that
appropriate treatment can reduce the risks by more than 90%.

Indicators
Situation analysis conducted in five selected countries by the year 2013.

At least three of the selected countries integrate early detection and timely
treatment programs for diabetic retinopathy into non-communicable chronic
diseases programs by the year 2013.


1.2.1 Integrate blindness prevention strategies into national diabetes programs and
ensure their incorporation into noncommunicable chronic diseases programs.
1.2.2 Develop public awareness programs that target ethnic groups that are at high risk,
depending on the country, and train primary care physicians to refer patients with
diabetic retinopathy to ophthalmologists.


1.2.3 Perform a situation analysis of the management of diabetic retinopathy in the
Region as a baseline for planning and advocacy.
1.2.4 Conduct national assessments on services for diabetic retinopathy in selected
countries.
1.2.5 Adapt and promote current international clinical guidelines for eye care for
patients with diabetes mellitus, and adapt and promote the WHO principles for
organizing eye health systems for patients with diabetic retinopathy.
1.2.6 Develop education packages and training programs for the general public and
health care providers.

162
CD49/19 (Eng)
Page 7

Objective 1.3: Reduce the incidence of blindness due to open-angle glaucoma (OAG)
in high-risk groups
The PAHO Regional Program and national programs on the prevention of blindness shall
include mechanisms for glaucoma detection and treatment for high-risk segments of the
population, including persons of African descent and the Caribbean population, persons
over 40 years of age, and individuals with a family history of glaucoma.

Indicator
Increasing the number of countries carrying out glaucoma community awareness
programs from three to seven by the year 2013.


1.3.1 Include glaucoma detection as an integral part of comprehensive eye
examinations for persons over 40 years of age.
1.3.2 Ensure that eye care units are properly equipped to provide glaucoma diagnosis
and treatment.
1.3.3 Train professionals to implement existing evidence-based protocols.
1.3.4 Increase awareness among the general population of the importance of regular eye
examinations and glaucoma screening for those over age 40, as well of other risk
factors for glaucoma.
1.3.5 Provide affordable treatments and medications.


1.3.6 Utilize the available epidemiologic information to promote early detection and
treatment in countries with high-risk groups.
1.3.7 Utilize best practices to promote and design public awareness programs and
interventions.
1.3.8 Mobilize technical and financial resources to strengthen the national eye care
services in glaucoma detection and treatment.

163
CD49/19 (Eng)
Page 8

GOAL 2: REDUCE BLINDNESS AND VISUAL IMPAIRMENT IN CHILDREN

Objective 2.1: Reduce blindness in premature babies due to retinopathy of
prematurity (ROP)

Indicator
Increase the number of countries that have a national ROP prevention policy from
7 to 15 by the year 2013.

Prevention of blindness due to ROP is planned on three levels:

(a) Primary prevention: reduce the incidence of ROP through improved prenatal and
neonatal care.
(b) Secondary prevention: early identification of severe cases of ROP in premature
babies in neonatal care through regular examination by skilled ophthalmologists
and timely treatment of those deemed to be high-risk.
(c) Tertiary prevention: restore useful vision in children with retinal complications
through vitreoretinal surgery and/or offer rehabilitation.


2.1.1 Promote systems, networks and protocols for safe neonatal care, adequate referral,
and follow-up.
2.1.2 Promote national ROP policies and sustainable plans.
2.1.3 Elaborate and promote national guidelines and minimal standards.
2.1.4 Train professionals (obstetricians, pediatricians, nurses, and ophthalmologists).
2.1.5 Ensure the availability of the necessary equipment for primary prevention,
screening, and treatment.
2.1.6 Develop curricula for undergraduate and in-service training courses for nurses and
physicians.
2.1.7 Improve the quality of available information on neonatal care.
2.1.8 Produce periodical reports based on local neonatal databases.
2.1.9 Provide ocular prophylaxis of newborns to prevent neonatal conjunctivitis.


2.1.10 Conduct national assessments of needs and resources.
2.1.11 Organize Regional and national workshops to promote advocacy and awareness.
2.1.12 Promote the development of Regional guidelines on neonatal care and ROP
programs.
2.1.13 Identify and provide support to advocacy groups (e.g., parents networks).
164
CD49/19 (Eng)
Page 9

2.1.14 Include standard ROP variables in PAHOs and other available neonatal
databases.

Objective 2.2: Reduce visual disability by detecting and treating uncorrected
refractive errors in schoolchildren

Indicators
Published regional document on principles about refractive errors by the year
2011.

Increase the number of countries implementing a national standard refractive
errors program as part of national eye care policies and plans from 7 to 12 by the
year 2013.

The steps in the provision of refraction services for patients are as follows:

(a) Screening: identification of individuals with poor vision which can be improved
by correction.
(b) Eye examination: to evaluate the condition of the eye and identify coexisting
pathologies requiring care.
(c) Refraction: determine what correction is required.
(d) Dispensing: provide and supply appropriate corrective eyeglasses.
(e) Follow-up: ensure compliance with prescription, care of the eyeglasses, repair or
substitution of spectacles, if needed.


2.2.1 Develop national guidelines for the detection and treatment of refractive errors,
taking into account national realities.
2.2.2 Develop and follow pilot refractive error programs to identify and disseminate
best practices.
2.2.3 Promote the availability of affordable eyeglasses and facilitate their production
through the establishment of low-cost laboratories.
2.2.4 Increase public awareness through information, education, and communication
strategies.


2.2.5 Elaborate regional principles in to guide refractive errors programs.
2.2.6 Standardize technology: screening kit and affordable instruments.
2.2.7 Develop advocacy plan for health and educational authorities.

165
CD49/19 (Eng)
Page 10

GOAL 3: REDUCE THE BURDEN OF BLINDNESS AND VISUAL IMPAIRMENT IN THE
GENERAL POPULATION

Objective 3.1: Provide comprehensive low-vision care and services for persons who
are blind or severely visually impaired
Comprehensive low-vision care integrates clinical eye care, low-vision, rehabilitation,
and educational services at the primary, intermediary, and tertiary levels in each country.
The goal is to have one comprehensive low-vision referral center and four satellite
centers per each 10 million population.

Children who are blind should have access to inclusive education and supportive
services; adults who are blind require rehabilitation (adjustment to blindness) programs to
strengthen their emotional and social capabilities; as well as training in daily living skills,
orientation mobility skills, and vocational training. Insofar as it is feasible, inclusive
education and adjustment to blindness services should be supported by access to adaptive
aids, including devices for reading and writing; white canes; adapted domestic aids; and
low-vision appliances.

Indicator
Increase the number of countries with low-vision services from 20 to 25 by the
year 2013.

Number of countries that are implementing national plans for inclusive education
and adjustment to blindness by 2013.


3.1.1 Develop national policies on comprehensive low-vision care.
3.1.2 Increase access to and demand for comprehensive low-vision services among the
visually impaired population.
3.1.3 Train low-vision teams (eye care, low-vision therapy, rehabilitation, education,
and social services) focusing on underserved geographical areas, taking into
account each countrys unique national profile of such professionals. Priority
should be accorded to the training of low-vision therapists.
3.1.4 Organize courses for residents in ophthalmology in countries with low-vision
services.
3.1.5 Identify early all children and adults who are irrevocably blind and severely
visually impaired and ensure that an effective referral system is in place.
3.1.6 Maximize the participation of children who are blind or severely visually
impaired in education, offering inclusive education programs; provide
rehabilitation (adjustment to blindness) for blind adults.

166
CD49/19 (Eng)
Page 11


3.1.7 Organize low-vision courses at Regional and national congresses of
ophthalmology.
3.1.8 Promote the establishment of resource centers for the training of trainers,
curricula standardization, and technology development.
3.1.9 Support the organization of low-vision centers in underserved geographical areas
and in countries currently without such services.
3.1.10 Develop a system to make low-vision aids affordable.
3.1.11 Conduct a regionwide situation assessment on rehabilitation and education
services for persons who are blind.
3.1.12 Advocate for national intersectoral policies and plans for inclusive education and
for rehabilitation programs for persons who are blind and mobilize technical and
financial resources to respond to the countries needs.

Time Frame

12. This plan of action will be implemented in 2009-2013.

Action by the Directing Council

13. The Directing Council, after reviewing the information provided, is invited to
consider adoption of the resolution recommended by the 144th Session of the Executive
Committee (see Annex B).

Annexes

167

Pan American Sanitary Bureau, Regional Office of the

CD49/19 (Eng.)
Annex A

ANALYTICAL FORM TO LINK AGENDA ITEM WITH ORGANIZATIONAL AREAS
1. Agenda item: 4.15. Plan of Action on the Prevention of Avoidable Blindness and Visual Impairment.

2. Responsible unit: THR - VP

3. Preparing officer: Juan Carlos Silva

4. List of collaborating centers and national institutions linked to this Agenda item:

There are no collaborating centers or national institutions linked to this item of the agenda.

5. Link between Agenda item and Health Agenda for the Americas 2008-2017:

Related Areas: Diminish inequities in health, reduce the burden of disease, increase the access to quality
services.

6. Link between Agenda item and Strategic Plan 2008-2012:

RER. 3.2, Indicator 3.2.6, RER 3.5.

7. Best practices in this area and examples from countries within the Region of the Americas:

CUB, DOM, GUY, PER.

8. Financial implications of Agenda this item:

For the 5-year period (2009-2013) US$ 590,000 will be invested in personnel, and $245,000 in activities.

168


49th DIRECTING COUNCIL
61st SESSION OF THE REGIONAL COMMITTEE


CD49/19 (Eng.)
Annex B
ORIGINAL: ENGLISH

PROPOSED RESOLUTION

PLAN OF ACTION ON THE PREVENTION OF AVOIDABLE BLINDNESS
AND VISUAL IMPAIRMENT

THE 49th DIRECTING COUNCIL,

Having reviewed Document CD49/19 Plan of Action on the Prevention of
Avoidable Blindness and Visual Impairment;

Recalling Resolution WHA56.26 of the World Health Assembly on the
elimination of avoidable blindness;

Noting that visual disability is a prevalent problem in the Region and is related to
poverty and social marginalization;

Aware that most of the causes of blindness are avoidable and that treatments
available are among the most successful and cost-effective of all health interventions;

Acknowledging that preventing blindness and visual impairment relieves poverty
and improves opportunities for education and employment; and

Appreciating the efforts made by Member States in recent years to prevent
avoidable blindness, but mindful of the need for further action,

RESOLVES:

1. To approve the Plan of Action on the Prevention of Avoidable Blindness and
Visual Impairment.
169
CD49/19 (Eng.)
Annex B - 2 -

2. To urge Member States to:

(a) establish national coordinating committees to help develop and implement
national blindness prevention plans;

(b) include prevention of avoidable blindness and visual impairment in national
development plans and goals;

(c) advance the integration of prevention of blindness and visual impairment in
existing plans and programs for primary health care at the national level, ensuring
their sensitivity to gender and ethnicity;

(d) support the mobilization of resources for eliminating avoidable blindness;

(e) encourage partnerships between the public sector, nongovernmental
organizations, private sector, civil society, and communities in programs and
activities that promote the prevention of blindness; and

(f) encourage intercountry cooperation in the areas of blindness and visual
impairment prevention and care.

3. To request the Director to:

(a) support the implementation of the Plan of Action on the Prevention of Avoidable
Blindness and Visual Impairment;

(b) maintain and strengthen PAHO Secretariats collaboration with Member States on
the prevention of blindness; and

(c) promote technical cooperation among countries and the development of strategic
partnerships in activities to protect ocular health.

17a

Pan American Sanitary Bureau, Regional Office of the

CD49/19 (Eng.)
Annex C

Report on the Financial and Administrative Implications for
the Secretariat of the Resolution Proposed for Adoption

1. Agenda item: 4.15. Plan of Action on the Prevention of Avoidable Blindness and Visual
Impairment.

2. Linkage to Program Budget 2008-2009:

(a) Area of work: THR-VP

(b) Expected result: OSER THS.04.01: Normative and operational strengthening of
ocular health and hearing programs.

3. Financial implications

(a) Total estimated cost for implementation over the lifecycle of the resolution
(estimated to the nearest US$ 10,000, including staff and activities): For the
5-year period of 2009-2013, expense on personnel will be of $590,000 and expense
on activities $245,000.

(b) Estimated cost for the biennium 2008-2009 (estimated to the nearest US$ 10,000,
including staff and activities): Personnel: $236.000, activities $98.000.

(c) Of the estimated cost noted in (b), what can be subsumed under existing
programmed activities? All funds are already programmed in activities.

4. Administrative implications

(a) Indicate the levels of the Organization at which the work will be undertaken):
Regional and national levels.

(b) Additional staffing requirements (indicate additional required staff full-time
equivalents, noting necessary skills profile): No.

(c) Time frames (indicate broad time frames for the implementation and
evaluation): Evaluation at the end of 2013.

- - -
171

Wednesday 4
th
December, 2013

Time allocation: Group Work 1hr 05mins

SWOT analysis on the implementation of National Eye
Health Plans

A 2012 report and discussion paper described lessons learnt from implementing the
Action Plan for the Prevention of Avoidable Blindness and Visual Impairment (2009
2013). One of the key lessons learnt is that 'Developing and implementing national
policies and plans for the prevention of avoidable visual impairment remain the
cornerstone of strategic action.'
A number of Caribbean countries have acquired experience in developing and
implementing national policies and plans for the prevention of avoidable visual
impairment. These experiences need to be better documented and disseminated so
that all countries can benefit from them.

Objective of Group Work: Capture experiences of Eye Health
Plan implementation and make recommendations for improvement.

Group 1 is invited to discuss their experiences of implementing National Eye
Health Plans and explore strengths, weaknesses, opportunities and threats,
taking into consideration effectiveness in the following areas:
Integrating eye disease control programmes into wider health care delivery systems.
Human resource development for eye health.
Increasing financial allocations to eye health.
Effective engagement with the private sector.
Care for the most vulnerable communities.
Please make a minimum of 3 recommendations for improvement relating to
implementation of National Eye Health Plans.

GROUP 1
FACILITATOR:
Joan McLeod-Omawale
RAPPORTEUR:
Keva Richards
RESOURCE PERSON:
To Be Determined

Group 1
172

Wednesday 4
th
December, 2013


SWOT analysis on National V2020 Committee function,
stakeholder participation, leadership and communications.

One of the proposed inputs from Member States stated in the Global Action Plan
(Towards universal eye health: 20142019) is to 'Establish new and/or maintain the
existing coordinating mechanisms (e.g. national coordinator, eye health/prevention
of blindness committee, other national/subnational mechanisms) to oversee
implementation and monitoring/evaluating the policies, plans and programmes.'
A number of Caribbean countries have established committees which have acquired
experience in developing, implementing and monitoring national policies and plans
for the prevention of avoidable visual impairment. These experiences need to be
better documented and disseminated so that all countries can benefit from them.

Objective of Group Work: Capture experiences of National V2020
Committees and make recommendations for improvement

Group 2 is invited to discuss their experiences of National V2020 Committees
and explore strengths, weaknesses, opportunities and threats, taking the
following areas into consideration:
Understanding of structure and function of the committee as a whole and the role of
its members (e.g. role of Ministry of Health, NGO's, private sector, etc.)
Ensuring stakeholder participation in planning, implementing and monitoring.
Internal and external communications, e.g. considering frequency of committee
meetings, availability of key documentation (plans, minutes, reports, etc).
Data collection, management and use.
Please make a minimum of 3 recommendations for improvement relating to
V2020 Committees.

GROUP 2
FACILITATOR:
RAPPORTEUR:
Keva Richards
RESOURCE PERSON:
Nurse Juliette Joseph

Group 2
173

Wednesday 4
th
December, 2013


Including Retinopathy of Prematurity (ROP) and Diabetic
Retinopathy (DR) in national policies and plans
Including Cataract Surgery statistics in National Health
Information Systems

Group 1 is invited to discuss the following topics:
How to include Retinopathy of Prematurity (ROP) in national
Neonatal policies and plans
How to include Diabetic Retinopathy in national Non-Communicable
Disease and Diabetes Policies and Plans
How to include Cataract Surgery in the national health information
systems
Groups should consider best practice and experiences of successful
inclusion and also highlight stakeholders, decision makers and resource
requirements.
Rapporteurs will feed back key points in a 15 minute presentation

GROUP 1
FACILITATOR:
Joan McLeod-Omawale
RAPPORTEUR:
Keva Richards
RESOURCE PERSON:
To Be Determined

Group 1
174

Wednesday 4
th
December, 2013


Including Refractive Error in school children in national
policies and plans
Including Primary Eye Care in Primary Health Care
Implementing National Eye Health Surveys

Group 2 is invited to discuss the following topics:
How to include Refractive Error in school children in National Ministry
of Education policies
How to include Primary Eye Care in Primary Health Care
How to resource and implement national eye health surveys
Groups should consider best practice and experiences of successful
inclusion and implementation, while also highlighting stakeholders,
decision makers and resource requirements.
Rapporteurs will feed back key points in a 15 minute presentation.

GROUP 2
FACILITATOR:
RAPPORTEUR:
Philip Hand
RESOURCE PERSON:
Nurse Juliette Joseph

Group 2
175
ueveloplng Lhe Cuyana Lye Care SLraLeglc lramework

"#$ %&'()*+,#' %-.#(/
01+2-)3'+3 45&3&')/1)1.(23 '+, 6)'-71/' %5*7(')(238 6*1#.*319+ :-;)(7 <125(3')8 6*1#.*319+8 6-='+'$

vlSlCn 2020: 1he 8lghL Lo SlghL - Lhe global lnlLlaLlve for Lhe ellmlnaLlon of avoldable bllndness
was launched by Lhe World PealLh CrganlsaLlon (WPC) and Lhe lnLernaLlonal Agency for Lhe
revenLlon of 8llndness (lA8) LogeLher wlLh nCCs. lL was recognlzed LhaL bllndness and low
vlslon are a publlc healLh problem LhroughouL Lhe world. 1he lnlLlaLlve Lhus brlngs LogeLher
governmenLs, WPC, lnLernaLlonal and naLlonal nCCs, as well as assoclaLlons of eye care
professlonals under one banner - Lo ellmlnaLe avoldable bllndness by Lhe year 2020.

Clobal daLa shows LhaL up Lo 80 of bllndness ls av oldable Lhls ls why lL ls lmporLanL LhaL all
naLlonal focus groups wlLhln Lhe counLry can be abl e Lo pool resources LogeLher Lo combaL
avoldable bllndess. 1he vlslon 2020 global lnlLlaLl ve was Lhen spread Lo Lhe reglonal and
naLlonal provlnces whlch were Lasked Lo develop plans of acLlon ln Lhe prevenLlon of avoldable
bllndness and lncluslve servlces. Cur reglon, Lhe Carlbbean vlSlCn 2020 was offlclally launched
ln 1rlnldad-1obago ln Aprll 2000. lurLhermore ln our reglon ln SepLember 2009 Lhe 49Lh APC
ulrecLlng Councll - WPC 61sL Sesslon of Lhe 8eglonal CommlLLee approved Lhe prevenLlon of
bllndness plan of acLlon and passed Lhe resoluLlon. 1hls paved Lhe way for LLhe vlSlCn 2020
Carlbbean sLraLeglc plan lmplemenLed by APC ln all lance wlLh Lhe lA8, SlghLsavers, CC8,
C8M, C88lS and Lhe 8Pvl. ln 2012 APC commlssloned a sLudy of Lhe eye-care secLor ln
Cuyana. 1he reporL - SlLuaLlon Analysls: Lye Care ln Cuyana was used by sLakeholders (lncludlng
CC8-LyeCare Cuyana, APC, SlghLsavers and MlnlsLry of PealLh) aL a plannlng meeLlng ln !uly,
2012 held ln CeorgeLown Lo drafL an Lye Care SLraLeglc lramework for Cuyana.

1he APC 2012 SlLuaLlonal Analysls of Lye Care ln Cuyana
1he SlLuaLlonal Analysls of Lye Care ln Cuyana showed LhaL some lmporLanL sLrldes were
already been made ln areas of Lralnlng and provlslon of servlces LhroughouL Lhe counLry. 1he
collaboraLlve efforL beLween Lhe CovernmenL of Cuba and Lhe CovernmenL of Cuyana called
'Mlsslon Mlracle' reporLs LhaL some 3000 persons were senL Lo Cuba for eye surgery. LaLer ln
2009 Lhe naLlonal CphLhalmology CenLre ln orL MouranL was seL up. ln 2003 a plloL projecL for
vlslon screenlng ln schools was lnlLlaLed. Cuyana now offers a CerLlflcaLe ln 8efracLlon
1echnlques and a 8Sc CpLomeLry rogramme aL Lhe unlverslLy of Cuyana. APC along wlLh
many non-governmenLal organlzaLlons, such as SlghLsavers lnLernaLlonal, C88lS and Carlbbean
Councll for Lhe 8llnd/Lye Care Cuyana have made slgnlflcanL conLrlbuLlons ln Cuyana and have
been worklng Lo achleve Lhe vlslon 2020 goals.

ln 2008, our naLlonal vlslon 2020 CommlLLee was formed buL was laLer dlssolved. 1hereafLer,
focal persons aL Lhe MlnlsLry of PealLh funcLloned ln Lhls capaclLy. WlLh Lhe formaLlon of Lhls
new Lye Care SLraLeglc lramework lL ls hoped LhaL a new vlslon 2020 CommlLLee wlll be
176
relnsLaLed and glven Lhe Lask Lo use Lhe framework Lo offer advlce on Lhe formulaLlon of eye
care pollcy, promoLlon of eye care and prevenLlon of bllndness acLlvlLles and also advocacy ln
relaLlon Lo malnLalnlng naLlonal commlLmenL and lnL ernaLlonal supporL for Lhe prevenLlon of
bllndness

1he documenL hlghllghLed LhaL currenL lnfrasLrucLure of reglonal and naLlonal hosplLals was
commendable buL now requlres an lnflux of new equlpmenL and sLaff wlLh above basls Lralnlng
ln eye healLh. lL also hlghllghLed Lhe need for ongolng Lralnlng aL all levels of eye care servlces.

Lven Lhough Cuyana had made some sLrldes ln some of Lhe Carlbbean 8eglon prlorlLy
performance areas, Lhere remalned conslderable room for lmprovemenL.

Maln flndlngs ln Lhe documenL were caLegorlzed under Lye Care ManagemenL (8oLh ln ubllc
SecLor, rlvaLe SecLor and nCC/volunLary SecLor), lnfrasLrucLure and Servlces ln all eye care
servlces across Lhe board, Puman 8esource dlsLrlbuLlon and CphLhalmlc Care erformance (as
wlLh regards Lo Lhe performance areas (CaLaracL, Claucoma, ulabeLlc 8eLlnopaLhy, 8efracLlve
Lrrors and Low vlslon, 8eLlnopaLhy of remaLurlLy).

naLlonal Lye PealLh SLraLeglc lramework - lannlng Workshop
1he lnlLlal plannlng workshop, whlch recelved Lechnlcal and flnanclal supporL from CC8-LyeCare
Carlbbean/Cuyana, MlnlsLry of PealLh, APC, SlghLsavers and Lhe Luropean unlon was held ln
!uly 2012 ln CeorgeLown. under Lhe leadershlp of Lhe rlnlclpal laclllLaLor, ur !uan Carlos Sllva
(APC/WPC 8eglonal Advlsor on revenLlon of 8llndess), Lhe process of Lhe creaLlon of Lhe
SLraLeglc lramework of Lye Care ln Cuyana was sLarLed. resenL aL Lhls meeLlng lncluded all
major eye care sLakeholders (lncludlng ophLhalmologlsLs, physlclans, opLomeLrlsLs, nurses,
lnLernaLlonal and local Lye Care nCCs, sLudenLs, Lhe unlverslLy of Cuyana, Lhe MlnlsLry of
PealLh eLc.)
AfLer revlew of lnLernaLlonal and reglonal documenLs and Lhe Cuyana SlLuaLlonal Analysls, Lhe
Carlbbean SLraLeglc lramework was used Lo gulde Lhe formaLlon of Lhe local drafL documenL. AL
Lhe concluslon of Lhe workshop and edlLlng sesslons a flnal drafL was agreed upon whlch would
Lhen be furLher developed by an elecLed LdlLlng CommlLLee LhaL wlll lead Lhe documenL Lo
flnallzaLlon and raLlflcaLlon.

Cuyana Lye Care SLraLeglc lramework 2013-2020
Cver Lhe followlng monLhs Lhe edlLlng commlLLee col laboraLed LogeLher Lo verlfy daLa, make
correcLlons/addlLlons Lo Lhe documenL ln consulLaLl on wlLh Lhe prlnclpal faclllLaLor, ur !uan Carlos Sllva.

177
1he documenL was subdlvlded lnLo Lhree major areas as follows:

ln each secLlon of Lhe documenL, currenL sLaLus was brlefly sLaLed (as drawn from Lhe SlLuaLlonal
Analysls of Lye Care ln Cuyana). lmporLanL lssues arlslng from each area were ldenLlfled by Lhe lannlng
Workshop wlLh Lhe expecLed ouLcomes. 1hls creaLed Lhe base for Lhe llsLlng of suggesLed sLraLegles LhaL
needed Lo be lmplemenLed LhaL would form Lhe enLlre naLlonal framework.

llnallsaLlon and 8aLlflcaLlon of Lhe uocumenL
1he LdlLlng CommlLLee held meeLlngs and consulLaLlons wlLh Lhe MlnlsLry of PealLh and Lhe
MlnlsLer of PealLh. 8ased on suggesLlon arlslng from LhaL meeLlng, a few elemenLs ln Lhe documenL
were edlLed and whlch paved Lhe way for Lhe raLlflcaLlon of Lhe documenL by Lhe MlnlsLer of
PealLh. 1he enLlre documenL was presenLed and submlLLed Lo Lhe edlLlng commlLLee of Lhe Cuyana
naLlonal PealLh lan. lL was declded LhaL an abrldged verslon of Lhe documenL would be lncluded ln
Lhe new naLlonal PealLh lan wlLh Lhe compleLe documenL belng appendlclzed as a reference
documenL.

1he MlnlsLry of PealLh and Lhe naLlonal vlslon 2020 CommlLLee can now rely on Lhls documenL as a
gulde when lL comes Lo approachlng eye care dellvery ln Cuyana. lL ls my slncere hope LhaL all
sLakeholders lnvolved ln dellverlng eye care servlces ln Cuyana wlll be able Lo collaboraLe ln all Lhe
areas wlLh regards Lo achlevlng Lhe goals for vlslon 2020.

We are opLlmlsLlc LhaL wlLh furLher experL plannlng, asslsLance and supporL, Cuyana wlll achleve
Lhe objecLlves of Lhe global lnlLlaLlve for Lhe ell mlnaLlon of avoldable bllndness - vlslon 2020: 1he
8lghL Lo SlghL.
178

!"#$%$
'#' ($)'
*+)$+'!,(
-)$.'/0)1
(2013 2020)

M|n|stry of nea|th,
Guyana
179
age | 2

1A8LL CI CCN1LN1S

loreward ................................................... ......... 3
Acronyms ................................................... ......... 4
AcknowledgemenLs ............................................. 4
lnLroducLlon ................................................... ..... 3
8llndness and vlsual lmpalrmenL ln Lhe
Carlbbean ................................................... ......... 3
Cuyana 8ackground ............................................ 6

1. LL CAkL SS1LMS ................................... 7
1.1 CenLral CrganlsaLlon, Leadershlp
and Covernance ....................................... 7
1.2 Lye Care Workforce .................................. 8
1.3 lnfrasLrucLure and Servlces rovlslon ..... 11
1.4. Lye Care lnformaLlon SysLems and
MonlLorlng ............................................. 13

2. DISLASL CCN1kCL AND kLVLN1ICN CI
VISUAL IMAIkMLN1 ............................. 16
2.1 8educe 8llndness and vlsual
lmpalrmenL ln AdulLs ............................... 16
2.1.1 8educe CaLaracL 8llndness ...................... 16
2.1.2 8educe Lhe revalence of 8llndness
from ulabeLlc 8eLlnopaLhy ...................... 17

2.1.3 8educe Lhe lncldence of 8llndness
due Lo Cpen-Angle Claucoma (CAC)
ln hlgh-rlsk groups .................................. 19
2.1.4. 8educe vlsual ulsablllLy by deLecLlng
and LreaLlng uncorrecLed 8efracLlve
Lrrors ln AdulLs ........................................ 20

2.2. 8educe 8llndness and vlsual
lmpalrmenL ln Chlldren ............................ 20
2.2.1 8educLlon of Lhe prevenLable causes
and of LreaLable causes of Chlldhood
8llndness ................................................. 20
2.2.2 8educe vlsual dlsablllLy by deLecLlng
and LreaLlng uncorrecLed 8efracLlve
Lrrors ln school chlldren .......................... 21

2.3. 8educe Lhe lmpacL of 8llndness and
vlsual lmpalrmenL ln Lhe Ceneral
opulaLlon ............................................... 22

3. LL CAkL kCMC1ICN, U8LIC
LDUCA1ICN & ADVCCAC ...................... 23

8lbllography ................................................... ... 23
18a
age | 3

ICkLWCkD

8llndness and vlsual lmpalrmenL are lssues whlch are acLlvely
engaglng Lhe aLLenLlon of Lhe publlc healLh secLor of our naLlon,
as ln oLher parLs of our world. ln Lhls regard lL musL be sLaLed
LhaL LogeLher wlLh our parLners boLh local and lnLernaLlonal,
several lnlLlaLlves have been launched ln an efforL Lo ensure LhaL
Lhe preclous glfL of slghL ls preserved and lf posslble lmproved.
lL ls hearLenlng Lo noLe, as recorded ln Lhe recenL SlLuaLlonal
Analysls of Lye Care ln Cuyana whlch was used Lo produce Lhe
documenL LhaL follows, lmporLanL sLrldes have already been
made ln areas of Lralnlng and provlslon of servlces LhroughouL
Lhe counLry. We are opLlmlsLlc LhaL wlLh furLher experL plannlng,
asslsLance and supporL, Cuyana wlll achleve Lhe objecLlves of Lhe
global lnlLlaLlve for Lhe ellmlnaLlon of avoldable bllndnes s - vlslon
2020: 1he 8lghL Lo SlghL.
1he naLlonal vlslon 2020 CommlLLee operaLes as an advlsory
body under Lhe ausplces of Lhe MlnlsLry of PealLh. 1he
commlLLee conslsLs of key sLakeholders ln eye care lncludlng Lhe
MlnlsLry of PealLh, MlnlsLry of LducaLlon, CeorgeLown ubllc
PosplLal CorporaLlon, Carlbbean Councll for Lhe 8llnd/Lye Care
Cuyana, unlverslLy of Cuyana, an Amerlcan PealLh CrganlsaLlon
[APC] and Lhe prlvaLe secLor. 1he Lask of Lhe commlLLee
lncludes offerlng advlce on Lhe formulaLlon of eye care pollcy,
promoLlon of eye care and prevenLlon of bllndness acLlvl Lles,
advocacy ln relaLlon Lo malnLalnlng naLlonal commlLmenL and
lnLernaLlonal supporL for Lhe prevenLlon of bllndness
8llndness poses a serlous publlc healLh, soclal, and economlc
LhreaL for any CovernmenL. Clobal daLa shows LhaL up Lo 80 of
bllndness ls avoldable (whlch means LhaL persons are bllnd from
condlLlons LhaL could have been prevenLed or condlLlons LhaL
may be successfully LreaLed Lo resLore slghL). 1hls ls why Lhe
MlnlsLry of PealLh welcomes Lhls SLraLeglc Lye Care lramework
for Lhe counLry.
Cuyana ls a slgnaLory Lo Lhe vlslon 2020: 8lghL Lo SlghL lnlLlaLl ve,
whlch was lnLroduced Lo Lhe Carlbbean aL a Workshop held ln
2000, ln 1rlnldad and 1obago. ln 2008, our naLlonal vlslon 2020
CommlLLee was formed. Some 3000 persons were senL Lo Cuba
for eye surgery. 1hls collaboraLlve efforL beLween Lhe
CovernmenL of Cuba and Lhe CovernmenL of Cuyana was called
'Mlsslon Mlracle'. LaLer ln 2009 Lhe naLlonal CphLhalmology
CenLre ln orL MouranL was seL up. ln 2003 a plloL projecL for
vlslon screenlng ln schools was lnlLlaLed. Cuyana now off ers a
CerLlflcaLe ln 8efracLlon 1echnlques and a 8Sc CpLomeLry
rogramme aL Lhe unlverslLy of Cuyana. APC along wlLh many
non-governmenLal organlzaLlons, such as SlghLsavers
lnLernaLlonal, C88lS and Carlbbean Councll for Lhe 8llnd/Lye
Care Cuyana have made slgnlflcanL conLrlbuLlons ln Cuyana and
have been worklng Lo achleve Lhe vlslon 2020 goals.
1he MlnlsLry of PealLh and Lhe naLlonal vlslon 2020 CommlLLee
can now rely on Lhls documenL as a gulde when lL comes Lo
approachlng eye care dellvery ln Cuyana. lL ls my slncere hope
LhaL all sLakeholders lnvolved ln dellverlng eye care servlces ln
Cuyana wlll be able Lo collaboraLe ln all Lhe areas wlLh regards Lo
achlevlng Lhe goals for vlslon 2020.

181
age | 4

!"#$%$
ACkCNMS

8Pvl 8rlen Polden vlslon lnsLlLuLe
CC8/LCC Carlbbean Councll for Lhe 8llnd /Lye Care Carlbbean
CPC CeorgeLown ubllc PosplLal CorporaLlon
lA8 lnLernaLlonal Agency for Lhe revenLlon of 8llndness
lCLvl lnLernaLlonal Councll for LducaLlon of eople wlLh
vlsual lmpalrmenL
lnCC lnLernaLlonal non-CovernmenLal CrganlsaLlons
LPC Llnden PosplLal Complex
MoL MlnlsLry of LducaLlon
MoP MlnlsLry of PealLh
nCu non-Communlcable ulseases
nCuC non-CovernmenLal uevelopmenL CrganlsaLlon
CAC Cpen Angle Claucoma
CSWl CphLhalmologlcal SocleLy of Lhe WesL lndles
AAC an Amerlcan AssoclaLlon of CphLhalmology
APC an Amerlcan PealLh CrganlsaLlon
8L revenLlon of 8llndness
LC rlmary Lye Care
MCC orL MouranL CphLhalmology CenLre
8C 8eLlnopaLhy of remaLurlLy
uC unlverslLy of Cuyana
unC8u unlLed naLlons ConvenLlon on Lhe 8lghLs of ersons
wlLh ulsablllLles
v2020 vlslon 2020
vC vlslon CenLres
W8u World 8llnd unlon
WPC World PealLh CrganlsaLlon
ACkNCWLLDGLMLN1S

1he MlnlsLry of PealLh and Lhe naLlonal vlslon 202 0
CommlLLee of Cuyana would llke Lo exLend our Lhanks Lo all
lndlvlduals and organlsaLlons LhaL conLrlbuLed Lo Lhe
developmenL of Lhe !"#$%#"&'%( *'%(+,", &- .+/ 0%1/ "' 2$+%'%
and Lhe 2$+%'% .+/ 0%1/ !#1%#/3"4 51%6/7&18 (2013 - 2020),
and Lo all Lhose who supporL Lhe dellvery of eye healLh
servlces ln our counLry.

1he !"#$%#"&'%( *'%(+,", &- .+/ 0%1/ "' 2$+%'% and Lhe
2$+%'% .+/ 0%1/ !#1%#/3"4 51%6/7&18 plannlng meeLlngs and
publlcaLlon has been underLaken wlLh flnanclal and Lechnl cal
supporL from:

182
age | 3

IN1kCDUC1ICN

8llndness and low vlslon are a publlc healLh problem
LhroughouL Lhe world, Lhls ls why Lhe World PealLh
CrganlsaLlon (WPC) and Lhe lnLernaLlonal Agency for Lhe
revenLlon of 8llndness (lA8) LogeLher wlLh nCCs have
launched vlSlCn 2020: 1he 8lghL Lo SlghL - Lhe global lnlLlaLlve
for Lhe ellmlnaLlon of avoldable bllndness. 1hls lnlL laLlve LhaL
brlngs LogeLher governmenLs, WPC, lnLernaLlonal and naLlonal
nCCs, as well as assoclaLlons of professlonals ln eye care, alms
Lo deLermlne global, reglonal and naLlonal plans of acLlon ln
prevenLlon of avoldable bllndness and lncluslve servlc es. ln Lhe
Carlbbean vlSlCn 2020 was offlclally launched ln 1rlnldad-
1obago ln Aprll 2000.

1he World PealLh CrganlsaLlon's llfLy-SlxLh World PealLh
Assembly approved 8esoluLlon WPA36.26, whlch requesLed
Lhe ulrecLor Lo sLrengLhen WPC's collaboraLlon wlLh Member
SLaLes on Lhe Clobal lnlLlaLlve for Lhe LllmlnaLlon of Avoldable
8llndness. ln 8esoluLlon WPA39.23, Lhe llfLy-nlnLh World
PealLh Assembly reafflrmed lLs commlLmenL Lo glve prlorlLy Lo
Lhe prevenLlon of bllndness. 1he 144Lh Sesslon of L he an
Amerlcan PealLh CrganlsaLlon - APC LxecuLlve CommlLLee
recommended LhaL Lhe ulrecLlng Councll adopL a resoluLlon as
a way Lo bolsLer reglonal and naLlonal efforLs Lo reach Lhe
objecLlves of Lhe lan of AcLlon for Lhe revenLlon of Avoldable
8llndness and vlsual lmpalrmenL. ln SepLember 2009 Lhe 49Lh
APC ulrecLlng Councll - WPC 61sL Sesslon of Lhe 8eglonal
CommlLLee approved Lhe prevenLlon of bllndness plan of
acLlon and passed Lhe resoluLlon.

ln Lhe year 2010, Lhe vlSlCn 2020 Carlbbean sLraLeglc plan
developed ln 2002 was revlewed and updaLed Lhrough a serles
of ln-house dlscusslons ln APC, as well as Lhrough meeLlngs
wlLh member sLaLes, Lhe lA8, naLlonal and lnLernaLlonal non-
governmenLal organlsaLlons and sclenLlflc socleLles. ln Lhe
Carlbbean, APC lmplemenLed Lhe vlSlCn 2020 lnlLlaLlve ln
alllance wlLh Lhe lA8, SlghLsavers, CC8, C8M, C88lS and Lhe
8Pvl. ln 2012 APC commlssloned a sLudy of Lhe eye-care
secLor ln Cuyana. 1he reporL - SlLuaLlon Analysls: Lye Care ln
Cuyana was used by sLakeholders aL a plannlng meeLlng ln
november, 2012 held ln CeorgeLown Lo drafL an Lye Care
SLraLeglc lramework for Cuyana.

8||ndness and V|sua| Impa|rment |n the
Car|bbean

1he resulLs of Lhe 8arbados Lye SLudy show LhaL 6 of people
40-84 years old have vlsual lmpalrmenL, 1.7 are bllnd or have
vlsual aculLy worse Lhan 6/120 (normal value 6/69: 1he
prlmary causes of bllndness are caLaracL 28, open angle
glaucoma (CAC) 28 and comblned caLaracL and glaucoma
4.

1he prevalence of CAC ln Afro-Carlbbean people over 40 years
of age ls over 7 and lncreases wlLh age. ln Lhe 8arbados Lye
SLudy, CAC affecLed 1 ln 11 Afro-Carlbbean over 30 years of
age, reachlng a prevalence of 1 ln 6 ln Lhose over 70 years old.

ln 8arbados, 18 of persons of Afrlcan descenL beLween Lhe
ages of 40 and 84 reporL havlng a hlsLory of dlabeLes melllLus,
among people wlLh dlabeLes 30 have dlabeLlc reLlnopaLhy,
8.6 of dlabeLlcs have cllnlcally slgnlflcanL macular edema and
1 have prollferaLlve dlabeLlc reLlnopaLhy needlng laser
LreaLmenL.

183
age | 6

1he lncldence of vlsual lmpalrmenL ls hlgh. Age-relaLed
caLaracL and CAC causes approxlmaLely 73 of bllndness
lndlcaLlng Lhe need Lo lncrease caLaracL surgery and early CAC
deLecLlon and LreaLmenL. ConLrolllng ulabeLes MelllLus and
hyperLenslon would prevenL dlabeLlc reLlnopaLhy
compllcaLlons.

Guyana 8ackground

1he esLlmaLed populaLlon ln 2002 was 731,223 persons
1
. uaLa
from Lhe 2002 populaLlon census showed LhaL Lhe largesL
naLlonallLy sub-group ls LhaL of LasL lndlans comprlslng 43.3
percenL of Lhe populaLlon. 1hey are followed by persons of
Afrlcan herlLage (30.2 percenL). 1he Lhlrd ln rank are Lhose of
Mlxed PerlLage (16.7 percenL), whlle Lhe Amerlndlans are
fourLh wlLh 9.2 percenL. CLher groups are WhlLes, orLuguese
and Chlnese (0.04 percenL).

ApproxlmaLely 28 of Lhe populaLlon llves ln urban areas. Cf
Lhe 71 LhaL llve ln rural areas 61 llve ln coasLal areas. Llfe
expecLancy aL blrLh was 67 ln 2009. AdulL llLeracy was 98.
Accordlng Lo Lhe 2011 overLy 8educLlon SLraLegy (8S)
LhlrLy-slx percenL (36) of Lhe populaLlon llve ln absoluLe
poverLy (less Lhan uS$310/year) and 19 llve ln crlLlcal
poverLy (less Lhan uS$364/year).

WlLh Lhe use of Lhe APC supporLed 2012 SlLuaLlonal Analysls
of Lye Care ln Cuyana, a workshop was organlsed ln 2012 by
sLakeholders (lncludlng CC8-LyeCare Cuyana, APC,
SlghLsavers and MlnlsLry of PealLh) Lo develop a drafL SLraLeglc

1
2002, National Population and Housing Census, Guyana National Bureau
of Statistics
lan for Lye Care ln Cuyana. 1he MlnlsLry of PealLh ln Cuyana
has promlsed Lo adopL Lhls plan and Lo have lL lncluded ln Lhe
naLlonal PealLh lan of Cuyana. lL wlll serve as a gulde f or Lhe
plannlng of eye care programs ln Lhe counLry.

184
age | 7

1. LL CAkL SS1LMS

1.1 CLN1kAL CkGANISA1ICN, LLADLkSnI
AND GCVLkNANCL

Cuyana's naLlonal PealLh SecLor SLraLeglc lan (2008-2012)
brlefly ldenLlfled eye healLh as parL of Lhe sLraLegy of LoLal care
Lo persons wlLh chronlc dlseases. Whlle Lhere ls no formal
naLlonal plan for eye care, Lhere have been several lnlLlaLlves
ln Lhe lasL decade LhaL have conLrlbuLed greaLly Lo
lmprovemenL ln Lhls area.
1he vlslon 2020 CommlLLee formed ln 2008 ls a body operaLlng
as an advlsory or execuLlve body under Lhe ausplces of Lhe
governmenL. lL ls headed by Lhe focal polnL for eye care ln Lhe
MlnlsLry of PealLh and makes recommendaLlons on Lhe way
forward ln Lhls area. 1he CommlLLee works ln advlslng Lhe
formulaLlon of Lhe eye care pollcy, promoLlon of eye care and
prevenLlon of bllndness acLlvlLles, advocacy ln relaLl on Lo
malnLalnlng naLlonal governmenL commlLmenL and
lnLernaLlonal supporL for Lhe prevenLlon of bllndness .
1he commlLLee conslsLs of key sLakeholders ln eye care
lncludlng Lhe MlnlsLry of PealLh, MlnlsLry of LducaL lon,
CeorgeLown ubllc PosplLal CorporaLlon (CPC) , Lye Care
Cuyana, an Amerlcan PealLh CrganlsaLlon (APC/WPC),
prlvaLe secLor and nCCs.

Issues:
noL enough aLLenLlon was glven Lo eye-healLh ln Lhe
naLlonal PealLh SecLor SLraLegy 2008-2012
1he 8udgeL for Lye Care ls llmlLed Lo respond Lo Lhe needs
of Lhe secLor
1he vlslon 2020 CommlLLee needs Lo hold more meeLlngs
Lxpected outcome:
rovlde leadershlp and governance LhaL ensures an effecLlve
and equlLable eye care sysLem, lncludlng ensurlng sLraLeglc
pollcy, coallLlon bulldlng and Lhe provlslon of approp rlaLe
regulaLlons, lncenLlves and accounLablllLy.

Nat|ona| Strategy - Centra| Crgan|sat|on,
Leadersh|p and Governance
lnclude eye care ln Lhe naLlonal PealLh SecLor SLraLegy
and naLlonal PealLh lans.
Lnsure a naLlonal SLraLeglc ollcy lramework.
Lncourage Lhe naLlonal CommlLLee Lo asslsL Lhe
MlnlsLrles of PealLh and LducaLlon and oLher
organlsaLlons ln Lhe developmenL of regulaLlons and
plans and ln Lhe lmplemenLaLlon and monlLorlng of
programs.
uevelop annual operaLlonal plans for prlorlLles
ldenLlfled by Lhe MlnlsLry and Lhe naLlonal CommlLLee.
LsLabllsh and keep updaLed an lnformaLlon sysLem for
monlLorlng eye care programs.
Pave a represenLaLlve from Lhe plannlng unlL of Lhe
MCP, and oLher governmenL secLor represenLaLlves
lnvolved ln Lhe naLlonal v2020 CommlLLee.
CbLaln a mandaLory resoluLlon from Lhe MCP Lo
esLabllsh Lhe sLaLus of Lhe naLlonal CommlLLee.
lncorporaLe Lhe Lye PealLh lan lnLo Lhe MCP currenL
naLlonal PealLh SLraLeglc plan.
Lnsure lncluslon of represenLaLlves from oLher reglonal
and lnLernaLlonal bodles wlLhln Cuyana Lo Lhe v2020
commlLLee e.g. unlCLl, APC, SlghLsavers, eLc.

185
age | 8

1.2 LL CAkL WCkkICkCL

Cphtha|mo|og|sts
ub||c Sector - 1here are currenLly 10 ophLhalmologlsLs ln Lhe
publlc secLor:
CeorgeLown ubllc PosplLal CorporaLlon (CPC) - 3
general ophLhalmologlsLs and 1 Claucoma SpeclallsL
LasL 8ank uemerara (L88P - ulamond) - 1 general
ophLhalmologlsL (who does noL perform surgery)
orL MouranL CphLhalmology CenLre (MCC) - 3 general
ophLhalmologlsLs and one speclallsed ln medlcal reLlna.
Llnden PosplLal Complex (LPC) - 1 general
ophLhalmologlsL.
6 of Lhese 10 ophLhalmologlsLs ln Lhe publlc secLor are forelgn
naLlonals - 3 Cuban naLlonals worklng ln Cuyana Lhrough a
parLnershlp wlLh Lhe Cuyana and Cuban governmenLs LhaL
ends ln 2013 and 1 Chlnese naLlonal Lhrough Lhe Cuyana- Chlna
Medlcal Servlces parLnershlp.

r|vate Sector - 1here are 6 general ophLhalmologlsLs ln Lhe
prlvaLe secLor who all operaLe. 3 of Lhese have pracLlces ln
CeorgeLown and 1 ln new AmsLerdam. 2 of Lhe
ophLhalmologlsLs LhaL work ln Lhe publlc secLor are
represenLed ln Lhls flgure.

1ra|n|ng ; Cuyana does noL have an ophLhalmology Lralnlng
programme for docLors. Powever, scholarshlps are offered
jolnLly by CC8-Lye Care Cuyana and Lhe CovernmenL of
Cuyana. Cne fully Lralned ophLhalmologlsL has recenLly
reLurned ln Aprll 2012 afLer beneflLlng from Lhls lnlLlaLlve.
1here are currenLly 2 docLors recelvlng Lralnlng ln LaLln
Amerlca and Lhey are scheduled Lo reLurn ln 2014.

CphLhalmologlsLs are reglsLered by Lhe Medlcal Councll of
Cuyana based on proof of quallflcaLlons provlded. 1hey ar e
requlred Lo reapply for conLlnued reglsLraLlon annuall y.
CpLomeLrlsLs, orLhopLlsLs and opLlclans are also reglsL ered
wlLh Lhe Medlcal Councll of Cuyana.

Cptometr|sts
CurrenLly Lhere are 13 opLomeLrlsLs pracLlclng ln Cuyana.
ub||c Sector - 1wo non-Cuyanese opLomeLrlsLs currenLly
pracLlce ln Lhe publlc secLor. Cne ls a member of Lhe Cuban
Leam and works aL Lhe MCC, Lhe oLher ls based aL Lhe CPC
buL vlslLs all of Lhe oLher vlslon cenLres, excepL MCC. 1hese
vlslLs are done aL leasL once per monLh, buL can be more
frequenL based upon demand. vlslLs are done every 2-3
monLhs Lo Mabaruma, 8eglon 1.

r|vate Sector ; 1hlrLeen opLomeLrlsLs are reglsLered wlLh Lhe
Medlcal Councll of Cuyana ln Lhe prlvaLe secLor ln
CeorgeLown.

1ra|n|ng ; a 8Sc ln CpLomeLry programme was commenced aL
Lhe unlverslLy of Cuyana (uC) ln SepLember 2010 ln
collaboraLlon wlLh Carlbbean Councll for Lhe 8llnd-Lye Care
Cuyana. 1wenLy four (24) sLudenLs comprlsed Lhe flrsL cohorL.

Crthopt|sts and Low-V|s|on ersonne|
1here ls currenLly only one non-Cuyanese person Lralned ln
Lhls area and employed ln Lhe publlc secLor and vlslLs Lhe
vlslon CenLers excepL MCC as requlred.

Cphtha|m|c Nurses
1here are currenLly 17 Lralned nurses and nurslng asslsLanLs
LhaL work ln Lhe area of Lye PealLh ln Lhe publlc secLor.
Powever, Lhere are approxlmaLely anoLher 10 LhaL are Lralned
buL work ln oLher deparLmenLs. ln Lhe prlvaLe secLor, Lhere are
186
age | 9

2 nurses wlLh Lralnlng ln eye care aL a prlvaLe hosplLal ln
CeorgeLown.

1ra|n|ng nurses and nurslng asslsLanLs lnLeresLed ln eye care
are afforded a 6-monLhs on-Lhe-job Lralnlng exposure aL
CeorgeLown ubllc PosplLal CorporaLlon. 1he sLlnL lnv olves
Lhree monLhs each ln Lhe ophLhalmology operaLlng room and
eye cllnlc and Leachlng from a baslc ouLllne.

kefract|on|sts
1here are 12 refracLlonlsLs currenLly worklng ln Lhe publlc
secLor (employed by CC8-LyeCare Cuyana) who operaLe Lhe
12 vlslon cenLres.

1ra|n|ng 1he CerLlflcaLe ln 8efracLlon 1echnlques programme
was sLarLed ln 2006 aL Lhe unlverslLy of Cuyana Lhrough Lhelr
School of rofesslonal uevelopmenL and Lye Care Cuyana. 1o
daLe, 23 persons have been Lralned lncludlng 19 Cuyanese.

Cphtha|m|c Lqu|pment Ma|ntenance staff
1he manager of Lhe 8lomedlcal ueparLmenL aL CPC ls
currenLly Lhe only person wlLh baslc Lralnlng ln repalr of
general ophLhalmlc equlpmenL. Pe beneflLLed from a 2-week
Lralnlng sLlnL ln !amalca ln 2004 LhaL was sponsored by C88lS
lnLernaLlonal. usually machlnery ls callbraLed and repalred by
Lhe company lL was purchased from elLher by reLurnlng lL or
havlng a Lechnlclan come Lo Cuyana.

1eachers
1here are Len Leachers wlLh posL-baslc Lralnlng Lo work wlLh
chlldren who are bllnd/low vlslon - seven ln CeorgeLown, one
ln 8eglon 6 and Lwo ln 8eglon 10.

1ra|n|ng ; An ad hoc formaL of Lralnlng currenLly exlsLs buL
Lhere ls a plan by Lhe MlnlsLry of LducaLlon Lo sLreamllne
Lralnlng ln lncluslve educaLlon for Leachers of sLudenLs who
are bllnd.

Issues
1he currenL raLlo of ophLhalmologlsLs performlng surgery
Lo populaLlon ls 1:83,469
1hls secLor ls heavlly dependenL on forelgn
ophLhalmologlsLs. CurrenLly only 4 are Cuyanese, wlLh
mosL of Lhe oLhers belng Cuban eye healLh personnel on
flxed Lerm appolnLmenLs.
All of Lhe ophLhalmologlsLs currenLly ln pracLlce wor k ln
reglons 4 and 6.
1he currenL raLe of Lralnlng Lhrough scholarshlps equaL e Lo
1/year.
1he raLlo of opLomeLrlsLs Lo populaLlon ls 1:30,081, buL jusL
2 opLomeLrlsLs work ln Lhe publlc secLor and cover reglons.
1here ls a four-year 8achelor Cf Sclence uegree ln
CpLomeLry Lralnlng program aL Lhe unlverslLy of Cuyana.
CurrenL enrolmenL averages 26 ln each cohorL.
1he Lye Care sysLem ls heavlly dependenL on forelgn
human resources whlch ls helpful ln Lhe shorL Lerm buL
may noL be susLalnable ln Lhe long Lerm.

187
age | 10

1ab|e 1: nk d|str|but|on |n the ten adm|n|strat|ve reg|ons:

Lxpected outcome:
Pave a well-performlng healLh workforce, lncludlng sufflclenL
numbers and mlx of sLaff, equlLably dlsLrlbuLed across Lhe
counLry Lo achleve Lhe besL eye care ouLcomes posslble.

kLGICN Cphtha|mo|og|sts Cptometr|sts kefract|on|sts
1 - - 1
2 - - 1
3 - - 1
4 8 14 3
S - - 1
6 3 1 2
7 - - 1
8 - - -
9 - - -
10 1 - 2
1ota| 14 1S 12
Nat|ona| Strategy - Lye Care Workforce
1raln Cuyanese eye surgeons Lo meeL Lhe LargeL raLlo
of 1 for every 30,000 populaLlon, wlLh emphasls on
caLaracL surgery aL publlc secLor faclllLles.
lncrease caLaracL surglcal producLlvlLy (number of
surgerles per year per surgeon).
ldenLlfy and/or Lraln sub-speclallsLs accordlng Lo
naLlonal needs.
uevelop conLlnulng eye healLh educaLlonal programs
for all cadres ln Lhe healLh servlces.
Conslder esLabllshmenL of an CphLhalmology
resldency programme ln Cuyana ln collaboraLlon wlLh
oLher Lralnlng lnsLlLuLlons worldwlde especlally ln L he
Carlbbean and LaLln Amerlca.

Nat|ona| Strategy - Lye Care Workforce
("#$%&$'())
1raln opLomeLrlsLs Lo achleve Lhe currenL unlLed
klngdom raLlo of 1 for every 10,000.
ALLaln and exceed Lhe World Councll of CpLomeLry
sLandards ln Lhe Lralnlng of CpLomeLrlsL, uslng as a
gulde, Lhe unlLed klngdom's four year 8achelor of
Sclence as Lhe flrsL level of quallflcaLlon for pracLlce.
MalnLaln unlverslLy-level Lralnlng programme for
8efracLlonlsLs.
1raln general pracLlLloners and prlmary healLh care
(PC) workers ln prlmary eye care.
uevelop or lmplemenL lnLervenLlons, boLh shorL and
long Lerm, Lo allevlaLe some of Lhe human resource
lssues belng affecLed by Lhe eye healLh sysLem ln
Cuyana.
Llnk eye care and Lhe non-Communlcable ulseases
(nCu) chronlc dlseases LogeLher e.g. lnLegraLe
ulabeLlc 8eLlnopaLhy ln Lhe dlabeLlc program.
PealLh workers ln Lhe nCu secLors need Lo be
educaLed ln relaLlon Lo eye healLh lssues LhaL may
affecL persons wlLh nCus.
uevelop a sLraLegy Lo ensure Lhe regular malnLenance
of eye care (and oLher medlcal) equlpmenL ln hosplLals
and eye healLh cllnlcs
Conslder lmplemenLaLlon of a posL baslc dlploma or
8achelor of Sclence ln Lhe educaLlon of chlldren wlLh
vlsual lmpalrmenL, focuslng on lncluslve educaLlon
sLraLegles ln baslc Leacher speclal educaLlon Lralnlng.
naLlonal Lye Care CommlLLee Lo develop a human
resource monlLorlng sysLem Lo ldenLlfy needs and
propose soluLlons (from nurses Lo ophLhalmologlsLs).

188
age | 11

1.3 INIkAS1kUC1UkL AND SLkVICL
kCVISICN
1here are Lhree key secLors LhaL offer servlces LhaL make up
Lhe eye-care servlces: publlc, prlvaLe and non-governmenLal
secLors. 1ogeLher Lhese provlde Lhe scope of servlces LhaL are
currenLly avallable ln Cuyana.

MllesLones ln lncreaslng Servlces rovlslon:
2007 lnLroducLlon of vlslon CenLres wlLh class 1 eye healLh
personnel (refracLlonlsLs) aL publlc hosplLals lncludl ng:
CPC, new AmsLerdam, WesL uemerara and Llnden.
2009 Cpenlng of Lhe orL MouranL CphLhalmology
Complex ln 8eglon 6.
2011 Lxpanslon of Lhe number of vlslon CenLres Lo 12, an
lnlLlaLlve of CC8- Lye Care Cuyana ln collaboraLlon
wlLh Lhe MCP.

Lye Care System
ubllc healLh care ln Cuyana ls provlded Lhrough a 3-Ll er
sysLem of healLh posLs, healLh cenLres, dlsLrlcL/coLLage
hosplLals, reglonal hosplLals and CeorgeLown ubllc Pos plLal
as Lhe maln referral cenLre for mosL servlces. Lye paLlenLs can
enLer aL any level and should be referred up Lo Lhe nearesL Ller
offerlng Lhe servlce needed. ln reallLy, paLlenLs are ofLen senL
Lo Lhe nearesL hosplLal whlch Lhen refers Lhem furLher on unLll
Lhey flnally arrlve where Lhe servlce ls offered.

1he medlcal offlcer aL Lhe healLh cenLre level may LreaL for
slmple lnfecLlons. Powever, more dlfflculL cases are referred
Lo:

8eglonal PosplLals - (LasL 8ank uemerara and new
AmsLerdam) - provldes ouLpaLlenL, non-surglcal
ophLhalmology servlces on weekdays, new AmsLerdam
offers surglcal servlces.
orL MouranL CphLhalmology CenLre - offers dlagnosLlc
and lnpaLlenL and ouLpaLlenL surglcal servlces Lo adulLs. lL
has 30 lnpaLlenL ophLhalmlc beds, 3 eye operaLlng
LheaLres buL only one ls currenLly ln use. 1here ls a reLlnal
camera and ?AC laser LreaLmenL avallable. 1he reLlnal
phoLocoagulaLlon laser ls noL yeL operaLlonal (awalLlng
machlne parLs). MoP provldes free LransporLaLlon for
paLlenLs from Lhe varlous reglons Lo access servlces aL
orL MouranL.
CeorgeLown ubllc PosplLal CorporaLlon - 1hls faclllLy has
seven ophLhalmlc beds and one eye operaLlng LheaLre. lL
offers 24 hour ophLhalmlc servlces for adulLs and chll dren
lncludlng elecLlve and emergency surgery. 1here ls a
Pumphrey fleld analyzer and vlsual fleld LesLlng ls off ered
Lwlce weekly. 1here are nelLher reLlnal nor corneal
servlces aL Lhe lnsLlLuLlon.
vlslon CenLres - 1here are 12 vlslon CenLres LhaL are
locaLed ln Lhe hosplLals ln 8 of Lhe Len admlnlsLraLlve
reglons (Mabaruma, CharlLy, Suddle, WesL uemerara,
Leonora, CeorgeLown, ulamond, Mahalcony, orL
MouranL, Skeldon, 8arLlca and Llnden) LhaL offer
refracLlon and baslc dlagnosLlc servlces durlng Lhe week.
CpLomeLry servlces are also offered aL leasL monLhly.
aLlenLs requlrlng medlcal LreaLmenL are referred.
vlslon unlLs ln Schools - 1here are currenLly 2 vlslon unlLs
aL schools - one ln 8eglon 10 and one ln CeorgeLown.
1hese provlde educaLlonal supporL Lo school chlldren wlLh
low vlslon/bllndness durlng school hours ln Lhelr
respecLlve regular schools.
189
age | 12

CuLreach AcLlvlLles - 1he MlnlsLry of PealLh Look vlslon
screenlng and medlcal eye care Lo remoLe areas Lhrough
33 eye care ouLreach sesslons ln 2011. aLlenLs ldenLlfled
for surglcal lnLervenLlon were afforded same aL MCC.

1he r|vate nea|th System
1here are Lwo prlvaLe hosplLals, boLh ln CeorgeLown, LhaL
offer ophLhalmologlc servlces:

SL. !oseph Mercy PosplLal - offers ouLpaLlenL cllnlcs Lhree
half-days per week and 24 hour on-call dlagnosLlc and
surglcal servlces. 1here are no dedlcaLed ophLhalmlc beds
or eye LheaLre. Powever, Lhey have operaLlng
mlcroscopes LhaL are used ln Lhelr exlsLlng LheaLres as
needed.
8alwanL Slngh PosplLal - offers ophLhalmology cllnlcs on
weekdays and 24 hour on-call ophLhalmology servlces.
1hey have a reLlnal phoLocoagulaLlon laser and plan Lo
lnLroduce CpLlcal Coherence 1omography (CC1). 1here l s
one eye LheaLre buL no dedlcaLed ophLhalmlc beds.

1here are four prlvaLe pracLlces: Cne ln new AmsLerdam and
Lhree ln CeorgeLown, all offer surglcal ouLpaLlenL servlces.
1hey each have Lhelr own operaLlng mlcroscopes and Lhe one
ln new AmsLerdam also has ?AC laser servlce avallable.

NGC and Vo|untary Sector
Lye Care Cuyana ls Lhe Cuyana chapLer of Lhe Carlbbean
Councll for Lhe 8llnd. 1hey are lnvolved ln many areas of
servlce provlslon wlLhln eye care. CurrenLly, Lhey are
responslble for Lhe day-Lo-day funcLlonlng of 12 vlslon CenLers
ln 8 reglons, provldlng low-cosL specLacles uLlllslng Lhelr own
sLaLe of Lhe arL specLacle lab, provldlng opporLunlLles for
Lralnlng ln 8efracLlon 1echnlques, CpLomeLry and
CphLhalmology Lhrough collaboraLlve efforLs wlLh Lhe
CovernmenL, lncreaslng awareness of eye complalnLs and
dlsablllLy among oLhers.

Issues
Some of Lhe servlces offered ln CeorgeLown are noL
avallable ln mosL of Lhe oLher reglons.
Sub-speclallLy servlces such as reLlnal servlce and corneal
servlces are noL avallable aL CeorgeLown PosplLal.
under-uLlllsaLlon of equlpmenL aL Lhe orL MouranL
CphLhalmology CenLre.
vlslon CenLers are only equlpped and sLaffed Lo perform
refracLlon and baslc eye exams (equlpmenL complemenLs
level of sLaff aL Lhe vC)
LlmlLed Lechnlcal and human resources ln some reglonal
hosplLals (new AmsLerdam, Llnden, Suddle, 8arLlca,
Skeldon eLc).
LlmlLed budgeLary resources for eye care Lo equlp hosplLals
and vlslon cenLres, and Lo supporL lnLegraLlon of eye care
lnLo Lhe prlmary healLh care sysLem.
19a
age | 13

1ab|e 2: D|str|but|on of Cphtha|mo|og|ca| Serv|ces by keg|on and Capac|ty

Iac|||ty keg|on
Cphtha|m|c
8eds
Lye 1heatre Serv|ces
Mabaruma nosp|ta| V|s|on Centre 1 none none
8efracLlon on weekdays, CpLomeLry every 2 -3
monLhs
Char|ty nosp|ta| V|s|on Centre 2 none none 8efracLlon on weekdays, CpLomeLry monLhly
Sudd|e nosp|ta| V|s|on Centre 2 none none 8efracLlon on weekdays, CpLomeLry monLhly
West Demerara keg|ona| nosp|ta|
V|s|on Centre
3 none none
8efracLlon on weekdays, 1onomeLry,
CpLomeLry monLhly
Lenora D|str|ct nosp|ta| V|s|on
Centre
3 none none 8efracLlon on weekdays, CpLomeLry monLhly
GnC Cphtha|mo|ogy Department 4 7 1
Surgery dally, CuLpaLlenL cllnlcs on weekdays,
24 hrs on-call, 1onomeLry, Conloscopy,
Pumphrey's erlmeLry
GnC V|s|on Centre 4 none none
CpLomeLry weekly
D|amond nosp|ta| and V|s|on
Centre
4 none none
CuLpaLlenL cllnlcs on weekdays, 8efracLlon,
1onomeLry, CpLomeLry weekly or forLnlghLly
8a|want S|ngh nosp|ta| 4 none 1
CuLpaLlenL cllnlcs on weekdays, 8efracLlon,
1onomeLry, 8lomeLry, osLerlor SegmenL
Laser, 24 hrs on-call, Surgery
St. Ioseph Mercy nosp|ta| 4 none none
CuLpaLlenL cllnlcs Lhrlce weekly, 24 hrs on-call,
Surgery
Maha|cony nosp|ta| V|s|on Centre 3 none none
CpLomeLry - monLhly
ort-Mourant Cphtha|m|c
nosp|ta| and V|s|on Centre
6 30
3
(1 currenLly ln use)
CphLhalmology CuLpaLlenL cllnlcs dally,
8efracLlon dally, 8lomeLry dally, Corneal
1opography, AdulL elecLlve surgery dally, ?AC
laser
Ske|don nosp|ta| V|s|on Centre 6 none none 8efracLlon on weekdays, CpLomeLry - monLhly
8art|ca nosp|ta| V|s|on Centre 7 none none 8efracLlon on weekdays, CpLomeLry - monLhly
Mackenz|e nosp|ta| 10 none none
CpLomeLry monLhly
191
age | 14

Lxpected outcome:
CpLlmal eye care faclllLles, equlpmenL, lnsLrumenLs and
consumables avallable for Lhe dellvery of eye care servlces.
Nat|ona| Strategy Infrastructure and
Serv|ce rov|s|on
Lnhance lnfrasLrucLure ln Lhe vlslon CenLres Lo be
beLLer equlpped and manned ln order Lo operaLe
beyond baslc eye screenlng Lo lnclude placemenL of
Class 2 eye care pracLlLloners (CpLomeLrlsLs- wlLh
supporLlng equlpmenL) ln all vlslon cenLres
SLrengLhen and expand currenL low vlslon programme
and servlces Lo lnclude lnLroducLlon of servlce aL
dlsLrlcL hosplLals wlLh vlslon cenLres.
Lqulp and sLaff reglonal hosplLals adequaLely so LhaL
Lhey can provlde more Lhan baslc eye servlce
upgrade Lhe currenL servlces of Lhe ueparLmenL of
CphLhalmology, CPC and Lo lnLroduce more sub-
speclallLy servlces
Moblllse resources for a slgnlflcanLly hlgher budgeL for
Lye Care as Lhere are sLlll many areas requlrlng
lnvesLmenL
uevelop a sLraLeglc framework ln Cuyana for
LducaLlon for all chlldren wlLh speclal needs and
commence lLs lmplemenLaLlon by placlng Leachers
wlLh formal posL baslc Lralnlng ln Lhe educaLlon of Lhe
vlsually lmpalred ln aL leasL 4 schools across Guyana
Achleve Lhe developmenL of a Cuyana 8llndness
Servlces SLraLeglc lramework, creaLe and ldenLlfy Lhe
lnsLlLuLlonal framework Lo supporL lLs
lmplemenLaLlon.

192
age | 13

1.4. LL CAkL INICkMA1ICN SS1LMS AND
MCNI1CkING
Lye Care daLa ln Cuyana comes prlmarlly from Lhe
CeorgeLown ubllc PosplLal, orL MouranL CphLhalmology
CenLre, Lye Care Cuyana and wlLh llmlLed reporLlng from Lhe
prlvaLe secLor. 1he MlnlsLry of PealLh lnformaLlon deparLmenL
collecLs reporLs on number of paLlenLs seen aL CPC and aL
Lhe MCC and also paLlenLs seen durlng varlous eye screenlng
programmes across Lhe enLlre counLry.

uaLa on caLaracL surgerles done aL boLh Lhe CPC and MCC
ls also avallable. 1he CeorgeLown ubllc PosplLal Corpor aLlon
keeps daLa arlslng from servlces offered aL Lhe ueparLmenL of
CphLhalmology and Lhe CphLhalmology 1heaLre. uaLa from
Lhese sources was used ln Lhe SlLuaLlonal Analysls and ls also
used as reference ln oLher parLs of Lhls documenL.

Issues
lnsufflclenL daLa on ouLpuLs and ouLcomes of servlces Lo
supporL plannlng, monlLorlng, advocacy and reporLlng.
1here ls no naLlonal eye-healLh daLabase for Lhe collecLlon,
sLorage and use of performance and oLher relaLed daLa.
1hls daLabase should lnclude Lhe causes of vlsual
lmpalrmenL and bllndness ln school chlldren.

Lxpected outcomes:
lnclude eye care ln Lhe naLlonal plannlng, healLh and educaLlon
lnformaLlon sysLem.

Nat|ona| Strategy Lye Care Informat|on
Systems and Mon|tor|ng
ldenLlfy mechanlsms Lo lnclude eye care ln Lhe
presenL PealLh ManagemenL lnformaLlon SysLem
uevelop daLa managemenL sysLems for eye care:
daLa collecLlon, compllaLlon, reporLlng and analysls
8evlew exlsLlng healLh sysLems Lo bulld on Lhose
sysLems for an lmproved daLa managemenL sysLem
(LhaL ls, uLlllzaLlon of daLa from vlslon cenLers)
lnLegraLe and lnclude Lhe collecLlon of eye healLh
daLa lnLo Lhe MlnlsLry's naLlonal PealLh Survelllance
SysLem and effecLlvely monlLor eye care lnformaLlon
uslng besL pracLlces
ConducL perlodlc evaluaLlon of eye care, dlssemlnaLe
flndlngs Lo approprlaLe sLakeholders and uLlllze
lnformaLlon for plannlng.

193
age | 16

2. DISLASL CCN1kCL AND kLVLN1ICN
CI VISUAL IMAIkMLN1

1he mosL prevalenL causes of bllndness ln Lhe Carlbbean are
non-operaLed caLaracL and glaucoma, followed by dlabeLlc
reLlnopaLhy and uncorrecLed refracLlve errors. Chlldhood
bllndness ls noL as prevalenL, buL ls a maln cause of bl lndlng
years ln Lhe populaLlon. An lmporLanL percenLage of bl lndness
ln Lhe Carlbbean reglon ls avoldable (prevenLable or curable).

CaLaracL and dlabeLlc reLlnopaLhy can be cured wlLh relaLlvely
lnexpenslve surglcal LreaLmenLs, refracLlve errors are
correcLable wlLh slmple opLlcal devlces, and prevenLaLlve
sLraLegles and effecLlve referral sysLems can reduce Lhe
burden of chlldhood bllndness. 1he appllcaLlon of new
Lechnology can be used ln Lhe fuLure Lo lmprove Lhe deLecLlon
and LreaLmenL of glaucoma.

Cuyana has made efforLs Lo develop Lhe flve performance
areas whlch were ldenLlfled as a prlorlLy ln Carlbbean
LerrlLorles - CaLaracL, Claucoma, ulabeLlc 8eLlnopaLhy,
8eLlnopaLhy of remaLurlLy, 8efracLlve Lrrors and Low vlslon.

2.1 keduce b||ndness and v|sua|
|mpa|rment |n adu|ts

2.1.1 keduce Cataract 8||ndness

ln Lhe Carlbbean, caLaracL (opaclflcaLlon of Lhe lens) ls Lhe
mosL prevalenL cause of bllndness, caLaracL surgery has been
shown Lo be one of Lhe mosL cosL-effecLlve of all healLh care
lnLervenLlons. MosL caLaracLs are age-relaLed and cannoL be
prevenLed, buL caLaracL surgery wlLh lnserLlon of an
lnLraocular lens (lCL) ls hlghly effecLlve, provldlng almosL
lmmedlaLe vlsual rehablllLaLlon.

ln Cuyana for Lhe year 2011, 1064 caLaracL operaLlons were
performed ln Lhe publlc secLor: 373 aL CPC and 489 aL orL
MouranL PosplLal by Lhe Cuban Leam. ApproxlmaLely, 630
caLaracL operaLlons were performed ln Lhe prlvaLe secLor
reachlng a caLaracL surglcal raLe of 2281/ mllllon populaLlon ln
2011.

Issues
lnsufflclenL daLa avallable on Lhe level of publlc awareness
of caLaracL and publlc knowledge on how lL can be recLlf led
wlLh a sLralghLforward surglcal procedure.
Plgh proporLlon of caLaracL surgery ls dependenL on
bllaLeral cooperaLlon.
lnsufflclenL lnformaLlon on ouLpuLs and ouLcomes ln p ubllc
secLor, prlvaLe secLor and bllaLeral cooperaLlon lnlLlaLl ves.
no lnsLlLuLlon or prlvaLe ophLhalmologlsL ls currenLl y
uLlllzlng a caLaracL ouLcome monlLorlng Lool/sysLem.
lnadequaLe access of rural populaLlon Lo servlce cenLres.
lnsufflclenL caLaracL cenLres dlsLrlbuLed LhroughouL Lhe
counLry.

Lxpected Cutcome
rovlde caLaracL surglcal servlces aL a raLe adequaLe Lo
ellmlnaLe any backlog of caLaracL, aL a prlce LhaL ls affordable
for all people, boLh rural and urban and wlLh hlgh succe ss raLe
ln Lerms of vlsual ouLcome.

194
age | 17

2.1.2 keduce the reva|ence of 8||ndness
from D|abet|c ket|nopathy

ulabeLes causes weakenlng of Lhe blood vessels ln Lhe body.
8eLlnal blood vessels are parLlcularly suscepLlble and
weakenlng of Lhese blood vessels, accompanled by sLrucLural
changes ln Lhe reLlna, ls Lermed as dlabeLlc reLlnopaLhy.
ulabeLlc reLlnopaLhy ls sympLomless ln lLs early sLage and eye
examlnaLlons/screenlng ls Lhe only way Lo ldenLlfy Lhose
affecLed Lo prevenL Lhem from golng bllnd. Lvldence-based
LreaLmenL ls avallable Lo slgnlflcanLly reduce Lhe rlsks of
bllndness and of moderaLe vlslon loss. Cllnlcal sLudle s spannlng
more Lhan 30 years have shown LhaL approprlaLe LreaLmenL
wlLh laser can reduce Lhe rlsks by more Lhan 90.

1he prevalence of u8 of any sLage varles greaLly beLween
sLudles, even amongsL conLemporary dlabeLlc populaLlons ln
Lhe same counLry buL ls llkely up Lo 40 and slghL LhreaLenlng
dlsease ls presenL ln up Lo 10
2

Accordlng Lo Lhe SlLuaLlonal Analysls of Lye Care ln Cuyana,
Lhe prevalence of dlabeLes ln Cuyana ls esLlmaLed aL 6.2 of
Lhe populaLlon. Powever, more recenL daLa esLlmaLes Lhe
prevalence of dlabeLes ln Lhe adulL populaLlon (20 Lo 79 years)
Lo be 13.3 (APC, 2013).
1oLal populaLlon (20 Lo 79 years) 428,000
1oLal populaLlon wlLh dlabeLes (13.3 of populaLlon) 63,000
1oLal u8 aL any sLage (40 of dlabeLlcs) 26,000
1oLal slghL LhreaLenlng u8 (23 of dlabeLlcs) 6,300
Cf Lhe 16,000 paLlenLs seen aL Lhe Lye Care ueparLmenL, CPC
ln 2012, approxlmaLely 2,300 were dlabeLlcs.

2
Clinical Ophthalmology, Kanski and Bowling 2011
roposed Act|ons keduce Cataract
8||ndness
Make regular naLlonal assessmenLs of caLaracL surglcal
servlces, lncludlng avallablllLy, access, affordablllLy and
quallLy, as well as collecLlon and managemenL of
lnformaLlon and daLa. AssessmenL meLhodologles llke
8apld AssessmenL of Avoldable 8llndness (8AA8) or 8apld
AssessmenL of CaLaracL Surglcal Servlces (8ACSS) should
be uLlllzed.
LsLabllsh CphLhalmology cllnlcs aL: Llnden and Suddle
uevelop counLry and dlsLrlcL-speclflc caLaracL servlce plans
wlLh measurable LargeLs LhaL address equlLy (avallablllLy,
accesslblllLy, affordablllLy) and quallLy of servlces.
lncrease resources for caLaracL surgery (flnanclal, P8,
equlpmenL eLc).
Lnsure eye healLh servlces are lnLegraLed lnLo a prlmary
healLh care sysLem Lo deLecL and refer people wlLh
caLaracL and eye dlseases. (8eferral sysLem should be
reflned so noL Lo overload Lhe sysLem wlLh unnecessary
referrals, Lhls lnvolves effecLlve screenlng programs and
Lralned personnel focuslng on prlorlLles).
romoLe hlgh-quallLy surgery and ensure saLlsfacLory
vlsual ouLcomes and paLlenL saLlsfacLlon (8ecommend
uslng monlLorlng Lool).
laclllLaLe cllnlc and populaLlon based knowledge, aLLlLudes
and pracLlces surveys relaLlng Lo caLaracL.
uevelop approprlaLe evldence based communlcaLlon
sLraLegles for Lhe LargeL populaLlon- vlz. adulLs 30 years
and older (CommunlLy approach has been proven ln oLher
communlLles Lo be effecLlve).
Lnsure remoLe areas recelve regular eye healLh servlces
(caLaracL) whlch can be done Lhrough frequenL ouLreach
programs.

195
age | 18

Issues
non-exlsLence of servlces for u8 LreaLmenL ln Lhe publlc
secLor. 1here ls one reLlnologlsL buL Lhere ls no worklng
equlpmenL for reLlnal laser phoLocoagulaLlon. Cne laser l s
avallable aL orL MouranL buL lL ls noL currenLly ln use. ln
2008 Lhe 8alwanL Slngh PosplLal acqulred a 8eLlnal
hoLocoagulaLlon Laser. 1hls ls however llmlLed Lo prl vaLe
and paylng paLlenLs.
Lye care screenlng noL currenLly lncluded lnLo llmlLed nCu
early deLecLlon programs
1here ls no acLlve deLecLlon - screenlng and referral
sysLems. ulglLal reLlnal phoLography ln Lhe publlc secLor ls
avallable only aL MCC buL noL used for screenlng
Comprehenslve communlcaLlve sLraLeglc approach needs
Lo be sLrengLhened
lnsufflclenL daLa on Lhe level of publlc awareness relaL lng
Lo cause and prevenLlon of bllndness due Lo dlabeLes.
lnsufflclenL daLa on Lhe level of awareness and knowledge
of PC pracLlLloners, general physlclans and lnLernlsLs
regardlng Lhelr role ln Lhe prevenLlon of bllndness due Lo
dlabeLes.
Lxpected Cutcome
lmplemenL early deLecLlon, referral and LreaLmenL servlces for
dlabeLlc reLlnopaLhy

roposed Act|ons keduce the
reva|ence of 8||ndness from D|abet|c
ket|nopathy ("#$%&$'())
lnLegraLe bllndness prevenLlon sLraLegles lnLo
naLlonal dlabeLes programs and ensure Lhelr
lncorporaLlon lnLo non-communlcable chronlc
dlseases programs of Lhe MlnlsLry of PealLh.
Lncourage sLraLegles for prevenLlon, early deLecLlon
and effecLlve LreaLmenL of dlabeLes and
hyperLenslon, whlch wlll prevenL compllcaLlons LhaL
lead Lo bllndness.
laclllLaLe Lhe lmplemenLaLlon of cllnlc and populaLlon
based knowledge, aLLlLudes and pracLlces surveys on
ulabeLes and ulabeLlc 8eLlnopaLhy.
uevelop publlc awareness programs for LargeLed hlgh
rlsk populaLlon groups wlLhln Lhe comprehenslve
communlcaLlon plan.
LsLabllsh approprlaLe referral cenLres Lo dlagnose
and LreaL u8.
Lnsure laser LreaLmenL servlces for dlabeLlc
reLlnopaLhy are avallable, accesslble and affordable
aL MCC and CPC.
LsLabllsh screenlng servlces Lo deLecL and refer
LreaLable dlabeLlc reLlnopaLhy, lncludlng aL vlslon
cenLres locaLed ln coLLage and dlsLrlcL hosplLals.
LsLabllsh referral sysLems from servlces for dlabeLlcs
Lo Lhe ophLhalmologlcal servlces.
196
age | 19

2.1.3 keduce the Inc|dence of 8||ndness due
to Cpen-Ang|e G|aucoma (CAG) |n
h|gh-r|sk groups

CAC ls a major publlc healLh problem ln Lhe populaLlon , where
lL ls a major cause of vlsual loss and Lhe leadlng cause of
lrreverslble bllndness. vlslon 2020 programs need Lo lnclude
mechanlsms for glaucoma deLecLlon and LreaLmenL for hlgh-
rlsk segmenLs of Lhe populaLlon, lncludlng persons of Afrlcan
descenL, persons over 40 years of age, and lndlvlduals wlLh a
famlly hlsLory of glaucoma.
Accordlng Lo a 2009 Cuyanese sLudy by errelra-8oach and
norLon
3
, 9 of paLlenLs presenLlng Lo Lhe Lye Cllnlc, CPC are
llkely Lo have a dlagnosls of slmple open angle glaucoma.
unofflclal daLa shows LhaL Lhe Lye Cllnlc recorded 278 newly
dlagnosed cases of glaucoma ln Lhe year 2011.
1here ls no naLlonal screenlng program for glaucoma. Some
awareness ls done durlng Claucoma Week and around World
SlghL uay by boLh Lhe MlnlsLry of PealLh and nCCs. 1here has
been an lncrease ln Lhe range of glaucoma medlcaLlons
avallable, all medlcaLlons for glaucoma are provlded free of
charge ln Lhe publlc secLor.

Cuyana has made prevlous efforLs Lo ralse publlc awareness
buL currenLly Lhere are no susLalned year-round awareness
programs.

Issues
Plgh dlsease frequency ln Lhe populaLlon.
LlmlLed avallablllLy of senslLlve and speclflc screenlng
meLhods aL reasonable cosL.

3
Epidemiology of Glaucoma in Guyana, Perreira-Roach, Norton, 2009
1here are no ouLreach programs Lo deLecL glaucoma.
LaLe deLecLlon and poor compllance.
Plgh cosL of Lhe medlcaLlon ln Lhe prlvaLe secLor or for
Lhose noL served by Lhe publlc sysLem.
Lack of on-golng publlc awareness of Lhe need for people
over 40 years of age Lo geL Lhelr eyes checked for
glaucoma.

Lxpected Cutcome
Larly deLecLlon and LreaLmenL of CAC ln hlgh rlsk groups .

roposed Act|ons keduce the Inc|dence
of 8||ndness due to Cpen-Ang|e
G|aucoma (CAG) |n h|gh-r|sk groups
lnclude glaucoma deLecLlon as an lnLegral parL of
comprehenslve eye examlnaLlons for persons over 40
years of age.
Lnsure prlmary eye care personnel are Lralned Lo
ldenLlfy paLlenLs wlLh hlgh rlsk facLors and Lo refer
Lhem Lo Lhe approprlaLe servlce cenLre.
Lnsure LhaL eye care unlLs have Lhe capaclLy
equlpmenL (porLable LonomeLers llke Lonopens,
perlmeLers, ophLhalmoscopes) and human resource
Lo provlde glaucoma dlagnosls and LreaLmenL.
laclllLaLe cllnlc and populaLlon based kA8 surveys
regardlng glaucoma.
lncrease awareness among Lhe general populaLlon of
Lhe lmporLance of regular eye examlnaLlons and
glaucoma screenlng for Lhose over age 40, as well as
oLher rlsk facLors for glaucoma.
rovlde affordable LreaLmenL and medlcaLlons.
197
age | 20

2.1.4. keduce V|sua| D|sab|||ty by detect|ng
and treat|ng uncorrected kefract|ve
Lrrors |n Adu|ts
1he 8arbados Lye SLudles found hlgh prevalence of myopla
and hyperopla ln adulLs. MosL adulLs over 40 years of age
suffer presbyopla. 1he CovernmenL of Cuyana and Lhe
subscrlbers of Lhe naLlonal lnsurance Scheme are provlded
wlLh subsldles for cosL of specLacles. 1he CC8-Lye Care Cuyana
programme, Lhrough lLs vlslon CenLres has been provldlng
low-cosL specLacles Lo Lhe general publlc.

Issues
Many paLlenLs of low socloeconomlc sLaLus cannoL afford
specLacles.

2.2. keduce b||ndness and v|sua|
|mpa|rment |n ch||dren

2.2.1 keduct|on of the preventab|e causes
and of treatab|e causes of Ch||dhood
8||ndness

Whlle daLa ls llmlLed, Lhe followlng causes of chlldhood
bllndness have been reporLed ln Lhe Carlbbean 8eglon:
8eLlnopaLhy of remaLurlLy (8C), caLaracL and glaucoma ln
chlldren.

CPC has Lhe only neonaLal lnLenslve Care unlL. unofflclal
records for Lhe year 2011 showed 44 bables LhaL were 1300g
or less survlvlng Lo dlscharge.

Issues
1here ls no slLuaLlon analysls of 8C servlces.
1here ls no 8eLlnopaLhy of remaLurlLy prevenLlon pollcy ln
Lhe publlc secLor buL Lhe usual pracLlce ls Lo refer all
premaLure bables for an eye examlnaLlon.
1here are no professlonals Lralned Lo LreaL 8C (aLlenLs
examlned and found wlLh 8C are referred for overseas
LreaLmenL).
1here are no sLaLlsLlcs on 8C.

Lxpected Cutcome
rovlde servlces Lo deLecL and LreaL chlldren wlLh 8eLlnopaLhy
of remaLurlLy, congenlLal caLaracL, congenlLal glaucoma
and oLher non-bllndlng eye problems, such as sLrablsmus and
Lrauma.
roposed Act|ons keduce V|sua|
D|sab|||ty by detect|ng and treat|ng
uncorrected kefract|ve Lrrors |n Adu|ts
Lnsure LhaL refracLlon and specLacles are accesslble,
avallable and affordable Lo adulLs and chlldren
laclllLaLe cllnlc and populaLlon based knowledge,
aLLlLude and pracLlces surveys regardlng refracLlve
errors
lncrease publlc awareness Lhrough lnformaLlon,
educaLlon, and communlcaLlon sLraLegles.
198
age | 21

2.2.2 keduce v|sua| d|sab|||ty by detect|ng
and treat|ng uncorrected kefract|ve
Lrrors |n schoo| ch||dren
revalence of refracLlve errors ln chlldren varles accordlng Lo
Lhe eLhnlc group: lor myopla, Aslans had Lhe hlghesL
prevalence (18.3), followed by Plspanlcs (13.2), Afrlcan
Amerlcans (6.6) and whlLes (4.4). lor hyperopla, whlLes
had Lhe hlghesL prevalence (19.3), followed by Plspanlcs
(12.7), Aslans and Afrlcan Amerlcans had 6.4. lor
asLlgmaLlsm, Aslans and Plspanlcs had Lhe hlghesL prevalence
(33.6 and 36.9, respecLlvely, Afrlcan Amerlcans had Lhe
lowesL prevalence of asLlgmaLlsm (20.0), followed by whlLes
(26.4). 1he prevalence of myopla lncreases wlLh age ln all
eLhnlc groups.

ln Cuyana Lhere ls a naLlonal rogram for vlslon Screenlng ln
Schools LhaL commenced ln 2003. lL ls a collaboraLlve efforL of
Lhe MoP, MoL, APC, LyeCare-Cuyana and unlCLl. Accordlng
Lo Lhe 2004 Screenlng roLocol, chlldren ln Crades 1 and 6
undergo a vlsual aculLy check and Lhose wlLh 20/40 vlslon or
less are referred for furLher examlnaLlon. 1eachers, parenLs
and healLh workers ln Lhe school area are Lralned so Lhey can
conLlnue screenlng as needed. 1here are currenLly some 70-80
schools LhaL have beneflLLed from Lhls efforL. lor L he perlod
Aprll 2009 - !une 2010, 3093 sLudenLs from 63 schools ln
8eglons 3, 4 and 10 were screened wlLh 633 chlldren referred
for furLher LesLlng. AddlLlonally, as parL of Lhe naLlonal School
Screenlng rogram, Lhe MlnlsLry of Puman Servlces and Soclal
SecurlLy supporLed Lhls lnlLlaLlve by offerlng subsl dles Lo
parenLs/guardlan of underprlvlleged chlldren.

CC8-LyeCare Cuyana operaLes a low-cosL specLacle lab LhaL
produces specLacles Lo meeL Lhe requlremenLs of Lhe Lwelve
vlslon CenLres. lor Lhe year 2011, a LoLal of 20,310 paLlenLs of
all ages were screened for refracLlve errors, 11,604 were
dlagnosed wlLh refracLlve errors and recommended Lo wear
specLacles, and 6,396 low-cosL specLacles were acLually
provlded.
Issues
LlmlLed number of schools lmplemenLlng Lhe school v lslon
screenlng program.
roposed Act|ons keduct|on of the
preventab|e causes and of treatab|e
causes of Ch||dhood 8||ndness
uevelop a naLlonal 8C pollcy and guldellnes, whlch
can be developed from exlsLlng lnLernaLlonal
guldellnes.
uevelop a naLlonal program for 8C.
Lxplore Lhe lnLegraLlon of chlldhood bllndness
prevenLlon (wlLh early dlagnosls, evaluaLlon and
LreaLmenL) lnLo all naLlonal maLernal and chlld healLh
plans and pollcles (e.g. exlsLlng lMCl naLlonal
program).
romoLe sysLems, neLworks and proLocols for safe
neonaLal care, adequaLe referral, and follow-up.
Lnsure Lhe avallablllLy of Lhe necessary equlpmenL
for prlmary prevenLlon, examlnaLlon and LreaLmenL.
AdvocaLe for Lhe lmprovemenL of Lhe quallLy of
avallable lnformaLlon on neonaLal care.
199
age | 22

Lack of currenL operaLlonal plan lncludlng a monlLorlng
sysLem ldenLlfylng Lhe Lype of lnformaLlon Lo be col lecLed.
no analysls conducLed Lo ldenLlfy besL pracLlces of
refracLlve errors programs of school chlldren ln Cuyana.
need Lo conLlnue subsldy programme for flnanclal
asslsLance Lo chlldren from famllles of low economlc s LaLus
LhaL need specLacles.

Lxpected Cutcome
revenLlon of vlsual lmpalrmenL and bllndness due Lo
uncorrecLed refracLlve errors ln school chlldren by
lnLegraLlng eye healLh lnLo pollcles and pracLlces prl marlly
ln Lhe healLh and educaLlon secLors.

2.3. keduce the |mpact of b||ndness
and v|sua| |mpa|rment |n the
genera| popu|at|on

Lnhance v|s|on re|ated qua||ty of ||fe for
peop|e w|th funct|ona| |ow v|s|on

Low-vlslon servlces are almed aL people who have resldual
vlslon LhaL can be used and enhanced by speclflc alds. L ow
vlslon ls currenLly deflned as vlsual aculLy of < 6/18 down Lo
and lncludlng 3/60 ln Lhe beLLer eye from all causes. ln
Cuyana, llmlLed Low vlslon Alds were prevlously dlsLrlbuLed ln
Lhe publlc secLor. Powever, nCCs such as Lye Care Cuyana
have reporLed dlsLrlbuLlon of 70 canes and Lralnlng of 10
persons ln lLs use for 2011. 1he Cuyana SocleLy for Lhe 8llnd
(CS8) provldes Lralnlng ln lnformaLlon 1echnology and
faclllLaLes access of lLs members Lo Lhe Cne LapLop per lamlly
CovernmenL lnlLlaLlve. 1he MlnlsLry of LducaLlon ls pursulng
lLs goal Lo advance Lhe concepL of an lncluslve educaLlon
sysLem.

Lxpected outcome

rovlde comprehenslve low-vlslon servlces for persons who
are bllnd or severely vlsually lmpalred Lhrough lnLegraLlng
cllnlcal eye care, rehablllLaLlon and educaLlonal servlces.

Issues
1here ls llmlLed low vlslon servlce ln Lhe publlc s ecLor, wlLh
lnadequaLe human resources and an lrregular supply of
devlces.
roposed Act|ons keduce v|sua|
d|sab|||ty by detect|ng and treat|ng
uncorrected kefract|ve Lrrors |n schoo|
ch||dren
8evlse naLlonal guldellnes for Lhe deLecLlon and
LreaLmenL of refracLlve errors based on avallable
evldence.
Analyze Lhe refracLlve error programme experlence
ln Cuyana Lo ldenLlfy and dlssemlnaLe besL pracLlces.
uevelop a 3-year operaLlonal plan (lncludlng
monlLorlng and evaluaLlon).
lncrease publlc awareness Lhrough lnformaLlon,
educaLlon, and communlcaLlon sLraLegles.
Lngage Lhe relevanL auLhorlLles Lo re-esLabllsh a
mechanlsm for flnanclal supporL Lo Lhose ln need of
specLacles.
2aa
age | 23

1here ls a lack of coordlnaLlon and collaboraLlon beLween,
publlc, prlvaLe and clvll socleLy Lo provlde or subsl dlse low
vlslon devlces.
1here ls an absence of a comprehenslve approach Lo Lhe
lnLegraLlon of opLomeLry and low vlslon and bllndness
servlces.

3. LL CAkL kCMC1ICN, U8LIC
LDUCA1ICN & ADVCCAC

AbouL 80 of bllndness ls avoldable: lL elLher resulL s from
condlLlons LhaL could have been prevenLed or condlLlons LhaL
may have belng successfully LreaLed Lo resLore slghL. lL ls
necessary LhaL hlgh rlsks groups have adequaLe lnformaLlon Lo
ensure Lhey look for servlces Lo deLecL and LreaL eye problems
and LhaL Lhey lncrease compllance on follow-up and
LreaLmenLs. 1he alm of eye care promoLlon and publlc
educaLlon ls Lo lmprove knowledge, aLLlLudes, moLlvaLlon and
acLlon for hlgh rlsk groups and healLh auLhorlLles.

1he promoLlon of eye healLh as parL of Lhe naLlonal healLh
pollcy ls, lnvarlably, a necessary prerequlslLe for a naLlonal
rogram for Lhe revenLlon of 8llndness. 1hls fosLers publlc
awareness, leads Lo socleLal responslveness and parLlclpaLlon
and faclllLaLes co-ordlnaLlon of acLlvlLles carrled ouL by varlous
parLners, such Lhe governmenL, non-governmenLal
organlzaLlons and Lhe prlvaLe secLor.

Issues
1here are no comprehenslve communlcaLlon sLraLegles.
1he non-prlorlLlsaLlon of flnanclal resources for
communlcaLlon acLlvlLles.

Lxpected outcome:
lncreased publlc knowledge of eye care and uLlllsaLlon of eye
care servlces.

roposed Act|ons Lnhance v|s|on
re|ated qua||ty of ||fe for peop|e w|th
funct|ona| |ow v|s|on
uevelop a pollcy and proLocol for a comprehenslve
approach for Lhe lnLegraLlon of opLomeLry and low
vlslon/bllndness servlces.
LsLabllsh low vlslon/bllndness servlces, sLarLlng wlL h
coLLage and dlsLrlcL hosplLals naLlonwlde.
romoLe early ldenLlflcaLlon of all chlldren and adulLs
who are lrrevocably bllnd and severely vlsually
lmpalred and ensure LhaL an effecLlve referral sysLem
ls ln place.
romoLe low vlslon and bllndness servlces for
chlldren as early as posslble Lhrough an lnLegraLed
sysLem of cllnlcal and pedagoglc servlces.
Lncourage Lhe provlslon of low vlslon devlces ln Lhe
prlvaLe secLor and non-governmenLal agencles Lo
complemenL Lhe llmlLed servlces provlded ln Lhe
publlc secLor.
2a1
age | 24

Nat|ona| Strategy Lye Care romot|on,
ub||c Lducat|on and Advocacy
Assess Lhe knowledge, bellefs, aLLlLudes and acLlons
of Lhe populaLlon ln relaLlon Lo eye care, Lhrough a
serles of cllnlc and populaLlon based surveys.
uevelop and lmplemenL a communlcaLlon sLraLegy
and lmplemenLaLlon plan for eye care.
uLlllze general healLh and eye healLh professlonals Lo
creaLe publlc awareness.
Lxplore oLher parLnershlps Lo collaboraLe ln Lhe
dellvery of communlcaLlon acLlvlLles.
uevelop advocacy and awareness Lools geared aL
educaLlng Lhe paLlenL and Lhe general publlc.
2a2
age | 23

8I8LICGkAn

1. an Amerlcan PealLh CrganlzaLlon. Sl1uA1lCn AnAL?SlS:
L?L CA8L ln Cu?AnA - llnAL 8LC1. ur. llona 8oach.
CeorgeLown. 2012
2. World PealLh CrganlzaLlon. vlslon 2020 1he 8lghL Lo Slg hL:
Clobal lnlLlaLlve for Lhe ellmlnaLlon of avoldable bllnd ness,
AcLlon lan 2006-2011. Ceneva, SwlLzerland: 2007.
3. an Amerlcan PealLh CrganlzaLlon. lorLy-nlnLh ulrecLlng
Councll, 61sL Sesslon of Lhe 8eglonal CommlLLee.
WashlngLon uC, APC, 2009 (8esoluLlon Cu49/19).
4. an Amerlcan PealLh CrganlzaLlon. Lye ulseases ln eople
40-84. 1he 8arbados Lye SLudles: A summary 8eporL .
WashlngLon uC, APC 2006. 1PS/CS/06/8
3. an Amerlcan PealLh CrganlzaLlon. SLraLeglc lramework lor
vlslon 2020: 1he 8lghL 1o SlghL Carlbbean 8eglon.
WashlngLon uC. APC 2010. CS-8L/10.1
6. an Amerlcan PealLh CrganlzaLlon. SlLuaLlon Analysls. Lye
Care Servlces ln 8arbados. 8arbados. APC 2010
7. losLer A, 8esnlkoff S. 1he lmpacL of vlslon 2020 on global
bllndness. Lye 2003, 19:1133-1133.
8. Leske C, Wu Suh, nemesure 8, Pennls A and 8arbados Lye
SLudles Croup. Causes of vlsual loss and Lhelr rlsk f acLors:
an lncldence summary form Lhe 8arbados Lye SLudles.
9. Sllva !C, 8aLeman !8, ConLreras l. Lye dlsease and care ln
LaLln Amerlca and Lhe Carlbbean. Survey CphLhalmol
2002,47:267-274.
10. Llmburg P, 8arrla l, Comez , Sllva !C, losLer A. 8evlew of
recenL surveys on 8llndness and vlsual lmpalrmenL ln LaLln
Amerlca. 8r !.CphLhalmol 2008,92,313-319.
11. Llmburg P, Sllva !C, losLer A. CaLaracL ln LaLln Amerlca:
flndlngs from nlne recenL surveys. 8ev anam Salud ubllca
2009,23:449-433.
12. CllberL C, losLer A. Chlldhood bllndness ln Lhe con LexL of
vlSlCn 2020-Lhe rlghL Lo slghL. 8ull World PealLh Crg
2001,79:227-232.
13. klelnsLeln 8n, !ones LA, PulleLL S 8efracLlve error and
eLhnlclLy ln chlldren. Arch CphLhalmol. 2003
Aug,121(8):1141-7,
14. owell ChrlsLlne, Wedner Susanne, PaLL Sarah 8. vlslon
screenlng for correcLable vlsual aculLy deflclLs ln school-age
chlldren and adolescenLs. Cochrane uaLabase of SysLemaLlc
8evlews. ln: 1he Cochrane Llbrary, lssue 12, ArL. no.
Cu003023. uCl: 10.1002/14631838.Cu003023.pub1

2a3
Abstract for CCB Conference Presentation on Caribbean Glaucoma KAP Study

Glaucoma was initially identified as an area of importance for the Knowledge,
Attitudes and Practices (KAP) studies, because it is the leading cause of irreversible
blindness worldwide, and has a high prevalence in the Caribbean. Given glaucoma's
increasing prevalence with age, the number of peopl e living with glaucoma is likely to
increase.
The Caribbean Glaucoma KAP Study is being conducted as part of the overall efforts
of the participating individuals and organizations, funded by the European
Commission in partnership with Sightsavers and The Caribbean Council for the
Blind, to prevent low vision and blindness from glaucoma, as one of the Vision 2020
(Right to Sight) priorities in the Caribbean.
Much work has been undertaken by the working group managing the Caribbean
Glaucoma KAP Study:
4 Caribbean countries and corresponding clinic locations identified - Barbados,
Guyana, Jamaica, St. Lucia
dentified Principal nvestigator & Working Group
Determined study population and sample size
Completed key documents - research proposal, consent forms, information
sheets, questionnaire
Completed ethical approval requirements and forms for each country
Obtained Ethics Board approvals in all 4 countries
Purchased & distributed electronic tablets for data collection
Recruited & trained data collectors
Recruited a Project Assistant

Data collection is due to start in a week's time, and last approximately 3 - 4 months.
Thereafter we will analyse the data and produce reports of the study.
We hope that the results from this study will enhance our understanding of the
issues affecting glaucoma patients and having an impact on their ability to manage
their disease. n the long term this should inform public health policy and clinical
strategies to improve the care of glaucoma patients.

Miss Dawn Grosvenor, MBBS, MRCOphth, FRCS (Glasg), FRCOphth
2a4
!"#$%&'$ #)**&%+ ,- $./ 01&"/$1' 2/$13,4&$.+ 53,67/89/: !$$1$)8/# &38
;%&'$1#/# <025!;= #$)8+

Regional and international epidemiological studies have established diabetic retinopathy (DR)
as the leading causes oI blindness and disability associated with low vision among the
working age population. Research has mainly been conIined to the prevalence within
predominantly Caucasian populations with limited available data Ior other ethnic groups.
The Barbados Eye Study (BES) provided a regional perspective on the highincidence oI DR
among diabetics. The main cause oI vision loss in the population was clinically signiIicant
macula oedema (CSMO) as opposed to proliIerative diabetic retinopathy (PDR). This is
likely due to the higher prevalence oI Type 2 as compared to Type 1 diabetes in the English
speaking Caribbean. Changing population demographics and socioeconomic circumstances
lead us to project increasing rates oI the disease.A decade prior, laser treatment was the only
treatment Ior CSMO. However, there are now several options available. The implications Ior
national Health budgets are signiIicant and the cost versus beneIit Ior the new therapeutic
models will have to be assessed.
The DRKAP study will take place in Iour territories: Jamaica, St. Lucia, Antigua and
Barbuda, Barbados and Guyana. Initial preparation will require a series oI strategic
consultations with public health policy stakeholders to optimise the study design beIore
applying Ior ethical approval and implementation.The process will involve administering
validated survey questionnaires to a representative cohort oI diabetic patients Irom each
country.This procedure will be replicated with medical and allied personnel to establish KAP
scores. Collated data will be analysed and a Iinal report presented Ior peer review.
The DRKAP seeks to identiIy as a baseline, the existing awareness within the population oI
the mechanism oI the disease process, surveillance methods and available therapy within
their country. The resultswill add considerably to the epidemiological data available to the
research community. It will constitute a valuable resource Ior public health oIIicials to assist
indeveloping evidence based regional health screening programmes, reIerral pathways and
cost-eIIective treatment models.

>.&%7/# ;1/%'/ ?@@A ?2>B4.$.

2a5

2013 Caribbean V2020 Regional Meeting

Transféré par

Informations du document

Copyright

Formats disponibles

Partager ce document

Partager ou intégrer le document

Options de partage

Avez-vous trouvé ce document utile ?

Ce contenu est-il inapproprié ?

Droits d'auteur :

Formats disponibles

2013 Caribbean V2020 Regional Meeting

Transféré par

Droits d'auteur :

Formats disponibles

Celebrating the 13th year of Vision 2020: The Right to Sight in the Caribbean

Vous aimerez peut-être aussi