The Eye

The eye is the organ that gives us the sense of sight. Sight is the most precious of the five senses. Our eyes enable us to learn far more about the world around us than do any of the other four senses. We use our eyes in almost every activity we perform in our daily life, such as reading, writing, working, cooking, sewing, watching television or driving a vehicle. Following is a brief review of its current indications, methodology, and logistics at the Clinic. Functions of the eye Characteristics of the eye Tips for Eye care Functions of the eye Vision is the ability to perceive the world around us. Our eyes allow us to see and interpret the shapes, colors and dimensions of objects by processing the light reflected from them. The eye is able to see in dim or bright light, but it cannot see in the total absence of light. Characteristics of the eye Visual acuity: The ability to see objects clearly Field of vision: The ability to see objects in the periphery of the vision Colour vision: The ability to distinguish between different colour Tips for Eye care Some general precautions for better eye health:

Consult an eye specialist immediately if you notice any of these problems:

Double or blurred vision Halos around lights Inability to see faces clearly Distortion of prints and fading of colors Parts of words or letters appear missing Difficulty in judging depth on stairs or pavements Tendency to bump into objects Prolonged difficulty in adjusting from lighted to dark areas Sparks of light appears on your peripheral vision Car headlights appearing to have spokes radiating from a central point Sudden pain in one or both the eyes Appearance of 'floaters' or spots in front of the eyes Visit an eye doctor every year for a comprehensive check-up. It MUST include a dilated eye examination and tests for glaucoma. If you have diabetes, high blood pressure or a family history of eye disease, you may need a check-up twice a year.

If you are above 45 years of age

When using tools always wear protective glasses to prevent accidental eye injuries. Avoid exposure to ultraviolet rays. If unavoidable wear glasses that block UV rays. Take care of your general health. Eat foods rich in vitamin E, B, C, zinc and selenium.

Some Common Myths Holding printed material close to the eyes is harmful.

Reading for long periods of time harms the eyesight. Our reading ability is correlated with visual acuity, binocular fusion and depth perception. A low vision child will eventually become blind. Use of low vision (optical) devices is harmful.

Persons with low vision can damage their vision further if they watch television from close. Children with poor vision always need spectacles or low vision devices.

FAQ

Eye Donation Movement in India has been in existence for the last 40 years, but unfortunately even today the demand far exceeds the number of donated corneas. In India there are approximately 1.2 crore blind people and corneal opacity causes about 25%of blindness. Corneal Transplant can relieve this kind of blindness. In Orissa the eye donation movement has just begun.

For Donors

For the Donors relatives What is an eye bank? Who can be an eye donor? How can I become a donor ? Do cataracts or the use of spectacles render the Corneas unfit? What about Diabetes or hypertension? Is the whole eye used for transplant? Is there any use for the Corneas which are for some reason unfit for transplant? Does corneal transplant guarantee sight to all blind people? Does the human body reject the transplant donor's cornea? How will my donation be used? What conditions render cornea unfit for donation? How quickly should eyes be removed after death? How soon after donation must a cornea be transplanted ? Does eye donation disfigure the donor's face? Is it necessary to transport the donor to the hospital after death for the donation? Are there religious conflicts to eye donation ? Will the relatives get to know the recipient of the eyes ? IMPORTANT STEPS BEFORE EYE DONATION

or Donors:-

1. Discuss your intention of eye donation with your family doctors, friends and relatives. 2. Enrollment is convenient but not compulsory. Instead your wish to donate your eyes conveyed to your to family members will make them fulfill this after your death. 3. Contact "drushti daan" for further details.

For the Donors relatives:-

You have the authority and moral responsibility to donate the eyes of the deceased, especially if the donor expressed his desire during his/her lifetime.
What is an eye bank ?

An eye bank is the link between the donor and recipients/eye surgeon . It is an organization recognized by the government to collect and distribute human eyes to those who require Cornea transplants.

Who can be an eye donor ?

Any one can be a donor irrespective of the age, sex, blood group, caste, creed or religion.
How can I become a donor ?

The most important action you can take to ensure you will be a donor is to tell your family and legal representative. It is helpful if they know how you feel in advance. Keep a donor card with you at all times so it will serve as an indication to your family, your legal representative and

hospitals of your intention to be an eye donor. Do cataracts or the use of spectacles render the Corneas unfit? No. Both these conditions relate to the lens of the eyes and not the Cornea. What about Diabetes or hypertension ? Even donors with these conditions can donate their eyes. Is the whole eye used for transplant ? No. Only the thin transparent layer in front of the iris (black portion) called the Cornea is used for transplant.
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Is there any use for the Corneas which are for some reason unfit for transplant ? Corneas that, for the technical reasons, are not used for vision restoring corneal transplant, are invaluable for research. Does corneal transplant guarantee sight to all blind people ? No.Transplant only helps when the loss of the sight is due to corneal defect. Does the human body reject the transplant donor's cornea ? Corneas do not have direct blood supply so the risk of rejection is very low. Rejection, if any occurs, can be suppressed by timely medication. How will my donation be used ? After the eyes are removed they will be evaluated, processed, screened and then supplied to the eye surgeon for transplant. What conditions render cornea unfit for donation ? Cornea of persons suffering from AIDS, tetanus, rabies, hepatitis, septicemia and viral diseases are considered unfit for donation. How quickly should eyes be removed after death ? The eyes should be removed from the donor and sent to the processing center as soon as possible to avoid deterioration of the cornea. The ideal time frame is 3-4 hours from the 'time of death to the cornea preservation centre'.

How soon after donation must a cornea be transplanted ? Cornea transplant is usually performed within 4 days after donation. Does eye donation disfigure the donor's face ? No. The removal of eyes does not produce disfigurement nor does it interfere with the customary funeral arrangements. Is it necessary to transport the donor to the hospital after death for the donation ? No. Eye bank/ Cornea Collection Centre have personnel who come to the donor's home to remove the eyes. The procedure takes about 20-30 minutes.
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Are there religious conflicts to eye donation ? No. Donation is a gift of sight to others. As such, eye donations are consistent with the beliefs and attitudes of major religions. Will the relatives get to know the recipient of the eyes ? No. The identity of both the recipient and the donor is kept a secret IMPORTANT STEPS BEFORE EYE DONATION 1. Get the valid death certificate quickly. 2. Contact the eye bank as soon as possible. 3. Close the eyelids and cover it with moist cotton. 4. Switch off the fan (Switch on the air conditioner if possible). 5. Raise the donor's head by 6 inches by placing two pillows under it. 6. Keep the consent of all the family members of the deceased donor ready, as it is mandatory.

Eye Donation Procedure

The Procedure for Eye Donation is actually divided into 3 parts.

Pledging of eyes by the prospective donor. This is preferred but not necessary. Consent of the next of kin to donate after the death of the individual Calling the Eye Bank to retrieve the eye of the deceased and implementing the directions of the Eye Bank to help keep the corneas in a good condition till their arrival.

The eye Bank team arrives and within approximately 30 minutes the cornea is harvested, stored in a preservative medium and taken immediately to the Eye Bank. Here the cornea is tested, evaluated and distributed as per rules laid down by the Eye Bank Association of India. The Donor :

The most important action you can take to ensure you will be a donor is to tell your family and legal representative. It is helpful if they know how you feel in advance. Keep a donor card with you at all times so it will serve as an indication to your family, your legal representative and hospitals of your intention to be an eye donor.

The Donors Relatives :

The Donors relatives have the authority and moral responsibility to donate the eyes of the deceased, especially if the donor expressed his desire during his/her lifetime Get the family to consent for eye donation .

IMPORTANT STEPS BEFORE EYE DONATION :

Get the valid death certificate quickly. Contact the eye bank as soon as possible. Close the eyelids and cover it with moist cotton and keep it moist till the eye bank team arrives Switch off the fan (Switch on the air conditioner if possible).

Raise the donor's head by 6 inches by placing two pillows under it. Keep the consent of the family members of the deceased donor ready, as it is mandatory

Activities : Awareness

Public Awareness programmes on eye donation and eye banking:

Audiovisual meetings at various forums like schools, colleges, Govt offices, Banks, Corporate houses, Multi-storied apartments. Rallies by students both school and college and eminent personalities of the state. Poster and hoarding displays at prominent places conveying the messages on eye donation. Street plays performed in the slums of Bhubaneswar, with eye donation theme in local language.

Publicity through print and electronic media. Production of documentary and short films with famous Oriya cine artists aired in the television channels and for the public to view Distribution of informative brochures and leaflets - Public places, religious gatherings, hospitals, private and community gatherings, Shopping Malls,railway stations, bus stand, schools , colleges, offices, banks etc.

Observation of National Eye Donation fortnight during 25th August to 8th September every year.

Activities : Procurement & Distribution

The cornea is a unique organ - essentially it has no blood vessels and derives nourishment from other sources in the eye. It is this inherent property of the cornea, which makes it excellent graft material with minimal chances of rejection.

Collection: It is easy

to

harvest

from

the

donor

and

can

be

done

anywhere. implements.

Does not require theatre facilities or Does not involve any significant monetary factor.

costly

surgical

Storage: With the availability of advanced storage medium , it is possible to store the cornea for a long period of time. Thus transplantation need not be done as an emergency procedure but can be elective.

Evaluation: The donor corneas are medically evaluated and are graded for distribution. Distribution:

Patients

requiring

transplants

are

registered

with

the

eye

bank.

Patients are usually wait listed. Priority is given to patients who are bilaterally blind, with very low vision, and those who are young. In certain circumstances, corneal transplantation is done on an emergency basis, such as a severe corneal ulcer and an impending or frank corneal perforation. In such circumstances the availability of reserve corneal tissue from any eye bank is of help.

Transplantation: Corneal transplantation is usually done on an elective basis. It can be performed for optical purposes (to restore vision) or a tectonic purpose (to restore the structural integrity of the eye). The surgical technique is simple and can be performed even under local anaesthesia in most cases.
The Issue Features... Counselling Vol. 3 No. 1 January 2006

Introduction of Counselling

 Methods of Counselling Effective Counselling Counselling in Eyecare Counselling Process Counselling Training Counselling Aids Counselling Setup Counselling Check List Analogies Barriers FAQ Case Study Collaborating Partner

itenews

The Issue Features... Counselling Vol. 3 No. 1 January 2006 Introduction of Counselling Methods of Counselling Effective Counselling Counselling in Eyecare Counselling Process Counselling Training Counselling Aids Counselling Setup Counselling Check List Analogies Barriers FAQ Case Study Collaborating Partner

Dear Readers, An eye hospital is established with the primary aim of providing care and cure to patients. What we have not realized is the fact that very often patient who have managed to cross the many barriers there are to access a hospital very often completes the test, receives the advice and then walks out with complying with it or accepting the Doctors decision. This is primarily the need with which the counsellors in an eye hospital are appointed-to convert a non acceptor of care to acceptor of care. For counselors in an eye hospital to deliver their work effectively they have to follow a counselling process, apply different methods of counselling, and leverage their delivery by utilizing different counselling aids. Analogies are a powerful communication tool that the counselors can use. The ideal counselling set up is also illustrated. The challenges for providing counselling are many and this is detailed in the barriers faced by a patient. Frequently asked questions provide a guideline to the counsellors on a set of questions patients constantly tend to ask which they must answer to. Case studies highlight the impact of counselling on transforming a patient life. Happy Regards, Vision 2020 e-resource team Reading!

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Introduction of Counselling
Counselling is considered as a purposeful conversation to facilitate decision making. Counselling in eye care has evolved to be there for the following objectives: 1. 2. 3. 4. To To To To increase awareness about eye diseases increase patient compliance to treatment market new products or services moderate patient expectations

In eye care as in other health care there are many barriers which prevent patients from following up with the Doctors advice. It is in this context that the role of the counsellors comes into prominence. The main reason for counselling is convert the non acceptors of eye care into acceptors. Any health care provider should be satisfied only if the person who approaches for treatment complies with the treatment and follows. Then only we can say that we, as an health care provider has impacted on improving health care. Very often, the hospital rests satisfied with treating only the patients who have come to them. But studies have repeatedly showed that among the persons who require healthcare, only a small minority come and utilize healthcare. Even those who come, listening to the Doctors advice does not automatically translate into an uptake of the service. It is all these issues which are taken up by the counselors to ensure that people utilize healthcare. One aspect of patient counselling is also to help patients who have apprehensions on aspects of treatment, surgery, adapting to hospitalization, resource mobilization. Patient Counselling helps such people in understanding about the treatment, length of stay, cost, prognosis, and plan for their rehabilitation.

BASIC COUNSELLING SKILLS FOR MEDICAL Abstract: This article focuses on some basic counselling skills required for Medical Practitioners. BASIC COUNSELLING Abstract: This article discusses the Basic Counselling skills required for counsellors.

PRACTICE

SKILLS

COACHING Abstract: This article focuses on values of a successful coaching and it also has a set of questions to test yourself on effectiveness of coaching you provide. PATIENT SATISFACTION SURVEY ON COUNSELLING IN ARAVIND EYE HOSPITAL Abstract: This article focuses on study which was conducted in Aravind Eye Hospital, Madurai to know the experiences about counselling services in the hospital through a postal questionnaire survey.

Methods of Counselling

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There are different methods of counselling a patient(s). It could be broadly classified as individual counselling, family counselling or group counselling. In the individual counselling scenario the counsellor sits face to face with the patient or the key decision maker and either explains about the disease or the treatment process to facilitate decision making. In the family counselling the details are also explained to key family members as they have a stake in the decision making or ensuring compliance to the treatment plan. In group counselling, the counselling is provided to a group of patients at the same time who have the same condition. Individual Counselling

GROUP COUNSELLING Abstract: This article discusses some of the important aspects of group like optimum group size, group formation, characteristics, and advantages of group Counselling in hospital etc.

Effective Counselling

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The effectiveness of counselling greatly lies on the skills of counsellors, utmost care should be taken while recruiting counsellors. We have provided you with Job descriptions, Patient counsellor training manual and recruitment guidelines in order to select right counsellors and train them in effective way.

COUNSELLING ETHICS Abstract: This article focuses on Counselling Ethics and covers some aspects on Self- Awareness, objectivity, rights and values. BODY LANGUAGE IN PATIENT COUNSELLING Abstract: This article focuses on Body language required for counsellors also it highlights what body language should not be adopted by counsellors. JOB DESCRIPTION FOR COUNSELLORS Abstract: This is a model job description for the Counsellors in an Eye Hospital. It clearly focuses the duties of the Counsellors, and how to manage the duties in an organized way PATIENT COUNSELLOR RECRUITMENT GUIDELINES Abstract: This article provides you with Job description, roles and responsibilities, qualifications and

characteristics required for recruiting Patient counsellor.

Counselling in Eyecare

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A patient has a stimuli which creates hundreds of questions while the patient undergoes screening and further medication. A doctor or a nursing staff cannot spend more time with the patient to clear the doubts and educate them. Patient wants the doctor to attend the problems, clarify the doubts and fulfill the needs. Though it helps to increase the patient satisfaction and it is our responsibility to communicate the details of medication, we have to think the time utilisation of medical personnel. The Concept of introducing Patient counselling is to increase the level of patient satisfaction and educate them and towards the optimum utilisation of the manpower.

PATIENT COUNSELLING AT ARAVIND EYE HOSPITAL Abstract: This article details counselling department activities at Aravind Eye Hospital. It covers the counsellors selection process, training, specific functions in different departments, coordination, and performance assessment. PATIENT COUNSELLORS: THE ROLE OF PATIENT COUNSELLORS IN INCREASING THE UPTAKE OF CATARACT SURGERIES AND IOLS Abstract: This article focuses on selecting, training and working skill of counsellors with some common questions asked by patients which a counsellor needs to answer.

USING PATIENTS AS MOTIVATORS Abstract: The power of word of mouth has always seen to be a powerful source to get more patients. It is this strategy which is detailed in this article which looks at how patients can be used to motivate others in the community to come to the hospital. COUNSELLING A SUCCESS STORY Abstract: This article focuses on importance of counselling and shares the experience of counselling at Netra Niramoy Niketan, Vivekananda Mission Ashram, Chaitanyapur. GRIEF COUNSELLING MANUAL Abstract: This article focuses on how a counsellor should deal with donor families and various aspects

involved for getting consent for donating eyes.

Counselling Process

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Counselling process in eye care is mainly divided into three types pre operative, post operative, discharge counselling. An elaboration of these steps is given in the articles below.

GENERAL PATIENT COUNSELLOR Abstract: This article highlights some general guidelines to be followed by patient counsellors.

GUIDELINES

THE COUNSELLING PROCESS Abstract: The main counselling process has been divided by the author into 3 stages beginning, action and ending. In this article the author highlights the critical objectives and tasks of each phase.

Counselling Training

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Training patient counsellors will improve their skills in order to increase the number of patients who accept and follow the the advise of their service provider.

PATIENT COUNSELLOR TRAINING MANUAL OUTLINE Abstract: This is an outline for a quick orientation of an eye care counselor. This document provides the details of the 10 day training program. TRAINING SCHEDULE FOR EYE DONATION COUNSELLORS Abstract: This is an outline for a quick orientation of an eye donation counsellor. This document provides the details of the 6 day training program. Eye Care System offers training for counselling as a part of the following course.

Aravind

Course details:

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Counselling Aids
During counselling there are different aids that a counselor can use to communicate the message more effectively. This includes model of an eye to help explain the aetiology of the disease, sample intraocular lens, videos of surgery, etc..

Counselling Aids for the patients:

IntraOcular Lens Model of eye ball Patient Education brouchers & Notice(Local language & English) Posters Motivation Card Stamp pad & Followup sheet Sample Medicine Video Awareness Sticker Room Photos & Flash Card Calendar (Monthly & Daily) Check List Consent forms

Counselling Setup

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There are many important aspects of setting up a counseling room so that it is done more effectively. This is described mainly through providing photographs to get a sense of the different counselling set up.

SETTING UP A COUNSELLING DEPARTMENT IN AN EYE Abstract: This article focuses on how to set up a counselling department in an eye hospital.

HOSPITAL

Counselling Check List

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CATARACT SURGERY Counselling CHECK LIST Abstract: In this article the check list of counselling activities to be done for patients who has accepted to undergo cataract surgery.

Analogies

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In eye care, with the large burden of avoidable blindness providing the right information becomes all the more crucial. But due to the complicated terms used in medical field many lay man finds it difficult to understand so we need vivid analogies to describe the medical terms which will be easier for them to understand.

ANALOGIES FOR COMMUNICATING WITH THE PATIENT Abstract: Medical information is full of technical words and jargons that often tend to distance patients from providers. This article provides analogies which can be used with a patient who has been adviced for cataract surgery.

Barriers

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It is important for providers to understand that despite there being clinical knowhow and infrastructure and human resource availability by the service provider still the people who require eye care are not availing of services. These are attributed to various barriers. These barriers have to be understood in order for the service provider like an eye hospital to reach the patients.

RECOGNISING AND REDUCING BARRIERS TO CATARACT SURGERY LOW UPTAKE OF EYE CARE SERVICES IN RURAL INDIA Abstract: This article focuses on a survey report which was made to investigate service uptake in a rural Indian population served by outreach eye camps and to identity barriers to uptake.

CHILDHOOD CATARACT: HOME TO HOSPITAL Abstract: This article focuses on a survey report which was made to investigate service uptake in a rural Indian population served by outreach eye camps and to identity barriers to uptake. SOCIAL AND ECONOMIC BARRIERS TO CATARACT SURGERY IN RURAL SOUTH INDIA Abstract: A follow-up study of cataract patients advised to have surgery was conducted in five villages near Madurai, South India.

Frequently Asked Questions

CATARACT COUNSELLING GUIDELINES WITH FAQ CORNEA COUNSELLING GUIDELINES WITH FAQ DR COUNSELING GUIDELINES WITH FAQ EYEBANK FREQUENTLY ASKED QUESTIONS FREQUENTLY ASKED QUESTIONS ON CONJUNCTIVITIS FREQUENTLY ASKED QUESTIONS ON CONTACT LENS FREQUENTLY ASKED QUESTIONS ON DRY EYES FREQUENTLY ASKED QUESTIONS ON EYE GLASSES FREQUENTLY ASKED QUESTIONS ON LOW VISION UVEA COUNSELLING GUIDELINES WITH FAQ FREQUENTLY ASKED QUESTIONS ON NEURO OPHTHALMOLOGY FREQUENTLY ASKED QUESTIONS ON REFRACTIVE ERRORS IN CHILDREN GLAUCOMA COUNSELLING GUIDELINES WITH FAQ

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Case Study
A HELPING HAND FOR Abstract: This case study covers the story of Jeyaraj experience of gaining back his sight. MY HAPPIEST Abstract: This case study describes how a patient was motivated by the counsellor. JEYARAJ

MOMENT

Collaborating Partner

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We are glad to collaborate with All India Ophthalmological Society (AIOS) which is the largest Associations of Eye Surgeons in India with around 10,000 Active Members. The AIOS was established in the year 1930. It is a registered Society under the Society's Registration Act of 1860. The objects of the society are cultivation and promotion of the study and practice of ophthalmic sciences, research and man-power development with a view to render service to the community and to promote social contacts among ophthalmologists of the country. They organise Annual Conferences in different parts of the country. In these conferences a number of scientific programmes, Symposia, Seminars, Workshops, Refresher courses, Live Survery etc. are conducted for the promotion and mutual exchange of knowledge in the field of Ophthalmic science. Weblink: http://www.aios.org

Archives
December 2005 - Vision Centre November 2005 - Human Resources in Eye Care October 2005 - Ophthalmic Equipment and Instruments September 2005 - IEC August 2005 - Start up eye Hospital July 2005 - Refractive Error June 2005 - Low Vision May 2005 - Cataract April 2005 - Paediatric Eye Care Service Delivery March 2005 - Strategic Planning Tools February 2005 - Frequently Asked Questions on Eye Glasses! January 2005 - Refractive Error Service Resources December 2004 - Highlighting Starting a New Eye Hospital Tool November 2004 - Diabetic Retinopathy Knowledge, Attitude and Practice Study October 2004 - Strategy worksheet for continually improving quality of services and checklist September 2004 - Quality Cataract Series - Paramedical Contributions Module August 2004 - Sterilization Protocol July 2004 - Medical Records Protocol June 2004 - Magnitude of Cataract Blindness Estimation Tool May 2004 - Cataract Frequently Asked Questions April 2004 - Introduction to SiteNews

Eye FAQs
ABCDEFGHIJKLMNOPQRTUVWXYZ B Botulinum Toxin Chemodenervation Therapy Brachytherapy C Cataract Computer Vision Syndrome

Corneal Blindness Blindness due to Consanguineous Marriages All India Concessions for the Visually Impaired E Eye Bank The Eye G Glaucoma L Low Vision Refractive Error Correction Laser Surgery R Radioactive Plaque Retinopathy of Prematurity S Squint T Trauma U Uveitis V Vitamin A deficiency Vision Rehabilitation

Cataract
A cataract is the clouding of the transparent lens, which is located inside the eye. Cataract causes blindness, which is treatable. What are the symptoms associated with Cataract? What causes Cataract? What is the treatment available for this condition? Should I take any preventive measures? Outcome What are the symptoms associated with Cataract? The vision usually becomes reduced or blurred.

There is worsening of the vision or eyesight. There are frequent changes in the number for spectacles. The pupil appears whitish.

What causes Cataract? Cataract is usually caused by the aging process. It can also develop in young people due to injury or illness. Sometimes it may be present at birth. Toxic drugs, acute diarrhea, diabetes, infection, injury and dietary deficiencies can also cause cataract. What is the treatment available for this condition? The only treatment for cataract is surgery, where the clouded lens is removed and replaced by an artificial lens. Spectacles may also be prescribed. An intraocular lens (IOL) is the best choice. Should I take any preventive measures? In children cataract formation can be minimized by awareness of risks and taking precautions for safety of the eyes.

Industrial workers should use protective goggles. Protect eyes from excessive exposure to sunrays, X-rays and intense heat. Quit smoking. Prompt medical and surgical treatment of eye injuries can prevent secondary cataract. Eat foods rich in proteins and vitamins, such as liver, eggs, milk products, carrots, cabbage and yeast.

Outcome A cataract operation done by inserting an intraocular lens offers good chances of visual recovery. After surgery glasses may be prescribed for better vision. If a cataract is not operated upon the vision will continue to deteriorate gradually. There is a misconception that the cataract should mature before it can be operated upon. This could be dangerous because a mature cataract may burst within the eye. An excessively ripe cataract can lead to complications such as glaucoma. Cataract can lead to blindness. Do not wait. Have an operation as early as possible.

Corneal Blindness
According to the World Health Organisation (WHO) calculations there are about 10 million blind and visually disabled persons in India alone - this number could double by the year 2020 unless immediate interventions are made. Of these 10 million, nearly two million persons have corneal blindness. Patients with corneal blindness can be visually rehabilitated only through transplanting their own damaged or disease affected corneas with healthy corneal tissues obtained from voluntary donors. Blindness continues to be one of the most important health concerns in Asia, Africa and Latin America. It is therefore critical, especially in the developing world, to set up eye banks of international standards that will pay particular attention to three primary objectives:

To increase the volume of corneal tissue available for transplantation, To apply the strictest medical standards in procuring and preserving donor tissues, and To maintain the highest levels of professionalism at every stage in the process of eye banking.

Corneal problems can happen to anyone at any age. Sometimes due to disease, injury and infection the cornea becomes cloudy or warped. A damaged cornea, like a frosted or misshapen windowpane, distorts light as it enters the eye. This not only causes distortion in vision; it may also cause pain. When there is no other remedy, doctors advise a corneal transplant. A transplant is the replacement of damaged or diseased tissues or organs with healthy replacements. In this procedure an ophthalmologist surgically replaces the diseased cornea with a healthy one to replace clear vision.

Glaucoma
Glaucoma is one of the major causes of blindness in India. In glaucoma the pressure inside the eye (intraocular pressure) becomes too much for the eye to tolerate. This damages the optic nerve resulting in loss of vision. Glaucoma usually affects both the eyes. It occurs in adults above 40 years of age, but can also occur in newborn babies. Glaucoma is a chronic disease; it cannot be cured but medication can arrest the progress of the disease. What are the symptoms associated with Glaucoma in adults? What are the symptoms associated with Glaucoma in infants and children? What treatment options are available for Glaucoma? Outcome What are the symptoms associated with Glaucoma in adults? Loss of peripheral vision: this is often not noticed until considerable damage has occurred.

Halos or rainbow-colored rings perceived around lights Vision may be blurred or foggy. Pain and redness of the eye Difficulty walking without assistance

What are the symptoms associated with Glaucoma in infants and children? Redness and watering, enlargement of the eyes, corneal clouding and photophobia (aversion to light) What treatment options are available for Glaucoma? Blindness due to glaucoma can be prevented by early detection, proper management and regular follow-up.

Congenital glaucoma requires immediate treatment. It is essential that patients use the medication on a daily basis, as advised. Surgery is suggested when it is not possible to manage glaucoma with medication. Medical management or surgery can halt further visual loss, it cannot restore the vision already lost. Outcome Glaucoma can lead to blindness. An early diagnosis is your best chance. Vision once lost due to glaucoma cannot be restored. Get your eyes tested regularly, especially if there is a family history of glaucoma.

Timely Treatment Preserves Baby's Vision -A Case Story

Why Should I worry about the eyes of a premature baby? The inside of the eye, the retina is not fully developed in premature babies, abnormal blood vessels can develop in such a retina. This abnormal blood vessels can cause internal bleeding and even retinal detachment. This is called Retinopathy of Prematurity (ROP). This condition results in low vision or blindness - both of which are irreversible. How can we detect ROP? A trained ophthalmologist can detect ROP by dilating the pupils of the eye, using eye drops. An indirect ophthalmoscope is used to scan the entire retina to detect ROP and gauge the state of retinal maturity. Do all babies need a retinal examination for ROP? Babies with a birth weight of less than 1700 grams or those born at less than 35 weeks of pregnancy are most likely to have ROP. Any other pre-term baby who has had problems after birth (lack of Oxygen/ infection/ blood transfusion/ breathing trouble etc.,)is also vulnerable.

Is it too late for my baby's eyes? Follow the "Day-30" strategy. The retinal examination should be completed before "day-30" of the life of a premature baby. It should preferably be done earlier (at 2-3 weeks of birth) in very low weight babies (<1200 grams birth weight). What is the treatment for ROP? ROP is treated with Laser rays or a freezing treatment (Cryopexy). The treatment helps stop further growth of abnormal vessels thus preventing vision loss. How often should the retina be examined? ROP can progress in 7-14 days and, therefore, needs a close follow-up till the retina matures. When should we treat ROP? ROP needs to be treated as soon as it reaches a critical stage called Threshold ROP. There is 50% or greater risk of vision loss if left untreated after this. Time is crucial! After treatment If treated in time, the child is expected to have reasonably good vision. All premature babies need regular eye examinations till they start going to school. They may need glasses or treatment for lazy eyes/ cross-eyes and sometimes, for cataract, glaucoma and retinal detachment. Faculty Details Subhadra Jalali Anjli Hussain Jyoti Matalia

Eye Health Pyramid


A First Namaste to Eye Care Transformations - taking eye care to communities

Vision Care For All

The LVPEI Pyramid Of Eye Care

LVPEIs model of Eye care, represented by a pyramid, emphasizes the creation of sustainable permanent facilities within communities, staffed and managed by locally trained human resources, and linked effectively with successively higher levels of care.

The pyramid rests on a foundation of community involvement, in the form of VISION GUARDIANS, trained young people who, through door-to-door surveys and other informal means, keep an eye on the eye health of around 5000 people. The second level has VISION CENTRES, which serve the primary eye health needs of the community. Each Vision Centre caters to a cluster of villages with a target of around 50,000 people. The Vision Centres draw upon local talent; they are staffed by persons from the local communities trained to address their Eye care needs. The initial capital investment needed to set up such a center is around US $ 10,000 (20 cents per person). The Vision Centres are networked with larger SECONDARY EYE CARE CENTRES that serve a population of 500,000 and provide ophthalmological care that can diagnose all diseases and offer high quality surgical care for cataractthe most common cause of blindness. These centers employ a team approach with almost all members of the team recruited from the local community and trained at the advanced tertiary center. The initial investment needed for such a center is US $ 100,000 (20 cents per person). The secondary centers are linked to TERTIARY CARE HOSPITALS/TRAINING CENTRES in cities, that provide a comprehensive range of services as well as training, each serving 5 million people. The establishment costs for such a center amount to US $ 1.0 million (again, 20 cents per person). The tertiary Eye care centers are linked to a CENTRE OF EXCELLENCE catering to a population of 50 million, which does service delivery for complex diseases, training of trainers of subspecialties and rehabilitation, while also engaging in advocacy. The total cost of setting up a center of excellence is US $ 10 million (20 cents per person).

This model does not depend on external funding or expertise in the long term, as the Vision Centres have the potential to grow into community hubs that address other health needs beyond ophthalmic needs. The cost of providing care, from base to apex, is just US$ 1 per person served.

The Experience Thus Far

LVPEI now has 65 Vision Centres providing primary care in the districts and villages of Andhra Pradesh, linked to secondary service centers which are in turn linked to LVPEI tertiary centers in Hyderabad, Vizag and Bhubaneswar (Orissa). The Government of India has adopted the pyramid as a model of Eye care service delivery in its current five-year plan budget and the model will soon be rolled out in other states in a phased manner.

While the LVPEI model evolved as a top down model, this has allowed it to leverage its existing linkages at the global and national level to bring the advantage of learning and influence to the grass roots. The development at all levels, but especially at the secondary and primary level, is based on community need, and is a tripartite arrangement between the community, LVPEI and an implementation agency, often an international NGO that supports the development with financial and material resources. The Vision Centres have helped not only bring services within the reach of villages that have been beyond the pale of most health care services, but have also become important points of community health awareness and education programs that have a potential to change attitudes toward and service uptake of not only Eye care programs, but also other social and health interventions in these areas.

FAQ about Eye donation

What is eye donation? Blindness can be due to several causes including cataract, damage to optic nerve, Xeropthalmia (vitamin A deficiency), retina detachment, damage to cornea, glaucoma, etc. The cornea is the transparent front portion of the eye separated from the pupil by a fluid-filled space. The damage to cornea can occur due to nutritional deficiency, injury to eye due to accidents and diseases or infections like trachoma, conjunctivitis and smallpox. The cornea becomes opaque preventing the light from entering the inside of an eye thus causing partial or total blindness. Research and advance techniques of modern surgery have made it possible to remove the opaque and defective cornea and replace it with a transparent healthy cornea. Out of the total estimated 2.5 million corneally blind people, at least half of them gain vision by means of proper corneal transplant. However, the new cornea to be transplanted cannot be artificially produced and has to come from a human body. As it is possible to use a cornea removed from a dead body, the necessity of removal of donor cornea from a live person does not arise. The transplant operation also known as Keratoplasty

Fig 1 The human eye, Cross section (above fig shows the location of the Cornea which is replaced during corneal transplant called Keratoplasty)
How does it Work? Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 st1\:*{behavior:url(#ieooui) } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-styleparent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; msopagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman","serif";} The eye bank has to first identify the hospitals where the mortality rate is high. The medical director has to obtain a consent from the Heads of Hospitals to place a social worker in the Hospitals, who will motivate the bereaved family for an eye donation. A social worker who is trained in the eye donor screening and counseling the family is a good choice.

The social worker may cover the hospital initially during the day. Depending upon the type of response obtained, round-the-clock coverage may be worked out. It would be ideal to have one or two social workers posted round the clock where the death rate in the hospital is about a minimum of 5-6 per day. If there are 3-4 such hospitals in the city/town where the eye bank is located, it would be ideal to have part-time counselors and pay them on per coverage basis. Wherever there are private hospitals and nursing homes with 10 to 15 deaths per month, Hospital Retrieval Program is better. In this program, the telephone operator who is covering the ye bank round the clock, should call the said hospital once in two to three hours, to enquire about any deaths. If so, the grief counselor and the technical staff may be alerted immediately. The grief counselors and the technical staff along with the enucleation/excision kit may go the hospital immediately. If the counselor succeeds in motivating the bereaved family for eye donation, the technical staff should act promptly and obtain the eyes. It may be noted that grief counseling works very effectively in hospitals where the patient population predominantly is of middle and upper socio-economic classes. However, it will take a minimum of two years for this program to succeed. In the meantime, the social worker has to become so familiar with the hospital personnel and its procedures that he/she must be considered one among them. At this juncture, it may be relevant to illustrate the success story of the efforts of Dr. Jhalla, an Ex-chairman of The Maharashtra Society for donation of Eyes who had during his tenure as the medical director of Sri Harkishandas Hospital in Mumbai, vigorously pursued the campaign for eye donation within the hospital. Besides reporting to personal contacts with the relative of the patients on the part of the medical and social workers, such a campaign also covered the distribution of promotional literature. These efforts brought very encouraging results in favour of the procurement of eye donations. During his tenure, the eye Bank attached to the Sri Harkishandas Hospital had registered the highest number of eye donations amongst all the year banks in India. Thus there is a tremendous scope available for promoting the growth of eye donation by proper motivational efforts. Who can donate eyes? Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colbandsize:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; msopadding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; msopagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman","serif";}

Eye donors can belong to any age group or sex. People who use spectacles, short sightedness, long sightedness or astigmatism or even those operated for cataract can still donate, as these conditions may not affect the cornea. Patients who are diabetics, those suffering from hypertension, asthma patients and those without communicable diseases can also donate eyes. Persons who were infected with or died from AIDS, Hepatitis B or C, rabies, septicemia, acute leukemia, tetanus, cholera, meningitis or encephalitis cannot donate eyes.

Eyes donated to The Eye-Bank that are not medically suitable for transplant may be used for medical research and education. When you come across death Please take the following precautions to preserve the eyes

Close the eyes of the deceased and place moist cotton over them. Raise the head about six inches with a pillow, to lessen incidence of bleeding during removal of the eyes. Fans should be switched off.

Put a polythene cover with few ice cubes on forehead. If possible instill antibiotic eye drops periodically to prevent infection. Inform eye bank immediately. What happens after eye donation?

The donor's family receives a certificate of appreciation from the eye bank. The eyes are taken to the eye bank and evaluated by trained staff. They are preserved in a solution of Optisol GS and refrigerated. This solution contains chemicals and drugs that are needed to keep the living cells of cornea healthy and functional. Tests are carried out and the report is sent to the corneal surgeon. The eyes are used for a corneal transplant operation within 72 hours, but with present day availability of special storage media the eyes can be stored for a longer time before being transplanted. The recipient is chosen from the eye bank's waiting list and called for corneal transplant. Neither the patient knows whose cornea is used for him, nor do the relatives of the donor know who has received the cornea. This information is strictly confidential. Periodic follow-up of the recipient is done over time to ensure that the graft is successful.

Facts on Eye Donation

Eyes may be donated only after death

Eyes must be removed within 4-6 hours after death, and the nearest eye bank should be informed immediately. Eyes may be removed only by a trained doctor. The eye bank team will remove the eyes at the home of the deceased or at a hospital. Eye removal takes only 10 to 15 minutes, is simple and does not lead to any disfigurement. Please remember that only the transparent section of the eyes called cornea is taken out and not the full eye ball. A small quantity of blood will be drawn to rule out communicable diseases. The eyes can be pledged to any eye bank preferably the nearest one. The identities of both the donor and the recipient remain confidential. One pair of eyes gives vision to TWO corneal blind people.

Clinical Services
LVPEI provides treatment for all eye diseases under various subspecialties, while also offering a complete range of services through specialized clinics. The Institute has an exclusive clinic for visually impaired children including newborns and infants, and a comprehensive oncology unit.

The clinical services work in association with the research departments, renewing treatment facilities based on scientific updates. The Institute encourages the clinical application of like stem cell transplantation technology, and has developed innovative applications of lasers for the treatment of corneal and retinal diseases. It has also evolved unconventional approaches for the treatment of glaucoma and conducted frontline research into the molecular genetic basis of eye diseases. The areas under the clinical services include:

Cornea and Anterior Segment LASIK and Refractive Laser Surgery Cataract Uveitis Glaucoma Retina Ophthalmic Plastic Surgery, Orbit and Ocular Oncology Strabismus (Squint) and Neuro-Ophthalmology Contact Lens Aesthetic Facial Plastic Surgery, Cosmetic Dermatology

Eye Bank
Q&A
What is the cornea? The cornea is a clear dome shaped outermost layer that covers the front black portion of the eye. What is corneal blindness? As long as the cornea remains transparent, light can pass through it and the person can see. Sometimes the cornea becomes opaque or cloudy (when it is damaged) or loses its transparency following trauma, infection or other diseases. A person with an opaque cornea cannot see; this condition is known as corneal blindness. What is corneal transplantation? A corneally blind person can see again through a surgical procedure known as corneal transplantation wherein the damaged cornea is replaced with a healthy cornea from a deceased donor. Who can be an eye donor? Persons of any age, those who use spectacles, as well as those with diabetes or hypertension can donate their eyes after death. Persons below 18 years of age need an authorization from their parent or guardian for donating eyes. The consent of the next of kin is essential for removing the eye after the donor's death. Are the eyes removed only after death? Yes, the eyes - or the corneal tissue - are removed only after death at the donor's home or hospital. Even if the donor has not pledged to donate eyes in his/her lifetime, the consent of family members is enough to make an eye donation. How soon should the cornea be removed after a donor's death? The cornea should be removed within 6-8 hours of death. Is it necessary to take the donor to the hospital for donating the eyes? No, the Eye Bank team will go to the donor's residence or the hospital and perform the corneal excision. Does eye donation cause any disfigurement? No, removing the cornea does not cause any disfigurement; a transparent eye cap is placed in the eye in place of the removed cornea. Does the procedure delay funeral arrangements? No, the procedure takes only 20 minutes and family members can proceed with the funeral arrangements as planned.

Is there an urgent need for eye donations? Currently, the supply of donor eyes does not meet the demand. It is estimated that over two million people in our country suffer from corneal blindness, 60% of those requiring corneal transplants are below the age of 12. We need one lakh corneal transplants every year, but only 10,000 surgeries are performed. How is the tissue harvested from a donor? The Eye Bank uses a simple procedure known as in situ corneal excision . This involves removing only the cornea from the eye of the donor. The excised cornea is kept in a preservative called the M K medium (developed by Ramayamma International Eye Bank, LVPEI) and stored in the refrigerator until it is used for surgery.

What is Eye Donation?

1. What is Eye Donation? Eye donation is an act of donating ones eyes after his/her death. Only corneal blinds can be benefitted through this process not other Blinds. It is an act of charity, purely for the benefit of the society and is totally voluntary. It is done after death. The eye donation of the deceased can be authorized by the next of kith & kin even if the deceased did not pledge to donate his / her eyes before death. 2. What is the use of eyes received? The eyes, which are received through such magnanimous gestures, are of great benefit to the society. The front, clear and transparent tissue of the eye called as cornea can be used to restore vision to corneal blind person. The other portions of the eye are also used for research and training purposes to develop cures for some of the common eye diseases. 3. What is Corneal Blindness? The Cornea is the clear tissue covering the front of the eye. It is a focusing element of the eye. The Vision is dramatically reduced or lost if the cornea becomes cloudy. This loss of the vision is referred as corneal blindness. 4. What causes corneal blindness? The cornea can get damaged through accidents. Children, while playing with sharp objects (e.g. bows and arrows ,pen, pencil, etc.) can accidentally damage their cornea. Corneal blindness can also happen to elders. Some of the industrial causes are chemical bums, flying debris or road accidents. The cornea can get damaged due to infections and malnutrition as well. 5. Is there a cure for corneal blindness? Yes. Removing the damaged cornea and replacing it with a healthy cornea by surgery can cure corneal blindness. Till date the treatment of the corneally blind people is corneal grafting. Artificial corneas have not yet been developed and hence the only source for cornea is from our fellow human beings.The first corneal transplant took place in 1905. 6. What is the source for the cornea? Fortunately, cornea can be removed from a deceased person within six hours of death and can be used for surgery. Artificial cornea has not yet been developed nor is there any other

objective. The eyes, which would ultimately be consigned to flames, or buried along with the body, can restore sight to two needy people. 7. What is the magnitude of corneal blindness? There are tentative 4.9 million people suffering from corneal blindness. Majority of the 4.9 million are young adults who have to spend long blind years even though they have a cure. The present collection from all over the source EBAI.) 8. How can one donate eyes? Eyes are removed only after death. A person wishing to donate eyes should make close family members aware of their intentions. After the death of the person, it is the family who can inform the nearest eye bank to fulfill the wishes of the deceased or authorize the removal of the eyes if somebody from an eye bank approaches the family. 9. What is an Eye Bank? An Eye Bank is a charitable organization and is not for profit .They are purely functioning for the benefit of the society. The eye banks facilitate removal of eyes, processing of eyes and evaluation of the eyes and distribute them to the needy. The first Eye Bank was set up in United states in 1945 at Newyark City. Around 500 + Eye banks in India. 10. How do I ensure that the eyes so donated would not be misused? Eye Banks are covered under Transplantation of Human Organs Act since 1994. It is a criminal offence to buy or sell organs. The Government issues a certificate of registration to eye banks and has a provision to inspect them regularly. In case a complaint is filed against any eye bank, the Government can take legal action. 11. How do I contact an eye bank? A special Toll free number 1919 (BSNL) Nationwide has been allotted for eye banks. Most of the eye banks all over the country have this number, once information for eye donation is communicated to eye banks; the eye bank sends its team to collect the eyes. By calling this number, details about eye donation can also be obtained.Also,all local news paper carry the eye banks number in their Emergency Number list.You can even get it from 197(BSNL/TATA Directory numbers.)At last,if required,you can contact any hospital and ask them for thelocal eye bank number.If you still could no find one,please call me up on +9422203645 and I shall help you find the local eye bank number. 12. What is the procedure for eye donation? The local telephone directory usually lists the phone number of eye banks under essential services. The eye bank personnel would give directions and precautions to be taken. The process of removing eyes does not take more than 15 to 20 minutes. The eye bank team can come either to the house where death has taken place or to the hospital where death has taken place to remove the eyes there. It would not delay the funeral arrangements. 13. What precautions are to be taken? Switch off fans and switch on Air conditioner (if available). Raise the head of the deceased slightly by placing a pillow underneath. Place wet clean cloth over the closed eye lids. Please COUNTRY is 37103 !! (Year-2009-2010 (

ensure that the eyelids are properly closed. Keep a copy of the death certificate ready (if available). Contact the nearest eye bank as quickly as possible.Give the correct address with specific landmarks or famous name of our area and mobile and residenc number to enable the team of eye bank for locating the house easily.Give alternate cell number of any available relatives also.The eye bank team, which would have a trained technician and/or a registered medical practitioner, would remove the eyes after taking consent on a printed form in the presence of two witnesses and also take A small quantity of blood sample will be drawn to rule out communicable diseases. 14. After the removal of eyes, would there be any complications or disfigurement? There are two methods adopted for removal of eyes. Some eye banks would remove the whole eyeball. In such a case there may be temporary bleeding. The team is well trained to take care of such eventualities. There would be no disfigurement. The eye bank team, after the removal of eyes would properly close the eyes so that there is no disfigurement. The second method is the removal of only the clear transparent tissue. Here also a plastic shield is placed in place of the tissue and no difference can be noticed. 15. Is eye donation against religious principles or traditions? All religions endorse eye donation. There are numerous examples in our traditions and scriptures, which endorse eye and organ donation. A part of the body would be consumed by flames and reduced to ashes or which is buried and allowed to decay and disintegrate & cannot be put to a better use than restoring vision to the needy!!! 16. Who can donate eyes? Is there any age limit? Any person of any age can donate eyes. Even if the deceased has medical history of hypertension, diabetes, asthma, tuberculosis etc., and even spectacle wearers and people who have undergone cataract operation can donate eyes. 17. Who cannot donate their eyes? Patients suffering from Rabies, Tetanus, Aids, Jaundice, Cancer, Gangrene, Brain Tumer, Food Poisoning, Septosamia & a person who has died due to drowning etc. cannot donate their eyes.