Environmental & Occupational Optometry (MOPG031) 2020 PDF

Preview

Summary

Warning: TT: undefined function: 321IntroductionEnvironmental optometry is an important aspect of Public Health. It aims to provide a comprehensive approach to patient care by considering patient presentation to an optometric practice to including but not limited to case history taking, assessment o...

Description

1 Introduction Environmental optometry is an important aspect of Public Health. It aims to provide a comprehensive approach to patient care by considering patient presentation to an optometric practice to including but not limited to case history taking, assessment of the patient, prescription of drugs and visual aids and the impact that all these may have in the day to day livelihood of the attended patient and the environment. Furthermore, environmental optometry encompasses all aspects of optometry ranging from binocular vision in adults and paediatric patients, general optometric clinical practice including contact lenses, and ocular emergency care among others. Therefore, optometrists need to be aware that while assessing a patient and simultaneously assessing the environment within which these patients are based in order to provide an environmentally friendly intervention, they are playing a major role in the provision of eye health care services from a public health perspective. The rationale upon which optometrists should be involved in public health for ocular health care can include but not limited to the following reasons: 

Some of the patients are in the working class and such, visual demands are high; and



Possible eye injuries among those who do not use Personal Protective Equipment (PPE) may occur thus requiring optometric care.

In view of the importance of ocular health for better performance and output in any given environment, optometrists should therefore play a vital role in patient education. Their actions are more likely to be considered and applied by the general public because of their perceived social standing in society. Such interventions may contribute positively in the elimination of various causes of avoidable blindness. Blindness is one of the most tragic but avoidable disabilities in the developing countries. There are currently 45 million blind people and 135 million with low vision in the world. The number of blind people increases every year by 2 million and is 1

expected to double this year in 2020. This poses a serious threat to the ‘VISION 2020: The Right to Sight’ campaign initiated by the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB) together with an international membership of Non-Governmental Organizations (NGOs), Professional Associations, Eye care institutions and Corporations. This campaign aims to eliminate avoidable cases of blindness by the current year of 2020. The campaign has three major components as target activities, namely; specific disease control, human resource development and infrastructure, and appropriate technology development. All these components are vital for effective eye care programmes in the developing countries. In view of the target activities of VISION 2020 campaign, the initial stages focused on disease control of conditions such as cataract, trachoma, onchocerciasis, avoidable causes of childhood blindness, uncorrected refractive error, and low vision. Therefore, with new emerging trends of eye diseases in the developing countries, it is important for African countries to set programmes in place to meet the objectives of VISION 2020 campaign. Failure to set up such programmes may result in the projected possible doubling of the number of people with blindness by the year 2020. Since we are now in the year 2020, the world is waiting to see the effects of all initiated programmes aimed at eliminating avoidable causes of blindness worldwide. Despite containing 10% of the world’s population, Africa accounts for 19% of the world’s blindness. The leading causes of blindness in most parts of Africa include trachoma, onchocerciasis, cataract, and glaucoma. South Africa has an estimated prevalence of blindness of about 0.75% of which 80% is avoidable. By the year 2002, the leading causes of blindness in South Africa were recorded to be cataract (66%) and glaucoma (14%). Majority of these people live in the rural areas. There is a hope that programmes were set in place to assist in the envisaged elimination of unwarranted cases of avoidable blindness. Considering the current burden of eye diseases in the world, it has been realized that actions by individuals, families and communities, as well as eye care professionals are vital to achieving the ambitious target of ‘VISION 2020: the Right to Sight’ campaign and this can only be achieved through effective health promotion. Health promotion is the process of enabling individuals and communities to increase control over the 2

determinants of health and thereby improving their health. The concept of health promotion was first elaborated in 1986 in the Ottawa Charter which set out five areas of activity in order to achieve health for all by the year 2000 and beyond. These areas included: 

Promoting health through public policy by focusing attention on the impact on health of public policies from all sectors through advocacy for health;



Creating a supportive environment by assessing the impact on health of the environment and clarifying opportunities to make changes conducive to health;



Developing personal skills by moving beyond the transmission of information to promote understanding, and to support the development of personal, social and political skills which enable individuals to take action to promote health;



Strengthening community action by supporting concrete and effective community action in defining priorities, making decisions, planning strategies, and implementing them to achieve better health;



Reorienting health services by refocusing attention away from the responsibility to provide curative and clinical services towards the goal of health gain.

Effective health promotion involves a combination of three components; 

Health education directed at behaviour change to increase adoption of prevention behaviours and uptake of services;



Improvements in health services such as the strengthening of patient education and increased accessibility and acceptability;



and advocacy for improved political support for blindness prevention policies.

Most developing countries have adopted the Ottawa Charter and it has been integrated in the Primary Health Care (PHC) approach to deliver health care. Health promotion is not limited to health education. Health education is any planned activity that promotes health or prevents illness by changing behaviour. It usually depends on experts to inform the public, and it most often is focused on preventing illness. In contrast, health promotion includes advocating for health needs, enabling people to achieve their health potential, and coordinating multiple sectors related to health promotion to contribute towards the general health of the population.

3

There are three types of health promotion models, namely: 

Planning models, which are guides in the planning process;



Behavioural models, which indicate why people adopt certain behaviours; and



Change models, indicating how behavioural change can be stimulated. Although planning models are useful for explaining health promotion, they provide little information for the structure and content of health promotion programmes. Behavioural models, such as the health belief model, show which factors influence health behaviour, but they are not guides for implementing health promotion projects at the community level.

There are five basic approaches to eye health promotion: 

Medical,



Behavioural change,



Educational,



Empowerment, and



Social change.

In the medical approach the basic tools are immunization and screening. Immunization works only for some communicable diseases. Screening is effective for illness that have long preclinical phases those for which early treatment improves outcomes; and those for which testing and treatment are cost-effective. In the behavioural change approach, health is an asset that belongs to an individual. The assumption is that, given the relevant and correct information about the protection of this asset, people will take the necessary action. Usually health messages are delivered by clinical or government experts. The educational approach is based on the assumption that, if people have the appropriate knowledge, attitudes, and skills (KAS), they will have health. KAS are developed in people not by teaching facts as much as by giving skilled counselling to individuals or groups to promote informed choice. In the empowerment approach the growth of individuals or groups is promoted through facilitating community or group-based projects. Communities are empowered toward social change, which leads to improved health. 4

Health education should take place alongside improvement in services. Improvements should address locally identified barriers, which might include quality of clinical care – for example, timing of clinics and operating sessions; ensuring men and women have separate waiting areas; providing culturally acceptable food and prayer areas; ensuring clean environment. This can be achieved if the proposed strategies contained in the NHI draft policy can be implemented. However, implementing patient education in resource poor settings may not achieve desired results. Currently most hospitals and clinics in South Africa are in a bad state. Issues of overcrowding, shortage of health care personnel, shortage of food in some hospitals, and certain health care personnel raping patients should be prioritized and be part of service improvements in the South African primary health care system. However, all these can be achieved if the Office of Standards Compliance set up through the NHI can meet its deliverables targets. Furthermore, there is a need to improve the quality of information provided to patients to promote adherence to treatment regimens and follow-up, to increase awareness of possible side effects and action needed to prevent recurrence. This can be achieved if a range of approaches including teaching in groups, using videos in waiting areas, training lay people as peer counsellors/educators, involving other family members, training clinic staff to give clear and relevant advice supported with leaflets or charts are used. It must however be emphasized that for successful implementation of any proposed strategies for health promotion, there must be a congruent proposed strategy to evaluate the programmes in order to improve service delivery. Monitoring and evaluation of any possible eye health promotion activities across the provinces has not been reported hence the conclusion that eye health promotion was actually not fully implemented across the country. The information needs for implementation and evaluation of eye health promotion is an integral part for any successful health promotion initiatives. A proposed model for implementation of eye health promotion strategies and evaluation is as show shown in Figure 1.1.

5

Eye health promotion, to be successful, must be built on details of its understanding and the intended audience. The vital contribution qualitative and quantitative data make to planning a health promotion strategy is critical as each community poses its own particular challenges and opportunities for creative solutions. Information from research about what an intended audience thinks, knows, and does about a particular health concern leads on to the development of the health education strategy, including the setting and nature of the intervention. Materials need to be developed and pilot tested, to ensure that the messages are correctly interpreted and understood. Evaluation is essential to the expansion of eye health promotion. Evaluation should provide the information and feedback to make improvements in future activities. While the ultimate goal is improved eye health, it is useful to incorporate intermediate indicators, such as increased awareness, behaviour change, skills, self-efficacy, coverage and quality of services, and adoption of specific policies.

6

INFORMATION Qualitative data

Quantitative data



Perceived health needs and priorities



Prevalence by age, sex and ethnic background



Perceived benefits and risks of taking action



Income of persons affected



Influences on behaviour/actions for prevention and



Incidence including seasonal patterns

treatment of eye conditions, e.g. beliefs, values and



Local risk factors, behaviours, environmental conditions

empowerment



Utilisation of formal and traditional healthcare services

Patterns of decision making and influence in family and



Evidence of effectiveness

community



Impact of previous interventions and lessons learnt



Willingness to pay for services



Policies of blindness issues



Community norms of behaviour



Coverage in the media



Quality of care provided to patients/perceived barriers to



Resources and channels of communication that could be



Coverage of population by eye health care services



uptake 

mobilised

Stakeholder perception of blindness issues

Health education:

IMPLEMENTATION Eye care services

Advocacy:

To involve individuals, families, and communities

to make them more accessible,

Activities to raise the profile of blindness in

in the sustainable control of blindness in their own

affordable, effective, and acceptable

public debate and influence formulation and

communities

implementation of policy

IMPACT 

Change in behaviour at personal, family



and community level including preventive practices and use of eye



health services 

Change in knowledge, attitudes,



Support of eye care programmes by

Improved quantity and



quality of services



decision making ability, and self efficacy

More people receiving



treatment



More effective and acceptable eye care

Reallocation of resources Legislation and machinery for enforcement

 

community

Policy change at the level of documents and action

Greater intersectorial collaboration Increased support by all stake holders

ELIMINATION OF AVOIDABLE BLINDNESS

Figure 1.1: Information needed for implementation and evaluation of eye health promotion and possible elimination of causes of avoidable blindness

7

2 School eye health Vision screening As part of continuous contribution to the ocular health of the general public, optometrists also engage in ocular health screening through various means. Screening is a presumptive method used to identify unrecognised disease or defects by applying rapid tests or procedures. These screening tests are not diagnostic and thus individuals with a positive test are usually referred for a diagnostic evaluation to confirm the presence of absence of disease. Vision screenings are meant to detect all cases with subnormal function to avoid unnecessary referrals of disease negative individuals. Vision screenings should usually be done to evaluate a particular condition in a population that is generally not defined by symptomatology. Although the screening process identifies those considered to be healthy but also at risk of a disease, and those with identified defects or diseases, they should further be provided with information for further comprehensive diagnostic tests to be undertaken in order to reduce the risk of complications that may arise later in life. School vision screening programmes are further defined by a principal objective which may be to identify children with vision problems or potential vision problems likely to affect physiological or perceptual processes of vision, and to find those who have vision problems that might interfere with school performance. Vision screening among children should be simple, rapid, inexpensive, safe and acceptable. The utilisation of valid and reliable test batteries is fundamental to successful implementation of the screening programme. Therefore, the tests to be included in the screening programme should be age appropriate in order to be able to detect the target condition based on epidemiological data.

8

Comprehensive school eye health Education has the potential to change individuals’ lives and fuel social transformation. There is a strong link between children’s health, including their visual health, and the quality of their learning and achievement at school. This, in turn, affects children’s future quality of life and economic productivity. School eye health programmes provide a unique opportunity to deliver comprehensive eye health services to school-going children. The World Health Organisation (WHO) reports that 43% of all visual impairment is due to uncorrected refractive errors. This amounts to 122.5 million people, 12 million of which are children. Programmes for the detection of uncorrected refractive error (URE) among school children are highly cost effective. Comprehensive school eye health programmes are not just about URE, but can also have a positive impact on locally endemic diseases such as vitamin A deficiency. School eye health programmes should also include identifying and referring children with other eye conditions such as strabismus or lens opacities. Health promotion and education in schools can reduce the spread of epidemic diseases such as viral conjunctivitis and reduce the risk of injuries. The eye health of teachers can also be addressed by detecting and managing any refractive errors, including presbyopia. The steps involved in developing a plan are shown in Figure 2.1. Determine the goal of the programme

Engage the ministry of health and the ministry of basic education Ensure their active engagement and support

Situational analysis of: 1.

The positive change that would come about as a result of successful implementation of all components of the programme

Engage the ministry of health and the ministry of basic education

2.

Any other programmes for refractive error The capacity of local eye care services to refract and refer children

Situational analysis of: 1. 2.

Policies for school health The school education system (term dates, examination dates, etc)

Ensure their active engagement and support Figure 2.1: Steps in developing a comprehensive school eye health programme

9

Develop plan Gap analysis To identify what needs to be addressed for each component of the programme

SMART objectives (specific, measurable, achievable, relevant and time-bound) for each component of the programme, with an action plan, indicators and budget

There has also been a lack of standard approaches to screening, referral, prescribing, dispensing and follow-up, and most programmes do not address the eye health needs of teachers. Another challenge is the inadequate monitoring and evaluation of school eye health initiatives. This can le...