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Most people know that an ophthalmologist is a medical doctor who
diagnoses and treats diseases of the eye. These diseases may
range from simple things like "red eye" to more serious infections
of the inner or outer eye, cataract, glaucoma, misalignments of the
eyes, diseases of the eyelids, retinal diseases and diseases in the
bony eye socket (orbit). People tend to become aware of their own
eye problems either because they have pain or because their
vision decreases. People with money, education, or easy access to
medical services may even go to see doctors when they have no
problem, just to be reassured that everything is OK.
It's easy for an ophthalmologist to work in a clinic or hospital and
simply examine and treat the people who come to see him; most
busy ophthalmologists won't think about the patients that need eye
care who don't come in for examination. Out in the community,
however, there may be many people with eye disease for every
one who shows up at a clinic for examination and treatment. We
know about this because of population-based surveys, in which
trained teams go into the community, track people to their houses
or work, and examine nearly every member of a community.
Results from such surveys are often surprising; for example, in
much of sub Saharan Africa we know that there are about 10
patients blind from cataract in the community for every patient who
gets his cataract operated at the hospital. Of course this varies
widely from place to place depending on many factors, but overall,
among those blind from cataract, generally less than 10% get an
operation to restore sight.
To assume that the reason so many go untreated is that there is a
lack of doctors is overly simplistic. In fact, many hospitals in poor
countries are not very busy and do not work to their full capacity.
The fact is that most blind people do not ever get to the clinic or
hospital for treatment.
Community ophthalmology examines the problem of blindness from
the perspective of the community. We look at the question of why
there may be 10 blind in the community for every 1 who makes it to
the doctor to receive treatment. This requires investigating the size
of the problem, the causes of blindness and eye disease in the
community, the availability of eye services, the attitudes of the
people towards visual disability or eye diseases, the attitudes of
the people towards the services, and the many barriers that
prevent people from using services. When these issues are
defined, then solutions can be sought, agreements can be
reached among all those concerned, and programmes can be
implemented to put solutions in place.
Community ophthalmology training complements clinical
ophthalmology; it includes training in survey methodology, needs
assessments, proper data collection and interpretation,
programme design and implementation, management, and
communication and effective teaching. Legions of ophthalmologists
trained only in how to diagnose and treat eye diseases will not
prevent blindness in most poor countries. Blind and visually
impaired people must come from communities to receive medical
care; we must look at the processes they go through to receive
care if we hope to make a significant decrease in the number of
blind and visually impaired.
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What is Community
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