Preservation and Restoration of Vision:

Vision for the Future, Part 2: Ophthalmic Education and Training: Allied Ophthalmic Personnel Training

Mr. R. D. Thulasiraj, Executive Director
Lions Aravind Institute of Community Ophthalmology

On this page:

• COMMUNITY-BASED EYE HEALTH WORKERS
  
  
• HOSPITAL-BASED MID-LEVEL EYE CARE PERSONNEL

COMMUNITY-BASED EYE HEALTH WORKERS

These workers play a very crucial role as a link between the community and institutions providing eye care services.

They can play a very crucial role in increasing the awareness, providing first line of treatment, counseling, motivating and providing follow-up services.

They can also be trained to provide refraction services. India has about 6,000 Para Medical Ophthalmic Assistants (that is what they are called - PMOAs) with such training, working in the community.

Nepal is also a good example of a country using such people.

• Specify the job responsibilities in the areas of health education, treatment and referral. Also define the population base.
  
  
• Based on the above, develop a detailed training curriculum. The curriculum, in addition to training in the clinical aspects, should also train the workers in other areas like record keeping, monitoring, planning their work, etc.
  
  
• The training must also include how to interact with other related agencies like the primary health care system and the secondary/tertiary eye care systems.
  
  

It is obvious that the work definition, need for such personnel and the training programme will depend on the eye care priorities and the existing infrastructure in the country.

So while there can be a generic framework for defining the job and the curriculum, in effect each country must be encouraged to come up with its own training programme.

HOSPITAL-BASED MID-LEVEL EYE CARE PERSONNEL

These personnel are essential to enhance the efficiency of an ophthalmologist and contribute both to the quantity and quality of eye care services provided.

In several countries (e.g., in Bangladesh and India) and in many settings, the ophthalmologist does all the clinical investigation and a lot of the preparatory work, most of which can be very safely delegated to well-trained ophthalmic paramedics.

With good training they can do all the measurements, be it the visual acuity, fields, tonometry or ultrasonography.

In surgery, they can do a lot of the preparatory work including administering local anesthesia, being the first assistant in surgery and being able to help in the postoperative period. They can also do counseling for the patients and clarifying doubts relating to their eye condition and treatment.

Here again, in order to proceed, the training programme requires similar steps:

• Define the role and activities of the hospital based ophthalmic paramedic.
  
  
• Based on the above, develop a detailed curriculum which would impart necessary knowledge and the practical skills to carry out the activities with complete understanding of the desired standards.

Since there are varying levels of sophistication in the delivery of eye care services, the training can be offered in two or more modules starting with the basic ophthalmic techniques and progressing to the more advanced techniques like imaging, photography, etc.

This training is more amenable to a generic model since the work is within a hospital setting, which would be quite comparable across countries. However, some adaptation and moderation will need to be done based on the local laws and practice of ophthalmology.

September 20, 2000

Next: Training Curriculum for Community-Based Eye Care Workers Ministry of Health, India

Also see:

• Ophthalmology Continuing Education
  
  
• Table of Contents for Vision for the Future