Current Projects

The main projects that ICARE is currently engaged in are:

• Rural Eye Health
• CAFE (The Community Assisted and Financed Eye care)
• Outreach
• Pediatric Ophthalmology Learning and Training Centre (POLTC)
• Diabetes Prevention Program through Child to Family Communication
• Nimmagadda Prasad – LVPEI Children’s Eye Health Initiative
• Community Linkage for Integration of Primary Health (CLIP)
• Capacity Development Program to Address Diabetes and Diabetic Retinopathy

The main aim of these projects is to develop good quality eye care services in the underserved areas of India, as well as in other parts of the developing world.

1. Rural Eye Health

Blindness imposes a heavy social burden, both in human and economic terms. The overall global prevalence of blindness is 0.7 percent. The data available on the incidence of blindness is unreliable but it is estimated that this number is increasing worldwide at the rate of 1 - 2 million per year. Two-thirds or more of all blindness is considered avoidable, because the causes are either treatable or preventable.

In India blindness is a major public health problem. It is estimated that there are 18 million people blind in India, which constitutes one-fourth of the total number of the blind worldwide.

The greatest prevalence of blindness in India is in the rural districts: firstly, because the majority of our population lives in rural areas and, secondly, because these rural areas have the least access to eye care services in particular and health care services in general.

Control of blindness in India has neither been effective nor efficient. The focus has primarily been on cataract surgery in make-shift environments, particularly in rural India. The quality of eye care available to the people in rural India is sub-optimal because of the lack of infrastructure and of human resources, i.e., capable and well-trained personnel for providing quality eye care.

A public health strategy that addresses the issues of availability, accessibility, and affordability of eye care services is needed to address current problems and to meet long-term plans for reducing blindness. In order to develop good quality, permanent, and affordable eye care for rural India, efforts should be made to plan new facilities and improve the existing ones.

To this end, the International Centre for Advancement of Rural Eye Care (ICARE) was established at the L V Prasad Eye Institute, Hyderabad, India. ICARE is working to develop a comprehensive approach to eye health in India by providing and coordinating training efforts for the development and management of eye care facilities in underserved areas.

Village Vision

All the rural outreach and community eye health programs are carried out by ICARE under the banner of Village Vision programs. These include service delivery, training and operations research projects. So far the programs have been confined to Andhra Pradesh. However, with the experience gained from such projects, the programs will be extended to other parts of the country and to other developing countries.

2. The Community Assisted and Financed Eye care (CAFE) Project

The Community Assisted and Financed Eye Care (CAFE) project was conceptualized as a pilot project to explore the modalities of delivering community assisted and financed eye care, and to find an entry point for the delivery of other health-care services and programs to an adopted community, based on the principle of a self-payment scheme. Under the scheme, the whole community makes a nominal contribution of Re. 1 per person, per month, and the entire family is registered under the scheme. This money goes into a fund to serve the whole registered community. Whoever requires eye care is given the benefit of a package of services, including a secondary level of eye care free of cost.

Under the CAFE scheme, 54,000 persons in 18 villages under Nidadavole, Chagallu and Devarapalle mandals in West Godavari district were enumerated in 2001. Till now approximately 32,000 persons have been registered, with 13,500 persons seen as outpatients and 150 surgeries performed.

Eyesight International, Canada has provided the support for CAFE, while L V Prasad Eye Institute is the implementing agency. Smt Rajeswari Ramakrishnan Lions Eye Hospital, Nidadavole, is the service provider.

This project serves to:

• To train eye care workers at every level required in these areas;
• To act as consultants providing information, training, and the benefit of experience in the field to local, governmental, private or international organizations working to develop eye care in Andhra Pradesh. 
• To participate in planning eye health in the developing world on the basis of reliable epidemiological research and biostatistical information.

3. Outreach

School Eye Screening

The L V Prasad Eye Institute undertakes School Eye Screening Program in the catchment population of all its partner secondary level eye facilities and vision centres. School Eye Screening is meant for generating awareness regarding eye health among the children, parents and the schoolteachers. 

The LVPEI strategy of School Eye Screening is to utilize teachers to identify children with poor vision and eye ailments. The teachers facilitate early detection of vision defects and refer them for eye examination to qualified ophthalmic personnel, or inform their parents. They also ensure that children who are provided spectacles, use them regularly while reading, writing or working.

It is recommended that the teachers do the eye screening once a year, and inform the respective vision centers / secondary level eye facility to provide appropriate services. Free services in the form of treatment and surgery are provided to those who are underprivileged and cannot afford payment.

Approach & Strategies:

Survey
Community Eye Health workers of this program conduct door to door survey for the entire population and would refer those with the eye problems for community screening program.

Community Screening Program (CSP)
CSPs would be conducted twice a week in the areas where the door-to-door survey has been completed. The ophthalmic technician at the CSP site would do ocular examination. Those in need of glasses would be prescribed glasses and those in need of further management would be referred to the base hospital.

Referrals
Those referred would be examined at the base hospitals by an ophthalmologist and the necessary treatment / surgical management would be provided.

Public awareness campaigns
Campaigns to create awareness in the public regarding the eye disorders and their prevention would be conducted once a week and along with every CSP twice a week. Posters, banners, pamphlets, dramas, and personal communication are a few of the methods for awareness. A link would be established with the existing health care workers, schoolteachers and community leaders to make the community aware about preventive and curative aspects of eye health in a manner that is long-term and sustainable.

School Screening Program (SSP): 
Teachers in the schools would be requested to participate in this activity. They would be trained in measuring vision and would be provided with a referral book. They would refer children suspected to have decreased vision or an obvious ocular abnormality to CSP. A field worker would always assist a teacher in the screening. Teacher would also be taught about the basic prevention to maintain good ocular health and would be required to check the compliance of the children with glasses.

Community Based Rehabilitation (CBR): 
Those identified as incurable blinds would be taken up as clients by the field workers and would be trained according to their needs and environment for better living and positive contribution to the community. 

The inclusion of visually impaired children in the local regular schools is one of our strategies in our target area. 

Activities of Community-based rehabilitation:
The fieldworkers would counsel the visually impaired and blind individuals and their family members, assess their potentials, interest of the clients and local resources and impart training /provide services in the following areas:

Orientation and Mobility training, training in Activities of Daily Living, training in related Occupation, access to Facilities given by Government for the blind, Economic Rehabilitation when indicated, and Inclusive Education for the visually impaired children.

4. Pediatric Ophthalmology Learning and Training Centre (POLTC)

Some of the major hurdles in the elimination of avoidable childhood blindness are shortage of skilled human resources to address pediatric eye diseases, inadequate infrastructure and lack of good anesthesia and para-ophthalmic support. To address these concerns in India and south-east Asia ORBIS has set up three Pediatric Ophthalmology Learning and Training Centres (POLTC) at Sankara Netralaya, Aravind, and L V Prasad Eye Institute, Hyderabad, in October 2006.
The objectives of the POLTC program are:

• Training 5 pediatric eye care teams; each team of 6 – an ophthalmologist, anesthetist, optometrist, nurse, counselor, and an outreach coordinator -  will empower one institution in pediatric ophthalmology
• Examination of 25,000 children, treatment for 2500 and surgeries for 975 children
• Enhancing capacity of the two ORBIS supported partners in pediatric ophthalmology
• Provision of 450 free spectacles
• Support in skill development of pediatric ophthalmology faculty of LVPEI
• Offering research and participation opportunities at national/international conferences and workshops

Training of fourth batch is completed. Trainees are not only involved in presentations, publications and research activities but also exposed to rural eye care activities at the primary and secondary levels.

January 2007 to March 2010
Children examined	:	84,294
Children treated	:	8568
Surgeries performed	:	11,494
Number of school screening programs	:	35
Pediatric hospital based program	:	01

5. Diabetes Prevention Program through Child to Family Communication

This program was launched in Prakasam district (Andhra Pradesh) in May 2006 and is supported by the World Diabetes Foundation. It aims at developing a sustainable district level model to promote lifestyle changes in rural Andhra Pradesh using the child-to-family communication strategy. Diabetes being a major public health problem, with alarming increases in its prevalence, there is an urgent need for interventions in lifestyle to prevent an epidemic of diabetes, which is a major factor in causing many retinal eye diseases. The project duration is from April 2006 to March 2011.

Project Performance: June 2006 - September 2008

Training Programs
School children trained: 119, 743
Teachers trained: 8288

Coverage
Schools Covered: 679
Villages covered: 513
Mandals covered: 56

Training Programs
Primary Health Centers doctors: 97
NGOs: 183
Self help group representatives: 41,108
Self help groups: 1184

Screening by trained children
Families: 528,150
Persons: 2,403,978
High risk persons identified and screened for blood and urine sugar: 131,786
Screened persons suspected to have diabetes: 7, 900

6. Nimmagadda Prasad – LVPEI Children’s Eye Health Initiative

Another major initiative to address childhood blindness is the Nimmagadda Prasad – LVPEI Children’s Eye Health Initiative, supported by the Nimmagadda Foundation. Launched on July 7, 2007, the initiative aims at preventing childhood blindness so that “No child in Andhra Pradesh is needlessly blind or visually impaired by the year 2020”. The Nimmagadda Foundation offers support in the areas of infrastructure development, screening and treatment including spectacles, awareness generation, development of information, education and communication (IEC) material, training and other community based programs.

July 2007 to December 2008

Outpatients: 38,570
Surgical procedures: 5,792
Spectacles distributed: 2,262
Teachers trained: 2,081
No. of children screened: 52,572
Schools covered: 221
No. of children identified with eye problems: 678

7. Community Linkage for Integration of Primary Health (CLIP)

The Community Linkage in Integration of Primary Health (CLIP) project is an attempt to study how LVPEI plays a vital role in providing affordable, accessible and quality healthcare to the community in its service area. LVPEI’s pyramidal eye care model in the state of Andhra Pradesh provides excellent and equitable eye care to the community through permanent infrastructure and manpower.
The eye care model is comprehensive in terms of controlling all the diseases that contribute to blindness; it has good geographical coverage and all the services are provided with appropriate delivery structures, relevant linkages and referrals. However, it was felt that with such a well-developed network of infrastructure and manpower, LVPEI could play an even greater role in providing linkages among various healthcare providers so as to provide quality healthcare at an affordable cost. LVPEI’s eye care delivery structure and referral network can be a suitable vehicle for achieving comprehensive healthcare for all with community involvement, with each tier supporting and implementing each level of activity.

LVPEI looks forward to playing the role of a facilitator, linking all health services (public and private) and other welfare schemes, such as the Rajiv Aarogya Sri scheme, EMRI and HMRI services. The on-ground service delivery would be done through Village Health Volunteers (VHV) — a cadre of volunteers from the village, trained by LVPEI in preventive and promotive health care, awareness creation about early detection and referral of cases. These volunteers will ensure linkage between various healthcare providers and work closely with government machinery. They will help create awareness about community health rights, ensuring active community participation in all activities, thus creating long term sustainability.

January to March 2010
Individuals screened		6514
Detected with eye problems		431
Detected with other health problems		1024
Preventive and Promotive advise given		2430

8. Capacity Development Program to Address Diabetes and Diabetic Retinopathy

This project aims at strengthening the existing infrastructure and building capacity to help better the quality of life of persons with diabetes in Prakasam district, Andhra Pradesh state, India. It will adopt a multidisciplinary approach (including modification in lifestyle, special diabetes oriented care of feet, eyes, etc) and emphasize strong public and private partnerships (among LVPEI, district health administration and private practitioners) with effective community integration and participation within the district. The World Diabetes Foundation is supporting the project for a period of 5 years (2008 to 2013). The objectives include:

• Developing a registry of all persons with diabetes in the district and ensuring continuous follow up,
• Strengthening the capacity of public health facilities and not-for-profit organizations at the district level for care of persons with diabetes and diabetic retinopathy,
• Establishing a working network of specialists both in public and private sector for specialties like cardiology, nephrology, care of feet and retina,
• Education and training of paramedics, general physicians, village volunteers, ophthalmologists and mid level ophthalmic assistants, and
• Facilitating annual comprehensive diabetic screening programs.

This project started on October 1, 2008, and was officially launched on November 14, 2008.

October 2008 to March 2010
Capacity building details	Target for 3 yrs	Actual trained
Ophthalmologists	30	15
Midlevel ophthalmic assistants	30	46
General medical practitioners	100	104
Paramedics	160	248
Community health workers	600	661

Service delivery
23,140 persons have been registered and 4143 persons have enrolled themselves in the project.