ECHO Clinics - Enhancing the quality of community eye care for cornea patients

TKCI’s new initiative ECHO Clinic (Extension for Community Healthcare Outcomes) is an innovative continuing education model that uses video conferencing to train primary care providers. The University of New Mexico Medical Centre (UNMMC) is the collaborating partner for this initiative. Headed by Dr Prashant Garg, the TKCI ECHO clinic will shortly commence in the areas of acute red eye, corneal infections and care for corneal transplant patients.

The Andhra Pradesh Eye Disease Study reported that a significant burden of corneal blindness in the rural population of Andhra Pradesh was avoidable. Of the 0.66% of corneal blindness reported in at least one eye in this population, nearly 95% was avoidable. The avoidable causes of corneal blindness were keratitis in childhood, trauma, aphakic bullous keratopathy, severe astigmatism post cataract surgery, keratitis in adulthood and traditional eye medicines. A vast majority of these patients suffer vision loss because they are incapable of accessing care by an Ophthalmologist. Even those who manage to access it, find it difficult to comply with follow-up care as the treatment for this disorder is usually very long and costly.

The WHO theme for making eye care available to all is “To get the right worker with right skills in the right place for doing right things”. The best way to ensure this is by training the eye care providers and helping them deliver quality eye care in their own work environment. ECHO clinics that use ZOOM Technology, will achieve this by focusing on:-

(a) Training ophthalmologists practicing in remote areas and advising them on difficult cases through a video conferencing web platform.

(b) Training and empowering primary health care physician in the care of corneal ulcer: Dr Garg believes that this will be a high impact area as primary care physicians are the first point of contact for patients with eye diseases. Most of physicians have some ophthalmology exposure in their undergraduate training, and have reasonable understanding in safe use of drugs. If they can be trained to perform external examination of the eye - especially the assessment of painful red eyes and its management, then we will be able to reduce morbidity from corneal ulcers and minimize damage to vision.

(c) Training community health workers and school teachers in health education to act as catalyst to guide patients to seek care at Primary Health Centres (PHC).

This will be done through:-

  • Developing curriculum for the participants (Community Health Workers/ PHC physicians/ ophthalmologists)
  • Initial on-site training of participating doctors or Community Health Workers (CHWs) at LVPEI (3 - 5 days)
  • Continued online training through weekly discussion of cases managed by them using ECHO portal
  • Final online debriefing, assessment and certification (2 days)
  • Impact assessment through survey and tracking outcomes of the cases – to be done by the faculty.

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