The resident should specifically reference their own country or health
district as they consider each of the community health-related items presented
below, as not all items may be relevant to each resident.
Basic Level Goals: Year 1
A. Cognitive Skills
Principles for the prevention of blindness
1. Explain the World Health Organization (WHO) definition of
blindness and low vision.**
2. Describe the magnitude of blindness in different economic
settings.**
3. List the major causes of blindness in different economic
settings.**
4. Describe the magnitude of blindness in the resident’s own
country.**
5. List the major causes of blindness in the resident’s own
country.**
6. Define the concept of blind-person years.**
7. Outline the structure of the health service, and how eye care
services are integrated into this structure.**
8. Outline the social and economic implications of visual impairment
and the impact on quality of life.**
9. Outline the barriers to the uptake of eye care services.**
10. Describe the principles of primary health care
and their application for primary eye care.**
Inclusive practice
1.
Explain the WHO
definition and conceptualization of disability.
2.
Appraise the epidemiology
of disability (including due to visual impairment) and its impact in different
economic settings.
3.
Describe the intersection
of blindness and visual impairment with other issues that may cause
marginalization, including the patient’s age, gender, other impairments,
poverty, ethnic group, and faith community.
4.
Critically appraise the
impact of disability in peoples
lives (eg, poverty, education, quality
of life [social and economic], and occupation).
5.
Describe the barriers to
the uptake of eye care services within health systems by marginalized groups.
6.
Describe the principles
of rehabilitation and community-based
rehabilitation with relevance to people with visual impairment and the
integration of rehabilitation within a health system.
7.
Describe strategies and
partnerships with disability support services that can improve quality of life
(eg, health, education, livelihoods, economic security, social inclusion) of
people with long term visual impairment.
Cataract
1. Describe the prevalence and incidence of blindness due to
cataract.***
2. Define cataract surgical rate (CSR).**
3. Describe the desired CSR required to eliminate blindness due to
cataract.**
4. List the barriers to the uptake of cataract surgery.**
5. Outline the rationale for the monitoring of cataract services.**
6. Describe the components of a system for the monitoring of cataract
services.**
7. List the WHO’s recommendations for the visual acuity outcomes
following cataract surgery.**
Refractive error
1. Define significant refractive error.**
2. Describe the prevalence of significant refractive error in
children and in adults.**
3. Outline the strategy for including refractive error in a blindness
prevention program, including a system for screening of school children to
detect refractive error.**
4. List the barriers to the uptake of refractive error services.**
Low vision
1. Define low vision.**
2. Describe the prevalence of low vision.**
3. Outline the strategy for including low vision in a blindness
prevention program.**
4. List the barriers to the uptake of low vision services.
5. Describe the impact of low vision on the
affected person and how it impacts their access to wider health, education,
economic, and social inclusion.**
6. List
the resources available for people with low vision (eg, low-vision devices,
low-vision training, and access to wider opportunities in education,
livelihoods, and social inclusion).**
Childhood blindness
1. Define
childhood blindness.**
2. Describe
the prevalence of childhood blindness in different economic settings.**
3. Describe
the incidence of childhood blindness.**
4. Describe
the classification of the causes of childhood blindness.**
5. Outline
the blind school survey method and the key informant method for identifying the
causes of childhood blindness.**
6. Summarize
the results of blind school surveys that have been conducted.**
7. List
the barriers to the uptake of services for childhood eye problems.**
8. Outline
the role of primary eye care in the prevention and treatment of childhood
blindness.**
9. Outline
how to partner with services that can improve quality of life (eg, health,
education, livelihoods, and social inclusion) of children with long term visual
impairment.
Trachoma
1. Describe the risk factors for trachoma.**
2. Outline the WHO clinical grading of trachoma.**
3. Outline the surgery,
antibiotics, facial cleanliness, and environmental changes (SAFE) strategy for the control of
trachoma.**
4. Describe the magnitude of trachoma, and describe the affected
regions.**
5. Outline the role of primary health care in the prevention and
treatment of trachoma.**
Onchocerciasis
1. Describe the risk factors for onchocerciasis.**
2. Outline the strategy for the control of onchocerciasis.**
3. Describe the magnitude of onchocerciasis, and describe the
affected regions.**
4. Outline the system for the distribution of ivermectin.**
Glaucoma
1. Describe the prevalence of glaucoma and blindness due to
glaucoma.**
Diabetic retinopathy
1. Describe the prevalence of diabetes and diabetic retinopathy.**
Human resources for blindness prevention program
1. Describe the role and distribution of
different cadres working in eye care.**
Planning of blindness prevention programs
1. Describe the steps in developing a one-year operational plan for a
blindness prevention program for a health district with a population of one
million people.**
B. Technical Skills
Principles of prevention of blindness
1. Calculate prevalence rates from given data sets.**
2. Calculate numbers blind from given prevalence rates.**
3. Calculate blind-person years from given data sets.**
4. Calculate estimates of numbers of persons who are blind.**
5. Calculate estimates of blind-person years.**
6.
Calculate an estimate of
the number of persons who are irreversibly blind and require rehabilitation
services.
Cataract
1. Calculate an estimate of the number blind due to cataract.**
2. Calculate cataract surgery rate.**
3. Calculate cataract surgery coverage from given data sets.**
4. Calculate and comment on visual acuity outcomes following cataract
surgery from given data sets.**
Refractive error
1. Calculate estimates of numbers of children and adults with
significant refractive error.**
Low vision
1. Calculate estimates of numbers of children and adults with low
vision.**
Childhood blindness
1. Calculate estimates of the numbers of children blind due to
different causes.**
Standard Level Goals: Year 2
A. Cognitive Skills
Principles for the prevention of blindness
1. Outline
the magnitude and distribution of global blindness, and compare this to overall
global disability prevalence.
2. List
the major causes of global blindness.
3. Describe primary, secondary, and tertiary prevention strategies
that are applicable to the leading causes of low vision and blindness.
4. Outline the different possible approaches (ie, disease orientated,
service orientated, strategy orientated, community orientated) to blindness
prevention.
5. Describe the integrated approach to blindness prevention that is
recommended for use in VISION 2020.
6. Describe the structure and function of a generic VISION 2020
program for a health service unit with a population of one million.
7.
In line with the WHO Universal Eye
Health: A Global Action Plan 2014–2019,
describe strategies to strengthen inclusive practices related to gender,
disability, and other groups within a generic VISION 2020 program.
Cataract
1. Describe the prevalence and incidence of blindness due to cataract
in different economic settings.
2. Describe the cataract surgery rates in different economic
settings.
3. Describe cataract surgery coverage, including its use and
limitations as an indicator to measure program output.
4. Outline the possible strategies to overcome the barriers to
cataract surgery.
5. Define cataract surgery efficiency and cataract surgery volume.
6. Outline the factors affecting cataract surgery capacity.
7. Outline the principles of an efficient cataract surgical service.
8. Describe a model for the staffing and running of a cataract
surgical unit.
9. Describe the components of a model for the costing of cataract
surgery.
10. Describe the possible strategies for cataract
surgery cost containment.
11. Describe the possible strategies for cataract
surgery cost recovery.
Refractive error
1. Describe the prevalence of refractive error in different
countries/regions.
2. Outline the possible strategies for the provision of spectacles in
a blindness prevention program.
Low vision
1. Describe the prevalence of low vision in different
countries/regions.
2. Outline the possible strategies for the provision of low-vision
aids in a blindness prevention program.
Childhood blindness
1. List the main causes of childhood blindness in different
socioeconomic settings.
2. Describe the primary, secondary, and tertiary prevention
strategies for the control of childhood blindness due to corneal scar,
cataract, glaucoma, and retinopathy of prematurity.
3. Describe the main barriers for children with
visual disabilities to access health, education, and social inclusion.
4. Outline the models/strategies for supporting
education for children with visual impairments through mainstream schools (eg,
inclusive education) or “special” schools.
Glaucoma
1. Describe the prevalence of glaucoma in different regions and in
different race groups.
2. Outline the possible strategies for the opportunistic case
detection of glaucoma.
3. Describe the advantages and disadvantages of medical, laser, and
surgical interventions for the management of glaucoma in middle and low-income
countries.
4. Define glaucoma treatment/surgery rate.
5. If known, describe the desired glaucoma treatment/surgery rate
that is required to adequately deal with glaucoma in a blindness prevention
program.
6. Outline the possible strategies for increasing the glaucoma
follow-up rate.
Diabetic retinopathy
1. Outline the possible strategies for the prevention of diabetic
retinopathy, including the use of appropriate educational health materials for
counseling.
2. Outline the possible strategies for screening for diabetic
retinopathy.
3. Outline the possible strategies for the treatment of diabetic
retinopathy.
4. Outline the possible strategies for increasing the diabetic
retinopathy follow-up rate.
Human resources for blindness prevention programs
1. Describe the recommended cadres and numbers of human resources
required at the community level, primary level, secondary level, and tertiary
level for a generic blindness prevention program for a health service unit of
one million in the resident’s own country or health district.
2. Describe the roles of each of the cadres that are recommended for
a generic blindness prevention program.
3. Describe the available training facilities for a generic blindness
prevention program.
Infrastructure for blindness prevention programs
1. From the International
Agency for the Prevention of Blindness (IAPB) standard list for VISION 2020, describe the recommended
instruments and equipment required at the primary, secondary, and tertiary
level for a generic blindness prevention program for a health service unit of
one million population.
2. Outline the strategies for the maintenance of the recommended
instruments and equipment.
Planning of blindness prevention programs
1. Describe the potential role of a VISION 2020 coordinator and a
VISION 2020 committee.
B. Technical Skills
Principles of blindness prevention
1.
For planning
purposes, integrate primary, secondary, and tertiary preventions for leading
causes of low vision and blindness into a district blindness prevention program
plan adhering to inclusive practices.
Cataract
1. For planning purposes, calculate estimates of numbers of people
blind due to cataract in different countries and regions.
2. For planning purposes, calculate cataract surgery rate in
different countries and regions.
3. For planning purposes, identify and include suitable strategies
for overcoming the barriers to cataract surgery in a blindness prevention
program. Consider how patients may
be affected differently based on their age, gender, other impairments, poverty,
ethnic group, faith community, etc.
4. For planning purposes, identify and include suitable strategies
for improving the efficiency of a cataract surgical unit in a blindness
prevention program.
Refractive error
1. Calculate estimates of numbers of children and adults with
significant refractive error in different countries and regions.
2. For planning purposes, identify and include suitable strategies
for including refractive error as a priority in a blindness prevention program.
Low vision
1. Calculate estimates of numbers of children and adults with low
vision in different countries and regions.
2. For planning purposes, identify and include suitable strategies
for including low vision as a priority in a blindness prevention program.
Childhood blindness
1. For planning purposes, use available program reports to identify
key gaps in and barriers to service delivery.
Trachoma
1. For planning purposes, use available program reports to identify
key gaps in and barriers to service delivery.
Onchocerciasis
1. For planning purposes, use available program reports to identify
key gaps in and barriers to service delivery.
Glaucoma
1. Calculate estimates of numbers of people with glaucoma in different
countries and regions.
2. For planning purposes, identify and include suitable strategies
for including glaucoma as a priority disease in a blindness prevention program.
Diabetic retinopathy
1. Calculate estimates of numbers of people with diabetic retinopathy
in different countries and regions.
2. For planning purposes, identify and include suitable strategies
for including diabetic retinopathy as a priority disease in a blindness
prevention program.
Human resources
1. For planning purposes, identify and include suitable strategies
for improving the human resource capacity in a blindness prevention program.
Infrastructure
1. For planning purposes, identify and include suitable strategies
for improving the infrastructure capacity in a blindness prevention program.
Planning of blindness prevention programs
1. Develop an activities plan for a one-year operational plan for a
blindness prevention program for a health district with a population of one
million.
Advanced Level Goals: Year 3
A. Cognitive Skills
Principles of prevention of blindness
1. Outline the different health service models in different countries
and regions, and how eye care services might be integrated into these.
2. Describe the components of a rapid assessment of avoidable blindness
(RAAB) survey.
3. Outline the government and nongovernment funding that are
available for eye care.
4.
Describe the key
practices and policies that will ensure
the principles of prevention of blindness are inclusive relating to gender,
disability, and other potential causes of marginalization.
Cataract
1. Outline the components of a system for monitoring the visual
acuity outcomes following cataract surgery.
2. Outline the components of the cataract surgery costs.
Trachoma
1. Describe the components of a rapid assessment of trachoma (RAT)
survey.
B. Technical Skills
Cataract
1. Set up a system for the monitoring of the visual acuity outcomes
following cataract surgery.
2. Calculate cataract surgery costs with recommendations for
strategies to decrease unit costs.
Refractive error
1. Evaluate the coverage and impact of school screening, and make
recommendations for improvement.
2. Evaluate the services for the provision of presbyopic correction,
and make recommendations for improvement.
Low vision
1. Evaluate the coverage and impact of low-vision services.
Childhood blindness
1. Where appropriate, set up a system for the screening and treatment
of retinopathy of prematurity.
Trachoma
1. Where appropriate, network and advocate with agencies and communities
to implement the F (facial cleanliness) and E (environmental changes)
components in the SAFE strategy.
Planning of blindness prevention programs
1. Develop a budget for a one-year operational plan for a blindness
prevention program for a health district with a population of one million.
Very Advanced Level Goals:
Subspecialist
Subspecialty training usually involves a 1-2 year master’s level training
in community eye health. This might be a stand-alone master’s degree in
community eye health, or it might be a component of a master in public health
degree. A community eye health subspecialist should have all the cognitive and
technical skills listed for residency training. A community eye health
subspecialist should be able to plan and manage a district or national
blindness prevention program.
A. Cognitive Skills
In addition to the cognitive skills listed for
residency training, be able to:
1. Describe the principles of epidemiology, as applicable to
community eye health.
2. Describe the principles of research methods, as applicable to
community eye health.
3. Describe the principles of biostatistics, as applicable to
community eye health.
4. Describe the principles of health economics, as applicable to
community eye health.
5. Describe the principles of health systems strengthening, as
applicable to community eye health.
6. Describe the principles of health education and health promotion,
as applicable to community eye health.
7. Describe the principles of project and program management, as
applicable to community eye health.
8. Describe the relevant WHO global programs (eg, millennium development
goals, disability framework).
9. Describe the relevance of the disability
policy at a global level and within the health system.
10. Describe the main concepts
of habilitation, rehabilitation, and community based rehabilitation for persons
with visual disability and its integration within a health system.
B. Technical Skills
In addition to the technical skills listed for
residency training, be able to:
1. Plan and conduct research projects to inform the planning and
implementation of district and national blindness prevention programs.
2. Plan and conduct RAAB surveys.
3. Plan and conduct RAT surveys.
4. Plan, implement, and manage one-year district operational
blindness prevention programs.
5. Plan, implement, and manage national three-to-five-year strategic
blindness prevention programs.
6. Advocate for national policy implementation and community
participation to strengthen national blindness prevention programs.
7. Provide training in community eye health to different eye care
cadres.
8. Engage with public health practitioners to advocate for
improvements in eye care services and the implementation of the disability
framework.
9. Assess the impact of disabilities and
advocate the application of global disability policy at a local level.
*
* *
Note: Inclusion of therapies and investigations in
the ICO Residency Curriculum does not imply that listings are all inclusive or
that methods are endorsed by the ICO. Appropriate levels of expertise and
knowledge should be achieved based on the care provided. Practitioners should
know of therapies and investigations not available at their hospital or clinic,
so that they can advise patients who may be able to seek care elsewhere.
