Cataract Screening Role in

Community
Dr. Hera Dwi Novita, Sp.M(K)
 20% LOSS OF
PRODUCTIVIT
Y
TOTAL
ECONOMIC

blind INDIVIDUALLY LOST 84.7

GLOBAL AND OTHER TRILLION
United Nation,
General Assembly, FAMILY RUPIAHS PER
75th sesiion (July,
MEMBERS YEAR
2021) 80 % OF BLINDNESS CAN BE
RESTORED THROUGH

2.2 billion
SURGERY DUE TO CATARACT

INDONESIA
Indonesian MoH in 74th world
health assembly, IAPB (May, 2021)
untreated impaired vision in 2020

1,1 billion prevented vision impairment 1.6 MILLION BLIND

recomendation : world report on vision
; eye care 6.4 MODERATE TO
integral part of universal health SEVERE IMPAIRMENT
coverage,
implement ipcec in health systems
across the
spectrum of promotive, preventive,
8 million
curative and
rehabilitative
REGARDNESS AGE AND THEIR INCOME LEVEL STATUS
 Genetic Change in health paradigm

Approach through treatment  Curative

Approach through precaution 

Health
Environment Problem Health Preventive
Service
“Cataract”
Cataract case finding trough
CATARACT SCREENING

Behavior
CSR
Identifying
unrecognized
disease or risk
factors for disease by
applying tests on a large
scale to a population
that does not have clinical
symptoms
Screening test usually seek
to identify small groups at
high risk of the condition 
further test are needed to
confirm the diagnosis
 Purpose of Screening
Used to select those people who are at higher risk of
developing a disease and offer them a health
intervention aimed at prevention by one of two means 
• Prevention of serious outcomes of existing disease (secondary prevention)
• Prevention of the development of disease (primary prevention)
cataract
Mass Screening and targeted Screening

Whole population (mass screening) or selected groups

who are anticipated to have an increased prevalence
(targeted screening)
 • Facilities are adequate
• Effective, acceptable and safe
Diagnosis treatment available
&
Treatment

“Cataract“
• Sensitive and specific
• Simple and cheap
Screening • Serious
• Safe and acceptable
• reliable Criteria •
•
High prevalence
Natural history understood
Diagnosis • Long period between first sign
Disease
Test and overt disease
 Evaluating Screening
Programmes
Relative burden disease
• Prevalence, incidence or mortality rates for the disease can be determined
Feasibility
• Depend on how easy it is to organize the population to attend for screening
Effectiveness
• Evaluated by the extent to which instituting a screening programme affects
health outcomes
Cost
• Cost effectiveness of screening programme compare with other form of health
care should always be considered
How to develop Cataract Screening in
Community ?
 STRUCTURE OF EYE CARE Cataract
World report on Vision recommendation &
Indonesia road map visual impairment Improving priority level
program  promotive, preventive, curative referral setting
trough IPCEC system

Research, Education, Difficult

Cases Central of 25 mill
Excellent
Difficult Cases Tertiery Eye
Care
10 mill
High Volume Cataract
Surgeries Secondary Eye Care 2.5 mill
Improving skill
Cataract Case Finding by
health Workers
by training,
workshop
Primary Eye Care 30.000
Visual Impairment Case Community Structures
Findings by Key
(Key Informants/Cadres)
5000
Informants/Cadres
 CATARACT PREVENTION STRATEGY
Empowerment Delaying &
community HOW TO IMPROVE CATARACT SURGICAL RATE?
HOW TO PREVENT CATARACT BLINDNESS? restore vision
Primary level from
setting CATARACT PREVENTION?? IS IT POSSIBLE??
Blindness
Secondary level
setting Cataract
screening

REHABILITATIVE

CURATIVE

PREVENTION

PROMOTION COLLABORATIVE HIGH TECHNOLOGY IN HEALTH SYSTEM

PROMOTION
PREVENTION CURATIVE
cataract risk factor REHABILITATIVE
risk factor control increasing cataract
increasing awareness secondary prevention
surgeries
cataract screening optimalitation visual acuity
education cataract output
increasing cataract increasing quality of life.
Online Display cataract outcome.
case finding
 Situasional analysis, stakeholder. Asses
need. Resources assessment (human,
finance, information, management),
Where utilization of resources (current service
provision)
are we?

Manage people, manage finances, Doing it Principles of Vision, overall aim, Goal, set

Planning & Where do we

Objectives and targets to be achieved
monitoring and evaluation effectively with in each year, milestones
implementation
efficient use of want to be?
resources Management

How will Strategy, priorities, mobilise,

resources, formulate the action plan
we get for each objective
there?

Planning & Management

 Where are we How will we What new
Where Do we How will we
now? Situation know when we problems do
want to go? get there?
analysis arrive? we have?

Target population: age > 40 priority: case finding Advocacy : collaboration

(gender, ages  BPS data operable cataract (visus < with dinkes, eye clinic, New problems  target &
Monitoring 
Resources  manpower : 3/60) or severe visual PKM, NGO indicators not achieved 
indicators & targets
teachers, cadre, impairment Capacity building : training, back to first health
achieved /month/ year
refraksionis, GP, SpM Goal : reduce cataract workshop (LIHAT methods planning cycles seek
Eye health services : optic, blinsness in Malang district dan light the pupil) root of problems
UKS, posbindu, prolanis Objective : improve Refferal data record
Infrastructure cataract case finding about cataract cases in
finance : government, 80% through 2023 in community  primary level
insurance, BPJS, NGO Malang District validation  secondary
level for definitive therapy
Tools for Cataract Screening in
Community
Visual impairment by : E-
thumbling, ETDRS, peek
acuity apps, LIHAT method
Cataract detection by :
ophthalmoscopy, slit lamp,
Image recognition base on
Artificial Intelligence and
Light the pupil methode
LIHAT (LOOK) Methods
Finger counting at 6 m away
L • Do eye examination in community trough
Integrated Counseling Post (Posbindu)

The Ministry of Health of

The Republic of Indonesia I • Visual acuity Identification by KI

(2017)  Visual acuity

detection by cadres H • Finger counting at 6 m away

Integrated Counseling
Post (Posbindu)  First-
Level Health Service or A • Refer to eye health service if finger
counting at 6 m failed

Public Health Centres

(Puskesmas) T • Treatment for cataract cases through
operation
Target 
Severe Visual
Impairment
(MoH of Indonesia, 2017)
(SVI) & Blind
 SMART HEALTH
STUDY in Malang
Study about empowerment of KI in collecting LIHAT method training
(951
SVI and blind and also cataract detection. This respondence)
study took place in Malang, East Java,
Indonesia, 2019. about 951 people have
examined by KI Group C
Group A Group B Complete (Video,
Video Module Module, direct
training)

Examination using
Finger counting at 6
m by KI

data analysis
(sensitivity,
specificity, PPV, NPV)
(Yunneke, Hera D Novita, 2019)
 15 steps (6 m)

1. Walk 15 steps (6m) from the

patient 2. Counting finger with opened both eye

3. Asses the answer, 3 times are true  4. Refer to eye care if there is visual
no visual impairment impairment
Validity of LIHAT method
Pemeriksaan Optometrist
Tidak Ada Total
Ada Gangguan Gangguan
Penglihatan Penglihatan
Ada Gangguan
47 (49%) 48 (51%)
Pemeriksaan Penglihatan 95
Tidak Ada
Key Informant Gangguan 7 (1%) 849 (99%)
Penglihatan 856

Total 54 897 951

Uji Skrining Hasil

Sensitivitas 47/54 (87%) SMART HEALTH
Spesifitas 849/897 (95%) STUDY in Malang
Positive Predictive Value (PPV) 47/95 (49%) (951
respondence)
Negative Predictive Value (NPV) 849/856 (99%)

(Yunneke, Hera D Novita, 2019)

 Pemeriksaan Optometrist
Ada Tidak Ada Total
Validity of LIHAT Gangguan
Penglihatan
Gangguan
Penglihatan

SMART HEALTH method Ada

Gangguan
Pemeriksaan Penglihatan
19 (46%) 22 (54%)
STUDY in Malang 41
Pemeriksaan Optometrist
Key Informant Tidak Ada
(951 Total Gangguan 4 (2%) 259 (98%)
Ada Tidak Ada
respondence) Gangguan Gangguan
Penglihatan 263
Penglihatan Penglihatan Total 23 281 304
Ada
Pemeriksaan Gangguan 18 (62%) 11 (38%)
Penglihatan 29
Key Tidak Ada
Informant Gangguan - (-%) 282 (100%) Pemeriksaan Optometrist
Penglihatan 282 Ada Tidak Ada Total
Gangguan Gangguan
Total 18 293 311
Penglihatan Penglihatan
Ada
Gangguan 10 (40%) 15 (60%)
Pemeriksaan Penglihatan 25
Roleplay Video Modul Key Informant Tidak Ada
Sensitivitas 83 100 77 Gangguan 3 (1%) 308 (99%)
Spesifitas 92 96 95 Penglihatan 311

Total 13 323 336

(Yunneke, Hera D Novita, 2019)
 “Light the Pupil Method”
Cataract screening by cadre

Light the pupil CATARACT NO CATARACT

Identification of pupil
colour ; White or no

compare with pocket

cataract screening book

cataract

SMART HEALTH
STUDY in Malang
no cataract
(1818
respondences)
(Gracia Harahap, Hera D Novita, 2019)
 Validity of Light The Pupil
SMART HEALTH
STUDY in Malang
(1818
respondences)
Cadre’s Ophthalmologist Examination (Slit Lamp  LOCS III) Total
Examination
(Light The No Cataract % Cataract %
Pupil)

No Cataract 1042 88.91 146 22.60 1188

Cataract 130 11.09 500 77.40 630
Total 1172 64.47 646 35.53 1818
Sensitivitas 77.40
Spesifisitas 88.91
PPV 79.37
NPV 87.71
(Gracia Harahap, Hera D Novita, 2019)
Cataract Screening Setting • Train Community & primary health
care for cataract detection
• Training & workshop for • Cataract validation from primary
cataract detection health care
• E-Thumbling, Peek acuity, • Cataract definitive therapy 
LIHAT methods Primary health surgery  restore vision
• Resources : cadres,
babinsa care setting • Resources  updating cataract
surgery skill, ophthalmologist
• Group target : posbindu • Infrastructure  further
age > 40 y.o, prolanis • Train community examination for cataract
• Recording data & referral • Resources : GP, nurse diagnostic, operating equipment
to primary health care • Infrastructure : visual
forcataract validation acuity examination,
funduscopy
• Further examination for
Community cataract validation Secondary health
setting • Recording data & cataract care setting
referral

Monitoring Evaluation &

Cataract Case Finding
proper tharapy
 Take Home Massage

To develop cataract screening base on health planning an management cycle

consist of where are we, where do we want to be, how will we get there,
doing it effectively and monitoring evaluation

Cataract screening criteria in community include high prevalence, using

diagnosis test which is sensitive, specific, simple, cheap, safe, acceptable
and reliable, and adequate facilities, effective, and treatment available

Cataract prevention trough cataract screening can help to improve cataract

case finding, improve cataract referral cases to secondary level and at last
improve CSR and reduce cataract blindness
Thank you
hera_spm@ub.ac.id