Public Health Optometry (Community Optometry) – A new discipline
Dr Srinivas Marmamula
Srinivas in Rapid Assessment of Visual Impairment Project in Rajasthan, India
Visual impairment is a public health challenge affects millions of people and uncorrected refractive errors continue to remain the leading causes of visual impairment worldwide. While the technology in refractive surgery and newer contact lens designs are catching up in developed countries and urban areas in developing countries such as India, millions remain uncorrected due to lack of accessibility, availability and affordability of proper spectacles. Research has shown that this problem is more acute in remote and rural areas.
The current situation should completely be unacceptable for optometrists like us. We cannot afford to remain ignorant of this glaring fact. We are the primary eye care providers and probably the largest ‘organized’ eye care providers of vision correction and continue to remain so. There is a need for the development of “Public Eye Health” “Public Health Optometry” or “Community Optometry” as a distinct discipline to address the challenge of visual impairment, more specifically the challenge of uncorrected refractive errors and presbyopia. Today we often see optometrists as “contact lens specialists”, “Low vision care specialists”, “pediatric optometrists” etc. providing care. We need to have “Public health optometrists” or “Community Optometrists” as well.
Public Health Optometry is a hybrid discipline that combines the principles of public health and optometry where an optometrist applies the principles of both the specialties to reach out to the communities to provide care, promote eye health and train community level eye care workers. A public health optometrist can lead in many roles that include teaching grassroots level community eye care personnel, epidemiologic and operations research on various issues related to refractive errors, spectacles use and coverage and also evaluate rural eye care programs. For those optometrists who have an aptitude to travel, public health optometry provides a wonderful opportunity to reach out to places, travel far and wide for research, providing services and teaching to different people. It provides immense satisfaction as we provide care in the most difficult regions to the most underprivileged sections in the society.
With increasing prevalence of chronic conditions such as diabetes and hypertension in developing countries especially in countries such as India, the need for public health optometrists is huge for early detection of ocular complications of these conditions. Though tele-ophthalmology as a modality for early detection is being trailed, optometrists can play an important role in training the teams for this activity and in data management.
I believe public eye health should be an integral part of teaching in optometry programs with due importance given to it both in terms of teaching and also providing practical experience like we do to any of our clinical topics. Beyond doubt this training will make better optometrists of those who have the acuity and acumen to care for the under privileged in their routine practices even if though they may not practice public health optometry in true sense. Mere understanding of a patient is a part of a family and that family is a part of a larger community will enable us understand the patient better and provide a better eye care in the rural communities. This will enhance the brand of “optometry” or “optometrists” as a whole among the general public and will been seen partners in societal development as a whole.
Rapid Assessment Survey in tribal areas of Adilabad, Telangana, India
Srinivas had his basic optometry training at L V Prasad Eye Institute. He completed his Masters degree in Community Eye Health from the London School of Hygiene and Tropical Medicine, University of London, with a joint sponsorship from the Department for International Development (DFID - UK), British Council for Prevention of Blindness (Boulter Award) and LVPEI. In 2011, he completed his PhD from the School of Optometry & Vision Science, UNSW, Sydney, Australia, with support from Vision CRC, Australia.
Dr Marmamula underwent post-doctoral research fellowship during 2012-2013 with Dr. David Friedman at Wilmer Eye Institute, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA. He was chief optometrist for LVPEI’s landmark Andhra Pradesh Eye Disease Study (APEDS, 1996 – 2000) and supported Refractive Error Study in Children (2000). Currently he is a co-investigator on follow up of Andhra Pradesh Eye Disease Study (APEDS III) and also leads the Master in Community Eye Health at ICARE
and also teaches at Bausch & Lomb School of Optometry. Dr. Marmamula also received Wellcome Trust / DBT India Alliance Early Career Fellowship earlier this year for his work on visual impairment in elderly populations in residential care.
He has several research papers to his credit and has participated as faculty in many workshops in India and abroad. His areas of interest include epidemiology of visual impairment, refractive errors, presbyopia and training personnel for community eye care.
Dr Srinivas Marmamula
Section Leader – Primary Eye Care, Community Eye Health Education and Research,
Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care (GPR ICARE)
Faculty, Bausch & Lomb School of Optometry
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