Project: Sight for blind and low vision
Rotary Club of Ribeirão Preto - District 4540
Ribeirao Preto - SP
Name of the project: Sight for blind and low vision
Focus Area: HUMANITARIAN PROJECTS / DISEASE PREVENTION AND TREATMENT
Rotary Club of Ribeirão Preto belongs to District 4540 that encompasses Rotary clubs from the northern region of the State of São Paulo and southwest of the State of Minas Gerais in Brazil
The project involves the entire community, since the HC-FMRP-USP (Hospital of Clinics - Ribeirão Preto Medical School - University of São Paulo) provides care to patients from a reference area that covers the Regional Health Departments (DRS) of Araraquara, Barretos, Franca and Ribeirão Preto, with a population of approximately 4 million inhabitants, 77.4% of Ribeirão Preto and region, 19.2% other DRSs and 3.4% other states. Especially for people who can not afford private medical care. The project is sustainable and the results will be long-lasting and a necessity of the local community.
About the disease:
Keratoconus is the most common corneal disorder that causes low vision. Keratoconus is a disorder called dystrophy. It is continuous and progressive, occurs in the cornea with central or paracentral thinning, usually inferior, resulting in the anterior bulging of the cornea, in the form of a cone. The presentation is usually bilateral and asymmetrical.
It is a rare condition, found in all races, in different parts of the world, with a prevalence ranging from 4 to 600 cases per 100,000 individuals. Family history is present in 6 to 8% of cases, suggesting family inheritance. Its most common appearance occurs at puberty, usually between 13 and 18 years of age. It progresses for approximately 6 to 8 years and afterwards, tends to remain stable. In the HCRP specialty contact lens outpatient clinic (ambulatory), an average of 5 new patients cases per week are seen. This amounts to approximately 200 patients per year.
Keratoconus may be associated with systemic diseases such as Down's, Turner's, Ehlers-Danlos, Marfan's syndromes, as well as atopy, osteogenesis imperfecta, and mitral valve prolapse. Ocular conditions to which it may be related are vernal keratoconjunctivitis, aniridia and Leber's congenital amaurosis. The patient may report frequent changes in prescription of glasses and usually not presenting satisfactory vision with the use of these.
Treatment and Compliance:
In milder cases, the treatment of keratoconus is initially performed through glasses. For larger or slightly advanced astigmatism, special contact lenses can be adapted successfully. Surgical treatment, with penetrating corneal transplantation, is indicated for more advanced cases or with extensive scars that do not improve with contact lenses. However, these cases are increasingly rare because with the evolution of specialty contact lens technology the number of transplant indications has greatly decreased. Corneal transplantation is a very delicate surgery with rejection rates of approximately 20% and should therefore be avoided. Today with the advancement in contact lens technology there is enough safety for the treatment of this disease (keratoconus) and important visual reestablishment with the use of specialty contact lenses.
When adapting a contact lens in the patient, the ophthalmologist seeks conditions that allow a more physiological adaptation, in which less aggression to the cornea occurs, less likely to worsen the evolution of keratoconus or other corneal alterations.
There are several designs of contact lenses that can be used in the optical correction of keratoconus, among them: monocurve lenses, Soper lens, rigid gas-permeable lens with scleral drawing; piggyback; toric lenses, etc. Depending on the stage of disease progression, the most appropriate design should be evaluated. In this project we will use scleral contact lenses for the treatment of very important ectasias that lead the patient to severe low-vision (advanced keratoconus).
Every user of contact lenses should periodically evaluate their adaptation. The lenses should be cleaned and disinfected with each use. This should be done by rubbing and rinsing with the use of appropriate solutions. All treatment will be provided free of charge by the structure and staff of the HCFMRP-USP Specialty Contact Lens Ambulatory.
In this context, the project is aligned with the area of Disease Prevention and Treatment of Rotary International.
THE HOSPITAL OF THE CLINICS OF RIBEIRÃO PRETO MEDICAL SCHOOL OF THE UNIVERSITY OF SÃO PAULO and its Foundation (FAEPA) will perform the complete evaluations of the corneas (corneal tomography, specular microscopy and confocal microscopy), providing Hospital facilities, hospital materials (gauze, serum, eyedrops, multipurpose solutions, etc.) and all medicines necessary for all 600 (six hundred) eyes that are the subject of the project
ROTARY CLUB OF RIBEIRÃO PRETO - DISTRICT 4540. And The ROTARY CLUB (international partner to be defined), and the Global Fund / The Rotary Foundation will participate in the project with the resources to purchase approximately 600 contact lenses that will be subject to adaptation in diseased corneas patients (totaling a period of 3 years).
The project will provide:
. Six hundred contact lenses for blind and low vision patients
. Recovery of vision of 600 eyes.
. Specific training for 57 medical residents in the specialization of ophthalmology to conduct the treatment to reduce the effects of low visual acuity due to corneal problems in patients in the Ribeirão Preto region.
Recovering the sight of blind and visually impaired patients
Buy 600 contact lenses (rigid gas permeable scleral contact lenses) to recover vision from 600 eyes (cases with advanced keratoconus).
Provide specific training for 57 medical residents to adapt patients' contact lenses during the 3-year period while conducting the project and thereby disseminate this medical procedure in the future throughout the national territory.
600 eyes suffering from low visual acuity based on the ICD-9-CM WHO / ICO Classification that will recover vision.
57 medical residents who will be able to perform this procedure in other parts of the country after completing training.
Doctors will be able to perform:
. Complete ophthalmologic assessment to identify the cause of low vision.
. Diagnosis of corneal disease through a Corneal Tomography scan.
. Establishment of the best contact lens that will adapt in the cornea, bringing the recovery of vision in patients.
. Complete and satisfactory patient recovery
6. MAIN ACQUISITION:
The patients will recover the vision in a very satisfactory way allowing a return to social and professional life.
The trained doctors will multiply the knowledge and procedure.
The Hospital is a national reference where students from all over the country seek specialization training. This project is of great importance in the training of medical residents for the treatment of irregular corneas that require the use of specialty contact lenses.
The FAEPA has been a partner of the ambulatory for several years, responsible for the financial contribution. During the Rotary International project, the Foundation (FAEPA) will be responsible for the purchase of new medical equipment and improvements to the site infrastructure. Upon completion of the 3 year project, FAEPA will maintain the supply of the lenses to new patients who will start treatment, guaranteeing sustainability.
The HCFMRP-USP is a school hospital where undergraduate medical students and medical residents are taught (currently there are 27 medical residents in ophthalmology and 4 in cornea subspecialty - during the 3 years of the project, a total of 57 medical residents will be trained).
The hospital was chosen as a partner since there has been a need to improve patient care and regain vision. The procedure is not covered by SUS (Sistema Único de Saúde - Brazilian Medcare).
8. MEASURE OF THE PROJECT'S IMPACT
600 eyes of blind patients benefited
57 trained medical residents benefited
Individuals treated will improve quality of life
Better access to eye care.
Events focused on health
9.1.Needlessness of Society
Hundreds of patients will regain vision and return to normal life in society.
2. 57 doctors trained for vision recovery procedures.
3. Need for training of medical residents to recover patients' vision
4. Need to improve care and provide contact lenses for patients to regain vision.
5. Continuation of donation of contact lenses to patients by FAEPA after the end of the Rotary project.
9.2. COMMUNITY RESEARCH AND IDENTIFICATION OF NEEDS
The project team conducted a Community Survey to identify needs, using the tools: Community Meeting and Resource Inventory.
The Community Survey was conducted through a meeting at the Ribeirão Preto Clinical Hospital with a group of people receiving medical care at the Department of Ophthalmology, a meeting with local officials from the Ophthalmology Department and a meeting with the medical staff of the Department of Ophthalmology of the Hospital. During the meetings participants were asked to express their needs and difficulties.
The Inventory of Resources was carried out by the medical team of the Department of Ophthalmology of the Hospital, with the objective of gathering information about the equipments and trained professionals available to perform the procedure.
10. PROJECT, TRAINING, COMMUNITY AND EDUCATIONAL IMPLEMENTATION PROGRAMS:
10.1. Theoretical training for medical residents
Objective of professional training (clinical diagnosis and adaptation of contact lenses).
Ophthalmologic evaluation of patients (evaluation of visual acuity with and without optical correction).
Identification of patients who fit the criteria for participation in the project
Identification and adjustment of selected lenses for each patient
Adaptation of contact lenses to the patient.
The medical resident will be trained and supervised to:
Application of the quality of life questionnaire to patients and their families
Adaptation and guidelines for the delivery of contact lenses (assessment of visual acuity with contact lenses).
Routine evaluation of the patient after 1, 6 and 12 months after lens adaptation.
Evaluation of the medical resident (certification of the medical resident in this project will be carried out through the application of theoretical tests and the supervised care of of approximately 10 patients per doctor).
10.2. Training of technicians and nurses:
Management of medical equipment and patient support.
10.3. Patient and family:
Guidelines for the preparation and caregiver for vision recovery
Research on the improvement of the ophthalmological and socioeconomic framework.
11. COST OF THE PROJECT (in USD)
600 Scleral lenses
Unit Price (local) R$ 500.00
Total R$ 300,000.00
Total in USD 79,575.60
FDUC 4540 USD 13,000.00
Local Foundation 4540 USD 27,000.00
FDUC International Partner USD 13,00.00
Foundation International Partner USD 27,00.00
Total USD 80,000.00
US Reference - 3.77 (2018/06/20)
11.1. RECURRING COSTS (monthly in USD- 36 Months)
Maintenance and repair of equipment: Payment by the Hospital and its Foundation (FAEPA).
Salary of assistants: Paid by the Hospital and its Foundation (FAEPA).
Salary of doctors: Paid by the Hospital and its Foundation (FAEPA).
Salary of technicians: Paid by the Hospital and its Foundation (FAEPA).
Fuel: Paid by the Hospital and its Foundation (FAEPA).
Basic hospital supplies (eye drops, serum): Paid by the Hospital and its Foundation (FAEPA).
Use of Ophthalmic Equipment and maintenance: Payment by the Hospital and its Foundation (FAEPA).
Administrative costs: Payment by the Hospital and its Foundation (FAEPA).
Total monthly costs: Payment by the Hospital and its Foundation (FAEPA).
IMPORTANCE FOR ROTARY
The proposal of this project is in perfect synchrony with the area of Prevention and Treatment of diseases. The immense need of the patients goes to the Rotarian focus of public image, disseminating the image of the organization. The project itself will have a major impact on society aligned with Rotary's goals.
NUMBER OF PEOPLE IMPACTED
The project will reach 600 blind or low acuity eyes of patients who can not afford the cost of the lenses to regain vision. The project will train 57 young doctors empowering them to disseminate the same procedures throughout all Brazilian territory.
DANIEL CECCHETTI, MD
Member Rotary Club of Ribeirão Preto
Rotary Humanitarian Project Comission
Ophthalmologist Coordinator of the Specialty Contact Lens Ambulatory of the "Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (University of São Paulo).
Mob +55 16 981196638
RAQUEL ALMQVIST, PH.D.
Member Rotary Club of Ribeirao Preto
Rotary Humanitarian Project Comission
Mob: +55 16 98147 4887
JOSÉ ROBERTO MALFARÁ DE SOUZA.
Member Rotary Club of Ribeirao Preto
Mob: +55 16 981003009
ROTARY CLUB DE RIBEIRÃO PRETO - DISTRITO 4540
Ribeirão Preto - Brasil
JOSE CARLOS SPANGHERO
Presidente da Comissão de Projetos Humanitários
REGINALDO SABIA DARINI
Presidente da Comissão da Fundação Rotária