We read with interest the article on 'Perceived barriers to the provision of low vision services among ophthalmologists in India' by Khan et al.1 We congratulate the authors' commendable work in this regard, as this, perhaps, is the first such study on awareness of low vision among ophthalmologists in India. Based on our experience in the care of low vision patients at our institute, we supplement a few points in this regard.
Low vision service is multidimensional and multidisciplinary, and not only ophthalmologists but also other professionals like optometrists, rehabilitationists and special educators working in integrated schools are all potential low vision service providers. As cited in this study, if 10.6 million people need low vision services,1 then ophthalmologists alone cannot provide the services to cover the entire needy population. It was also of interest to note that a few ophthalmologists were not providing or referring patients for low vision services. Listing their specific perceived constraints to providing or referring for low vision care would have made the study more interesting and useful for policy makers.
It is also important to consider the barriers perceived by the patients on accessing low vision services in the country. A study from Australia that focussed on this fact found that
- The awareness and knowledge of low vision services by the general public was poor.
- There was poor access to low vision services as perceived by the low vision patients themselves.
- Eye care professionals gave patients limited information on coping with low vision and referred them to low vision services at the end of the treatment process.
- The image of low vision patients is that of a people who are blind and who use canes and guide dogs, which was difficult for people with partial sight to relate to.2
In our country, where there are barriers to accessing basic eye care services, such additional perceived barriers make it more difficult for patients to avail themselves of low vision services.
A study on the distribution of low vision services in the United Kingdom (2002) noted the geographically uneven distribution and scarcity of services in some areas.3 If this is the scenario in a developed country, it is not difficult to imagine the Indian scenario. In our country, the few available low vision services providers are concentrated in large eye institutes, eye departments in large hospitals and a few social organisations.
However, one reassuring fact is that relatively simple optical devices which can be supplied by non-hospital based professionals can meet a high proportion of the optical requirements of people with partial sight.4
We conclude that a comprehensive study on low vision services which includes a state-wise/geographical listing of the professionals offering low vision services and the perceived barriers for low vision care and distribution of low vision services in the country, would help the policy makers to plan and upgrade the future network of low vision services in India.
1. Khan SA, Shamanna BR, Nuthethi R. Perceived barriers to the provision of low vision services among ophthalmologists in India Indian J Ophthalmol. 2005;53:69–75
2. Thmara LP, John AS, Ecosse LL, Jill EK. Barriers to accessing low vision services Ophthal Physio Opt. 2003;23:321–7
3. Culham LE, Ryan B, Jackson AJ, et al Low vision services for vision rehabilitation in the United Kingdom Br J Ophthalmol. 2002;86:743–7
4. Shuttleworth GN, Collins AJK, et al How effective is an integrated approach to low vision Rehabilitation.Two-year follow-up results from South Devon? Br J Ophthalmol. 1995;79:719–23