Eye Care for All : Indian Journal of Ophthalmology

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Editorial

Eye Care for All

Sen, Mrittika; Honavar, Santosh G1

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doi: 10.4103/ijo.IJO_2063_22
  • Open

The data curated by the International Association for the Prevention of Blindness (IAPB) shows that there are 1.1 billion people globally with vision loss and this is projected to increase to 1.7 billion by 2050.[1] The main contributors to the vision loss include:[1]

  1. Uncorrected refractive error (671 million)
  2. Cataract (100 million)
  3. Glaucoma (8 million)
  4. Age-related macular degeneration (8 million)
  5. Diabetic retinopathy (DR) (4 million)

It is evident that 90% of the vision loss is either preventable or treatable. Over 90% of this population resides in low-middle income countries and 73% are aged 50 years or more, 55% are females.[2] With improved survival, ever growing population and increasing age of the population, billions will require eye care services during their lifetime. Looking at the numbers in India, the 2020 data shows that with a population of 1380 million, 270 million were living with vision loss and 9.2 million were blind, with an all-vision loss rate of 19.3%, putting India amongst the countries with highest prevalence of vision impairment.[2]

Vision loss is estimated to cost global economy 411 billion dollars per annum with productivity loss.[1] The World Health Organisation’s (WHO) World Report on Vision, Lancet Global Health Commission on Global Eye Health and United Nation’s (UN) resolution of Vison for Everyone make it exceedingly clear that improving eye health lies at the core of fulfilling UN’s sustainable Development Goals (SDGs) [Table 1].[1]

T1
Table 1:
United Nations Sustainable Development Goals and their Relation with Eye Health

The IAPB launched its global strategy, 2030 in Sight: Ending Avoidable Sight Loss. The plan for the next decade is to Elevate vision as a fundamental, economic, social and developmental issue, Integrate eye health in wider health care systems and Activate consumer and market change.[3] Achieving these goals would require bringing to the community an integrated, people-centered eye care delivery system, building public-private partnership, training a diverse workforce and channeling political will and financing. The eye care being rendered must be promotive, preventive, and curative while adopting ways and means to be accessible, affordable and of high quality to all.[4] A vast majority of the causes of visual impairment can be tackled with periodic screening and early diagnosis (glaucoma, refractive error, DR), simple prescription of glasses (refractive error), and timely referral to tertiary centers (glaucoma, cataract, macular degeneration, DR).

Periodic community outreach camps did bring quality eye care to the homes of the masses not residing in the big cities and metros. However, they did not fulfil all the requirements because patients had to wait for the mobile camps to visit their locality/community, many did not utilize the facilities, and follow-up of patients was difficult. Strengthening and improving our primary eye care must form the basis for this change. In India, Vision Centers (VC) established and supported by different base hospitals including L.V. Prasad Eye Institute, Aravind Eye Care System (AECS), Shroff’s Charity Eye Hospital, H.V. Desai Eye Hospital, Sadguru Netra Chikitsalaya, and Vivekananda Mission Asram Netra Niramay Niketan are performing this task of ensuring eye health to all.[4] A VC typically serves anywhere between 20000-50000 population within a radius of 7-10 km and is manned by 1-3 trained ophthalmic technicians, skilled in refraction, spectacle dispensing, diagnosis of common eye diseases and referral of required cases to higher centers.[4] These are equipped with slit lamps, retinoscopes, trial sets, tonometers, blood pressure measuring machine and sugar level determinants, electronic medical records, and basic supply of medicines and regular supply of spectacles. Patients can visit the VC as per their convenience. Teleconsultation has become a routine with doctors from the base hospital. Patients requiring consultation or treatment are transported to the base hospitals. They are thus receiving quality health care at affordable prices. The supporting hospital is usually able to recover 50-75% of the cost of setting up a VC and within a year or two they become self-sustainable. The follow-ups can also be carried out at the VCs. The ophthalmic technicians are often recruited from the community and therefore people, including women are more comfortable with them. VC also allow tertiary hospitals to deal with critical and complicated cases, thereby attempting to partially balance the highly skewed ophthalmologist to patient ratio. Table 2 lists the benefits of VC to community eye care.

T2
Table 2:
Benefits of a Vision Center

This month’s Indian Journal of Ophthalmology is proud to feature Dr P. Namperumalsamy, lovingly called Dr Nam, as a part of its Living Legends Series.[56] Here is a legend who emerged from the shadows of a giant of a predecessor, Dr G. Venkataswamy or Dr V., and carved a niche for himself and for Indian Ophthalmology as a whole. Father of vitreoretinal surgery in India, he understood that to eliminate preventable blindness, it was not sufficient to treat diabetic retinopathy with lasers and surgeries but to screen and detect DR at its earliest stage. He saw the importance of putting primary eye care at the bottom of the pyramid of the strata of eye care in India to form a strong foundation long before the UN, WHO or the IAPB. Under his able leadership, AECS now nurtures 105 vision centers, 6 community eye clinics, seven secondary eye care centers and 7 tertiary eye centers. He saw to reality vision centers to work as a primary contact between people and ophthalmologists and changed the perspective of community eye care’s focus on cataract to other avoidable causes of blindness like screening of DR, glaucoma, retinopathy of prematurity, macular degeneration and even eye cancers to the masses. While we honor and celebrate his contributions, we, as ophthalmologists must draw inspiration and strive to attain the goals of 2030 in Sight with a people-centered and community-integrated approach.

It is better to lead from behind and to put others in front, especially when you celebrate victory when nice things occur. You take the front line when there is danger. Then people will appreciate your leadership.” Nelson Mandela

References

1. https://www.iapb.org/wp-content/uploads/2022/02/2030inSight-Strategy-Document-Sep2021-English.pdf
2. Bourne R, Steinmetz JD, Flaxman S, Briant PS, Taylor HR, Resnikoff S, et al. Trends in prevalence of blindness and distance and near vision impairment over 30 years:An analysis for the Global Burden of Disease Study Lancet Global Health 2021 9 e130 43
3. Available from: https://www.iapb.org:8443/about/2030-in-sight/
4. Khanna RC, Sabherwal S, Sil A, Gowth M, Dole K, Kuyyadiyil S, et al. Primary eye care in India –The vision center model Indian J Ophthalmol 2020 68 333 9
5. Das T, Venkatesh R, Kannan NB, Krishnadas R, Dr P Namperumalsamy:Transitioning dreams, transcending barriers in accessible eye care Indian J Ophthalmol 2022 70 3171 4
6. Namperumalsamy P My journey in ophthalmology as a retina-vitreous surgeon:Crusade against blindness due to diabetic retinopathy Indian J Ophthalmol 2022 70 3175 81
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