When I was invited to write this guest editorial, I started thinking about the transformation in Indian ophthalmology and eye care delivery in the quarter century since I had the privilege of editing this journal. That progress occurred on all fronts and very impressive in some is without doubt. In terms of service, the reach and the coverage have increased, the volume and the quality have improved, education has transformed, research is beginning to get better and more focused, and the image of Indian ophthalmology has enhanced all over the world. While I surmise that the Indian journal has played some part in this transformation, it would be good to have a more detailed analysis, as the new editorial team is getting ready to take charge. I believe that now is the most opportune time for the membership to express their aspirations to the editor on how this journal can add value to them in their practice. The rapid proliferation of knowledge, technological revolution, and change in techniques and practice patterns can be very unsettling to the best among us. Our journal may be a conduit to transmit all this in a way that we can get a simple distilled product to grasp easily. With the sound financial health of our society, the executive committee may allocate adequate resources for the journal to promote this phenomenon.
We are living in an era when the entire world is aspiring for “Universal Health coverage” and India is actively engaged in this issue. Indian ophthalmology can be justifiably proud that we have made more progress than any other specialty on this front. The exemplary leadership provided over generations, the rapid adoption of advances, and the philanthropic spirit ingrained from our residency training onward, cumulatively contributed to this development. We have demonstrated notable success in the control of cataract blindness and have become a model for the world. The active participation of every sector of eye care, ophthalmic industry, private philanthropy, and significant governmental commitment has made this possible.
As we look at the current situation, we have bigger challenges in the form of eye conditions that demand more complex care. Glaucoma, corneal blindness, retinal diseases including diabetic retinopathy, childhood blindness, and low vision problems constitute the gamut of conditions that are now in the realm of tertiary care. This creates problems of availability, accessibility, and affordability of services. As of now, no public health approaches for large-scale application are available. This is an opportunity for Indian ophthalmology to make a major contribution to the world and the consequent impact. Uncorrected refractive error is a problem of great magnitude responsible for >50% of visual impairment, and if presbyopia is added to this, the problem is even more immense. While effective and cost-effective solutions are already available, reaching out to all those who can benefit from these services is still a challenge. While in India, we have pioneered the models for providing these services, scaling up is the next big task. We should work toward developing a high quality, comprehensive eye care available to all people. The word “Comprehensive Eye Care” encompasses prevention, treatment, and rehabilitation. An integrated, multitier model needs to be replicated on a large scale. Innovation is the key to finding solutions to this situation.
While the situation has improved, a lot needs to be done in meeting the requirements of “quality” and “equity.” The basic minimum requirements of quality must be more universally practiced and should become an integral part of the fabric of ophthalmic care. While agencies such as National Accreditation Board for Hospitals & Healthcare Providers (NABH) have helped in improving the situation, “quality” is still limited to isolated pockets. Future generations should be exposed to the importance of good quality care and how a little extra attention makes all the difference. As the popular adage goes, “the difference between ordinary and extraordinary is that little extra.”
We live in a country of enormous contrasts. We are still home to the largest concentration of poverty anywhere in the world. While only 22% are below the “poverty line” as per the official figures, this refers to people living in abject poverty. McKinsey Global Institute proposed a new index called “Empowerment line” taking into account the minimum cost for a household to fulfill eight basic needs, namely, food, energy, drinking water, housing, sanitation, health-care, education, and social security. When this was applied to India, 56% in India (680 million) were below the empowerment line in the year 2012. When we juxtapose this to the kind of eye care available to this group, how much more needs to be done to achieve “equity” becomes stark.
Education is an area where IJO in partnership with other committees of the society can play a critical role. Much change occurred in the transmission of knowledge and competencies, and if both dissemination and delivery of knowledge can be combined in an optimal way, AIOS can influence the quality of our education significantly. India has the talent pool, islands of excellent infrastructure, and an enabling environment for education to flourish. What is required is a big National Vision for transformation. If this can be achieved, we may have future generations of ophthalmologists with a rich combination of “Hands,” “Head” and “Heart” - the “3-H Ophthalmologists.” Some among these will alter the course of eye health, some will contribute to major breakthroughs in research and fill a glaring gap, and some will become visionary leaders that make the future of ophthalmology even brighter. Opportunities should be created to foster a culture of enquiry in the minds of our younger generations to overcome the lack of exposure to any kind of research during both undergraduate and postgraduate medical education. Together, these future generations will be able to rid our country of the scourge of needless blindness and visual impairment.
The breathtaking revolution in technology – information, communications, etc., – and their ability to influence health care positively is immense. Exploiting these benefits to make eye care available and accessible to more pockets of neglected groups of populations will enhance the coverage and contribute to universal eye care. Several innovations targeted at eye care are already available. Critical assessment and large-scale applications are the next steps. As India is the home of significant power in information technology and start-up culture, this should be harnessed for the benefits of eye care.
Another encouraging development since my time as editor has been the growth in the number of papers published in this journal and many others as well as the number of presentations made in major meetings around the world. The focus should now be directed to high quality and greater number of contributions from our medical colleges. Both the journal and the AIOS together with other major institutions in the country should seriously consider a way of accomplishing this. With the access to very high volume and variety of ocular pathology that is seen in India, we should be innovative in techniques and technology, create new knowledge, and offer new solutions to the world. The brain power of our youth should be harnessed to transform ophthalmic science working from India. The culture of detailed documentation of medical records has to be incorporated into our practices and education. This is a potent source for both improving clinical training and clinical research.
My congratulations to the new editor, Santosh Honavar, who has all the attributes needed for the job, and his team. I wish them the very best in their exciting journey at a crucial time in the evolution of Indian Ophthalmology.
About the author
Gullapalli N Rao, fondly called Nag, founded the LV Prasad Eye Institute (LVPEI) in 1987 after a successful career in the US as an academic ophthalmologist. LVPEI is a unique blend of excellence in clinical care, training, and research. Dr. Rao has published over 300 papers in addition to serving on the editorial boards of several journals. As editor of Indian Journal of Ophthalmology (IJO) from 1993 to 1999, he was instrumental in nurturing the exponential growth of the journal. He has been honored with several international and national awards, the most recent one being induction into the prestigious “Ophthalmology Hall of Fame” instituted by the American Society of Cataract and Refractive Surgery. He was formerly the Chair of the Board of International Agency for the Prevention of Blindness and is currently the Chair of the Academia Ophthalmologica Internationalis. Dr. Rao is a Visionary Leader and an Academic Ophthalmologist who leads from the front and preaches and practices the amalgamation of the best of hand, head, and heart in delivering compassionate, affordable, and quality eye care. As someone who has inspired generations of ophthalmologists and has made a deliberate and a long-lasting positive impact on the way in which Indian ophthalmology is practiced today by finding a unique opportunity in every adversity, Dr. Rao is most appropriate to pen the Guest Editorial “Ophthalmology and opportunities.”