Awareness about Eye Health in Kerala

As ophthalmologists, we are a witness to a paradox on almost every day of our clinical practice, which perhaps is unique to our state, Kerala. We find patients visiting private clinics armed to the teeth with all the information about a particular disease from Google, asking so many questions that it makes the doctor defensive. On the other hand, we find patients visiting government hospitals without any awareness about their disease. So much so that there are patients who have been diabetic for more than 25 years and yet they have never undergone an ocular examination! They have never been advised for an ocular examination, nor have they found out by themselves that it is essential. Why is it that the most literate state of India has such diametrically opposite levels of awareness about eye diseases?

In a study by Dandona et al.[¹] in 2001, 69.8% of the respondents were aware of cataract, but only 27% were aware of diabetic retinopathy and 2.3% were aware of glaucomas in the urban population of Hyderabad. In a hospital-based cross-sectional study performed at Kozhikode, 66% were aware that diabetes could affect the eye, yet 51% had an eye check-up only when they had symptoms.[²] In another study by Misra et al.,[³] to assess the awareness and health-seeking practices about cataract among the people aged 18–60 years living in slum areas in Delhi, most participants have heard of cataract, but there is low awareness of its symptoms and treatment. Good eye health-seeking practices were observed for cataract in that urban slum population. Most of the studies about awareness are hospital-based studies, and therefore, extrapolating their conclusions to the general population becomes untenable.

Besides the ubiquitous social media forward of health-related messages, which may or may not be fake – the downside of information revolution – most of the people come to know about eye diseases only if a family member or a close relative or a friend is suffering from the disease. The people with a higher level of education and a higher socio-economic status use search platforms such as YouTube and Google to garner information about their health or disease. However, it is the people in the lower socio-economic strata who remain ignorant and fall prey to the morbidity and sometimes the mortality of the event. A common example of this is the assumption by many patients that all cases of painless loss of vision are because of cataract, and so important conditions such as diabetic retinopathy and glaucoma are neglected.

It is high time that we ophthalmologists introspect among ourselves and examine our role in propagating awareness about ocular diseases or ocular manifestations of systemic diseases. Are we doing enough? We celebrate the World Sight Day, The Glaucoma Week, and the Eye Donation fortnight and pat each other's back once we have filed the pictures to our respective ophthalmic societies. A cursory glance into the celebrations would tell us that we are using them more as photo-opportunities for ourselves rather than as meaningful ways of disbursing information to the public. Instead of tokenisms by organizing online felicitations and educational meetings by the ophthalmologists for the ophthalmologists, sincere efforts must be made to percolate the awareness to the masses.

We must involve the nursing students, medical students, and other paramedical staff to speak to the public about the ocular diseases. This connect should be exercised not using complex medical terminologies but in a simple language that the patient and public can understand. This can be in the form of posters, exhibitions, and seminars among the patients in hospitals, rather than conducting online meetings in the off-hours. At the Primary Health Centre level and at the Non-Communicable Diseases Clinics level, we must conduct regular sessions of talks on eye diseases on different days of the week so that different patients benefit. We must have a holistic approach to improving health services in by tackling barriers at different levels, considering local context and geo-spatial features of individual communities.[⁴]

The social media have demonstrated their power with respect to their reach and educational value. The Kerala Society of Ophthalmic Surgeons is pitching in by conducting interviews with senior ophthalmologists to share their experiences and by disseminating bite-sized clips of those programs. The school-based programs have enabled greater awareness of refractive errors. Camps have spread knowledge about cataracts. We need more of screening camps for diabetic retinopathy. The public should be encouraged to visit an ophthalmologist at least once every 2 years if they are healthy to undergo a fundus examination. The Government must also incentivize it.

Artificial intelligence (AI) is emerging as a major tool in diagnosing eye diseases. Innovative medical exhibitions, installations, or floats in both rural and urban areas can be used to catch the attention of people and make them aware about eye diseases. A smartphone-based, slit lamp-mounted fundus-on-phone (FOP) camera for early detection of glaucoma and diabetic retinopathy uses AI to pick up glaucoma/disc suspects or diabetic retinopathy cases from the fundus images. This will reduce the doctor's workload and patients' unnecessary travel expenditure yet guide them toward the right treatment.[⁵]

Poor socio-economic status and illiteracy are the key factors for such a poor level of awareness in India. We have just celebrated the 75^th Independence Day, and this is a major milestone for India. We must propagate scientific literacy not only among the public but also among the teachers and students. Another important aspect is expansion of advocacy—the most undeveloped component of health promotion which is essential to convince governments to channel increased resources to eye health promotion.[⁶]

The physicians are the primary contact for most patients with systemic diseases. Case detection is the approach to the problem of eye diseases other than cataract. For case detection, awareness and knowledge among the public are very important so that they come forward for routine eye examination.[⁷] The Government must also incentivize those physicians and ophthalmologists who spread awareness. The network of hospitals from the level of primary health centers to the tertiary care centers is strong and vibrant in our state. Let us take this opportunity to critically assess our successes and failures and prepare for a promising future.