|Year : 2018 | Volume
| Issue : 1 | Page : 2-4
Community Ophthalmology: Is it still relevant in our country?
S Tony Fernandez
Chairman & Senior Consultant, Dr.Tony Fernandez Eye Hospital, Kochi, Kerala, India
|Date of Web Publication||7-Jun-2018|
S Tony Fernandez
Chairman & Senior Consultant, Dr.Tony Fernandez Eye Hospital, Kochi, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Fernandez S T. Community Ophthalmology: Is it still relevant in our country?. Kerala J Ophthalmol 2018;30:2-4
There has been a lot of wars being fought in the world. Mostly for forceful occupation and greedy possession of territories and spiteful retaliations. Lives have been lost, cities destroyed, and economic catastrophe of the nations has happened.
In India, the government and private organizations and international nongovernmental organizations (NGO) have been waging a war against blindness because it was found that one-third of the world blind were in India. The sad part of the finding was that the majority of the blind were due to cataract a preventable disease. The war is not won completely, but millions of blinds have been given sight through projects implemented on war footing.
Camp surgeries to compact the preventable blindness have been going on for the past many decades. The bilateral blind in the villages was treated by unqualified vouchers. A lot of institutions and doctors came forward in conducting camps. The prominent name that comes to our mind is that of Dr. Modi, who went to many villages in India and organized free surgeries in the makeshift camps. There was a dearth of ophthalmic specialties all over India then, and those who were qualified preferred to settle in cities and towns. Although there was a lot of opposition from the qualified medical faculties against such camps, the people and the government appreciated the free services rendered by him and honored him with the Padma Vibhushan award. He has a Guinness Book record of operating nearly 5.79 lakhs of cataracts and for doing 833 cataracts a single day. He was honored internationally as well.
When I joined Madurai Medical College in the year 1965, there were a large number of blind people attending the OP with blindness due to cataract and also due to Vitamin A deficiency. There were many operating camps conducted in the villages of the south of Tamil Nadu. I had the privilege of doing a lot of surgeries there. Thousands were examined and 200–300 hundred patients were operated in each camp. When I joined at Little Flower Hospital, Angamaly in the year 1969, Modi had completed a large camp at Aluva examining more than a thousand patients and operating on more than 300–400 cataract Patients. Almost after 1 year, we started the eye camps all over Kerala, some examination camps and some operating camps. Makeshift camps had to be stopped because many people lost their sight due to infection in such large camps mainly in the northern states.
To assess the high incidence of blindness that was prevailing then, the first survey by the central government was conducted in 1971–1974. It was found that 1.4% of the population in India remained blind. It was said that 12 million blind people lived in India. The National Programme for the control of Blindness was formed in 1976 (NPCB, The name of this organization has been changed to National Programme for the Visual impairment and Blind last year).
The Government gave the highest priority for this program and with the help of WHO Cataract Blindness Control Pogramme was started. Both private and public institutions were encouraged to conduct eye camps in the villages. Financial incentives were also given.
These measures gave great incentive to cataract surgery and millions of surgeries have been undertaken bringing down the incidence of blindness due to cataract.
In the year 1999–2001, a detailed and scientific study was conducted to assess the result of the work undertaken by the NPCB. The following facts were found out in this scientifically made study.
The incidence of treatable blindness was reduced from 1.4% to 1.1% (the NPCB had in mind a target to reduce this number to 0.3%).
Cataract topped as the major cause of blindness with 62.4%; refractive errors at 19.65%, glaucoma 5.83%, corneal blindness 0.89%, and posterior segment diseases 4.72%.
This survey was done on people above 50+ population. Cataract was found to be responsible for 50% –80% of bilateral blindness.
These statistics were done applying the definition of the blindness declared by the NPCB and not the definition of the WHO; now, the government has accepted to follow the norms prescribed by the WHO. The percentage of blindness will come down very much if the WHO norms are used.
NPCB defined blindness as vision <6/60 (20/200) and field of vision <20° in the better eyes.
WHO defined blindness as vision <3/60 (20/400) and field of vision <10% in the better eyes.
If the WHO criteria is accepted in India, the percentage of blindness will comedown considerably. Achieving the target of bringing down the blindness to 0.3%will be more practicable.
Vision 20/20 the right to sight program with the initiative of the international agency for the prevention of blindness, and WHO a new and innovative project was launched in the 6th General Assembly at Beijing in the year 2000 “Vision 20/20 the right to sight programme.” The aim was to eliminate the preventable blindness from the world by 20/20. In India, the aim was to do maximum cataract surgeries to regain sight to the bilateral blind people, especially living in the villages.
With the cooperation and combined efforts of the private and government and NGO, the number of cataract surgeries increased from a million in the early 1990s to more than 6 million by 2010. All the agencies involved in this project have been working hard to achieve this goal.
In 2008 a study under the Rapid Assessment of Avoidable Blindness done on adults above 50 years of age was surveyed and finding were as follows the prevalence of blindness in the rural area was 8.2% and the urban area 7.1%. The incidence among the females were found to be more that is 9.2% and males 6.5%.
Nearly 58%–60% of blindness was due to cataract.
Many studies done have shown a decline of the blindness due to cataract.
According to some studies done at Andhra Pradesh, they concluded that the ophthalmologists and program planners have been able to effectively increase cataract surgical output from a low 1.2 million surgeries in 1992 to a high of 3.86 millions of surgeries per year in 2003.
In war against blindness, India has shown that it can arrest and contain the occurrence of preventable blindness. But can we reach the target of 0.30% of blindness or eliminate the preventable blindness by 2020? This is a big question.
There are many factors we have to take into consideration.
- There has been an increase in our population
- The number of aged population has been increasing considerably
- The increase in the number of ophthalmologists has not proportionately increased. Many Villages in India are still without ophthalmic services
- We have now not only cataract but increase in the number of age-old diseases such as Diabetic Retinopathy and senile macular degeneration
- Studies done at Tirunelveli in Tamilnadu by P.K Nirmalan and R.D Tulasiraj et'al has shown that inspite of free operations available people especially the woman folk were reluctant to get their cataract operated. This could be due to illiteracy
- In another study done at Andhra Pradesh, it was found a small number of patients lost sight, due to complication of the cataract surgery undergone
- Under these circumstances, we have to strengthen our efforts in the society, by educating them and bringing them for the treatment. More work is needed in diagnosing diseases early and making them to go for treatment. Routine school screening has to done to avoid blindness among the children.
To achieve the target of preventable blindness in India, it was estimated that nearly 14 million of good quality cataract surgeries have to be undertaken every year to reach the target.
To achieve our targets and to avoid blindness among the aging population, we have to have an active Community Ophthalmology Department in all the major hospitals in India.
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Murthy GVS, Gupta SK, John N, Vashist P. Current status of cataract blindness and Vision 2020: The right to sight initiative in India. Ind J Ophthalmol 2008;56:257-60.
Nirmalan PK, Thulasiraj RD, Maneksha V, Rahmathullah R, Ramakrishnan R, Padmavathi A, et al.
Apopulation based eye survey of older adults in Tirunelveli district of South India: Blindness, cataract surgery, and visual outcomes. Br J Ophthalmol 2002;86:505-12.
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