Dr Shonraj Ballae Ganesh Rao, PhD, Head of Clinical Research, Remidio highlights that teleophthalmology helps bridge the gap in India’s divided healthcare priorities. With its innovative accessibility and reach, it has the capacity to decentralise comprehensive eye testing. However, teleophthalmology requires highly skilled and trained professionals to select appropriate referrals for teleconsultation/teleopinion
World over, modern technology is getting closer to touching human lives, especially in terms of primary eye healthcare. There was a time when patients had to make medical appointments, travel a physical distance to a centralised eye specialist facility, wait their turn for a Checkup and then wait all day for results to begin treatment in case a disease was diagnosed. However, now, there is a possibility of comprehensive eye screening with the help of teleophthalmology right at the patient’s doorstep or at common access areas like supermarkets, public health centres, pharmacies, ophthalmic clinics as well as homes.
India is pioneering groundbreaking innovations to address preventive blindness at the grassroots level. Integrated software and advanced artificial intelligence algorithms have made significant strides in the field of ophthalmology, offering various applications that assist in early detection, referral, and timely patient care. This technology enables remote screening of eye conditions, especially in underserved or remote areas, providing preliminary assessments and improving access to eye care. However, as newer solutions emerge, it is essential to study past instances for practicality purposes.
Nearly two decades ago, Vision 2020: Right to Sight initiative was launched as a collaborative movement by WHO and IAPB. During this period, several efforts were made at policy as well as ground level to eliminate vision impairment issues and bring down blindness figures from 12 million (Vision 2020 India Newsletter, 2007) to 4.8 million (National Blindness and Visual Impairment Survey, 2019) people. Although the number appealingly seem on a decline trend, there are visible gaps in the Indian eye healthcare sector that need a very timely intervention.
As per a WHO report released pre-pandemic (2019), globally, at least 2.2 billion people suffer vision impairment, out of which, at least 1 billion people have a vision impairment that could have been prevented or is yet to be addressed. India with a population of 1.44 billion people is a greatly divided nation. Around 80 percent of its residents inhabit the rural parts of the country. This is the section wherein even if one wants to access timely eye health care with ease, may not be able to do so because 70 percent of India’s potent healthcare infrastructure and resource is available only in Urban India.
The fast-paced urban Indians, even with choicest resources at hand, barely can prioritise their eye care. A simple analogy could be that whenever there is dysfunctionality in a crucial organ, pain is the body’s first signal to bring notice to it. But when it comes to problems with the eye, it’s mere discomfort that can be tolerated longer until a dire need to visit a health practitioner arises.
Loss of vision or blindness continues to be a major public health scare in India. A news report from this year revealed that in India, there are 70 million people with visual impairment. Between 2015-2019, the National Blindness and Visual Impairment Survey by the Union Ministry of Health and Welfare declared that over 55 million people have moderate to severe vision impairment. Although the survey also stated that 6 million people are blind, certain other reports suggest that the number now crosses the 12 million mark. The survey also noted that blindness in rural India was 1.37 times higher than urban India. And the majority of those affected were in the age group above 50.
While developed countries celebrate the world’s first-ever whole eye transplant, developing countries continue to face challenges of raising public awareness around regular eye-screening, avoidable blindness, effects of diabetic retinopathy, cataract and glaucoma amongst other eye diseases that may lead to permanent loss of vision.
Teleophthalmology helps bridge the gap in India’s divided healthcare priorities. With its innovative accessibility and reach, it has the capacity to decentralise comprehensive eye testing. However, teleophthalmology requires highly skilled and trained professionals to select appropriate referrals for teleconsultation/tele opinion. It also requires a reliable internet connection and high-end equipment to capture better quality images. Teleophthalmology, integrated with an AI system that can operate without an internet connection, can effectively bridge this gap. An offline AI system could significantly reduce the burden on teleophthalmologists, facilitating patient counselling with detailed reports and improving the referral process.
Simplicity, reliability, and scalability should be the essence of any problem-solving capacity. If primary care centres in villages and small towns have affordable ocular health devices that can instantly screen the eye and diagnose related eye-disease with limited effort and guidance, rural citizens can avoid delaying their check ups due to inaccessibility or economic reasons. In cities, if workplaces, public parks, supermarkets, high-frequented areas or even at home, immediate screening of the eyes for potential diseases is a possibility, urban residents who delay their checkups due to non-availability of time may be motivated to go ahead and get tested. This shall also help in reducing the burden that presides over the ophthalmology sector in India where in most patients feel the urge to establish immediate contact with specialists and surgeons at tertiary centres during advanced stages.
As per comparative figures made available from last few years, in India, there are only around 20,000 ophthalmologists and 42,000 optometrists or primary eye care practitioners for a population of 1.44 billion. Fundus imaging, coupled with an integrated AI algorithm for screening major sight-threatening ocular conditions through Teleophthalmology, serves as an advanced mechanism with the power to provide primary vision care from a distance. The technology is both simple and advanced, allowing even individuals with basic guidance to capture eye images using a fundus camera. These images can then be sent to an eye health practitioner online or offline. This capability is particularly beneficial for patients in remote locations or primary clinics with limited access to advanced eye hospitals. The captured images enable ophthalmologists to conduct a significant diagnosis and prescribe the right treatment during video consultations. Physical visits may only be necessary if surgery or further examination is deemed vital.
The minimum required equipment for offering teleophthalmology anywhere in the world includes a fundus camera which can take ocular images and a computer or smartphone to transfer the images. Innovations in eye examinations have introduced smartphone-based fundus exams that non-specialists can perform in under 5 minutes for patients. Virtual clinics with well-equipped teleophthalmology diagnostic devices needing limited supervision are the need of the hour in a country that allegedly hosts the planet’s largest human population today.