Challenges and opportunities of ophthalmic care in India

Sandeep Bothra, Country Head, Surgical, Alcon Laboratories, India opens up about how India can achieve its goal of Vision 2020

Eye diseases are among the most easily overlooked medical problems in India, where primary healthcare infrastructure is not robust like other developed countries. A lot of this is because we are not conditioned to understand eye-problems beyond the need to wear glasses. Not many for example know that their eye can be infected by chronic diseases and even cancer; or realise how disabled the blind are. With around 12 million blind people against 39 million globally, India is home to one-third of the world’s blind population. Most instances of moderate to severe vision impairment are said to be caused by uncorrected near-sightedness, far-sightedness and astigmatism (blurred vision). A 2007 study by SightSavers suggests, as per the national survey records, that states like Madhya Pradesh, Rajasthan and Jammu and Kashmir have a high blindness prevalence (2 per cent and above). The prevalence of blindness is higher among those in lower socio‐economic status. Diabetic retinopathy, a progressive disease with no cure, is also a significant contributor to blindness; and with diabetes cases on the increase, the risks too remain high.

The challenges

The two big challenges that are adversely affecting eye care in India are inadequate facilities and lack of access. There are only an estimated 15,000 ophthalmologists in India and only 45,000 optometrists against a required 125,000. With a population of more than 1.32 billion people, this means, a serious shortage of medical professionals leading to severe handicap in both screening and treatment of eye ailments in the country. The United States averages 1 ophthalmologist for every 15,800 people, which is recognised as an adequate ratio. In contrast, India has one ophthalmologist for every 1,07,000 people. While there are regions which have a ratio of 1:9000 (largely urban centres), some regions have as low a ratio as 1:608,000. The uneven distribution of surgeons and underutilisation of their skills, because of unavailability of optometrists for basic procedures, has resulted in an unabated increase in blindness despite all the efforts made so far.

The reasons behind this sorry state of affairs are not far to seek. India, with a per capita public expenditure on health of just over 1 per cent of GDP, lags behind its South-Asian neighbours in the area of healthcare spending. The World Health Organisation recommends that countries should spend 4-5 per cent of their GDP on health to achieve universal healthcare.

The other big reason is awareness. Public perception is highest for health problems such as cancer and cardiac problems or lifestyle diseases such as diabetes. In cases of cataract, which is the leading cause for blindness in India (accounting for close to 63 per cent of vision impairment cases), a report revealed that 59 per cent of senior citizens incorrectly believed that cataracts could be prevented. In many cases, evidence shows that, even when services are readily available, the population in rural areas are far less likely to access them due to such misconceptions. Even though loss of vision is a disability that is far more limiting to a patient than suffering from most other diseases, eye care remains at the lowest rung when it comes to listing India’s healthcare challenges for policy makers in the country. The problem intensifies when combined with a broad lack of public understanding of eye health and its relationship with general physical health.

The opportunities

Comprehensive approach: Focus on eye care needs among all levels of health services. Primary, secondary and tertiary levels need to rise to the challenge if avoidable blindness is to be eliminated. All the data and findings point towards the impending need of bringing focus on increasing access, better training of human resources and driving awareness among the masses to get their eyes checked at regular intervals, the absence of which has immediate and long-term consequences (both personal and economic).

Investments in access: Eye care must be made available, accessible and affordable by identifying and addressing the factors which are acting as barriers. Resources in terms of upgrading existing infrastructure, upskilling ophthalmologists and optometrists and building a community health programmes and behaviour change communications should be directed towards the development of areas most in need, to successfully eliminate preventable and curable causes of blindness.

Investments in manpower: To address the lack of human resources authorities should look at increasing the seats for ophthalmology in medical colleges to encourage medical students to opt for this speciality. Technology can also be effectively used to revolutionise eye health services. For example, through the use of telemedicine in public health centres, doctors can perform remote diagnosis. With increasing internet usage across the country, health apps have also emerged as a possible option to create awareness about the symptoms of eye diseases.

The integration of eye care into the government’s primary healthcare ecosystem will be required to achieve India’s Vision 2020 goals. In countries, where primary healthcare development is strong and functional, eye care programmes have achieved success. Blindness imposes not only lost quality of life and well-being for the affected individuals, but also a significant economic burden on society. As 80 per cent of blindness is preventable, one can imagine the larger impact of timely, better eye care of society and economy. Nearly 10 million people can enter the mainstream of life resulting in adding many more millions to the labour market, as even care givers now can concentrate their full energies in economic activity. By curing and preventing blindness, India can dramatically improve its productivity and reduce the overall burden of healthcare on families as well as economy at large.