|Year : 2017 | Volume
| Issue : 2 | Page : 116-120
Aravind eye care system
Head of Cataract an IOL Services and Department of Paediatric Ophthalmology and Strabismus, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
|Date of Web Publication||10-Aug-2017|
Aravind Eye Hospital, Avinashi Road, Civil Aerodrome Post, Coimbatore - 641 014, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Aravind Eye Hospital was founded in 1976, by Dr. G. Venkataswamy, a man known to most of us simply as Dr. V. In an eleven bed hospital manned by 4 medical officers, he saw the potential for what is today, one of the largest facilities in the world for eye care. Over the years, this organization has evolved into a sophisticated system dedicated to compassionate service for sight. The Aravind Eye Care System now serves as a model, for India, and the rest of the world.
Keywords: Diseases in epidemic proportions and illiteracy, GOVEL Trust, low per capita income
|How to cite this article:|
Narendran K. Aravind eye care system. Kerala J Ophthalmol 2017;29:116-20
| Aravind Eye Care Services|| |
The problem of avoidable blindness rapidly escalating remained a major cause of concern in the Indian healthcare scenario. In a developing country, the government alone cannot meet the health needs of all due to a number of challenges such as growing population, inadequate infrastructure, low per capita income, aging population, diseases in epidemic proportions and illiteracy.
Realizing this, Dr. Venkataswamy [Figure 1] wished to establish an alternate health care model that could supplement the efforts of the government and also be self-supporting. Following his retirement at age 58 in 1976, he established the GOVEL Trust under which Aravind Eye Hospitals were founded. Dr. G. Venkataswamy, a man known to most of us simply as Dr. V. In an 11 bed hospital [Figure 2] manned by 4 medical officers, he saw the potential for what is today, one of the largest facilities in the world for eye care. Over the years, this organization has evolved into a sophisticated system dedicated to compassionate service for sight. The Aravind Eye Care System now serves as a model, for India, and the rest of the world. Aravind Eye Hospital has over the past 40 years handled more than 48 million outpatient visits and performed 5.5 million surgeries. Now, each day across all its facilities, Aravind sees about 12,500 outpatient visits and performs around 1500 surgeries. Close to 2600 eye camps are conducted every year that takes quality eye care to the rural masses. Now the Aravind Eye Care System includes 5 tertiary care centers, 6 secondary care centers, 6 outpatient eye examination clinics and 62 vision centers [Figure 3]. As a result of a unique fee system and effective management, the organization is able to provide free eye care to 50% of its patients from the revenue generated from its 50% paying patients. With 1% of the country's ophthalmic workforce, Aravind accounts for 5% of the ophthalmic surgeries performed.
| Extending the Reach of Quality Eye Care to the Poor and Needy (Community Outreach)|| |
An integral part of Aravind Eye Care Services (AECS) is its community outreach programs which take eye care service to the doorstep of the community. These camps also serve to educate the local community on eye care. Toward this end, several comprehensive eye care programs are organized. It ensures that people in all age groups are covered under these programs.
| Comprehensive Screening Eye Camps|| |
The clinical team (made up of ophthalmologists and paramedical) examines all patients for eye problems with basic required instruments and equipment which include dilation and fundus examination to some extent. Refraction is also done in the camp and eyeglasses are offered at affordable prices to support the service delivery system. People who need cataract surgery are counseled and transported to the base hospital. No surgery is performed at the camp [Figure 4].
| Diabetic Retinopathy Screening Camps|| |
According to the World Health Organization, 180 million people are affected by type 2 (formerly called adult-onset) diabetes worldwide, 41.9 million in India alone, the largest diabetic population of any nation in the world. These figures are expected to double by 2030. Various studies conducted in India show that 15%– 20% of the diabetic population develops diabetic retinopathy (DR) [Figure 5].
DR screening camps are often held in conjunction with general hospitals (diabetes clinics) and diabetic associations and include a large community education component. Since screening people for this disease requires special medical expertise, DR screening camps are specialized exclusively in the diagnosis and treatment of this disease. However, whereas the focus is on detecting DR before it causes irreversible blindness (and this sometimes means detecting diabetes in patients who don't know they have it), patients who suffer from other eye disorders will also be referred to the eye care institution, eye clinic or specialty ophthalmology practice.
| Workplace-Based Screening Eye Camps|| |
It is estimated that 153 million people in the world have a visual impairment due to uncorrected refractive errors (visual acuity <6/18 or <20/60 in the better eye) and that is excluding presbyopia. In an aging world, the magnitude of uncorrected presbyopia is unimaginable. Since this is a problem among working populations, refractive error camps can be held for the sole purpose of screening and dispensing eyeglasses to large numbers of patients at one time. Industries and other fields of work that are likely to cause seeing disorders (or that are likely to suffer losses due to workers with poor vision) are also prime targets for this type of outreach camp.
Refractive error screening camps are conducted very similarly to cataract or comprehensive screening camps. Every patient is subjected to the same series of eye examinations, in the same order as in a regular screening camp Indeed, assessment of individuals who have refractive errors, particularly those aged 50 years or above, provides an opportunity for identifying other potentially blinding conditions before they cause visual loss (such as cataract, glaucoma and DR).
| School Children Screening Eye Camps|| |
Globally, the uncorrected refractive error is the main cause of vision impairment in children aged 6– 15 years and the prevalence of myopia (short-sightedness) is increasing dramatically among children. Outreach in schools concentrates on refractive error, which can lead to a lack of academic success in school. Students with other eye ailments are also noted and referred to the base hospital.
Aravind prefers to conduct a short term orientation (about a day) for the teachers in the school premises based on 1:200 teacher-children ratio. The training covers anatomy and physiology of eye, common eye disorders among the children and visual acuity measurement. This exposure helps the teachers to conduct a preliminary assessment on the school children as a whole. This kind of assessment helps the Aravind Medical team to conduct detailed eye examination on the children identified with eye problems. Furthermore, the training for teachers helps to gain good ownership of the screening process effectively.
| Paediatric Screening Eye Camps (0– 5 years)|| |
A child goes blind somewhere in the world every minute, yet much childhood blindness is preventable or treatable. Pediatric screening eye camps target babies and preschool-aged children and their parents, to educate about prevention (measles, harmful traditional eye remedies, eye safety) and to detect eye defects (congenital or traumatic), childhood illnesses and nutritional deficiencies that can lead to blindness:
- Vitamin A deficiency
- Corneal scarring
- Congenital and traumatic cataract
- Congenital glaucoma and retinopathy of prematurity
- Serious refractive errors.
The process in a pediatric screening eye camp is quite similar to that of other screening camps. A major challenge of this type of camp is how to get more children with eye defects attending the camps. One way is through greater eye health education, targeted at young parents. Another way is to work with primary health centers, children health centers, family physicians, pediatricians, maternity clinics, preschools, etc.
| Extending Eye Care Service Delivery to Remote and Rural Communities (Vision Centers)|| |
Even after doing a lot of community outreach activity, we reached only 7% of those in need of eye care, those with rarer eye conditions were not reached, in which Vision Center Concept was developed. Vision centers are small, permanent facilities set up to extend eye care service delivery to remote and rural communities, with the objective of increasing the uptake of comprehensive primary eye care. Aravinds Vision Centers offer innovative internet-based information technology that allows patients in rural areas to be remotely diagnosed by ophthalmologists at the base hospital [Figure 6]. Via high-speed wireless video-conferencing, doctors can consult with hundreds of rural patients per day, providing high-quality eye care while eliminating the need for patients to travel to the hospital (unless more advanced treatment is needed).
| Lions Aravind Institute of Community Ophthalmology - education and Training|| |
In early 90's Dr. V received many request from worldwide for proactive eye care delivery model to be engaged in their place, To address this Lions Aravind Institute of Community Ophthalmology (LAICO), established in 1992 with the support of the Lions Club International Sight First Programme and Seva Sight Programme, is Asia's first international training facility for blindness prevention workers from India and other parts of the world. It contributes to improving the quality of eye care services through teaching, training, research, and consultancy. Each year close to 300 ophthalmologists, 600 paramedical workers, and 200 eye care management professionals receive training in various aspects of eye care. Around 8,300 candidates from 100 countries have been trained so far at Aravind.
| Amrf - research|| |
The research activities at Aravind reflect Aravind's commitment to finding new ways to reduce the burden of blindness. The combination of high clinical load, extensive community participation, and access to a large network of eye hospitals provides ideal opportunities for conducting clinical, laboratory, population-based studies, and social and health systems research. Research at Aravind provides evidence and evolves methods to translate existing evidence and knowledge into effective action. Currently, research is happening in the four areas: basic and translational research, clinical research, operations research and product development. Altogether 119 papers have been published, and 17 scholars have received PhD from the Institute.
| Aurolab - ophthalmic Manufacturing|| |
In the early 1990s, there was a great deal of debate about the relevance of intraocular lens (IOL) to developing countries. Although widely accepted as a better procedure, it was argued that developing countries should not go in for it as the IOLs were expensive. Taking on this challenge, in 1992, Aurolab Aravind's manufacturing arm was established as a nonprofit charitable trust for manufacturing ophthalmic consumables. Aurolab brought down the price of intraocular lenses to one-– tenth of the then market price. Aurolab products are exported to 120 countries around the world and accounts for a total of 7.8% of global share of intraocular lenses and have also diversified into manufacturing suture needles, pharmaceuticals, blades, equipment and so on [Figure 7].
| Consultancy and Capacity Building|| |
Often times, real issues in eye care are not relating to ophthalmology but lack of enabling environment - under- utilization of existing infrastructure and resources, creating the demand, lack of good supply chain, policies, and procedures that could be addressed by good program design, governance, and efficient management. To address this existing scenario, LAICO partners with the international nongovernmental organizations like Lions Clubs International Foundation, Sight Savers International, CBM International, International Eye Foundation, ORBIS International, Right to Sight, Seva Foundation, WHO and other eye hospitals [Figure 8]. LAICO provides its expertise and support to the eye hospitals through structured consultancy and capacity building process. LAICO teams conduct needs assessment visits to the hospitals to gain a better understanding of the working systems and management structure. This enables to establish a framework for capacity building specific to each hospital. LAICO, Aravind's training and consulting arm helps develop eye hospitals across the world through a structured process of consultancy and capacity building and now works with over 335 eye hospitals worldwide.
| Aravind Eye Banks|| |
In India, the need for corneas for sight-restoring surgeries is 1 lakh/year. According to the Eye Bank Association of India, the number of eyes collected in 2010 is 41,549. Moreover, more important is the fact that of this total, only a little more than 10,000 meet all the criteria of medical standards as per the requirement for quality control of eye banks.
Started in 1998 at Madurai with just a collection of 253 eyes, now the eye banks across the Aravind Hospitals procure more than 4000 eyes and perform about 1400 corneal transplants annually. Eyeballs which cannot be used for transplants are effectively used for various research and development programs. Eye banks across the Aravind centers help reduce corneal blindness. In the year-ending March 2017, more than 5300 eyes were collected and 2,700 eyes were utilized for surgery.
| Postgraduate and Fellowship Programs|| |
Aravind has launched its postgraduate programs to develop a cader of the well-trained ophthalmic human resource. These training program has been evolved to an international standard over years with its well organized and structure modules. Interactions with faculty, didactic lectures, grand rounds, and journal club discussions give ample opportunities for them to become an excellent ophthalmic clinician and an efficient surgeon. So far, we have trained 9983 eye care professionals (922 postgraduates and 1471 fellows). AECS offers long term fellowship programs in all subspecialties and also short term courses in ophthalmology.
Aravind Eye Care System will remember the year 2006 as the year it lost its founder, the legendary Padmashree Dr. G. Venkataswamy on July 7. Dr V's life was a long dedication to serving the Divine through work in the field of eye care. His tireless vision, inspiring leadership as well as his selflessness and humility shaped Aravind into all that it is today. The Organization has evolved into a sophisticated system dedicated to compassionate service for sight. The Aravind Eye Care System now serves as a model, for India, and the rest of the world and working towards his Mission “To Eliminate Needless Blindness.”
“Intelligence and capability are not enough. There must also be the joy of doing something beautiful”
- Dr. G. Venkataswamy
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]