|Year : 2021 | Volume
| Issue : 2 | Page : 109-111
Eye care in India– past, present, and future
Cherungottil Viswanathan nair Radhadevi
Retired Professor, Department of Ophthalmology, Amala Institute of Medical Sciences, Thrissur; Former Director and Superintendent, RIO, Thiruvananthapuram, Kerala, India
|Date of Submission||10-Jul-2021|
|Date of Decision||10-Jul-2021|
|Date of Acceptance||10-Jul-2021|
|Date of Web Publication||21-Aug-2021|
Cherungottil Viswanathan nair Radhadevi
Lakshmee-Krishna No. 11, Rose Gardens, Thiruvambadi Post, Thrissur - 680022, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Radhadevi CV. Eye care in India– past, present, and future. Kerala J Ophthalmol 2021;33:109-11
| The Long Journey … and Where Do We Stand Now?|| |
India has always had a long tradition of eye health care starting from the Vedic ages, 3000–1000 BC and transmitted through King Nimi, Sage Susrutha and Nagarjuna in the 2nd to 4th century AD and Vagbhata in the 6th century. Cataract surgery first done by Sage Susrutha-couching-was done even in the early stages, but with below par conditions. Prescription of glasses was also done in those days. The “golden age” of Indian medicine was between 800 BC and 600 AD. With the arrival of Mughals by the 13th century, Unani medicine was introduced and Indian medicine was subdued for some time.
Western medicine was brought to India by the British in the early 18th century. Ayurvedic medicine was also revived during that time. Eye infirmary was started and the first medical school was established in Calcutta in 1822 which started functioning in1824. In 1747, French surgeon Jacques Daviel performed the first extracapsular cataract surgery, leading to notable advancement in cataract surgery. The 19th and 20th centuries saw tremendous progress in eye care leading to the modern era, including the introduction of phacoemulsification by Dr. Charles Kelman in 1967. The great surge was seen with the starting of All India Institute of Ophthalmology and R P Centre for Ophthalmic Sciences, New Delhi in 1967, established by Princess Rajkumari Amrit Kaur. Eye institutes were started in other parts of India as well. Presently, well-equipped eye departments are there in all the medical colleges throughout the country, both in the government and private sector. Corporate hospitals with modern amenities and skilled staff have also come up in various parts of India.
India has always been in the forefront with regard to the prevention of blindness and eye care. The NPCB, launched in 1976 was directed towards prevention, treatment, and control of blindness. The District Blindness Control Society functioning in all the states conducted school health programmes, cataract screening camps, and surgical camps. With the advent of new technologies, cataract surgery which was done at the campsite, was in due course shifted to the hospitals, to ascertain aseptic conditions. Vision 2020- the right to sight was launched in 1999 by the World Health Organization (WHO) and the International Agency for the Prevention of Blindness to eliminate preventable blindness by 2020. This project also was carried out effectively in India.
With changing times, transition in health care has occurred both demographically and epidemiologically. The same changes reflect in the delivery of eye care as well. Subspecialties have been an inevitable change in the field of ophthalmology over the past few years. This has in turn brought us to crossroads with a shortage in the category of “the general or comprehensive ophthalmologist.” In this scenario, we need to realign our resources to provide the best of comprehensive and specialty eye care to the public.
| The Concept of Comprehensive Eyecare|| |
Comprehensive eye care (WHO)
Comprehensive eye care is defined as the strategy which “aims to ensure that people have access to eye care services that meet their needs at every stage of life. This includes not only prevention and treatment services but also visual rehabilitation. Comprehensive eye care (CEC) also claims to address the full spectrum of eye diseases.”
Being a person who has evolved through the times of “ab externo” incision cataract surgery to phacoemulsification, I am a strong supporter of technology and advances in ophthalmology. Albeit, we should not be oblivious of the fact that CEC is the face seen by the public and is the base of the eye care pyramid, without which we cannot effectively provide eye care to the masses. Hence, the importance of the same cannot be left unseen.
The components of CEC are human resources, finance, health information, consumables and technology, and service delivery under governance to give a good quality high cover and safe health care. It should be incorporated into the health system and can be utilized for the care of chronic eye conditions-non communicable eye diseases, which may be quite challenging. The plan of action is based on a multilevel integrated structure which includes comprehensive eye examination, comprehensive eye care services, and comprehensive eye care system. The eye care delivery should be planned according to the disease, socioeconomic and demographic setting.
| The Eye Care Pyramid|| |
The Eye Care Pyramid, is an infrastructure model for the implementation of VISION 2020: The right to sight. Eye care infrastructure consists of the primary, secondary, tertiary, and advanced tertiary centers.
Primary Eye care Centre (PEC) is an integral part of comprehensive eye care. In the PEC, health education, identification of symptoms, recording basic eye examination, diagnosis, and timely referral are done. This forms the base of the eye care pyramid, along with community eye care.
Secondary centers provide quality eye care which includes diagnosis of eye diseases and high-quality surgery mainly for cataract, the leading cause of treatable blindness.
Tertiary centers provide comprehensive services and training of personnel. Specialized surgeries for glaucoma, retina, and cornea are done here. Training and Continuing Medical Education (CME) is also conducted.
Center for excellence caters to service delivery of complex eye diseases, training of trainers in subspecialties, vision rehabilitation, and supportive advice.
CEC can be carried out in medical colleges, district hospitals, and even in the private sector.
Education and research should be undertaken in such centers. School Heath programs and eye camps intensify the community eye care. CME along with training programs for internal and external faculty helps to keep pace with advancing technology and knowledge. This also helps to develop good rapport between the Ophthalmologists. Teamwork is important in cases such as trauma or diseases. A good teamwork with departments such as neurology, neurosurgery, ENT, Dental, or plastic surgery can be of great help in tackling complex cases.
General ophthalmologists can handle specialty cases with sufficient training.
Furthermore, specialists can do the work of a general Ophthalmologist, if he/she is willing. That depends largely on the attitude and skill of the specialist. Interaction between the general Ophthalmologist and specialist will be helpful in the delivery of eye care services, especially in chronic cases.
Teleophthalmology is becoming important as an effective eye care modality. It can play an additional role in screening, emergency eye care, urgent diagnosis, treatment, and prompt referral. Useful in conditions such as diabetic retinopathy, retinopathy of prematurity, and glaucoma.
| Future of Eye Care in India|| |
The way forward depends on certain factors-human resource development, skill-based training, appropriate eye care to all and interaction between eye care providers– both public and private sectors, usage of technology for documentation, data collection and analysis along with innovation, and translational research
How can we go forward?
By strengthening the components of the health system, assuring eye health continuity and service delivery, integration into the healthcare system, use of modern technologies and data collection tools, training with regular maintenance, and by providing rehabilitation to the irreversible visually impaired.
In training centers, trainees or postgraduates should be exposed to handle all types of ophthalmic cases, so that when they go out, they will have no difficulty in giving good eye care service to patients. Now is the time to redefine eye healthcare delivery so that it is accessible to the masses without much difficulty.
There surely is a bright future for Indian Ophthalmology. The younger generation should be able to maintain and intensify the glory of Indian Ophthalmology, as there is neither scarcity of talent nor shortage of patients.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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