The need of the hour is for strengthening eye care services in the country through their integration into the health system. Comprehensive eye care services need to become an integral part of primary health care. It can no longer be neglected. There is no room for debate that an inclusive model of eye health within the general health promotion and practice will prove to be much more beneficial and sustainable in the longer run for the country and its people. Such an inter-disciplinary approach in health care delivery can also address issues such as premature birth, vitamin A deficiency, diabetes and smoking.
Estimates by WHO on visual impairment globally and the causes thereof show that as of 2010, there were 285 million visually impaired people, of which 39 million were blind. WHO estimates that 80% of all causes of visual impairment are preventable or curable if determining causes and treatment were made priorities and control measures were implemented consistently across the world, by providing refractive services and offering surgery to people in need. Two thirds of visually impaired people globally could be rid of impairments to their vision.
The two main causes of visual impairment in the world are uncorrected refractive errors, accounting for 42% of visual impairment and cataract at 33%. Cataract is the clouding of the lens inside the eye, preventing clear vision. Although most cases of cataract are related to ageing, it is also possible for children to be born with the condition, or a cataract may develop after eye injuries, inflammation, and some other eye diseases. In most cases vision can be restored by timely intervention through a surgery to replace the clouded lens.
A refractive error is more common, in fact as estimates show, it is the most common eye disorder. It occurs when the eye cannot clearly focus on images. The result is blurred vision, which can sometimes be so severe as to cause visual impairment.
The most types of refractive errors are myopia (nearsightedness), hyperopia (farsightedness), and astigmatism, which leads to difficulty in seeing the distance; reading or seeing at arm’s length; and distorted vision resulting from an imperfection in the curvature of cornea or lens. Another major eye condition is presbyopia (which literally means “aging eye”). It is an age-related eye condition that makes it more difficult to see very close.
According to WHO estimates, 153 million people worldwide live with visual impairment due to uncorrected refractive errors. Unlike cataract, refractive errors can easily be treated by a pair of spectacles.
In India, the prevalence of childhood blindness is estimated at 0.17%, of which 33% is caused by refractive errors. Over 10 crore people suffer from uncorrected refractive error, which can cause preventable blindness. Perhaps more distressingly, over 1 crore Indian children, 5% of all children in the country, suffer from vision impairment due to uncorrected refractive error. Most of them are underprivileged and cannot afford a pair of spectacles. Also, it will increase the productivity of those affected by 34 % and their wages by 20% .
This scenario poses a number of challenges before society in general and policymakers in particular. India has one of the largest reservoirs of young, employable people in the world. It is expected to become the world’s most populous country in the years to come. For the country to realise its potential, it is doubtlessly imperative that the productivity of the population should be enhanced. The correction of refractive errors through a pair of spectacles is therefore something that should be looked into with some seriousness given the magnitude, in absolute terms, of the prevalence of eye health issues among young people.
Similarly, eye health issues among older citizens must also be viewed with seriousness, in equal measure. For instance, it is best for a cataract to be diagnosed and treated at an early stage rather than for it to reach a stage where serious visual impairment or potential blindness is inevitable. Poor vision is also statistically shown to multiply the risk of hip fractures in the elderly by seven times.
A critical shortfall in the number of optometrists also needs to be addressed. Ideally, India should have 125,000 optometrists based on the current population but there are unfortunately only 45,000 of them, which is just a third of the requirement. This is where the educational component of healthcare is vital in the context of eye health. Students should be made aware of Optometry as a field of study and encouraged to take it up just like in any other specialty.
MEDICAL TECHNOLOGY IN OCULAR HEALTH
In recent years, Indian healthcare industry has been growing at a double –digit rate. The sector grew at a rate of 18 percent from 2010 till 2016 and is expected to reach USD 300 million by 2030. The medical technology plays a crucial part throughout the healthcare lifecycle and has been instrumental in transforming healthcare ecosystems across the world. For India too, it offers the potential to address healthcare issues by using a mix of nascent as well as advanced technologies.
Med tech is defined as any devices, procedures, systems developed to solve and improve quality of life. There are an estimated 1.5 million medical devices used worldwide. These devices are very crucial for the diagnosis and treatment of eye ailments.
In today’s world, with the availability of modern technology and advancements in technology and devices, serious eye ailments can be picked up much earlier than was not possible a few years back. Some of the major advancements that help in treatment of eye disorders include:
RELEX SMILE OR LASIK SURGERY
Long working hours and par use of electronic gadgets have led to sudden rise in the patients with refractive errors.
The quality of life reported by patients who had undergone lasik procedure are feeling similar to patients who never wore glasses and this has remained stable even 10-15 years later.
Dr Naresh Purohit is (Advisor-National Blindness Control Programme. An Epidemiologist, he is advisor – National Communicable Disease Control Programme. The views and opinion expressed in this article are those of the author)