The Lancet Global Health Commission report on global eye health estimates that 596 million people have distance vision impairment and 510 million have uncorrected near vision impairment worldwide. Additionally, with the worldwide prevalence of diabetes tripling over the past two decades, there has been an increase in the incidence of vision loss due to diabetic retinopathy. The high prevalence of vision-related conditions can be attributed to the increase in the aging population with an increase in age-related eye problems such as cataracts and macular degeneration, co-morbidities such as diabetes and a mode of life that exposes the eyes to blue light from electronic devices.
Closer to home, India has 62 million people who are estimated to be visually impaired, of whom 8 million are blind. This is an entirely preventable tragedy, as timely medical intervention could have saved at least 50% of cases of total vision loss. But for that to happen, we need to understand the challenges and focus on eye care.
Cataract is one of the leading causes of visual impairment in India. Cataracts cause the natural lens of the eye to cloud, leading to blindness over time. The National Survey of Blindness and Visual Impairment shows that cataracts are the cause of 66.2% of cases of blindness in people over the age of 50. Blindness can be prevented by a simple surgical procedure that replaces the clouded lens with an artificial lens. Despite this, many cataract patients experience permanent vision loss, especially in semi-rural and rural India.
Multiple reasons prevent patients from accessing eye care and surgery that can restore their vision. These include lack of easy access to a quality eye care hospital, financial constraints, fear of surgery and feeling that there is no need for surgery. This shows the urgent need to educate people about available cataract treatments and ensure easy access to affordable, quality eye hospitals where cataract surgery can be performed.
After cataract, diabetic retinopathy is a major cause of eye morbidity and blindness if not treated in time. India has the unwelcome distinction of being the diabetes capital of the world and diabetic retinopathy is emerging as a disease with significant impact on public health. A recent study showed that 16.9% of people with diabetes suffer from diabetic retinopathy. Considering that India has 77 million people with diabetes in India, of which 57% are still undiagnosed, this represents a potential of 13 million cases of diabetic retinopathy. The number of diabetics is expected to reach over 134 million by 2045 and this huge number highlights the need to approach the problem of diabetic retinopathy on a war footing.
But are we ready? The challenges lie both in training talent and in accessing facilities.
The shortage of ophthalmologists and optometrists in small towns, villages and rural areas cannot be ignored. India has only about 25,000 ophthalmologists and only 45,000 optometrists against the required 125,000. Expanding the infrastructure to train eye specialists is essential if we are to be prepared for the growing number of cases in the future. With government support for accreditations and the creation of standardized training programs, we can be a step ahead of future challenges.
Eye camps set up from time to time are limited in the treatment that can be offered and face challenges in ensuring quality of care. It requires permanent facilities that provide easy access to quality and affordable advanced eye care. This can be achieved by government and the private eye care sector working together in a public-private partnership (PPP) model to build an integrated eye care infrastructure across the country. Ease of access will ensure that vision problems are detected early and timely treatment is instituted to prevent deterioration of vision leading to blindness.
With the largest blind population in the world, India is now known as the blind capital of the world. A focus on Eye Care is the need of the hour if this is to change.