We target to set up 1,50,000 health care centres across the country, claim experts

Digital tech and internet proved to be a huge support for all of us during the Covid-19 quarantine, but we were also made to face the adverse affects of increased screen time of our gadgets and televisions. Eye-related problems have increased dramatically across all age groupd, especially among the younger ones. To understand and know about the possible cures and preventions of the eye-related disorders, Medically Speaking talked to a panel of experts on the occassion of World Sight Day that was on October 14. The panel included: Dr Jiwan Titiyal, Chief, RP Eye Centre, AIIMS; Dr Manpreet Kaur, Ophthalmologist, RP Eye Centre, AIIMS; and Dr Praveen Vashisht, Professor of Internal Medicine, AIIMS.

Here are a few snippets from the interview:

Are vision problems given less attention than they need?

Dr Jiwan Titiyal: People disregard the basic problems of vision, which are so important for their lives. If you have a good vision, your life will be better. Ranging from children to adults, everybody suffers from some sort of vision-related problem.

One of the most common problems in terms of magnitude is refractive error, which is not corrected across the community or country.

We have a large group of people who have become older and require glasses for near. All of them fall into the category of visual impairment. That’s why this year’s World Sight Day theme is “Love Your Eyes”, because if you love your eyes, you are going to love yourself and you can see the world in a beautiful way. We need to look into all the causes of blindness and visual impairment and see how we’re going to correct them by constituting various ways to assist the magnitude of these causes of blindness in our country. Then implementing basic ways to attack those areas and get people into the best shape in terms of vision and subsequently getting them into the mainstream of country’s economy, which is a major challenge today. If most people are visually impaired, the economy also goes down and it is a vicious cycle that has to be broken by us.

 

Is eye checkup affordable for everyone? Is the government investing enough in the same as it needs to? Do you see a huge disparity between the monetary allocation from the government and awareness of people?

Dr Manpreet Kaur: There is, of course, a disparity in the resources and the infrastructure and the patient load that we have, but still the patients do not make use of even their existing resources adequately. We have a community Ophthalmology Department, we conduct outreach camps to promote basic health check-ups and we go to the doorstep of the patients. So this awareness is a two-step process. It has to come both from the patient’s side and from our side. We have camps in school, (school eye screening camps), camps in villages and in each and every district. So coverage is there, but people have to come forward and utilise it.

 

How are you trying to close this gap between organizations and the people? There is universal access, to eye health for everyone. But how are you ensuring that?

Dr Praveen Vashisht: The government of India is trying their level best. If we see eye-care infrastructure, from top to bottom, we have regional institute of ophthalmology, that is 1/5 of the population. And in the bottom level, we have primary eye care centers. You’ll be happy to know that as far as the three upper levels are concerned, be it the regional institute of ophthalmology, tertiary care centres and secondary-level centers, they are quite sufficient. In fact, against the target of 2000 secondary-level centers, we have recently conducted a survey and we have nearly 8,000 such centers. But the major issue strengthening primary eye care and what we need is one primary eye care centre for every 50,000 population, which means we need a lot of initiative because the target is 20,000 centers. We just have around 5,000 vision centers in our country. The government of India is responsible for the last two to three years have taken a lot of initiatives. In fact, health and wellness centres have been recently targeted by the year 2022. We will be able to have 1,50,000 health and wellness centres in the country that will be providing comprehensive health care services, including primary.

 

How to increase refractive surgery targets? Also, to increase the chance of cataract surgery. First of all, make us understand the difference between refractive errors and cataract surgery and what your targets are for the same? What is the coverage in India as of now, especially when we speak of cataracts because that is a major popular problem in the adult population of the country?

Dr Jiwan Titiyal: We have to really look into the target area and as you rightly pointed out, the first targets for Cataract blindness has to be decreased to an extent where people are comfortable, and it’s not only the blind that are induced by cataract, it is also the visual impairment caused by cataract that is in huge numbers. If you look into the stats before 2019, before the pandemic, India used to do around 50 or 60 lakh surgeries in a year, which is a huge number. Despite that, we still have cataract being the largest see a group of people getting to the blindness category is not good. If you look into that, we have to increase the strength of infrastructure to cater to a large number of people, not in the city area, but in the village area where facilities may not be there. We have to increase the number of  surgeons trained with modern day technology and give them access to the required instruments. The government is giving us some sort of insurance scheme which will provide a comfortable journey for patients coming from their home to the area where they can get their surgery done. That is one area we are working on. Second, and most importantly, the refractive error, which is in a large number from children to adults. Those people who undergo surgery still require glasses after surgery. There also, support of a government or an NGO is needed where we can provide low-cost, effective spectacles to a large number of people.

 

Refractive error surgery, practical in a country like ours, is for the rich, for those who can afford it. But is there something we can practically even discuss as of today? 

Dr Jiwan Tityal: Refractive surgery is one option for a group of people who may not like to wear glasses. There are some therapeutic reasons for doing those surgeries also. But this number is not enough to decrease the category of blindness or visual impairment. This is some sort of management for those people who don’t want to wear contact lenses or glasses or they have some requirement which may be job-related or some other therapeutic. This is a good option for those people who are suffering from refractive error, which is bothering them physically, psychologically, and in other ways.

 

Does exposure to digital devices like mobile phones and tablets affect them? How harmful can it be? Any tips on how we can take care of our eyes in today’s day and age?

Dr Manpreet Kaur: The screen time in today’s time is definitely affecting our eye health across all the age groups, starting from the very young. In fact we should restrict screen time, but we are somehow dependent on it in the Covid era. The school classes are going on laptops and mobile screens. For this, there is a 20-20 rule. After every 20 minutes, you should have a 20 second break from the screen so you can give rest to your eyes and apart from the essential usage, the non-essential screen time can be reduced. Less of leisure computers for laying and surfing and more of outdoor activities in this time and it’s not absolutely necessary. Easier said than done. But then somehow, we will have to incorporate into our daily life.

 

I think access to eye-care in rural areas would be still a distant dream because our Primary Health Care is in a state of disarray, as of now. What would you say about it?

Dr Praveen Vashisht: We have conducted National blindness and visual impairment survey all over the country in 31 districts and we have realized that people are blind and they are not loving their eyes. They do taking care of themself. They are not going to nearby hospital for treatment gear. It is something so pathetic, that we have seen cases where a simple glass can work, but people feel like that the doctors will perform surgeries on them and they avoid going to the hospital because of this fear. An awareness is so poor. In our country in rural areas, services are not available, not even primary-level services, forget about secondary or tertiary. Doctors are not ready to work in rural areas. This is the major issue and probably, we need to work hard and there should be some schemes for what doctors, where they should be able to work in rural areas. And the best part is at least the primary-care year level services, vision centers need to be developed in the rural areas.

 

Does Ayushman Bharat scheme cover eye surgeries as well? Are they considered non-essential?  

Dr Praveen Vashisht: Definitely it covers eye care and there are 58 different procedures that have been covered in ophthalmy-care including cataract surgery. Cataract surgery is the most widely used surgery under Ayushman Bharat scheme.

 

Over a thousand Canadians lost their vision because they kept delaying their basic eye care due to pandemic fear. What has been your experience when it comes to retina-care and what is your message to people?

Dr Jiwan Titiyal: Looking back at the last one half year which was totally affected by the covid-19 pandemic, we have three-fold increase in our backlog. First, those people who are afraid of coming to hospitals and delay their checkups and they are suffering now. Second, those people who had come to hospitals but did not get the proper treatment because services were hampered. Third, new people who are going to join these two backlogs. What we have seen in this recent time in last two, three months after the second wave is that there is a number of patient coming in with chronic disease, which has worsened in those one and a half years. We have patients with glaucoma whose visual field, has decreased, the IOP (intraocular pressure control) has gone haywire. We have diabetic patients who would say my diabetes is well under control, but it led to a deterioration in their management, which could have been possible. Unfortunately, we did have complete lockdown for some time, but the hospitals were working, but these people were not aware that they could come to hospital for emergency services and despite that we could not cater to this large number of patients. Apart from that, young children or young adults are coming down with a change in the refractive error because they’re sitting at home, into the know online work due to which the number has changed, the myopia may have increased much more than earlier. We thought we were able to control myopia before 2019, but that was turned upside down after the pandemic.

 

Tell us really the effect which Covid has had or could have had on your eye sight?

Dr Jiwan Tityal: We did have a huge influx of patients coming in with mucormycosis affecting not only their nasal and oral areas, but also the eyes.

By the time it affects eye, it is slightly late stage of mucor infection in the body and we have had patients losing vision because of mucor affecting their eyes. If somebody has suffered Covid and he has recovered for at least a month or so, losing vision might mean he is suffering from mucormycosis which directly affects the optic nerve of the person. The fungus this goes for backside of the eye, that is the orbital area and from there it can go to the brain. Once it affects the orbit and brain, the deaths is almost 50% in these cases. We have had a series of cases where this is also causing significant loss of vision in these patients. But I am happy to say that since AIIMS was working on a mucor patients 24×7, we could save many patients from losing their vision. We have worked on awareness programs, we have put pamphlets, we have talked to media.

 

What is your last word closing the conversation?

Dr Manpreet Kaur: Cliché does hold true even today, that prevention is better than cure. So focus on preventive measures and get your eyes checked.

 

What do you think the government needs to do from its side to shorten this gap that we’ve spoken about?

Dr Praveen Vashisht: We have huge burden of visual impairment country and what we need to see that the services should be available in both rural as well as urban areas. There should be a lot of awareness. People are suffering, but they are not coming to hospital. So we have to generate demand among the people. If they are having eye problems, they should come to the hospital for treatment. This is the need of the hour.

 

What would you tell people on how to implement the theme of World Sight Day “Love your Eyes”?

Dr Jiwan Titiyal: One of the most loveable thing somebody’s life, in their own body is the eye. If you love your eyes, you’re going to take care of not only the eyes, but your body. Eyes are the vision for seeing what is happening inside your body or through your emotions. I request the public that don’t just wait for things to happen. Go and get your eye checked up that might detect, diabetes, hypertension, etc. as many other diseases can be diagnosed by examination of eye itself.