India currently has the highest number of blind and vision impaired people in the world, which places an enormous burden on the country’s health care system. Dr. Nag Rao, Chairman of the LV Prasad Eye Institute (LVPEI) has plans that he hopes will make a dramatic difference.
Dr. Nag Rao is on a mission to eliminate avoidable blindness, including that from uncorrected refractive error (URE), in India by 2020. While this might sound like a lofty goal, upon closer inspection of the country’s alarming eye health figures, the sheer magnitude of this task is revealed.
An estimated 456 million of India’s 1.12 billion population require vision correction and there are 133 million – including 11 million children – blind or vision impaired, simply from lack of eye examinations and appropriate spectacles. The staggering global cost in lost economic productivity from vision impairment caused by URE is estimated at $269 billion1 a year.Enhancing access to optometry services in India will require a dramatic increase in the number of eye care professionals, as well as more efficient use of existing professionals.
Dr. Rao and LVPEI have been utilising optometric services as part of the eye care team to address the shortfall in eye care in India through the LVPEI Eye Health Pyramid model, which Dr. Rao pioneered. The model emphasises the creation of sustainable permanent facilities within communities, staffed and managed by locally trained personnel, and linked effectively with successively higher levels of care. These range from ‘vision guardians’ monitoring eye health at a community level, to vision centres serving the primary eye care needs of the community and facilities such as training centres and hospitals for the treatment of complex diseases.
Around 456 million of India’s 1.12 billion people require vision correction. The global cost in lost economic productivity from vision impairment due to uncorrected refractive error is estimated at $269 billion every year
LVPEI was established in 1987 by Dr. Rao and colleagues and by 2010 had overseen the development of 72 vision centres, nine secondary service centres, three tertiary centres (eye hospitals) and one centre of excellence. In 2009 – 2010 these services reached over 1.3 million people (almost one million received free eye care) with around half being covered through community programs and half receiving treatment through higher level facilities.
Recent calls by Dr. Rao and colleagues for greater urgency in developing the necessary eye care personnel, has focussed on the importance of establishing a unified system of regulation for optometry in India.
The International Centre for Eyecare Education (ICEE), of which Dr. Rao is Chair, has estimated that India needs 115,000 optometrists to provide necessary vision care to its population. However, it currently only has approximately 9,000 four-year trained optometrists and 42,500 personnel at various levels of optometry.
Leading Australian researcher, educator and blindness prevention advocate, Professor Brien Holden said “If India is to further develop into a regulated profession, it is estimated that the country will need at least 100 schools of optometry over the next few decades to meet the demand for fully qualified optometrists.
“Ensuring that quality education is delivered in all these undergraduate programmes would require the development of a minimum of 1,000 optometric educators who are capable of facing the challenges ahead to help produce around 5,000 optometry graduates per year,” he continued.
Prof. Holden played instrumental role in the landmark ‘Delhi Declaration’, a recent groundbreaking decision by Indian and international optometry representatives to support the development of eye care services throughout India. The Declaration was endorsed by the Indian Optometric Association, the Association of Schools and Colleges of Optometry, the World Council of Optometry, LV Prasad Eye Institute, the Brien Holden Vision Institute, ICEE and other eye care organisations.
The initiative has already resulted to the historic unification of optometry in India through the establishment of the Indian Optometry Federation (IOF) in February 2011. The IOF, which is supported by the Australia-India Council, has brought optometry groups in India together with the objective of educating more optometrists and developing quality vision care to stem the rising tide of preventable vision problems.
Infrastructure the Key
According to Dr. Rao, a core priority in working towards eliminating URE over the next decade is to upgrade the development of infrastructure. This can be achieved by ‘scaling up’ existing successful models.
“There must be human development to take care of the refraction and dispensing services, and the development of effective public and private partnerships,” Dr. Rao said recently.
“In India, the government supports work in the private sector. There is 72 per cent of all cataract surgery in India (is done by) the non-government sector and the government gives a small subsidy to provide that service free of cost to India’s poor.
“That is how we have achieved that quantum jump in volumes from one and a half million… it’s a three time jump. There are a lot of committed people around the country and the governmental/political commitment in particular has made a huge difference.”
Optometry in Australia has made its mark as a well-defined profession and makes a major contribution to the welfare of Australians and those in other nations. By sharing experiences and lessons learned from the academic, professional and legislative pathway that Australian optometry has followed over the last 80 years, optometry in India may be further developed to combat the country’s enormous burden of blindness and impaired vision over the next decade.
During the two-day meeting, delegates explored concepts to develop and implement education and competency standards for optometry in India, and the establishment of a Graduate School of Optometry to train academic staff through facilitating post-graduate studies and research. They also discussed national accreditation and regulation for optometry as an independent profession in India as well as the establishment of continuing education programs.
Mr. Vinod Daniel, from the Australia- India Council and who is part of the Australian delegation, added that blindness prevention is one global initiative where a very small amount of investment provides large financial returns for any country both in terms of increased productivity as well as improvement in self dignity.