Health is wealth goes the old adage. By extension, the wealth of a nation is the health of its people – the state of its health sector, allocation of resources to the health sector, as well as delivery of services, especially to the poor and deprived sections of society.
Within the health sector, visual impairment and blindness, including preventable blindness or permanent impairment of vision, ought to be a matter of grave concern to policymakers and the medical profession.
In the words of Helen Keller, “The only thing worse than being blind is having sight and no vision.” It may be said of government policy and indeed society today that there is little vision in determining health prerogatives, with very little, if any at all, emphasis on eye health viewed as an element of holistic healthcare.
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 (Dandona et al. Childhood Blindness in India). 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% (The Socio-Economic Impact of Poor Vision- Vision Impact Institute).
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 (The Socio-Economic Impact of Poor Vision- Vision Impact Institute).
The need of the hour in this situation 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.
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.
India Vision Institute screening programs: Since 2012, India Vision Institute (IVI) has conducted 220 vision screening programs in and around Chennai and other cities in Andhra Pradesh, Telangana, Tamil Nadu, Kerala, Maharashtra, Gujarat, Puducherry, West Bengal, Delhi and Mizoram. Underprivileged children from government, corporation, municipality schools, orphanages and adults from various underprivileged communities such as gypsies, lepers, fishermen, daily wagers, Puzhal prison inmates (men, women and juveniles), firecracker makers, beedi makers and auto drivers underwent vision screening programs through Eye See & I Learn and Eye See & I Work campaigns and received free spectacles. Over 106,990 individuals from the underprivileged communities (including over 68,564 children) were screened and free spectacles were distributed to 10,846 individuals (including 4,810 children).
