India was the first country to launch a publicly funded program solely dedicated to eye care and controlling blindness and visual impairment, with the National Programme for Control of Blindness and Visual Impairment in 1976. Since then, conscious steps have been taken to achieve the objectives of the Program and periodic population-wide surveys have been conducted to ensure that the country is moving in the right direction.
Most of the existing literature around the issue of eye care is still contributed towards suspected or already diagnosed blindness. It has been seen that the literature around the subject is much more recent and published in at least in the past 5-6 years. There exists a dearth of data on eye care-related deficiencies or illnesses faced by people caused due to the lack of administrative data.
Most eye care-related cases are reported at the later state of advancing illness which ends up blinding the person. Data on early-stage symptoms and other non-blindness visual impairment is lacking as most cases come from rural areas. The National Blindness and Visual Impairment Survey 2015-19 is a first-of-its-kind assessment of eye care in India.
There is also the study by Rohit C Khanna, Shalinder Sabherwal, Asim Sil, Mohammed Gowth, Kuldeep Dole, Subeesh Kuyyadiyil, Heidi Chase titled “Primary eye care in India – The vision center model” which looks into the state of PEC in India and how the PEC model could be used advantageously in Rural India.
Under the Program, multiple Vision Centres and Multipurpose District Mobile Ophthalmic Units were also established in district hospitals of States and Union Territories to focused on the identification of eye disorders and correction for refractive errors.
Several non-governmental organizations have started to work towards Universal Eye Health Coverage (UEHC) through their Primary Eye Care (PEC) network of Vision Centers (VCs) in line with NPCB. They serve as the first level of response for patients and most of the VCs operate 6 days a week and they use various tracking mechanisms to improve the uptake of referral services. Key performance indicators are used to gauge the success of VCs. By including VCs into eye care services, apart from effective implementation, the scope for community engagement was improved and economic barriers were reduced.
Currently, there are 3 notable centers in the peninsular region that are involved rigorously in their effort to reduce needless blindness in India- the Aravind Eye Care System at Madurai, Sankara Nethralaya in Chennai (and Bengaluru), and the L.V Prasad Eye Institute in Hyderabad. They cater to the needs of blind people in the city and its suburbs through mobile facilities and free treatment for the needy.
LV Prasad Eye Centre has set up a system in Telangana, Andhra Pradesh, Odisha, and Maharashtra by establishing Rural Eye Health Pyramid. This pyramid comprises over 208 rural “Vision Centres”, situated at the bottom of the pyramid, each of which offers eye care service to a local rural population free of charge. A crucial link to the communities is the number of ‘vision guardians’, individuals trained to be involved in their local environment and communicate with people about eye health.
In the second tier of the pyramid are 21 Secondary Centres such as rural eye care clinics, for people in the districts. There are 3 tertiary centers that also do research work in ophthalmology, besides their regular clinical activities. The Quaternary center at the top of the pyramid oversees and monitors in real-time the work being carried out at the tiers and corrects what needs to be done, round the clock. Other notable Ophthalmology centers across India are Aditya Jyot Centre, catering to Mumbai; Project Prakash in Delhi and western UP and at Ahmedabad, Haryana, and elsewhere.
In order to minimize controllable blindness and visual impairment, setting up more Visual Centres is imperative for eye health care to be more accessible and affordable.
For the purpose of early diagnosis and treatment more, Primary Eyecare centers must be developed and established in rural areas. There must be sufficient geographical indications of the places with the least level of access to eye care facilities or treatment.
Researchers have to expand primary data collection to provide comprehensive vision assessments which can prove to be beneficial in the implementation process. WHO has committed to strengthening health information systems so that the capacity of local areas to collect, analyze and use data can be boosted and in turn, effective and equitable eye health services can be implemented.
Moreover, as the government’s implementation is considered to be weak, several non-governmental organizations have started to work towards Universal Eye Health Coverage (UEHC) through their Primary Eye Care (PEC) network of Vision Centers (VCs) in line with NPCB. They serve as the first level of response for patients and most of the VCs operate 6 days a week and they use various tracking mechanisms to improve the uptake of referral services. Key performance indicators are used to gauge the success of VCs. By including VCs into eye care services, apart from effective implementation, the scope for community engagement was improved and economic barriers were reduced.
The integration of vision centers into the prevailing health services is essential to increase the population’s access to eye care initiatives.
Another recommendation is partnering with lens manufacturers, not-for-profit institutions to better reach and serve the grassroots-level community. For example, CooperVision, a UK-based manufacturer of contact lenses as part of its One Bright Vision Program of 2016 partnered with the Indian Vision Institute and Optometry Giving Sight to screen children in Southern India. The program, especially, focuses on screening school children belonging to socially and economically disadvantaged sections of society.
Apart from undertaking early interventions by screening children, there is a need to ensure that screening programs are also undertaken throughout the life-cycle of a population. This would require the state to partner with, and nudge multinational corporations to screen their employees as well as those involved in their supply-chain management.
Williams-Sonoma, a private American multinational corporation partnered with VisionSpring in 2018 to provide eye care services to around 20,000 workers in India and the Philippines (Business Wire, 2018). Such interventions do not merely help ensure better healthcare but also help realize the longer capability of workers in the labour market.
Recognizing interventions like free screening of workers, such as artisans and miners, gives an impetus to achieve multiple sustainable development goals (such as SDG 3 and SDG 8) at once. Moreover, they provide crucial evidence towards informing policies that recognize the nexus between different objectives.
In the near future, the National Programme for Control of Blindness seeks to set up more PHC/Vision Centres to increase people’s access to eye care facilities.