India must scale up its war on blindness

Create a comprehensive costeffective model that provides screening, diagnosis and treatment detection

India is home to one-fourth of the world’s blind population with eight million blind people in the country. Over six million of them should not have been blind, as 75% of blindness is easily preventable. On World Sight Day today, let’s see how we can prevent most of blindness in the country.

Anshu, 14, Muskan, 12, and Shrasti, 6, attend school in Vidisha, Madhya Pradesh. The children, instead of playing with their classmates, sit idly not engaging with children their age. It is the mandate of the playgroup coterie for they believe they, too, will go blind if they talk to blind children. The three sisters have cataract, the largest cause of preventable blindness in India.

Vision loss from avoidable causes like cataract (63%), refractive errors (10%) and glaucoma (5%) can be treated or prevented with cost-effective means. The first task is awareness. The next is to have a robust system to provide accessible quality eye care facilities across the country, so that no one is blind due to avoidable causes.

The National Programme for Control of Blindness (NPCB), a centrally sponsored scheme, was launched in 1976 to bring down the prevalence of preventable blindness to 0.3% by 2020.

Surveys over the years have shown considerable reduction in the rate of preventable blindness, yet there is a lot that needs to be done. The current survey — 2015-18 — is in progress with results awaited any time.

The backlog for cataract surgeries continues to remain a big challenge and is primarily because of the non-availability of human resources. Our country has an acute shortage of doctors for correcting eye ailments. As per Vision 2020 of The Right to Sight initiative, there are about 12,000 ophthalmologists in India for its 1.3 billion population, resulting in a ratio of one ophthalmologist for every one lakh people. In rural India, this ratio is even worse: one ophthalmologist for every 250,000. There ratio of availability of qualified optometrists, approximately one for every 25,000 people, is also skewed.

The scaling up of a comprehensive costeffective eye care model that provides quality screening, diagnosis and treatment detection, especially through a health system strengthening approach is required. A humongous advocacy effort to educate the ageing population, which is most affected by cataract, and a workforce of mid level health workers to provide basic eye care services can enable us to take eye care everywhere.

Those who are blind should certainly have adequate means to realise their full potential and lead a life of dignity. The loss of sight owing to avoidable reasons affects people in more ways than one. First, blindness has an important cause and effect relationship with poverty. Educational, social, and economic deprivation becomes an integral part of their lives, especially those living in marginalised urban and rural pockets of our country. Their burden grows multifold when gripped with visual impairment.

The National Programme for Control of Blindness envisions “eye health for all”, which is the mainstay of this year’s World Sight Day theme: “eye care everywhere”. The national body seeks to enhance community awareness on eye care, strengthen infrastructure facilities, and lay an emphasis on preventive measures for eye care. In doing so, it is not alone. Several non-government organisations are key in combating avoidable blindness.

The three Vidisha girls (mentioned earlier in the article) were screened for cataract in their school under Sightsavers India’s School Eye Health Programme. What followed was a visit by a community health worker to meet their parents who are illiterate and have no clue that their children’s blindness is irreversible.

It is through counselling and assurance that they send their children for sight saving surgery 60 kilometers away to Bhopal. The children are able to see the world clearly, not being a part of the 8 million or more blind population of India. The hope of a bright future awaits them.