Vision for Everyone: Bridging Gaps in Eye Care Access

Sarbari Ray, B.Optom

 

India is an unique nation with diverse geographical location, weather, languages, culture, prejudice level of literacy and overall economic condition.⁽¹⁾

In our diverse India, community eye care plays a vital role for early detection of eye conditions, preventive education, and reducing the burden of avoidable blindness and underserved populations.

According to WHO (World Health Organisation), globally 2.2 billion people have a near or distance vision impairment. In 1 billion of these, vision impairment could have been addressed. The leading causes of vision impairment and blindness at a global level are refractive errors, cataracts, Diabetic Retinopathy, Glaucoma and Age-Related Macular Degeneration.⁽²⁾

Blindness and visual impairment are one of the major problems in India.⁽³⁾ To eliminate vision impairment and to avoid blindness, adequate standardised and training of eye care is essential in ground level.⁽⁴⁾

Optometrists in the community provide primary eye care, early detection of eye conditions, community education, accessible eye care, prescription and fitting of corrective lenses, referral to specialists, and contribute to public health initiatives.

Basic steps of community eye screening ⁽⁵⁾

• Preparation: Plan logistics and coordinate with local authorities.
• Outreach: Raise awareness about the screening in the community.
• Registration: Collect basic information from participants.
• Testing: Conduct visual acuity, refraction and intraocular pressure tests.
• Examinations: Inspect external eye structures and perform fundus examination if needed.
• Education: Provide eye care information to participants.
• Referral: Identify individuals needing further care and facilitate referrals.
• Data: Document screening results for analysis.
• Follow-up: Establish a system for post-screening care and intervention.

Figure 1: This chart describes Basic Eye Screening Test (BEST).⁽⁵⁾

The BEST protocol is done with the subject wearing spectacles under good lighting conditions. Community eye screening involves a systematic approach to identify, address, and educate regarding potential eye health issues within a given population (Figure 1). ⁽⁵⁾

Challenges in community eye screening: It includes limited access, low awareness, financial barriers, inadequate infrastructure, cultural beliefs, and shortages of trained professionals. ⁽⁶⁾

Addressing these challenges requires a holistic approach involving community engagement, education, improved infrastructure, and policies promoting affordable and accessible eye care services.

Economic impact of visual impairment in India

Visual impairment in communities often results in reduced work productivity, limited job opportunities, increased healthcare costs, dependence on social support, and educational challenges, contributing to significant economic impacts. ⁽⁷⁾

Strategies to address eye conditions to avoid vision impairment

Promote regular eye check-up, raise public awareness, ensure affordable eye care, combat malnutrition, emphasise hygiene, integrate eye health into schools, leverage technology for telemedicine, and enact supportive government policies. ^(6,8)

Community eye care in India is influenced by government policies aimed at improving accessibility and affordability. Initiatives like the National Programme for Control of Blindness focus on preventive measures, cataract surgeries, and strengthening infrastructure. The emphasis is on partnerships with Non-governmental Organization (NGO) and community participation to enhance eye health services across the country. ⁽⁹⁾

In conclusion, community optometry plays a crucial role in promoting accessible eye care. Despite its significance, challenges like limited access, awareness issues, financial barriers, and resource shortages persist. Overcoming these challenges requires concerted efforts in community engagement, education, and policy initiatives to ensure comprehensive and equitable eye care for all.

India can reduce blindness by implementing widespread eye health awareness, ensuring affordable and accessible eye care services, incorporating preventive measures into public health programs, promoting early detection and treatment, and fostering collaborations between government, healthcare providers, and NGOs.

 

References:

1. Samanta S. K. (2020). Community based eye care in India – Reconciling quality and quantity – The ACOIN prescription. Indian journal of ophthalmology, 68(2), 307–308.
2. Blindness and vision impairment. Available at: https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment (Last accessed on: 5^th February 2024)
3. Neena, J., Rachel, J., Praveen, V., Murthy, G. V., & Rapid Assessment of Avoidable Blindness India Study Group (2008). Rapid Assessment of Avoidable Blindness in India. PloS one, 3(8), e2867.
4. De Souza, N., Cui, Y., Looi, S., Paudel, P., Shinde, L., Kumar, K., Berwal, R., Wadhwa, R., Daniel, V., Flanagan, J., & Holden, B. (2012). The role of optometrists in India: an integral part of an eye health team. Indian journal of ophthalmology, 60(5), 401–405.
5. Marmamula S. (2020). The Basic Eye Screening Test (BEST) for primary level eye screening by grassroot level workers in India. Indian journal of ophthalmology, 68(2), 408–409.
6. Sathyan, Sanitha. Vision screening at schools: Strategies and challenges. Kerala Journal of Ophthalmology 29(2):p 121-130, May–Aug 2017. | DOI: 10.4103/kjo.kjo_86_17
7. Mannava, S., Borah, R. R., & Shamanna, B. R. (2022). Current estimates of the economic burden of blindness and visual impairment in India: A cost of illness study. Indian journal of ophthalmology, 70(6), 2141–2145.
8. Jose, R., Rathore, A. S., & Sachdeva, S. (2010). Community ophthalmology: revisited. Indian journal of community medicine: official publication of Indian Association of Preventive & Social Medicine, 35(2), 356–358.
9. Mannava, S., Borah, R. R., & Shamanna, B. R. (2022). Current estimates of the economic burden of blindness and visual impairment in India: A cost of illness study. Indian journal of ophthalmology, 70(6), 2141–2145.