About 9.1% of the world’s population in 2019, 703 million people, were 65 and over: the result of an acceleration in the ageing of the world populace. By 2050 it is estimated that this will rise to 1.5 billion (15.3%). As populations age, there is an increasing disease burden of vision-related disorders. Several of the most common reasons for blindness or moderate-to-severe visual impairment – cataract, under-corrected refractive error, glaucoma and diabetic retinopathy are avoidable if there are mechanisms available for early detection and intervention. Offering treatment to prevent or restore vision would be a noble deed of great value. Indeed, many nations across the globe are bravely doing their best, offering vision restoration with great commitment. As we can imagine, this is a Gargantuan task.
Data for the last 30 years, from a major study on the global burden of eye disease, published in the Lancet in February 2021, has noted that although much progress has been made in reducing blindness in this period, there is much scope for reducing the impact of blindness and vision impairment in our society. Outreach is far from complete and there is considerable variation between countries. There are over 1.5 crore people over the age of 50 with cataracts in the world today. A further 8.6 crores have severe refractive errors which can be corrected by properly prescribed spectacles. It is vital that more countries should get involved in this effort in their regions so that the number of needlessly blind people reduces in number and as many as possible enjoy 20-20 vision.
Peninsular India, comprising Karnataka, some eastern parts of Maharashtra, Telangana, Tamil Nadu, Puduchery, Andhra Pradesh and Odisha, has a population of about 36 crores. About 13 lakhs of these are blind, with 76 lakhs suffering from easily correctable cataracts and refractive errors. If we can devise viable methods to reduce this needless blindness by offering treatment modes, that would be a major advancement in reducing this burden.
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Indeed, there are three notable centers in the peninsular area, the Aravind Eye Care System at Madurai, Sankara Nethralaya in Chennai (and Bangalore), and the L V Prasad Eye Institute in Hyderabad.The former two cater to the needs of blind people in the City and its Suburbs, and Aravind also caters to people in several districts in Tamil Nadu through mobile facilities, and free treatment for the needy; so does Sankara Nethralaya through similar facilities in Chennai and its suburbia, and at Bengaluru and its suburbia, catering to the needy poor for free). L V Prasad Eye Institute has set up a system that covers the entire states of Telangana, Andhra Pradesh and Odisha, (and Nanded in Maharashtra) by establishing what has become known as the Rural Eye Health Pyramid (shown in the attached Figure). This pyramid comprises over 208 rural “Vision Centers”, situated at the bottom tier of the pyramid, each of which offers eye care services to a local rural population of about 500 people, essentially free of charge, by providing spectacles, and advising the cataract patient to go to the nearest ophthalmologist and so forth. A crucial link to communities is the number of ‘vision guardians’, individuals trained to be involved in their local environment and communicate with people about eye health and care.
In the second tier of the pyramid are 21 Secondary Centers such as rural eye care clinics, catering to people in the districts. Then we have three Tertiary Centers (each with its branches), which also do research work in ophthalmology, besides their regular clinical activities. And the Quaternary Center at the top of the pyramid at LVPEI Hyderabad which oversees and monitors in real- time the work being carried out at the tiers and corrects what, if any, that needs to be done, around the clock or 24/7.
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What is most appreciable is the readiness with which local merchants and other public-spirited individuals from all the tiers of the pyramid have come forward to support the cause of the Rural Eye Health Pyramid- a total of about 1000 at the village level (bottom of the pyramid) and about a dozen at the secondary centers at the district level. These are the local equivalents of the Gates or the Tata Foundations, and we are deeply obliged to their philanthropy.
What about other ophthalmology centers across India? Yes, e.g., Aditya Jyot Centre, which caters to Mumbai, particularly Dharavi, where a million people live in a little over 2 sq. km of space; Project Prakash in Delhi and Western UP, and at Ahmedabad, Haryana, and elsewhere. They are no doubt analyzing the Pyramid Model, improving on it and will come out with their versions, based on the geographic and demographic conditions, and we welcome them and help them, in case they need. Indeed, we need more pyramids across the whole of India so that no one in our nation be needlessly blind al all; let all of India enjoy Vision 20-20!
dbala@lvpei.org