The Indian eye care ecosystem
The uneven distribution of surgeons and underutilisation of their skills has resulted in an unabated increase in blindness, says Sandeep Bothra
Being the world capital for diseases like diabetes and blindness, and with rapidly increasing numbers for lifestyle diseases like cancer and communicable diseases, the country requires an overhaul in the existing healthcare system. Additionally, India’s rural and urban poor have little to no access to quality healthcare, and there is extreme inequality in terms of public and private healthcare frameworks. The other issue affecting the access of communities, especially in rural areas to seek medical services has also been ignorance – in large part due to high poverty and low education levels.
The eye-care segment is perhaps one where this has been particularly pronounced. According to a study published by the Lancet Global Health journal, 8.8 million Indians were found to be blind in 2015 and 47.7 million people had moderate to severe vision impairment. A significant reason for this problem can also be linked to ignorance around what causes cataracts – the main reason for blindness. Conversely however it is interesting to also note that this is one of the areas where an unprecedented collaboration between government agencies; private med-tech companies (including MNCs); volunteer doctors and agencies have come together to enable millions of vision-defective people regain their eyesight.
While there is still room to improve, the country has developed the right business models along with policies and programmes to address blindness and these lessons should be shared. India was the first country to launch the National Programme for Control of Blindness (NPCB) in 1976, as a 100% centrally sponsored Programme. Since then the eye care ecosystem has made tremendous strides in terms of innovation, technology and training programmes.
The good news
Role of non-profits - Non-profit institutions like The Aravind Eye Hospitals, Dr Shroff Charity Eye Hospital, Sadguru Netra Chikitsalaya amongst others have played a huge role in the evolution. The business model at non-profits is simple where care is provided to those who can afford market rates to pay for procedures and the profits from these surgeries is used to provide care to those who cannot afford the rates. Also, these institutions are investing in training programmes in partnership with companies to upskill existing manpower in the ecosystem so that the diagnosis of eye problems are faster, and surgeons have more time in-hand to perform more surgeries.
There are numerous successful examples where institutions have optimised the latest technologies compounded with a tested business solution to provide care to the underserved/rural population of the country. From surgeries in make-shift camps to providing transport for the affected population in rural areas for free surgeries in charitable hospitals, these institutions have supported the cause enormously.
Role of technology - Eye-surgery is an extremely delicate procedure and technological innovations have made it possible to identify diseases in early stages. Technology giant Google has developed an eye-scanning technique that can look at retinal images and detect diabetic retinopathy. The machine-learning algorithm cross references millions of web images with the patient’s retina to spot tiny aneurisms indicating early stages of diabetic retinopathy. The company has already begun integrating the technology into a chain of eye hospitals in India.
Combining sophisticated technology with portability has also given rise to low-cost diagnostic tools for doctors. Smartphone-based vision testing has greatly helped identify refractive eye problems in rural areas. There is also an increasing focus on building the capacities of existing surgeons and ensuring that they are not only best-in-class but also abreast with the latest technological developments in the field.
Affluence – With increasing internet penetration and digitisation number of informed and connected population have increased rapidly which has resulted in increased awareness about the symptoms and available procedures. However, amongst the rural population there is an urgent need to drive awareness campaign to counter the myths and misconceptions around eye problems.
The bad news
The task of increasing quality eye care for underserved patients comes with many challenges as well.
Eye diseases are not glamourous - Public perception is highest for health problems such as cancer and cardiac problems or lifestyle diseases such as diabetes. In cases of cataract, which is the leading cause for blindness in India accounting for close to 63% of vision impairment cases, a report revealed that 59% of senior citizens incorrectly believed that cataracts could be prevented. In many cases, evidence shows that, even when services are readily available, the population in rural areas are far less likely to access them due to such misconceptions.
Lack of ophthalmologists – There are only estimated 15,000 ophthalmologists in India and only 45,000 optometrists against a required 125,000. With a population of more than 1.32 billion people, this means, a serious shortage of medical professionals leading to severe handicap in both screening and treatment of eye ailments in the country. The uneven distribution of surgeons and underutilisation of their skills, because of unavailability of optometrists for basic procedures, has resulted in an unabated increase in blindness despite all the efforts made so far.
Rural v/s urban - India is not only home to the world’s largest number of blind or vision-impaired people, but also as a country where metros and urban centres have hospitals and doctors to rival the best in the world, whereas smaller cities and towns suffer due to the lack of qualified doctors, medical staff and have poorly equipped hospitals and clinics.
Low expenditure on health - India, with a per capita public expenditure on health of just over 1% of GDP, lags behind its South Asian neighbours in the area of healthcare spending. The World Health Organization recommends that countries should spend 4-5% of their GDP on health to achieve universal healthcare.
Focus on eye care needs among all levels of health services. Primary, secondary and tertiary levels need to rise to the challenge if avoidable blindness is to be eliminated. All the data and findings point towards the impending need of bringing focus on increasing access, better training of human resources and driving awareness among the masses to get their eyes checked at regular intervals, the absence of which has immediate and long-term consequences (both personal and economic). As 80% of blindness is preventable, one can imagine the larger impact of timely, better eye care of society and economy.
Sandeep Bothra is country business head- surgical with Alcon India.