Address at the 65th Annual Meeting of the All India Ophthalmological Society, Hyderabad

Removal of avoidable blindness our Mission Knowledge makes you great

I am delighted to participate in the inauguration of 65th Annual Meeting of the All India Ophthalmological Society and interact with Indian Ophthalmologic Trade Leadership and National and International NGOs. I extend my greetings to the organizers, ophthalmologists, optometrists, medical social workers, medical technologists and distinguished guests. Through the participants of this Conference, let me greet all the 12,000 members of All India Ophthalmological Society.

I know that apart from annual meetings, the society publishes peer reviewed and indexed journal, and encourages young ophthalmologist by various travel fellowships and awards through its Academic and Research wing. I have read the Indian Journal of Ophthalmology published by All India Ophthalmological Society which has done an excellent job and has become an important component of all the ophthalmologists. During the last seventy seven years, the society has made significant contribution to eye care missions of the nation. I congratulate all of you for this important societal mission. I would like to discuss on the topic ?Removal of avoidable blindness our Mission?.

My experience with Ophthalmologic community

During the last four years, I had an important experience in the Indian Ophthalmologic area. I inaugurated the Aravind Eye Hospitals in Pondicherry in the year 2003 in the presence of Dr. G. Venkataswamy. This hospital caters to the needs of about 1,500 patients per day with 600 beds for free patients and 150 beds for paid patients. This gave me a message how Arvind Eye Hospital culture of treatment and management of eye care is spreading.

On 14th August 2004, I participated in the 52nd Tamil Nadu State Ophthalmic Conference through multimedia teleconferencing from Rashtrapati Bhavan studio which focused on prevention of blindness and eye-care. Later, I visited Sri Sadguru Seva Sangh Trust, Chitrakoot on 6th October 2005 who had conducted over 50,000 cataract operations in rural areas of Chitrakoot. Again in October 2005, I participated in the World Sight Day organized by the "Vision 2020: The Right to Sight" programme at Hyderabad. This conference focused on "sight for kids" and ?Diabetic Retinopathy".

In July 2006, I participated in the inauguration of Bhubaneswar Eye Institute (BEI) which is providing specialized eye care to the needy in the Orissa region. BEI has brought out an important culture of establishing a high tech institute within a year and making it self-sustaining including provision of certain percentage of free treatment to the needy within the next six months. Recently in December 2006, I participated in the South-East Asia Glaucoma Interest Group Conference which is carrying out focused research on Glaucoma. Also, in December 2006 I participated in the laying of the foundation stone for Dr. G. Venkataswamy Eye Research Institute in Madurai which has the focus of research on retinopathy. Also I participated in the launching of Antonio Champalimaud Science Award for supporting translational research that directly impacts the vision and alleviation of blindness. In addition I have been meeting a number of ophthalmologists from India and abroad who have apprised me of various actions taken by different specialists in various parts of the country to provide quality eye care to the needy particularly in the rural areas.

Capacity building in eyecare

India has great strengths in eye care area. We have nearly 15,000 ophthalmologists spread in different parts of the country. Our eye care community has successfully reduced some of the common blindness problems during the last two decades. The cataract blindness has reduced from 80% to 47% and the refractive error related blindness has reduced from 20% to 7%.

With the effort of Indian Ophthalmologists, the cataract surgical rate has more than quadrupled from 1.19 to 4.8 million cataract surgery annually in last two decades. The Indian ophthalmologists must be congratulated for all these great achievements. Let us look more closely at these statistics and analyze the facts vis -a- vis our 2020 vision statement. We want a nation without avoidable blindness before the year 2020. We want a nation of empowered ophthalmologists before the year 2020. We want a knowledge nation before the year 2020. How do we do so?

Eye Care Human Resource

Though we have 15,000 ophthalmologists in the country in terms of per capital availability we have only one ophthalmologist for 75,000 individuals against the world standard of one per every 50,000 population. So we need to increase the number of trained eye doctors. Meanwhile, we have to aggressively use the technology and introduce large number of tele-ophthalmology centres in different States to cover the eye care of rural areas. Also, we may consider training of medical graduates in detection and treatment of some of the common eye disorders. One example could be detection of diabetic retinopathy. This is an emerging blinding problem in the country. A three pronged approach of using the available eye doctors, diabetologists and use of newer technology is required for tackling the rising problem. In addition, I would suggest that medical graduates can be taught direct ophthalmoscopy to detect a clinically evident retinopathy. This should be cost effective. I am sure this medical graduate will be able to treat the diabetes also because he has already got the basic skills.

The situation of the support staff also needs immediate attention. The current situation of 1:1 of ophthalmologist to support staff has to ideally increase to 1: 5. So we need to increase the support staff. A mission mode programme is needed to address the problem of the paucity of para-medical professional including ophthalmology personnel. There are programmes but there is a need for increasing the number and quality of training. In my opinion the programs should contain both class room and clinic based teaching. I want to see a program that combines both earning and learning simultaneously. Such programs are likely to attract large number of students from economically underprivileged section of the society particularly in the rural areas. These staff trained in the rural setting will find it attractive to work in the rural areas. These are the professionals who could take care of the Vision Centers designed at the bottom of the Vision pyramid. I am aware of such program working well in rural Phillipines.

Treatment at the door step of the patient

Due to the overall shortage of ophthalmologic personnel many of them are concentrated in the cities and the people in the rural areas have to go to the cities for receiving eye care. If the patients with common eye problems such as cataract and refractive error have to travel longer distances, and obviously accompanied by one or two relatives the cost of blindness eradication goes higher. Think about the travel costs of all of them, wage loss to the accompanying relatives, and the man-hour loss to the nation. Can we afford this? Hence, bringing eye care delivery to the door step in the rural setting is an important ophthalmologic mission for the ophthalmologic community assembled here. The mass eye camps that this country has mastered were good in the past, we should review this now in the light of certain surgical complications reported about the eye camps in Andhra Pradesh, Punjab and Karnataka. Today we should have fixed surgical facilities at least at the district hospitals. Mobile once could be used for teaching rather than treating. A good mobile teaching eye hospital is the flying Orbis that I have visited once. A similar initiative can be taken by the All India Ophthalmological Society of India by creating ten mobile ophthalmologic training hospitals which can go to rural areas and train ophthalmologic nurses and paramedics.

Health Care of Children

In my opinion the best time to begin detection of eye problems must begin early in life. The school is the ideal place. The teachers must be trained to measure the eye sight so that they could seek help of ophthalmologists immediately. The members of the All India Ophthalmological Society can institute a training programme in their districts to train the teachers in their districts who can periodically test the children every year and seek professional advice if they find any child with vision difficulty. They can also train NSS volunteers, NCC cadets and scouts and guides in their region, who can become ambassadors of ophthalmologists in their districts.

Networking of Ophthalmologists

I am here with the 65th annual meeting of the society. I have spoken on a number of occasions to the ophthalmologic community. I would request the societies to extend their activities beyond the annual meetings. There is a need to network all the 15,000 ophthalmologists in the country through a special website. The website may have provision for any individual having an eye-care problem to post his problem on the website. The problem so posed should be examined by a team of ophthalmologists nominated for this purpose by the All India Ophthalmological Society and the patient must be advised suitable corrective action. Also, the ophthalmologic centres in different parts of the country have special social welfare programmes to treat the economically weaker sections of the society free of cost. This culture must be spread amongst all the ophthalmologists participating in this Conference. All India Ophthalmological Society may consider having a permanent headquarter facility which can carry out tele-education and also tele-consultancy to the needy as a part of their mission.

Promoting Global Competitiveness

I feel that some of the important research areas for Indian Ophthalmic Community may include the following.

1. Genetic Research - Genetic Phenotic correlation of eye diseases like Glaucoma

2. Application of stem - cell research

3. Infection Research - Design anti bacterial Intra Ocular Lens and new anti fungal antibiotics

4. Device Research - Develop low cost high quality eye care instruments for national and international market

5. Develop country specific Electronic Medical Record for application in all eye care centers

The ophthalmologic community assembled here have to create new research institutions adjoining the eye care centres so that the research is integrated with clinical science. Also, there is a need for reviewing the curriculum of medical education keeping the present needs of healthcare particularly eye care in mind. During my visits in Singapore and South Korea, I found that these countries are able to catch the potential researchers very young. They have also created all the facilities for these young people to carry out research in the chosen topic. The members of All India Ophthalmologic Society should also consider working towards these objectives for making our eye-care institutions to provide world-class eye care to the needy. In this way the 15,000 members of All India Ophthalmological Society will become partners in developed India vision 2020.

Conclusion

?Complete Vision is the Mission? should be the mission of all the members of All India Ophthalmological Society. Eye problems of patients can be corrected, if diagnosed early. This must be the focus of the members. A closed cycle among researchers, pharmaco-technologists, doctors, nurses, paramedics, teachers and NGOs should be created by the members of All India Ophthalmological Society which will enable availability of quality eye care at an affordable cost to every citizen of the country. I suggest that all of you join together and say, ?let us remove all causes of avoidable blindness? and I am sure India will become a much more lighted and brighter place to live.

With these words, I inaugurate the 65th Annual Meeting of the All India Ophthalmological Society. My best wishes to all the members of All India Ophthalmological Society success in their mission of making India free from eye diseases.

May God bless you.