The unread crisis of Eye-care industry in India

Dr Rajeev Prasad completed his bachelors in optometry with his BHMS in Homeopathy medicine. In 2014 he became the board member of the Indian Optometry Association and in 2018 he got an opportunity to serve as an organizing chairperson to 37th All India Optometry Conference.

Further he was unopposed elected as Secretary General of Indian Optometric Association and within the lockdown period SAARC nations Optometry Forum was formed and got elected founder secretary of SAARC Optometry Forum as well.

Our Editor-in-chief, Siddharth Salecha spoke with Dr Rajeev Prasad, Secretary General, Indian Optometric Association and Founder secretary, SAARC nations optometry forum to understand the crisis and norms of the eye care environment, what experience it offers and how a well-designed system setup can give the much needed energy and culture boost to the Optometrists in India.

INTERVIEW:

What are your career experiences and the journey of being the Secretary of Indian Optometric Association today?

Originally, I am born and brought up in Patna. In 1996 I got into optometry and post optometry I thought of joining the family business but somehow after a couple of years, I realized that probably the retail business is not for me. Finally, I decided to get in different areas in search of trying to do something new, which is more exciting to me. And then in 2002, I got the opportunity to pursue a fellowship in low vision from LV Prasad Eye Institute – Hyderabad, a very famous Eye Care Institute. They had started a new course in low vision and in each batch; they wanted only two people every year which was supported by TATA’s, So, you have to give a lot of interviews to get into the batch but I was quite fortunate to get into that. I was in the second batch and was a part of the top four initial groups. After I got this opportunity, I left Patna and moved to LV Prasad to complete my fellowship and that is where I realized that there is a lot beyond just checking up eyeglasses. There’s a lot that can be done in Eye Care even if you aren’t an eye surgeon with an MBBS. Low vision actually opened my eyes and gave me the idea that there are a huge number of people struggling with many of the other vision-related problems. And most of the time they are denied a treatment saying that ‘nothing can be done’. For a clinician it is very easy to say that, but for the patient it’s the end of a beautiful life. We do tell patients that they have a retinal problem or some major issues, but what is the solution? So, unless and until as a doctor if you don’t give the patients a solution, the problem still lies ahead. In search of the answers, I got into low vision. After completing my fellowship, I did my first webinar in prestigious Patna Medical College Hospital, Department of Ophthalmology in Patna. I also wrote a book on low vision which was called ‘The Basics of Low Vision’ and later got an opportunity to be a part as a clinician for an event by Special Olympics International happening in India. For the first time, I realized that there is a special population that needs our assistance and the event gave me exposure to connect with them because of which I had made up my mind to help and give smiles to them which pulled me to Special Olympics. I continued to volunteer for such events and attended couple of events on my own expenses. Somehow in one of the events in Patna, there were a few International officials present as guests who noticed me and asked me to join the for a training taking place in Japan, without thinking for a moment I agreed and visited them for almost 15 days. After the training, I came back and I did two more events in Hyderabad and Afghanistan. Year 2005, in Afghanistan, the Taliban war was on and so the organization weren’t keen enough to send me there and risk my life, but back then I said if I have to die, I might as well go and do something good and constructive for the society before dying. And that’s how I went to Afghanistan and conducted a Medical training of the doctors there, about 16 of them I recall which also got covered on BBC. The organization was happy with my work and offered me a position to join them as an employee. I served them for almost four and a half years and during that period I was promoted as the Asia Pacific Health Head for one of their initiatives taking care of almost 21 countries.

I was travelling all over the world. Since I was trained in low vision So it was more of vision rehabilitation. But in general understanding about a disability, I got a real idea about the special population being a different segment. Although we call them mentally challenged, later I realized that it is our disability to see the ability in them. Unfortunately, I was going through a health issue at that time I had a brain haemorrhage in 2009 because of excessive travel. And I came out of the Special Olympics considering my health. Then I decided to go back to my hometown Patna and do something there. But even after having so much exposure it was difficult. I never lost hope as I wanted to continue helping the society so I finally decided to expand my knowledge gained during travels across the globe for low vision as there were hardly any practices on low vision in India. At this point, I have my visiting practice in Mumbai, New Delhi, Bhubaneshwar, Patna and Jamshedpur.
I completed my bachelors in optometry. I also completed my BHMS in Homeopathy medicine. In 2014 I got an opportunity from the Indian Optometry Association as a board member and in 2018 I got an opportunity to serve as an organizing chairperson to 37th All India Optometry Conference. Further I got unopposed elected as Secretary General of Indian Optometric Association and within the lockdown period SAARC nations Optometry Forum was formed and got elected founder secretary of SAARC Optometry Forum as well.

What is Eye Gurukul? What are your plans with it?

Eye Gurukul was started on 8th April 2020, yes during the lockdown. Here my aim was to connect with my colleagues and get their knowledge shared to optometry students and other viewers through webinars. Till date we have completed more than 158 sessions and more to go. From that 20 – 25 sessions are by International speakers from Africa, US, UK, Singapore, and even World Health Organization. Eye Gurukul is now being followed by people from Africa, Philippines, Singapore, Malaysia, besides SAARC nations. Looking at the increasing demand we have also started an online course as this is the new normal which gives people the liberty to attend lectures at their ease.
We have two courses currently, one course we did in neuro optometry which was an eight-lecture series by Dr Cathy Stern -USA and another course we launched was on contact lenses i.e. EGCLS – Eye Gurukul Contact Lens Series which is a 40-hour lecture.

Also, last week we collaborated with an organization in the USA which runs webinars related to vision problems there and we managed to sign a MOU to bring those International lectures to India. The Mission and Vision of Eye-GURUKUL are to provide a low-cost virtual education platform (in Current scenario) that connects with colleagues across India and around the world offering equal learning opportunities for everyone. Eye-Gurukul does not intend to compete with existing education providers or institutions/Universities rather envisage Eye-GURUKUL as one part in the optometric education landscape that serves to drive participants to other formal education opportunities. On the occasion on 73rd Independence Day on 1st August Eye GURUKUL announced “Paathshala” an Eye Gurukul Initiative. The idea and concept behind Eye GURUKUL in Hindi in “Paathshala” is that in the recent past we came across that the Optometric educational system in India is not uniform and few colleges’ lacks training of theories and practical’s, due to non-availability of good facilities or infrastructure besides other administrative challenges, thus this gap forced us to start something which bridges the gap especially in northern and central India, wherein Hindi is most preferred language and easy to understand by all.

What according to you are the simplest methods to prevent vision related problems looking at digitalization and increase in screen time?

Firstly, The 20-20-20 rule:
The major precaution is the 20-20-20 rule. For example, if you are sitting on a chair for a long time, you feel like standing and stretching your body, Similarly, if you are continuously over the gadget, your eyes need a stretch too. This 20-20-20 rule states: every 20 minutes for 20 seconds you should move away from the screen, blink 20 times and see at a distance of 20 feet
which will not only give your eyes a sense of relief, but with every blink new tear would develop and help the eyes from dryness. At a minute we blink for almost 30 to 40 times, but when you stare at a screen your blinking rate goes down to 7- 8 blink per minute. It is more of theory evaporation than formation of tears which leads to burning sensation, heaviness, headaches and all that.
Secondly, The viewing screen:
The viewing screen should be 15 to 20 degrees below eye level and about 20 to 30 inches away from the eyes with good light and anti-glare screen protector.
The blue coating is additional but make sure you have one which protects your eyes from the reflection. Even a normal green coating is fair enough.
Thirdly, The coating:
Recently, there has been hype on the blue light and screen rays. The solution to that is the blue or green coating on your glasses to prevent those emissions enter your eyes. There are many companies online selling these glasses but I would suggest to buy from a really trusted source as bad glasses could damage your eyes further.

What does the three O’s stand for, in eye care industry? What are the statistics?

Eyecare stands with three O’s. i.e. 1. Opticians, 2. Optometrist (eye physicians) and 3. Ophthalmologist (eye surgeons).

OPTICIANS: The job of an optician is to dispense good quality eyeglasses but there’s a special training for that, unfortunately India doesn’t have any training for it so anybody who has money can start their own optical store, and that is the biggest flaw in the industry. As making and selling good glasses requires a lot of skill because if they are not made with fine measures or not sold of best quality customer/patient may face problems like headaches, eye strains, etc.
The government is in talks about coming up with a bill which will help situations be more streamlined.

OPTOMETRISTS: Optometrists or eye physicians, usually deal with basic eye problems such as burning, itching, etc. People with any primary eye problems visit optometrists to get their eyes checked.
Around 4000 to 5000 optometrists pass out every year in India, which clearly states that we have a good number of optometrists. But the problem is registering the optometrists, that’s because we don’t have a regulatory body ensuring their capability as we lack in having an equal education system. There are a lot of excellent colleges where the students are very thorough with the subjects with many private colleges having high fee structure, facilities etc. but lack in giving good training. These corporate optometrists do present themselves really well but the practical work is difficult to say. In brief, the government-allied health bill has already proposed and is expected to pass within few months. I hope the bill is implicated and all deserving qualified optometrists who can practice in this field start their own optical store.

OPHTHALMOLOGISTS: Ophthalmologists or eye surgeons usually deal with the major eye disorders like glaucoma, iritis, chemical burns etc. They conduct surgeries like cataract extraction, lens replacement, cornea reshaping, transplants, retinal detachment repair, and glaucoma treatment.

In terms of statistics, All India Ophthalmological Society (AIOS) has registered close to 20000 to 22000 ophthalmologists in India. So, if you see the population of this country i.e. 132 billion people cannot be served with a team of just 20000 to 22000 ophthalmologists. Additionally, India bags around 65 million people who have diabetes as per article published in Indian Journal of Ophthalmology in January 2016. This increase in global prevalence of diabetes would have its impact on the number of people with diabetes-related complications, such as Diabetes Retinopathy; nearly one-third of them are likely to develop this complication.

Does India have a regulatory body for the 3 O’s?

At this moment, no. Any profession has two kinds of bodies one is the statutory body and one is the regulatory body, in medical if you see we have Indian Medical Association (IMA) which is a statutory body. They look after the wellbeing of the doctors and anything that is needed for the benefit of the doctors they will propose to the Council and the government will look into the matter to ensure that their interests are safeguarded. Similarly, IOA, the Indian Optometric Association is also a statutory body but we are waiting for the government to come up with the regulatory body to it. I represent Indian Optometric Association as a secretary at this moment and we have already tabled the request. We hope that by this year things will change though it has been a very tough year for everybody but I see eye care has a lot of positive change coming ahead. This year will mark history because India will definitely have a regulatory body for eye care.

What do you mean by Astigmatism?

Vision is defined depending on where the light hits.In layman terms when from a distance, the ray of light enters your eye to form a vision on the retina is called normal vision. In technical terms, we call it an Emmetropia.
When parallel rays fall before the retina or in front or before the retina it is called myopia.
In myopia we give minus lenses to divert the rays directly to the retina and give a clear and sharper vision. When the parallel rays go behind the retina that is called hypermetropia for which the plus power is given.
On the other hand, when these parallel rays go towards the retina, where the rays focus at one point of the retina, but all rays are forming on different points that is called Astigmatism. To fix that, these rays are merged at one access for a clearer vision.

What do you mean by amblyopia?

In simple terms, Amblyopia is known as lazy eyes. It is actually a disorder in vision development or in other words is a disorder of the brain’s ability to use both eyes together as a team.
If I go by its definition, Amblyopia is an active process due to suppression, or the brain actively ignoring the information coming from one eye due to which people with amblyopia are more prone to have difficulties with depth perception, eye movements related to reading, and visual decision making while driving as an eye fails to achieve normal vision activity even with the prescription glasses. It can be one or both eyes, unilateral or bilateral amblyopia and even infancy or early childhood. There is anisometropic amblyopia too, where one eye’s vision is absolutely okay and the other eye has a very high power, like – 6 or + 6. Yet another type is called deprivation amblyopia that happens because of surgery or maybe the patient had a cataract because of which one eye is not working. One is refractive and reverse amblyopia.

The causes are all different, but in most cases, amblyopic patients will have some kind of refractive error. And, it is all about the brain and the eye not being in sync together.
It is important to note that a child with amblyopia rarely has any symptoms.
There was a big Myth that amblyopia cannot be treatable after 10-12 years of age but now with latest techniques in place it is treatable at any age. Earlier the diagnosis, the more successful is the outcome. Until recently, Patching of better Seeing Eye was the only option considered and only proven method of treating amblyopia. Recent research has shown that a binocular approach to treating amblyopia may be an effective alternative to patch and Vision Therapy has proved it.