Empowering Lives by Enabling Quality Child Eye Health Services in Communities

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Rishi Raj Borah

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Dr Rishi has been an integral part of the Orbis journey for the last 16 years. He has developed innovative, impactful and sustainable homegrown eye care initiatives for communities across India, Nepal and Indonesia, impacting the lives of millions of children. He received Eye Health Hero Award 2017 by IAPB and also a recipient of Vision Excellence Award 2020. He has also contributed to programs supported by UNICEF, CORDAID, World Bank supported education programs, CEE supported Environmental Education programs and Various Developmental Don Bosco Institute, and is Board Member of VISION 2020: The Right to Sight India. He is a graduate from Assam Agricultural University.

India has more than 20 per cent of the world's blind people, including the largest number of blind children in any one country. As the gap between the rich and the poor widens, a substantial section of the population - the majority of whom live in rural India or urban slums -  is left without access to essential healthcare services.

School eye screening is not a new concept in India; it has been practiced for decades by various groups around the country. However, Uncorrected Refractive Error (URE) remains a substantial issue in the school-age population. Some of the difficulties as faced in existing school eye health programmes are as follows:

  • There is no provision for annual vision screening and follow-ups to detect new instances
  • There is no system in place to monitor children who have already been diagnosed with URE
  • The absence of a method for measuring and promoting compliance with spectacle wear
  • The absence of integration with other school health programs or activities
  • As with any public health issue, lack of trustworthy data to support decision making

 

Background
India has more than 20 per cent of the world's blind people, including the largest number of blind children in any one country. As the gap between the rich and the poor widens, a substantial section of the population – the majority of whom live in rural India or urban slums – is left without access to essential healthcare services. 

The need for ophthalmic treatment is at an all-time high, where there are about 15 ophthalmologists per million residents, and less than half of them conduct surgeries. More than 1.61 million children in the paediatric population have uncorrected refractive errors, which not only causes vision loss but also negatively impacts early development. Even though paediatric eye care continues to be one of the top concerns, most cases can be easily tackled with simple solutions like eyeglasses.


Building a Sustainable Model for Screening of School-Aged Children 
The need of the hour is to have a comprehensive, scalable and sustainable model to effectively screen school-aged children. Such an initiative would help address visual impairment in children in their communities.

To ensure that an efficient and scalable strategy can be implemented, special attention must be paid to elements such as capacity building of partner eye hospitals to deliver primary eye care at the community level as well as have access to tertiary level child eye care services through a dedicated Children’s Eye Centre (CEC). Such programmes help strengthen partner eye hospital’s capacity to provide comprehensive, affordable and sustainable eye care services over the long term. The programmes ideally include developing fixed facilities in the community for delivering primary eye care services, strengthening hospital facilities to deliver tertiary level child eye care services, health care worker training, community engagement, prevention and treatment programmes including patient education and counselling.

In addition to the country's tertiary level child eye care facilities, there is also a need for Paediatric Ophthalmology Learning and Training Centres (POLTCs) that have adequate training facilities and provide technical support to the implementing hospitals. This includes standardising training curricula for various cadres of eye health professionals for Children Eye Centres (CECs) and community outreach. These POLTCs should continue to offer fellowships in paediatric ophthalmology, short/long-term training programs, and workshops/refresher training as well as Continuing Medical Education (CME) to help produce more and more capable young child eye care professionals who will ensure that children across India have access to quality paediatric eye care.

In addition to planning outreach activities in schools, a well-equipped Vision Centre (VC) can offer primary eye care services to the community catering to children below 18. These services ideally include thorough eye examinations, the issuance of prescriptions for medications and eyeglasses, as well as referral to the base hospital for surgical treatment. Teams from such community based fixed facilities can also ensure that all school-aged children in their catchment receive an annual eye screening. 

Such VCs are seen to offer an extraordinarily affordable and inclusive approach for maximising access to sight-saving care, with the capacity to serve a significant number of individuals.

Envisioning and Enabling a Greener Tomorrow

Green Vision Centres offer the answer to a better and cleaner tomorrow since they not only enhance the standard of eye health in areas where people have historically had difficulty accessing care, but also operates with sustainability at the forefront. A Green Vision Centre runs on solar energy, a green approach that helps deal with issues brought on by frequent power outages and guarantees that eye care is provided without interruption regardless of availability of electricity. Energy efficient equipment and electrical appliances ensure low power consumption. To make outreach effective, workers at the centres are to use electric scooters to conduct door-to-door and local school screenings and raise awareness in the neighbourhood.

Such Green Vision Centres typically offer eye examinations, eyeglasses, and other eye care services. Children attending schools and day-care facilities in the neighbourhoods near these centres can also be screened and given eyeglasses if required. Additionally, these community-based facilities continuously offer primary eye care services to the local population. It is crucial to get eye examinations done regularly to ensure that abnormalities are identified early, when they are most likely to be effectively treated. Each facility should have a referral relationship with a tertiary care facility for cases requiring more sophisticated care. 

Tele-medicine, Tele-ophthalmology, and Tele-education Platforms
Some of the main causes of blindness and vision loss include eye conditions such as cataract, glaucoma, diabetic retinopathy, age-related macular degeneration, refractive error, etc. To avoid vision loss, prompt medical interventions in the form of screening, diagnosis, and treatment are essential. Rural residents who lack access to care due to a lack of nearby treatment choices are concerned about this.

The distribution of ophthalmologists is primarily in metropolitan regions, while a large portion of the Indian population lives in rural areas, making it difficult to provide effective eye health treatments to disadvantaged communities. Technology and connectivity, however, have revolutionised the way healthcare is provided and are the key to removing access barriers and enabling prompt intervention.

Teleophthalmology
By connecting with an eye doctor who is stationed remotely, teleophthalmology proves to be a time and money-saving method. Optometrists at a given Vision Centre can assess patients based on the need facilitates consultation with the remotely stationed eye doctor for additional testing or treatment. The eye doctor may recommend a prescription or treatment plan based on teleconsultation and virtual diagnosis. Teleophthalmology provides methods for preoperative planning, routine monitoring, and post-operative follow-ups in addition to diagnosis and reducing unnecessary referrals. Teleophthalmology makes it possible for an eye doctor to be virtually present at a remote location, which otherwise does not have access to an eye doctor. This practise also helps boost the confidence within the patient since they have had some means of interaction with the eye doctor. 

Online Training and Tele-education Platforms
Training and Tele-education platforms helps link ophthalmic professionals with specialists from across the world and facilitates learning opportunities through mentorship, case discussions, and webinars. Such platforms also provide opportunities to help undertake self-paced learning on specific topics of interest. This has proved to be crucial in creating a cadre of skilled eye health workers who deliver services in their local areas and continue to upskill, improving access and quality of care. This approach has shown to be effective in enhancing patient care as well as in mentoring the upcoming generations of eye health professionals.

Health care is not an exception to how digitisation has affected other industries. Combating avoidable blindness depends heavily on prompt action. As a result, improving the infrastructure is essential to take ophthalmic care to the next level. Additionally, routine eye examinations can help prevent vision problems.

Conclusion
Access to eye care has expanded greatly in recent years. Blindness has decreased from the expected threefold increase in 2050. Even yet, the World Health Organisation (WHO) estimates that half of the population of the world may be myopic by 2050, and there are already more individuals in need of eye care than there are qualified ophthalmologists. The solution is to make sure that eye care professionals have access to high-quality ophthalmic training so they may develop the abilities required to offer their patients high-quality eye care.

Innovative methods and cutting-edge technologies have long been crucial tools for addressing the rapidly expanding scope of the world's eye care demands; the COVID pandemic has rendered them crucial to avoid falling farther behind. The solutions to eradicate preventable blindness already exist, and it is only a question of scaling them up and equipping eye care teams.


References:
https://www.biospectrumindia.com/views/17/21531/addressing-glaring-gaps-in-ocular-healthcare-.html