IMPRI Team

Our eyes are the points of primary access to the world around us. They allow us to interact with it and facilitate physical, emotional, and mental well-being. There is mounting evidence indicating that vision loss affects more than how people see, and has implications for physical, cognitive, and mental health, and can exacerbate inequities in employment, healthcare access, and income. The COVID-19 pandemic has exacerbated the same.

Background

The government of India launched the National Programme for Control of Blindness and Visual Impairment in 1976 to reduce the prevalence of blindness to 0.3% by 2020. According to the National Survey on  Blindness and Visual Impairment 2015-19, the blindness prevalence was  0.36%, indicating the country’s success in achieving its objective of the NPCB. India in 2017 included visual impairment in its national program on account of rising cases of refractive errors, especially among children. 

Given the likely hesitancy of people to visit hospitals due to the risk of infection, the government will have to create a new screening process to ensure that the blindness prevalence is adequately captured in its national program.

In the context of the current Covid-19 pandemic, the worsening ocular health of many is a concern to look out for as people neglect getting routine check-ups or following up on previous treatments. Studies reveal that there has been a sudden surge of patients arriving to be treated with advanced stages of cataract, loss in vision due to glaucoma, or even with severe bleeds inside the eye. Most of these conditions are irreversible or have increased probabilities of complicated and expensive procedures. While the long and drawn out lockdowns are mostly to blame resulting in financial constraints and covid-included anxieties, increased screen time is another factor in deteriorating ocular health. 

Moreover, disruption to health services caused by the COVID-19 pandemic is threatening the gains made in rehabilitation services for those who are blind and visually impaired. The lockdown measures have the potential to exacerbate poor eye health: sustained near focusing on screens and reduced exposure to natural daylight are known risk factors for progressive myopia, and reduced physical activity could affect the progression of diabetes and the onset of diabetic retinopathy (Aubrey Webson, 2021). 

Implications for Children’s Eye Health

With the COVID-19 pandemic-induced shifts in living standards and mode of education, the burden of children’s eye care will only rise in the future. Compiled with a lack of a database that adequately captures children’s eye issues, the country will face a grave threat in this niche yet important sub-sector of ophthalmology. 

The factors primarily responsible for children’s blindness and visual impairments have strong linkages with their social, environmental, and economic backgrounds. With improvements in nutritional security and the rising usage of digital devices, children’s eye care issues have substantially shifted. These causal changes have also necessitated modifications in national-level programs and their implementation. Further, these changes have revealed the importance of adopting complementary and integrated health care surveillance in the country.

Spending more time indoors and undertaking fewer outdoor activities are known risk factors that cause myopia. Excessive use of digital devices can cause dry eyes. Eyes are accustomed primarily to far-away vision. Hence, repeated usage of near-vision devices can impact children’s eyes and cause irritation and even blurred vision. 

Increased usage of digital devices coupled with lack of sunlight may affect the growth and development of children’s eyes, putting them at risk of developing near-sightedness or myopia. The impact of digital devices goes beyond disrupting eye care. Blue light, emitted from digital devices, is known to disrupt the secretion of melatonin, a hormone that regulates sleep patterns. The shutdown of schools for two consecutive years will adversely impact – preventable and corrective factors- that help reduce the prevalence of childhood blindness across the country.

Programs and Schemes

The mid-day meals scheme, which stipulates the provision of cooked meals for children till primary school, has been adversely impacted due to the shutdown of schools. The program has outlined dietary guidelines relating to the provision of pulses and vegetables in the meals. Apart from missing out on cooked nutritious meals, children belonging to the vulnerable sections are affected by lower family wages. In a way, the pandemic has doubly burdened the children’s access to nutrition. Lower nutrition levels can impact pediatric eye care, leading to a rise in cases attributed to preventable causes such as corneal scarring.

The government of India launched the school eye screening program in 1994 as part of the National Program to Control Blindness and Visual Impairment (Jose, R. & Sachdeva, S., 2009).  Health authorities at the district level are responsible for carrying out the eye screening program. One of the actors who plays a crucial role in the eye-screening program is the teachers, often trained to screen school children for possible eye defects (Jose, R. & Sachdev, S., 2009). With classes taking place in the online mode, the school eye screening program will undertake a hit.

Some initiatives driven by communities and schools such as; shortening the duration of online classes, providing children with hourly breaks, ensuring adequate outdoor activity, and minimizing the use of gadgets, can have a lasting impact on eye health. This needs to be integrated with the public health model which advocates for collaborative networking of healthcare professionals to understand the impact of nutrition, overall lifestyle, and genetics on children’s eye health.

Given the unlikely abatement of the pandemic for months, the Indian government’s policy response to tackle new eye issues will lay the framework for eye care governance in the future.