At 8 Million, India houses the 2nd highest number of blind people in the world. India was the first country to launch a publicly funded program solely dedicated to controlling blindness and visual impairment, with the National Programme for Control of Blindness and Visual Impairment in 1976. Since then, conscious steps have been taken to achieve the objectives of the Program and periodic population-wide surveys have been conducted to ensure that the country is moving in the right direction.
Most of the current eye care models in India are focused on screenings and surgeries. They include school screening, consequent referral, and community-based eye health programs. The target set for eye screening camps for school children was at 9,00,000.
At the school level, the focus is to train teachers, which is followed by organizations like Operation Eyesight, Orbis India where the teachers take responsibility for screening and referral of the students of their respective classes. The community-based eye health program is time-consuming as it requires connecting with training and sensitizing Anganwadi (a type of rural childcare center) and Integrated Child Development Services (ICDS) workers for screening and referral of children with eye problems.
Programs and Policies
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.
The National Programme for Control of Blindness and Visual sets annual targets for each state and union territory in terms of cataract operations, distribution of free spectacles to school children, collection of donated eyes, and treatment of Other Eye Diseases, such as diabetic retinopathy, glaucoma, squint, among others.
In the year 2018-19, the performance of northeastern states is underwhelming across all the four parameters mentioned above. Roughly half the states and union territories underperform in terms of distribution of spectacles and collection of donated eyes.
The Rashtriya Bal Swasthya Karyakram (RBSK) program of the National Health Mission, which evaluates a child’s health, includes screening for visual disorders. However, limitations of equipment and ophthalmologists allow only for a test for refractive error. The program has been designed primarily to identify developmental delays (usually associated with a neurological deficit) in early childhood. It does not specifically identify visual impairment in children under 4-5 years of age.
In 2018, the state government of Telangana launched the biggest ever vision screening program anywhere, with an ambitious target of covering the entire population of 35 million in a period of 6 months. The goal was to screen for impairments and create awareness among all citizens of the state and provide necessary services. The funding provided was the highest ever one-time support to eye care in India and the developing world as a whole. Over 15 million people were screened. About 4 million people were provided spectacles, and almost a million were referred to higher healthcare centers for the treatment of various conditions including cataract surgery.
In the same year, the state government of Odisha inaugurated the “Universal Eye Health Programme” and allocated a budget of over INR 600 crores (US$ 100 million) over 5 years. Following this, the government of Andhra Pradesh also decided to replicate the successful Telangana program. The aspiration was a comprehensive coverage for the entire population in about 5 years.
Partnerships for Grassroot Impact
For example, CooperVision, a UK-based manufacturer of contact lenses as part of its One Bright Vision Program of 2016 partnered with the Indian Vision Institute and Optometry Giving Sight to screen children in Southern India. The program, especially, focuses on screening school children belonging to socially and economically disadvantaged sections of society.
Vision Spring is a charitable organization that distributes spectacles at a very low cost (approx. $3-4 per pair). They provide glasses in a certain geographical area, in accordance with the fund donor’s wishes.
According to a study by Wadhwani et al., on ‘Prevalence and causes of childhood blindness in India: A systematic review’, a major recommendation to combat CHB would be effective referrals to eye surgeons and especially pediatric ophthalmologists. A lot of school screenings are done by state governments but this strategy falls flat as no follow-ups are taken and affected children are not referred further to specialists and therefore no interventions are done.
There is also a need for policy advocacy that RoP screenings must be mandatory for every child who is born preterm and weighs less than 2 kg. The RBSK manual mandates that every neonatologist or pediatrician must refer children at least once to a pediatric ophthalmologist or retina specialist. If RoP screening is made mandatory in every NICU by government centers, it will lead to private centers following the same path.
A major hindrance is the lack of recognition of pediatric eye care as a specialty by state governments or the Government of India. Since the government fails to recognize this, only school screenings are possible and no preschool screens are done or are effectively taken up. Lack of specialized equipment, screening mechanism, and charts for child eye screening are major hindrances.
With the schools shifting to an online mode of education, instances of refractive errors are likely to rise in the country. Further, the closure of schools has hard hit the eye screening programs conducted in schools as part of the country’s national eye program. 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.
Apart from undertaking early interventions by screening children, there is a need to ensure that screening programs are also undertaken throughout the life-cycle of a population. This would require the state to partner with, and nudge multinational corporations to screen their employees as well as those involved in their supply-chain management.
Recognizing interventions like free screening of workers, such as artisans and miners, gives an impetus to achieve multiple sustainable development goals (such as SDG 3 and SDG 8) at once. Moreover, they provide crucial evidence towards informing policies that recognize the nexus between different objectives.
Efforts must be taken to address genetic diseases in children and provide genetic evaluation, counseling, and treatment at lower costs. In their study on tribal areas in Odisha, Reddy, Sandip. et. al (2018), suggest large-scale school-level screenings, investment in skilled human resources, and the use of technology in objective refraction as viable solutions.