For a large number of people, the difference between day and night is not much. These are people who are suffering from a disease that they were not aware of till suddenly everything grew dim around them.
Most of them are over the age of 40 and a small change in their condition could push them into irretrievable blindness. These patients of glaucoma have either been saved from blindness by laser surgery or are moving towards blindness untreated.
A small group of ophthalmologist in the country, supported by pharmaceutical companies, is busy educating colleagues to screen eyes for glaucoma and to make this a part of routine eye examinations. For, if the condition is detected early, eyedrops can stop the slide to blindness.
The programme to educate doctors to detect glaucoma and providing treatment is being conducted by the Glaucoma Society of India, which has divided the country into four zones, with each zone further divided into local committees. In these zones, faculties run courses for a nominal fee in what is probably the only intervention of its kind in the country to keep the vision alive in millions of eyes.
A study carried out in Chennai by doctors of Shankara Netralaya a year ago found the incidence of glaucoma in 1.6 per cent of the rural population and in 3.5 per cent of the urban population.
Says L Vijaya, director of glaucoma services at Shankara Nethralaya, and former president of the Glaucoma Society of India: “The incidence is higher in urban folks but there is no proof that the condition is linked with lifestyle.”
She says the fact that awareness among people and ophthalmologist is low makes it all the more dangerous. Though glaucoma is taught in medical colleges, screening is not a priority and lack of awareness makes things worse, she says.
The heath ministry has included glaucoma in its Vision 2020 programme for health care, but glaucoma awareness programmes are still low-key and detection tests are not yet part of routine examinations in hospitals. She says there are about 11,000 ophthalmologist in the country and of these, the Glaucoma Society has 460 members, who are trained to proactively detect the condition.
The Chennai Glaucoma Study, conducted by Dr Vijaya and colleagues, found that more than 90 per cent patients were not diagnosed with the disease in time. She said her study found lack of gonioscopy and optic disc evaluation in routine eye examinations. Gonioscopy refers to checking blood pressure in the eyes, mainly in the optic nerve.
According to statistics, 40 per cent glaucoma cases are in Asian countries and according to Dr Vijaya, it is prevalent in 2.5-5 per cent of those are above 40 years of age.
While Aravind Eye Hospital and the Netralaya have dedicated programmes for glaucoma with patients accessing them from all over southern India, there are no comparable interventions in the northern belt. A charitable institution which was a legend till the 50s, the Sitapur Eye Hospital, founded by philanthropists in the 1920s, is in decline, surviving on a handful of interns who are paid as low as Rs 13,000. Dr Vijaya says the RP Eye Hospital in New Delhi and the PGI Chandigarh remain the main names in eye care in the North while in the private sector, no one in the region has achieved the scale of the southern giants, which have been able to mix charity with business.
According to Vijaya, under the government programme to control blindness, it is now mandatory for every taluk hospital to have an ophthalmologist. With just 11,000 of them in the country, that does not seem like a possibility.
