Govt shifts focus from cataract to childhood blindness

Sapna Dogra - New Delhi

After achieving its target of reducing incidence of cataract, the government has recently revised the National Programme for Control of Blindness (NPCB) in the 10th five year plan to shift focus to childhood blindness, glaucoma, diabetic retinopathy and strengthening of eye banks.

According to Dr Rachel Jose, deputy director general (ophthalmology), ministry of health, with the prevalence of cataract plunging from 82 to 62 per cent along with the prevalence rate of blindness declining from 1.49 to 1.1 as of December 2004, the government will now focus on other areas which demand attention. For more than two decades, the government utilised resources to target cataract, the commonest cause of blindness, neglecting childhood blindness, glaucoma and diabetic retinopathy.

According to WHO, of an estimated 450 lakh blind people in the world, 70 lakh are in India alone of which over 2,70,000 being blind children. Unfortunately, no nationwide population-based survey has been undertaken on the prevalence of childhood blindness in the country, making it more serious than it seems on the surface, say experts. Besides announcing advocacy programmes and screening programmes in the far flung areas, the government has zeroed in on 11 regional ophthalmology institutions for setting up specialised paediatric units. The funds earmarked Rs 30 lakh per institution.

The government will arrange for training of ophthalmologists in paediatric ophthalmology. The government is seeking help from NGOs in setting up ophthalmology units and low vision centres for tackling refractive errors and childhood blindness.

Under the scheme, the NGOs are given Rs 25 lakh as non-recurring grant for expansion/upgradation of eye care units for tribal/backward rural population along with a recurring aid of Rs 750 per inter ocular lens (IOL) surgery conducted by the NGO.

According to Dr Jose, NGOs can play an important role in reaching out to the community. The government has already asked NGO ORBIS to conduct training programmes, fellowships and hospital-based programmes. Says Dr G V Rao, country head, ORBIS, “We have selected five government regional institutions of ophthalmology in Calcutta, Patna, Allahabad, Ahmedabad and Bhopal for the training, based on a survey conducted by us.”

By October 2005, ORBIS will start these programmes, including outreach programmes for screening of children in rural and tribal areas. In an endeavour to reach out to children who go to doctors, ORBIS will adopt five to six hospitals from north-eastern, western and northern part of the country. Besides the selected 11 regional centres, the government has plans for providing free training for the doctors in paediatric ophthalmology in centres of excellence like RP Centre, Delhi, LV Prasad Eye Institute Hyderabad, Arvind Eye hospital, Madurai.

“The prerequisite for a trainee is that she should have served minimum for three years in a government hospital. After the training, he/she should serve in a government hospital at least for three years,” informed Dr Jose.

According to Tanuja Joshi, director, Venu Eye Institute and Research Centre (VEIRC), it is a positive step that government has taken to shift focus from cataract to other eye-related problems in the country. “What we require is trained paediatric ophthalmologists working in well-equipped tertiary centres as part of a comprehensive child eye care programme,” she says.

To tackle the menace of blindness caused due to vitamin A deficiency, the government is running a programme in providing Vitamin A supplement in pockets having an acute deficiency of Vitamin A. Comments Dr Ritu Arora, professor, ophthalmology, Guru Nanak Eye Centre, “Every week a child becomes blind due to vitamin A. Babies born with vitamin A deficiency are susceptible to various disease, making them vulnerable to blindness,” she explains. Guru Nanak Centre gets about about 70-75 cases per month of childhood blindness.

However, as pointed out by Dr GN Rao, chairperson, L V Prasad Eye Institute (LVPEI), Hyderabad, the government needs to improve the distribution facilities of this programme.

He adds that vaccination against measles and rubella, which are the main reasons behind corneal infection and childhood blindness, needs to be addressed. “Also, refractive errors should be managed not in piecemeal methods. When it comes to treatment part, the situation is grim in the country with just less than a dozen good centres for paediatric ophthalmology and about 25 paeditric ophthalmologists in the country,” laments Dr Rao.

As per WHO guidelines, there should be one paeditric eye centre for a population of about 20 million people, which means that India needs about 50 such centres. As per the government strategy there will be about 25 by the end of 10th plan.

Government may rope in NGOs to set up the rest 25, says Dr Rao. “There is a need to take inputs from everybody and forge an ideal public private partnership in true sense. The government shouldn’t act like a typical boss”.

VEIRC has a dedicated paediatric clinic which has trained paediatric ophthalmogists, optometrists and full-time aneasthetists. “Paediatric surgery is technically more difficult and requires frequent follow up”, says Dr Anil Tara, CEO, VEIRC.