This article is more than 5 years old. Information may no longer be current.
Aravind Eye Care System targeting undiagnosed Indian glaucoma cases
As the prevalence of glaucoma in India reaches an estimated 16 million people by 2020, clinicians are increasing efforts to improve screening, diagnosis and follow-up care.
Click Here to Manage Email Alerts
A high rate of undiagnosed glaucoma, poor access to eye care and increasing costs have spurred ophthalmologists in India to expand glaucoma care where it is needed most, a clinician said.
Ramaswami Krishnadas, MD, described novel strategies of rapidly expanding community outreach efforts in India at Glaucoma Subspecialty Day preceding the American Academy of Ophthalmology meeting.
“Despite the efforts of the national program for control of blindness and many non-government and private eye care providers, there is a huge unmet need as far as eye care is concerned in India,” Dr. Krishnadas said in a subsequent email interview. “Moreover, adherence to treatment and follow-up of chronic diseases are inadequate, making monitoring progression of asymptomatic diseases like glaucoma difficult.”
The Aravind Eye Care System aims to eliminate preventable blindness by supporting innovative research, improving diagnostic and screening efforts, and expanding access to care, particularly for patients in underserved rural areas in India, Dr. Krishnadas said.
“The primary mission of the Aravind Eye Care System is the elimination of needless blindness by providing compassionate and high-quality eye care for all,” he said.
The Aravind Eye Care System was founded in 1976. It is the largest eye care provider in the world, with a network comprising five hospitals and 3,400 ophthalmology beds.
Rising prevalence
Currently, India has about 12,000 ophthalmologists, not all of them surgeons, serving a population of 1.2 billion, amounting to one ophthalmologist per 100,000 people. Most eye care providers are in urban areas, out of reach for many rural patients.
In addition, eye care is cost-prohibitive for many patients, despite the inclusion of eye care in India’s public health programs. Younger people may have trouble leaving their jobs to journey by bus for hours to visit a tertiary eye care center. Older and visually disabled people, over 90% of people with glaucoma in India, often must ask a younger, more productive family member to accompany them to the center, losing an important day’s wages, according to Dr. Krishnadas.
“In a developing country like India, the government alone cannot meet the health needs of all owing to a number of challenges like growing population, inadequate infrastructure, low per capita income, aging population, diseases in epidemic proportions and poor literacy,” he said.
The prevalence of primary open-angle glaucoma is about 6.8 million people, and the prevalence of primary angle-closure glaucoma is about 6.62 million people. The age-adjusted prevalence of glaucoma is about 1%. About 27 million patients have potential angle-closure disease, Dr. Krishnadas said.
The prevalence of glaucoma in India is expected to reach 16 million people by 2020, he said.
Screening, education, outreach
A study undertaken by the Aravind Eye Care System showed that 94% of glaucoma cases in India are undetected, despite ongoing screening and community outreach efforts, Dr. Krishnadas said. Also, less than 10% of patients initially diagnosed with glaucoma continue follow-up care for 5 years or longer, he said.
About 700,000 patients underwent glaucoma screening at almost 2,500 eye screening camps in semi-urban and rural areas in 2010, Dr. Krishnadas said. An additional 4.5 million people underwent screening and remote diagnosis across the teleophthalmology-equipped network of Aravind Eye Care System primary eye care centers.
Aravind Eye Care System personnel have also begun to screen family members to improve glaucoma diagnosis.
“[Because] most primary glaucomas are inherited and the risk of glaucoma is fivefold higher in persons related to those with glaucoma, significant efforts go into educating and counseling patients identified with primary glaucomas to bring in their siblings, children and parents for an annual screening to detect glaucoma early,” Dr. Krishnadas said. “It is believed that such targeted screening aids glaucoma detection better than population screening, which is thought to be impractical in most developing countries.”
Initial screening is often provided free of charge. Patients diagnosed with glaucoma undergo counseling and education. The Aravind Eye Care System additionally provides training in diagnostic and therapeutic methods for ophthalmologists, Dr. Krishnadas said. – by Matt Hasson
For more information:
Ramaswami Krishnadas, MD, can be reached at Aravind Eye Hospital, 1 Anna-Nagar, Madurai 625 020, Tamil Nadu, India; +91-452-435-6118; fax: +91-452-253-0984; email: krishnadas@aravind.org.
Disclosure: Dr. Krishnadas has no relevant financial disclosures.