By Dr. Sribhargava Natesh
The World Health Organization (WHO) estimates that 1.3 billion people worldwide suffer from some form of visual ailment. What's more alarming is that around 80% of these cases are considered avoidable or preventable. Globally, common causes of visual impairment are uncorrected refractive errors, cataract, age-related macular degeneration, glaucoma and diabetic retinopathy, among others. But, the causes usually vary across geographies. For example, the proportion of vision impairment attributable to cataract is significantly higher in India and other low middle-income countries, when compared to higher-income countries.
Diabetic retinopathy, another threat to eyesight, has emerged as one of the leading causes of blindness among people of all ages in India. This is because every person out of 70 million diabetic patients in the country is at the risk of developing diabetic retinopathy. In some cases, diabetic retinopathy can start as early as 3 to 5 years from the onset of diabetes. The increasing threat of diabetes-related eye diseases is further exacerbated by the shortage of ophthalmologists and inadequate awareness among the affected people. Given the fact that diabetic retinopathy shows no symptoms in the early stages, most people with diabetes go undiagnosed for years. And, when they finally find out, it's too late to restore the lost vision.
Access to eyecare remains a key challenge in India
According to the latest data released by WHO, India is home to 40 million blind or visually impaired people, accounting for 20% of the world's visually impaired. According to industry reports, the prevalence of blindness is higher outside urban settings. Improper facilities and lack of access are the main reasons for this, among others. A staggering 70% (Census report 2011) of India's population resides in rural areas, with little to no accessibility to eye care facilities. In fact, the majority of eye specialists happen to be concentrated around tier I and tier II cities, where consumers have greater spending power.
However, cases of cataract, age-related macular degeneration, glaucoma and diabetic retinopathy are on the rise in both rural and urban parts of the country. India, which is home to billion-plus people, reportedly has only around 15,000 ophthalmologists. To put things into perspective, there is one ophthalmologist for every 15,800 people in the US, and this is the accepted ratio globally.
However, the skewed ophthalmologist-to-patient ratio is not the only problem India faces. Ophthalmologists and Optometrists practising in the country are not only overworked, but also face inconveniences like limited resources and staff. Inadequate awareness is another area of concern when it comes to eye care. The fact that Indians hardly go for eye exam indicates the severity of the problem. Especially, among the lower rungs of the economic ladder, regular eye check-up is never a priority. All of this has prevented India from reaching the target set by the WHO-to reduce preventable visual impairment by 25% by this year, from the baseline established by WHO in 2010.
Virtual ophthalmologists: A game-changer in eyecare
What will effectively help plug this access gap is the intervention of technology. Tech-based solutions can play a pivotal role in improving access to eyecare in emerging economies. The viability of tele-ophthalmology has already been explored in the first-world countries, but its impact can be truly far-reaching in India. The concept of teleophthalmology, in which ophthalmologists remotely assess images of the eye and then give their advice, has now started gaining grounds in India. From giants like Google to home-grown startups, a number of companies are combining technology with innovation to address issues of accessibility and availability of quality eyecare.
Alphabet's health subsidiary Verily has utilized AI to introduce (developed by Google) an algorithm that helps in early detection of diabetic retinopathy. Built on thousands of retinal images, compiled over the years, the algorithm has been deployed in Madurai's Aravind Eye Hospital on a pilot project basis. According to a blog post by Verily's Product Manager Sunny Virmani and Google's Program Manager Kasumi Widner, the algorithm has been able to perform on par with both eye doctors and retinal specialists in detecting the disease in medical imaging.
Other companies like Forus and Remedio have also come up with devices that can detect diabetic retinopathy at early stages. Zeiss's Bangalore based Medtech R&D center CARIn is another organization that has made great strides towards providing better access to eyecare in India. Its AI-powered solution uses a machine-learning algorithm to detect diabetic retinopathy. With over 25,000 patients having undergone the virtual screening, the system uses a camera that takes high-quality images of the interior surface of the eyeball (fundus). The AI algorithm then analyses the pictures to detect early signs of diabetic retinopathy such as hemorrhaging.
However, technology alone cannot solve the problem of disease screening and management. There needs to be an ecosystem which includes screening devices, cloud connectivity, remote applications, AI, and skilled manpower so that the entire loop can be closed.
While modern technology is being touted as the key to achieving India's Vision 2020 goals, the government must join hands with private healthcare providers to identify key focus areas and provide funding as well as operational support. Favourable policies, the launch of outcome-based pilot programs and more investments towards the improvement of state-run eye care hospitals are the few things that should be taken care of on a priority. Weighing in the socio-economic consequences of visual impairment and blindness, increased access to better eye care facilities will also help India to improve its productivity and accelerate its journey towards becoming a trillion-dollar economy.
(The columnist is a Vitreoretinal Surgeon. Views expressed are the author's own.)