Analysing
Cataract Situation in India
(24.09.2013)
When one wants to know, why
is there blindness due to cataract in India, one must dig out the numbers
number of back log cases of cataract, number of cataract surgeries done, number
of additional cataract patients added every year, the cost of cataract surgery,
number of free cataract surgeries, number of ophthalmic surgeons and so on.
Clearly for India to be
entirely cataract free, India must entirely treat the backlog of cataract cases
and then also treat the new load of cataract patients added every year due to
aging. If we have to answer this question if it is possible for India to do
this or better still, how long will it take for India to be cataract free, we
need to answer three questions:
1. Number
of cataract backlog cases
2. Number
of cataract patients added every year
3. Number
of cataract surgeries conducted every year
Here are the figures from Newsletter published by
National Program for control of Blindness.
Source :
National Program for Control of Blindness
Source:National Program for
Control of Blindness
So very clearly from the
above graph the number of backlog cases is reducing. Especially with the jump
in number of surgeries in year 2011-12, numbers of cataract back log cases have
significantly reduced. If the number of surgeries increases to 6.6 million/year
as projected in 12th 5 year plan it should be possible to
substantially reduce the back log within few years.
Bottlenecks
in Cataract treatment
We must seek to understand,
what are the bottlenecks in treating cataracts in India? Is it the number of
opthalmic surgeons in India? Does India have enough ophthalmic surgeons to
treat cataract cases?
Now let us find out how many
cataract surgeries can one surgeon perform. Each Small Incision Cataract
Surgery takes 15 minutes. So in an hour a trained surgeon can perform 4
surgeries, or in a day perform up to 20 surgeries. It would not be a stretch
for single cataract surgeon to perform up to 5000 cataract surgeries in year.
So India requires merely around 1200-1400 cataract surgeons to take care of the
required 6-7 million cataract surgeries a year.
Against this requirement of
1200-1400 cataract surgeons, India actually has 14000 opthamic surgeons. Of
course they have to attend to other causes of blindness apart from cases of visual
impairments. Even accounting for that, it would be still safe to say that India
has adequate number of ophthalmic surgeons.
Now the interesting news is
that almost 50% of ophthalmic surgeons are non operating. So the bottle neck is
not in the number of surgeons, but attendant facilities, such as hospitals,
operating rooms, consumables, medicines and other material means of treatment.
With some training and
adequate facilities, it should be possible to substantially add to the number
of operating ophthalmic surgeons in India.
Who
conducts cataract surgeries?
India conducts around 6.5
million cataract surgeries a year. This load is divided between government, ngos
and private practitioners. So here are the numbers:
While the 12th
Five Year Plan projects that Government would perform 3 million surgeries a
year, presently government performs around 1.8 million surgeries and NGOs
perform 2.4 million surgeries, the rest 2.2 million being performed by private
practitioners
While the cost of Small
Incision Cataract Surgery is around Rs. 1800, National Program for Control of Blindness
(NPCB) subsidizes NGOs with up to Rs. 1000 for each such surgery. NPCB also
reimburses around Rs. 450 to Government hospitals for cost of consumables such
as lenses for each surgery.
Areas
of Improvement
While significant strides
have been made in the area of cataract treatments, there still remain areas for
improvement.
One area that certainly
requires improvement is the area of quality. The proportion of surgeries
meeting acceptable level of quality as required by WHO, needs to increase. This
requires efforts in area of improvement in hygienic conditions as well as education
of patients.
The second area that
requires improvement is in the area of equity. This means gender equity, social
equity and geographic equity. There must be an endevour to ensure that cataract
treatment does not suffer from gender bias. It should also be efforts to ensure
that cataract treatment reaches the more marginal sections of society. Finally
the regional disparity in performance on cataract treatment reach must be
corrected, where areas which substantially fall short of targeted number of
surgeries are encouraged and helped to catch up with targets as required.