Cataract Blindness Control Wardha District

Data from 2006-07 surveys show that ten persons out of every 1,000 in Maharashtra are blind. The Rapid Assessment of Avoidable Blindness in India (RAAB) India study revealed cataract, glaucoma, refractive errors, and corneal opacity as a major cause of blindness and low vision in India. Of the estimated 18 million blind people in India, a little over half of them are blind due to cataract-related causes, which include cataract, complications of cataract surgery and uncorrected aphakia after cataract surgery.

Old people living in villages often cannot access cataract surgery. Cataract surgery in private hospitals costs between Rs. 3000 and Rs. 60,000, depending on locality, quality of intraocular lens (IOL) implanted, and reputation of surgeon. Government and not-for-profit hospitals do the same - free of cost. With the idea that "if a blind cannot come to the hospital, let the hospital arrive at his door" the department of Ophthalmology at MGIMS has been organizing free diagnostic eye camps in collaboration with NPCB and local charity organisations for restoring vision in the cataract filled eyes.

The mission of the Ophthalmology department is to bring eyesight back to anyone who needs it, regardless of his or her ability to pay — and to do so with pre- and postoperative care that rivals the highest quality. The ophthalmologists at MGIMS use a technique that allows safe, high-volume, low-budget operations. And these masterful surgeons perform dozens of flawless cataract operations in the eye operating room at MGIMS over a 12-hour day. Dr Ajay Shukla who leads the department puts it succinctly, “the surgical chair is the most comfortable place on earth that I have.”

Every year, the departments screens close to 70,000 pair of eyes and performs surgery on a tenth of them. In each camp, average 270 patients are examined, ranging from 100 to 500 patients. The department ensures that eye camps are well-organized and well-publicised and keeps an eye on several factors that contribute to the outcomes of eye camps: selection of villages, adequate publicity by print and electronic media, transportation, cooperation of local social and charitable groups, dedicated skilled workers, convenient time, and appropriate season. Every year, the department launches the eye camp on October 2 — Mahatma Gandhi’s birthday— and conducts community based eye camps till March. The ophthalmologists at MGIMS see eye-to-eye with international and national nongovernmental organizations, and have created a high-quality high-volume cataract surgery model with emphasis on outreach diagnostic camps and reach-in model for surgery.

A medical teams from MGIMS reaches patients in rural areas in and around Wardha district by conducting free eye camps. Patients are screened for various eye diseases; those who require cataract surgery are transported to the base hospital, treated, returned to the camp site and followed up after four weeks, all free of cost. Typically, this is how the department spends its time between October and March:

Step 1: Patient registration: The camp team, composed of ophthalmologists and paramedical staff, proceed to the campsite. With support from local community, local volunteers (usually students with legible handwriting) record the patient details - name, age and address - in the OP register and case sheet. Patients are given identity cards, which may be used for any future follow-up.

Step 2: Preliminary vision test: Preliminary vision test is performed by ophthalmic assistants. Vision charts, such as the Snellen (in the local language) and E type charts, are used.

Step 3: Preliminary examination: Ophthalmologists perform the preliminary examination. Clinical conditions such as external eye infections, vision loss caused by nutritional deficiency and the incurably blind are examined. After this basic examination with the help of torch light and direct ophthalmoscope, the patients are directed to further steps.

Step 4: Tension and duct examination: Patients above the age of 40 have their intraocular pressure tested. Senior level ophthalmic assistants administer topical anaesthetic drops and measure the intraocular pressure with a Schiotz tonometer. Lacrimal passage is also tested by syringing for the patients with cataract in operable condition. Facilities for the patients to lie on, additional benches for waiting patients, and adequate lighting are ensured.

Step 5: Refraction: Refraction is performed on patients who have refractive errors, presbyopia, outdated glasses, or pseudo-aphakia. This process occurs in a simple, prefabricated, dark cubicle which is equipped with one or more foldaway partitions, trial lens sets, and mirrors. Well-trained ophthalmic technicians conduct refraction while volunteers control the patient flow.

Step 6: Final examination: Senior Ophthalmologists evaluate the test findings, perform the final examination (which includes fundus examination on needy patients), review the patient records, make the final diagnoses and prescribe required management which could be , medication, eyeglass prescription, surgery or treatment.

Step 7: Counselling: Patients advised for surgery or further specialty interventions are educated by the counsellors to uptake the relevant eye care. Patients who are advised for cataract surgery undergo blood pressure measurement and sugar test. Those who fit for surgery are counselled at the campsite are registered in Inpatients register.

Step 8: Transport to MGIMS for surgery: The screened patients are brought to the hospital, admitted to the Ophthalmology wards where they receive surgery, postoperative care, lenses, glasses, meals, and round-trip transportation all free of cost.