On a warm sunny day in early winter, a small crowd is waiting expectantly for my arrival. I am on my annual visit to my village in Bihar; people with eye problems have heard of my arrival and have assembled on a given day. Armed with my assortment of portable equipment, I begin my pro bono service.

Parbhua has cataract which has greatly affected his eyesight; it is hampering his ability to earn money as a daily wager. Sunil, a Class VII student, just needs a pair of glasses for his short-sightedness. Ramesh is an affluent villager who is diabetic and has significant diabetic eye disease which may cause blindness but he has never seen an eye doctor. Malti has glaucoma which will eventually lead to loss of vision. All this in a village just 20 kilometres from a premier medical college and hospital. I do what I can for them but this is in essence a snapshot of the spectrum of eye problems facing rural India.

Let us look at some cold facts. They don’t make pleasant reading. Seventy per cent of Indians live in rural areas but 70 per cent of eye specialists live in urban India. According to the World Health Organisation, there should be one eye specialist per 20 thousand persons; in India there is one per 100 thousand but in rural areas it is a lot worse at one per 250 thousand. Many rural areas may have eye specialists but, due to severe lack of facilities to manage eye conditions properly, most people have to travel long distances for basic eye care.

Even according to conservative estimates there are over eight million blind people in India, roughly one out of every four in the world. What is even more disappointing is that 80 per cent of these people have curable eye disease. Cataract (clouding of the natural lens inside the eye primarily due to ageing) still accounts for nearly 65 per cent of blindness, followed by refractive errors (short or longsighted eyes where vision can be improved by a pair of glasses) and, in smaller numbers, conditions like glaucoma.

However, visual impairment due to diabetes-related eye disease is the leading cause of blindness in the age group between 20 and 55 years. India, which is considered the diabetic capital of the world, has more than 72 million people with diabetes, with virtually non-existent screening facilities for eye disease.

The country is fortunate to have a young population and our primary goal should be to increase awareness among everyone, especially children and young adults because, as they say, prevention is better than cure.

Lack of a proper pair of glasses is the most common cause of reduced vision in children and is increasingly becoming worse in urban and, even more so, in rural areas. There is enough evidence to link shortsightedness with lack of exposure to natural sunlight and more time spent looking at screens, whether it’s a mobile phone, tablet, computer or television. Recent efforts in Singapore — where shortsightedness is very common — to expose children to more outdoor time in natural light have already shown an improvement in their eyesight. Parent education, pre-school eye screening and regular visits to an optician are some very simple steps which can lead to early diagnosis; with a simple pair of glasses children can see better and avoid the long-term risk of developing a lazy eye which will restrict their entry into certain professions, such as that of pilots, for instance.

Visual impairment and even blindness due to cataract remains one of the biggest burdens on Indian society, especially in the rural areas because it affects the livelihood of a huge underprivileged population. The good news is that the greatest advancement made by charitable eye hospitals, NGOs and government as well as private hospitals is in the field of cataract surgery. Many premier hospitals such as Sankara Nethralaya and Aravind Eye Hospitals are working tirelessly to reach rural and remote areas. Innovations such as teleophthalmology and mobile vans equipped with diagnostic and treatment facilities are providing quality care. A lot more needs to be done but we are moving in the right direction.

The biggest threat to the eyesight of the working age population in coming years will be from diabetes related eye diseases. This is an area where there is an urgent need to develop a nationwide screening programme.

The United Kingdom set up a national programme for diabetic eye screening just over a decade ago and it is now the only country in the western world where diabetes is no longer the leading cause of blindness in the working age group. Teleophthalmology and other innovative projects can make a massive difference if we can find a way to take digital photographs, which are then accessed remotely by eye specialists at specified reading centres who can then give appropriate advice regarding monitoring and treatment.

At the same time, providing facilities such as laser and other types of treatment in district general hospitals and training eye specialists to use them would enable these patients, who cannot travel to urban specialist centres, to have the right treatment at the right time. Lastly, community awareness and education needs to play a pivotal role and joint projects between eye specialists and NGOs are therefore vital.

Parbhua was fortunate to be referred to an eye hospital and had a successful cataract operation. He is now back to work full time and is able to support his family. But there are many such Parbhuas who need help and support to get back on their feet and once again become useful contributing members of our society.

EYE ON EYES

Working on a computer 6-7 hours a day is a common cause of eye strain. Called Computer Vision Syndrome, it leads to dry eyes that are also sore and gritty

To combat the dryness, you can use special drops that are available over the counter

A good way to reduce the risk of dry eyes is by observing the 20-20-20 rule. Look at an object 20 feet away for 20 seconds after every 20 minutes spent looking at the screen

A balanced diet, which includes green leafy vegetables, fruits (such as oranges), oily fish (such as tuna and salmon), eggs, nuts and beans is very good for the eyes

Get yours eyes checked every year to rule out conditions such as glaucoma

Keep the area around the eyes clean by using a face wash twice a day

Simple eye exercises can help maintain the strength of eye muscles

Dr Choudhary is a UK-based consultant ophthalmologist and clinical lead for the North Derbyshire Diabetic Eye Screening Programme