Blindness Prevention Week 2023: Challenges and Solutions for Addressing Cataracts in India

Cataracts are one of the leading causes of blindness in India, affecting millions of people across the country. Despite the availability of effective treatment options, there are significant challenges to ensuring access to care and addressing this growing health concern. Challenges facing the treatment of cataracts in India, include limited access to care, lack of awareness, and cost barriers.

“Cataract continues to be the primary contributor of preventable blindness. Visual impairment is a public health problem. According to National Programme for Control of Blindness and Visual Impairment survey India, 2015-19, cataract is the principal cause of blindness (66.2%) and severe visual impairment (80.7%),” says Dr Sandeep Buttan, Technical Lead at Eye Health & Health System Strengthening, Sightsavers India.

The surgical treatment is relatively safe and very effective in restoring the vision lost due to the disease, but it requires a well-equipped facility and a trained and motivated team to provide it. While the disease does present early symptoms also like inability to clearly read street signs or fading of colours, most people tend to ignore these or worse label them as a mere sign of ageing.

“Cataracts are a common eye disorder that affects people of all ages, especially older adults. It is a condition where the lens of the eye becomes cloudy, leading to blurred vision and eventually blindness if left untreated. In India, cataracts are the leading cause of blindness, affecting over 12 million people. While cataracts are a treatable condition, there are several challenges in tackling them in India,” says Dr Harshul Tak, Director, Rawat Eye & Phaco Surgery Centre, Jaipur & Medical Adviser for Entod Pharmaceuticals.

According to the Center for Global Development, around 80% of blind persons in India had bilateral cataracts during the beginning of the 1990s, while another 10 million had cataracts in only one eye.

Dr Tak explains the challenges that India faces:

Challenges:

1. Lack of Awareness: One of the biggest challenges in tackling cataracts in India is the lack of awareness among the population about the disease, its symptoms, and the available treatments. Many people in rural areas are not even aware that they have cataracts.
2. Accessibility: Another challenge is the lack of accessibility to eye care facilities, especially in rural areas. Many people living in remote areas do not have access to eye care services, and even if they do, the cost of treatment may be prohibitively high.
3. Lack of Trained Personnel: There is also a shortage of trained eye care professionals in India, particularly in rural areas. This can result in delays in diagnosis and treatment, which can lead to further vision loss.

India’s Status In Tackling The Cataract Crisis

India has implemented a series of measures in its ongoing National Program for Control of Blindness and Visual Impairment (NPCB&VI) to combat blindness and visual impairment. However, the road ahead is still fraught with challenges as access to eye health services is limited for certain vulnerable sections of the society.

“Approaching the health services early is avoided due to the fear of losing day wages and lack of a self-perceived need to get treatment. According to Rapid Assessment of Avoidable Blindness (RAAB) in Alipurduar district in West Bengal (July 2022), carried out by Sightsavers India, a development organisation working to eliminate avoidable blindness and promote equality of opportunities for people with disabilities, the finding shows lack of awareness i.e., not having had surgery was not feeling a need (28.8%) as the most common reason for not getting cataract surgery. A lack of eye health awareness and negative feedback of members from the community may also deter people from reaching out for early treatment,” adds Dr Buttan.

Additionally, women, elderly, tribal population, people with disabilities and communities that are geographically located in remote regions constitute the core which face issues in accessing eye health services. Studies have shown that women are more vulnerable than men when it comes to cataract and accessing eye health services.

Dr Tak shares the possible solutions:

1. Awareness campaigns: To tackle the lack of awareness, the government and non-profit organizations can conduct awareness campaigns in rural areas to educate people about the importance of regular eye check-ups and the available treatments.
2. Mobile Eye Clinics: The government and NGOs can also set up mobile eye clinics that can travel to remote areas and provide eye care services to people who do not have access to them.
3. Subsidized Treatment: To make cataract treatment more affordable, the government can provide subsidies or financial assistance to those who cannot afford the cost of treatment.
4. Training Programs: To address the shortage of trained personnel, the government can set up training programs to train more eye care professionals and encourage them to work in rural areas.
5. Partnerships with Private Sector: The government can also partner with private hospitals and clinics to provide affordable cataract treatment to those who cannot afford it.
6. Consuming a balanced diet that includes good omega-3 fatty acids from green vegetables, oily salmon, walnuts, and flax seeds is advantageous. The addition of vitamin E in the diet like cereals, nuts, and seeds, may be beneficial.
7. Medical practitioners advise against smoking since it can delay the development of cataracts. But, regular eye checkups with an eye professional are the best approach to preserve good eye health.

Surgery is a permanent remedy that is widespread, rapid, and generally simple thanks to advances in medical technology. It entails removing the cataract-affected eye lens and replacing it with an intraocular lens made of plastic. Some patients may see improvements right away, but for others, it could take up to a month before they regain full eyesight.

“To tackle the challenges of preventable blindness, Sightsavers has four key eye health programs—Rural Eye Health (REH), Urban Eye Health (UEH), School Eye Health (SEH), and National Truckers Eye Health (NTEH). Our eye health programs address the challenges of both supply and demand sides: ensuring that quality and affordable eye health services are available and accessible for all and that communities are proactively seeking sight-restoring treatment. Interventions such as training of health care workers, community sensitization, encouraging health-seeking behavior, and advocating for policy change and inclusion of the most marginalized people, especially persons with disabilities, are integral components of our work,” opines Buttan.

Under Sightsavers eye health programmes, as part of the engagement with the National Health Mission (NHM), grassroots functionaries such as Mahila Arogya Samiti (MAS) members and Accredited Social Health Activist (ASHAs) were sensitized, leading to an increase in uptake of eye health services by those in need.

In order to improve eye care quality and access, The United Nations General Assembly has adopted the ‘Vision for Everyone’; accelerating action to achieve the ‘Sustainable Development Goals ‘-  committing the international community to eye health for the 1.1 billion people living with preventable sight loss by 2030. We can also use data as an empowering tool to ensure that best practices are adapted widely and no one goes needlessly blind.

In conclusion, tackling cataracts in India is a significant challenge that requires a multi-pronged approach. By addressing the lack of awareness, accessibility, affordability, and trained personnel, we can ensure that more people receive timely treatment and prevent needless blindness.

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