New Delhi: A survey by AIIMS, Delhi, revealed that on average, there is only one ophthalmologist available for every 65,000 people in the country.
There are 20,944 ophthalmologists and 17,849 optometrists (primary eye care providers) working nationwide at secondary/tertiary level, while the Vision 2020 initiative set a target of 25,000 ophthalmologists and 48,000 hospital-based paramedics to be achieved by 2020 for eliminating avoidable Blindness in India.
The study led by Dr Praveen Vashist and his team from Dr Rajendra Prasad Centre for Ophthalmic Sciences at AIIMS was performed to determine the human resources (HR) and infrastructure available for providing ophthalmic services from the existing secondary and tertiary level hospitals in India and to assess the achievement of targets related to HR and infrastructure as per Vision 2020 norms.
Dr Praveen Vashist, Professor and Officer In-Charge of Community Ophthalmology at RP Centre, said the study highlighted that the distribution of ophthalmological services in India is highly uneven.
The situation is comparatively better in the states of South and West India, while there is a severe shortage of doctors in Bihar, Uttar Pradesh, Jharkhand, and West Bengal.
Out of the 8,790 eyecare institutes enrolled as part of the study, 7901 institutes completed the questionnaire (response rate 89.9 per cent), he said.
The eye institute population ratio for the entire country was one per 1,64,536 population, with better ratios in the Southern and Western states, compared to Northern, Eastern, and Northeastern states.
Among the nine union territories, the highest proportion of eye institutes was reported from the Delhi National Capital Region, the study said.
As far as ownership of eye institutes is concerned, nearly two-thirds of institutes (70.6 per cent) were in the private sector, followed by the public sector(15.6 per cent) and the NGO sector (13.8 per cent).
The number of optometrists per ophthalmologist at secondary/tertiary levels was 0.85, meaning that for every ophthalmologist, there is not even one eye care professional who conducts eye tests, and diagnoses and treats certain eye diseases.
The optometrist: ophthalmologist ratio ranged from 8.33 in the Andaman Nicobar Islands to 0.45 in Delhi, the study found.
The ophthalmologist population ratio in the country was found to be 1:65,221. The number of ophthalmologists per million population was 15 for the country, ranging from the highest of 127 in Puducherry to the lowest two in Ladakh, it stated.
The study was published in the Indian Journal of Ophthalmology on October 29.
According to the study, the number of eye beds per million population was 74.
The proportion of eye institutes reporting a 24-hour eye emergency facility was 40.5 per cent, while functional eye Operation Theatres (OT) were present in 87.0 per cent of institutes.
Facility of eye bank (with tissue processing and storage) was reported by only 5.7 per cent of the institutes.
The proportion of institutes having 24-hour eye emergency, functional eye OT, eye bank (with tissue processing facility), refractive eye surgery, and low-vision services was significantly higher in the private sector in comparison to the public sector and NGO sector, the study said.
The gap between the proportion of eye institutes in the public, NGO and private sectors is more in the case of refractive eye surgeries and low-vision services, whereas the gap is minimal in the case of eye banking services, the study said.
This clearly indicates that financially lucrative services like refractive surgeries are being prioritised by the private sector, whereas charitable services like eye banking are predominantly in the public sector, the doctors stated.
The proportion of institutes having sub-specialities of cataract, glaucoma, squint, uvea and vitreo-retina, keratoplasty, oculoplasty, and neuro-ophthalmology was also significantly higher in the private sector in comparison to the NGO sector and public sector.
The corresponding figure for other countries ranges from a mean of 3.7 per million population in low-income countries (LICs) to a mean of 76.2 in high-income countries (HICs).
Among the HICs, it ranged from 14 in the United Arab Emirates to 56.8 in the United States to 183 in Greece.
The number of ophthalmologists in the current survey was 20,944, which falls short of the 25,000 required to eliminate the burden of avoidable blindness in the country by 2030, the study said.
The Health Management Information System of India needs to be strengthened with a strong HR component that can help build the evidence base to plan for the availability of required health workers of desired quality in the right place, at the right time, the study underscored.
The study clearly highlighted the wide gaps in the achievement of universal health coverage. The available HR is not homogeneously distributed across the country. Given the diversity of potential information sources, monitoring and evaluation of HR for eye care requires good collaboration between the Union health ministry and other sectors that can be reliable sources of information.
Eyecare services need further strengthening via investment of time and money, and professional and political commitment to support the establishment of need-based eyecare infrastructure and HR, the study said.
