Bringing Light to Life.
Corneal Blindness in Delhi, a case study.
Globally 39 million People are completely blind and India contributes around 30% of the Blind Population i.e. 13 million. That is approximately 1% of the total population of India, ie. 1.2 crore people.
Out of this, corneal blindness amounts to 1 %, i.e nearly 1.2 lacs people. Later in the subsequent survey 2007 this share increased to 3.6%of the total blindness in India. An estimated 4.9 million bilaterally corneal blind persons are there worldwide, and nearly 95% are avoidable. Avoidable means it is Preventive and treatable.
As most of the corneal blindness is preventable, and because surgical intervention for treating corneal blindness is a difficult option in a developing country setting, the need for effective health promotion strategies takes paramount importance. Prevention and early treatment will prove to be more viable and cost-effective in the long term in reducing the burden of corneal blindness in our country.
There are many individuals who could potentially have their sight restored through corneal transplantation. The avoidable causes of corneal blindness are keratitis(inflammation of cornea). In childhood, trauma(injury), , severe astigmatism, post cataract surgery.
In adults , significant causes of corneal blindness (based on indications of keratoplasty- repair/ transplant of cornea) are corneal scars (28.1%) and active keratitis (12.2%).
In the pediatric age group,,In a multi-state blind school study in India, the available data indicates that corneal scarring due to Vitamin A deficiency has been a major cause of childhood blindness in our country tThe most common indication for keratoplasty in the developing world has been reported to be acquired non-traumatic scars (71.32%).
Dr Promila Gupta told us that “ National Programme for Control of Blindness was launched in the year 1976 as a 100% Centrally Sponsored scheme. Since the National Programmes have their reach to each district through their units and there they coordinate with the state Health teams to implement various advisories and programmes.” Government of India observes a eye donation phakhwara each year. 32nd pakhwara was observed this year from 25th August to 8th September 2017.”
Although Health is a State Subject, the coordinated effort of the central and state government are aiming to reduce the prevalence of Blindness to 0.3% by 2020, which still seems a mirage.
Two Big Institutes in Delhi, R.P. Institute (Central Government) and Guru Nanakeye Centre (Delhi Government) are trying to help the cause of Corneal Blindness with their respective eye banks which are transplanting Corneas through various Surgeries, around 1000 in Rajender Prashad Eye Institute and 350 surgeries at GNEC, Delhi, last Year. The number of Corneal Blind Population is such big and the capable Institutes are ready to work for the cause, adequate dedicated specialists are available in both places who even go to the extent of paying for tests etc from their pockets in the interest of patient care to avoid administrative delays, in due approvals. The probable reason for the delay in achieving the desired outcome is the deficiency of the Corneas for transplants. The only source of Cornea for Transplant is the Cadaver i.e. donated eyes after the death of an individual. As necessity is the mother of all invention the premier Institute AIIMS could device method to optimize the usage of each received cornea. The anterior Lenticule, Posterior Lenticule and Limbal stem cell are the three parts of each Cornea,which can be separated to meet different needs in three awaiting blind people.
Dr Jeevan Titiyal of Dr. Rajendra Prasad Centre for Ophthalmic Sciences, an Apex Organisation of the Government of India under the National Programme for the Control of Blindness was launched in 1976 to combat blindness problem in India , told us that “ Motivators are working with other Tertiary care Hospitals, under the Hospital Corneal Retrieval Programme, to increase Cornea donations from the Institutional Deaths. R P Center gets a major Chunk of the donations from the Mortalities occurring at All India Institute of Medical Science, DeenDayal Upadhyay Hospital and Guru Teg Bahadur Hospial”. He stated that RP Institute gets around 120 – 150 donations each month and around 150- 170 new patients gets registered for corneal transplant each month. This increases the waiting list each month. Prof. Titiyal shared that waiting time for corneal transplant is from one month to one year, depending upon the clinical condition and urgency, each patient is registered accordingly, under different categories (emergency, top priority, priority and general). Out of the total cornea that we receive 70% tissues are retrieved through Hospital Cornea Retrieval Programme while only 30% are through Voluntary donation. 60% of the tissues retrieved through HCRP is of optical grade while only 30% of the tissues received through VD are of optical grade. Our utilization rate is approximately 66% including both optical and therapeutic penetrating keratoplasty, informed Prof. Titiyal.
Prof. Dr. Kamlesh, Director of the GuruNanak Eye center, claimed that their Eye Bank is the oldest Eye Bank of the Delhi Government and GNEC gets its major institutional cornea donations from near by Lok Nayak Jai Prakash Narayan Hospital and G B Pant Hospital, where the volunteers are working relentlessly to generate more corneas available for donations. Despite many campaigns and National Programme the availability of corneas is far below the demand, even though the team of Doctors, the infrastructure and the manpower are available to take on the challenge and they are willing to go extra mile to eradicate corneal blindness..
In India, the awareness amongst the masses is quiet low to donate the eyes of the kin after their death. This awareness is gradually increasing through the combined efforts of Government campaigns, and dedicated NGOs but still a long way to go.
Lack of confidence in local facilities due to overcrowding, inadequate infrastructure, nonavailability of specialists, etc. prompts the patients from various parts of thee country to come to Delhi for proper diagnosis and treatment. Delhi being a metropolitan city and the capital of India contributes a large chunk of cases of corneal blindness. According to the interim results of an ongoing national blindness survey Govt. of India 2015-18, the prevalence of blindness in Delhi is 1.7% and corneal blindness accounts for 14% of the total blindness, but registration for the corneal transplantation is still quiet low. As per the record, registration list of RP Institute is just 1300 and GNEC is 451 till 1st Oct 2017.
Although the patients have not to pay anything for the diagnosis, treatment, cornea and surgery, but the cost incurred as overhead to receive the treatment and follow up is quiet high. Dr Titiyal appeals for more Philanthropists to come forward to help poor patients to bear the overhead cost during treatment and follow-ups which are mandatory for five years.
There are many Non-Government Organizations are which are trying to motivate masses and propagate this social cause. It’s an irony that even after 70 years of freedom, the nation still has to fight various myth and wrong notions regarding Eye Donation.
It is learnt that several NGOs in Delhi are actively participating in promoting eyes donation to remove corneal blindness. For example, Saksham has decided to deployment of six ambulances in different parts of Delhi and NCRfor quick retrieval of eyes after death. Dadhichi Deh Samiti is also one such organization which is committed to promoting Body and Organ donation after death for Humanity. In the last 7 years it hascontributed around 700 pair of eyes to eye banks in Delhi.
An aggressive approach to treat avoidable cases by screening and preventive care may reduce further bulk of cases.A sustained campaign to motivate masses to shun myths and adopt a must donate eye and a better coordination between all the stake holders i.e. NPCB, NSPB, SIGHTLIFE, Dadhichi Deh Dan Samiti, Radha Soami Satsang Beas, Saksham, Dristhidaan Samiti Sonepat, Swami Shivanand and Delhi Ophthalmological Society, may certainly yield better compliance and early eradication of this menace, like our neighboring countries like Sri Lanka have achieved.
तमसो मा ज्योतिर्गमय
(O god take me from darkness to light)
Insight By : Ms Manju Prabha | Shri Rajiv Goel | Shri Vinod Aggarwal | Dr.Vishal Chadha
Dr. Vishal Chaddha,
Vice President, Dadhichi Deh Dan Samiti