The Ophthalmologist’s Burnout: Diagnosed, Debated but Never Treated

Despite efforts by the Government to overcome the shortfall of ophthalmologists in India, the ophthalmologist to people ratio remains extremely skewed, writes Sandeep Bothra, Country Business Head – Surgical, Alcon

Image for the representational purpose only.

India has the dubious distinction of being home to over 30 percent of the world’s visually challenged population. Yet, there are only about 15,000 ophthalmologists in India for 8 million blind people; which means that there is only one ophthalmologist for 5,33,333 people. This is considerably lower than the 1:20,000 ratio that the WHO recommends. While the government has set up several eye hospitals, a majority of them are restricted to metropolitan cities.

This means that eye care services are out of reach for large swathes of population in rural areas where connectivity is a challenge and supporting infrastructure is not adequate. Only a small proportion of the population in India, with a decent per capita income, is able to access the best treatment and care for eye-related issues.

In 1976, the government launched the National Programme for Control of Blindness & Visual Impairment (NPCB) to address this issue. This was followed by the ‘Vision 2020: The Right to Sight’ program in 2004 to eliminate blindness; which led to the establishment of 20,000 primary eye care units. Despite all these efforts by the Government to overcome the shortfall of ophthalmologists, the ophthalmologist to people ratio remains extremely skewed.

An increasing number of diabetic patients, as well as people with weak eyesight and cataract is creating an even greater demand for ophthalmologists and optometrists. Unfortunately, as more ophthalmologists retire each year, fewer enter the field.

There are two aspects to this. On one hand, there is an issue of access to quality care. People living in remote, far-flung areas struggle to reach qualified health care professionals. Unfortunately, we find that millions of cataract sufferers are unable to get surgery simply because they are unable to travel to the hospital location. The second issue is to do with the demand-supply mismatch that puts ophthalmologists under immense pressure. On one hand, it impacts quality and thereby the outcome of treatment. When ophthalmologists are forced to take on more work than their capacity permits, it can potentially lead to medical errors and poor quality of post-surgery care.

Technology to the Rescue

Technology can revolutionize eye health services by encouraging the use of telemedicine i.e. doctors can perform remote diagnosis through government health-centres. Emerging technologies such as robots powered by artificial intelligence, laser, and ML can help ensure timely diagnosis and also improve the quality of diagnosis. For instance, it can help detect the onset of cataract and other eye conditions at an early stage. Preventative care can be made possible leading to early intervention.  This will help share the burden of ophthalmologists to a great degree. Quality cataract and refractive services reach only 50% of the population suffering from eye problems, says international NGO, Sightsavers.

The second area that needs attention is ensuring the availability of quality surgical equipment that can enable health care professionals to perform quality and reproducible surgery. Today, technology has made way for 3D visualization and surgical equipment that can help manage the pressure on the eye / blood vessels real time. This equipment can provide greater visibility and empower health care professionals to deliver better clinical outcomes.

New technologies like these are crucial for our country as they help healthcare professionals achieve maximum productivity.

Education and Awareness

One issue that exacerbates issues related to shortage of eye care professionals is the tendency of patients to self-diagnose (or rather mis-diagnose) when it comes to eye issues. For instance, you may mis-diagnose a simple eye infection as something potentially fatal and unnecessarily go to an eye-surgeon. This gap in understanding and awareness needs to be bridged. People also need to be better informed about the type of eye care facilities available at their disposal so that they can make the right decisions with respect to the type of treatment needed.  This will not only lead to better results post-surgery/treatment but also lesser pressure on the professionals.

Training and Skills Upgradation

It is recommended that the entire ophthalmology staff, including practicing surgeons, should go through training and development procedures at regular intervals. This will help them offload a large portion of their burden through a better patient filtering process. Medical colleges also need to work on increasing the number of ophthalmology seats / courses.

With all of these measures, we can strive towards an ideal world where there is an adequate number of ophthalmologists, and empowered patients. Also, people will have access to hospitals and clinics equipped with suitable infrastructure, technology, and better surgical equipment. Here’s to achieving this ideal world in the near future!

About Author: Currently based in Bangalore, Sandeep Bothra is the Country Business Head – Surgical at Alcon, the global leader in eye care. He has also been with Johnson & Johnson where he served in different capacities including Head of Marketing, National Director of Sales for their orthopedics business in India. He is an MSc in Technology from the Massachusetts Institute of Technology USA and an MBA from the Asian Institute of Management, Philippines.