Advanced Ocular Tumors in India: A Reflection

Dear Editor, In 2015, the Indian Journal of Ophthalmology published an editorial titled “Ocular Oncology in India,” an optimistic commentary on the emergence of specialized centers, improved training, and research in the field.[1] Ten years later, while these advances are noteworthy, they remain unevenly distributed and insufficient in addressing the persistent, and in some cases, worsening, gaps in access, awareness, and integration, particularly in North India. As an ocular oncologist working in a tertiary care multispecialty hospital in North India, I witness a number of advanced malignancies including orbital retinoblastoma, neglected basal cell carcinomas, and locally invasive squamous cell carcinoma requiring exenteration or mutilating surgery [Figure 1]. These cases are not exceptions but increasingly the norm despite the fact that such tumors are often curable when detected early.Figure 1: Advanced ocular and adnexal tumors presenting to our tertiary care center from January 2025 to April 2025. (a) A 3-year-old boy with massive orbital retinoblastoma of the right eye. (b) A 68-year-old male with a large nodulo-ulcerative basal cell carcinoma involving the upper eyelid, medial canthus, and the lower eyelid with orbital extension. (c) A 62-year-old male presenting with advanced squamous cell carcinoma involving the right lower eyelid, ocular surface, and extending into the orbit. A large preauricular nodular swelling (black arrows) denotes lymph node metastasisThis is not merely a problem of patient delay. It reflects systemic failures. Lack of trained frontline personnel: Optometrists and technicians in peripheral centers are rarely equipped to identify early signs of ocular tumors Low prioritization of ocular oncology training: A 2020 survey by the All India Ophthalmological Society of 1026 ophthalmologists revealed that only 1.9% had subspecialty training in oculoplasty and/or ocular oncology.[2] The field continues to receive limited institutional or financial support, discouraging young ophthalmologists from pursuing this subspecialty Absence of integrated care pathways: Unlike comprehensive cancer centers in the West, India still lacks robust coordination between ophthalmologists, ocular pathologists, pediatric oncologists, and radiation oncologists. Multidisciplinary tumor boards remain the exception rather than the norm Geographic disparity: South India houses the majority of established ocular oncology units and integrated care centers. A study by Kaliki et al. from a major South Indian referral center analyzed 9633 ocular and periocular tumors using a robust electronic medical record system over 6 years, highlighting the sheer volume and diagnostic diversity of cases managed in a single institution[3] Cultural and socioeconomic barriers: While awareness campaigns exist, they have not adequately penetrated rural populations. India cannot afford to manage ocular oncology with a fragmented, center-of-excellence model alone. What is required is a national strategy that prioritizes decentralized capacity-building with regional ocular oncology units supported by government and public–private partnerships. Integration of ocular oncology into primary and secondary eye care, including structured training for optometrists and general ophthalmologists to identify red-flag signs. Mandatory inclusion of ocular oncology exposure in ophthalmology residency programs and fellowship funding incentives. Development of regional tumor boards that include virtual participation to bridge access gaps. State-sponsored awareness and screening programs, especially for high-risk pediatric populations. It is time to move beyond anecdotal successes and piecemeal progress. With a population of over 1.5 billion, India requires a public health approach to ocular oncology that emphasizes early detection, timely referral, and equitable access to multidisciplinary care. The vision articulated in 2015 must now evolve into policy-backed implementation. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.