Eye injury rates and community cost savings through vision centers: Evidence from southern India

Dear Editor, The Alma-Ata Declaration of the World Health Organization incorporated “Health for All by 2000” and made primary health care the main vehicle to achieve this goal. Primary health care was to be available, affordable, and accessible to all, and healthcare would be brought to the doorstep of the community.[1] Ophthalmology was envisaged as a specialty branch, and there were few ailments treated at the primary level. While the Sitapur Eye Hospital had nearly a hundred vision centers (VCs) in Uttar Pradesh, the surrounding states, and Nepal, just after Indian independence, primary eye care through VCs was popularized by the L.V. Prasad Eye Institute and Aravind Eye Care System at the turn of the century.[2,3] This manuscript looks at how trauma can be easily managed at VCs with the help of telemedicine and a well-set eye care system.[4] It looked at VC medical records to study all eye injury cases reported at 35 VCs affiliated with the Aravind Eye Hospital, Madurai, between 2021 and 2022. Of the 219,172 outpatients who availed service, 7% presented with eye injuries, with men comprising 63.9% of cases and women 36.1%.[4] However, in 18 VCs, there was a slight preponderance of females (51.4%), these being centers catering to agriculture and manual labor. Globe injuries comprised 85.3% of injuries, with the remaining 14.7% being periocular injuries. Most injuries cases (85.8%) were managed at VCs. The authors estimate that this resulted in savings of ₹5.6 million (US$67,233) in travel and registration costs.[4] Globally, an estimated 1.6 million people are blind due to eye injuries, with 2.3 million living with bilateral visual impairment (VI), and 19 million suffering from unilateral blindness or VI.[5] In India, the prevalence of ocular trauma ranges from 2.4 to 10.6%,[6–9] with younger individuals, males, laborers, and rural residents particularly vulnerable.[6–10] The Andhra Pradesh Eye Disease Study reported an eye injury prevalence of 4% in urban populations and 10.6% in rural areas, consistent with broader evidence of higher eye injury rates in rural areas.[6,8] VCs helped counter trauma in two ways; they allowed the affected person to seek easy and early redressal with the optometrist/ophthalmic technician at the VC, which was linked by telemedicine to the ophthalmologist in a tertiary center. The community health workers linked to VCs can educate the populace on protective measures and appropriate first aid response. VCs can also ensure the availability of antibiotic eye drops and should have clear guidelines for their usage. Not just trauma, but cases of red eye, refractive errors, conjunctivitis, dry eye, nonspecific ocular complaints, and pre- and postoperative care for ocular surgery can be provided at VCs. This would allow even remote and aspiring communities to access eye care at a very affordable cost and help reduce the burden of avoidable visual impairment in the community.[3,11] A recent publication in the Indian Journal of Ophthalmology from rural, tribal Gujarat showed that the median interval between trauma and presentation to the eye center was 15 days, and only 17% presented within 24 h.[12] This delay due to ignorance, cost, and underestimating the severity had implications for final visual outcomes.[12] VCs help increase accessibility, act as screening gates for severity, and help reduce poor outcome after injury. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.