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EDITORIAL
Year : 1993  |  Volume : 41  |  Issue : 4  |  Page : 151-152

The cataract problem


India

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How to cite this article:
Rao GN. The cataract problem. Indian J Ophthalmol 1993;41:151-2

How to cite this URL:
Rao GN. The cataract problem. Indian J Ophthalmol [serial online] 1993 [cited 2019 Oct 16];41:151-2. Available from: http://www.ijo.in/text.asp?1993/41/4/151/25601

Every important advance in the understanding of the disease process often stems from basic research and has significant impact on medical practice. However, the process of dissemination of such information to the clinician is very sluggish. Nowhere is this phenomenon better illustrated than in the case of cataract. While research has identified several factors contributing to cataractogenesis and consequent possibility of prevention and medical therapy, most ophthalmologists are not familiar with these facts.

The review article in the "Current Ophthalmology" section of this issue surveys the present status of our understanding of cataract. The statistics on the prevalence and incidence of cataract in India and the wide gulf between the demand for cataract surgery and shortage of surgeons is quite revelatory. These figures raise doubts about our capacity to overcome the problem of 'cataract backlog.' While the overall figures look daunting, there is little doubt that the 8,000 ophthalmologists in the country, performing 500 cataract operations each per year, can overcome this backlog. In other words, this amounts to only two cataract operations each per day for 250 working days in a year. In reality, however, only a small fraction of them meet or exceed this figure. It is certain that most ophthalmologists with low volume surgical practice will be inclined to perform more cataract surgeries. Therefore, the need of the hour is to develop appropriate strategies to facilitate this process.

One crucial element is to initiate systems that optimize the utilization of this available trained manpower. Suggestively, this is an appropriate role for the various governmental agencies since they are endowed with a vast infrastructure permeating the country. The success of such programmes is linked as much to the rigour in implementation as in planning. The other key ingredient is resources. With significant funding becoming available for cataract blindness programmes in India in the near future, this should no longer be an inhibiting factor.

Equally important is the attention to be paid to preventive measures. Ultraviolet light, diarrhoea and dehydration, nutritional factors, and smoking have been identified as possible risk factors. Both laboratory and clinical investigations are currently in progress to further elucidate the mechanisms of cataract formation. Documentation of observations is essential to the quality of research and even more important when follow-up assessment on progression of a disease is required. Several systems of documentation and grading of cataracts have been reported and are described in the article by the Hyderabad cataract research group.

The field of human genetics is one of the frontier areas of biomedical research today. The genetic basis for cataract has long been considered a possibility and is steadily gaining support from recent investigations.

A number of biophysical and biochemical phenomena in the formation of cataract have been unravelled and these form part of the complex process that determines the loss of lens transparency. Some of these fundamental processes are discussed in the aforementioned review article.

The application of these research findings to therapy is an area of burgeoning interest. Multiple mechanisms of cataractogenesis have raised the possibility of various types of medical intervention. As a result, a number of pharmacologic agents considered as potential anti-cataract drugs are being studied. Aldose reductase inhibitors and aspirin, while showing initial promise, have failed to prove effective in clinical trials. Alternatively, antioxidants and a host of other agents are being investigated. The goal, however, is to identify a medical therapy that would successfully inhibit the formation or arrest the progression of cataract. This subsequently would reduce the number of cataract cases resulting in a socio-economic benefit. The multidisciplinary approach, as exemplified by the authorship of the article, "The Biology of Cataract" may be the most desirable way to study the problem of cataract.

As of now, surgical treatment remains the sole method for the visual rehabilitation of cataract patients. Cataract surgery is one of the most active areas of ophthalmology and is in constant tran­sition. While in India and most other developing countries intracapsular cataract extraction (ICCE) continues to be the method of choice for the majority of cases, the trend towards extracapsular cata­ract extraction (ECCE) is clear. Modern techniques of cataract surgery result in better quality of vision and produce less visual morbidity besides providing early ambulation and visual rehabilitation. The "Ophthalmology Practice" section in this issue deals with different steps and modalities of extracap­sular cataract surgery. Since a significant percentage of our colleagues are in the process of learning this technique, this information may provide some guidance to them. The wide spectrum of surgical techniques should provide our readers ample scope to comprehend the intricacies of extracapsular cataract extraction and enable them to develop their own techniques as well. This alone does not suffice the need for learning newer surgical techniques. It is imperative for every ophthalmologist wishing to acquire skills in extracapsular cataract surgery to undergo intense practical training. This exposure would not only accelerate the learning process but would also yield better surgical results.

The curriculum of our residency training should lay emphasis on modern cataract surgery. The first phase in this direction is evolving now in the form of "training of trainers programme." Ideally, more such programmes should be replicated throughout the country.

The responsibility of providing surgical care to the ballooning volume of patients, incorporating the safest and the best possible methodology is our challenge. A successful formula that can bring quantity and quality together is central to the solution of our "cataract problem."




 

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