Indian Journal of Ophthalmology

: 1962  |  Volume : 10  |  Issue : 2  |  Page : 50--51

An American ophthalmologist visits India

Rudolf H Bock 

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Rudolf H Bock

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Bock RH. An American ophthalmologist visits India.Indian J Ophthalmol 1962;10:50-51

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Bock RH. An American ophthalmologist visits India. Indian J Ophthalmol [serial online] 1962 [cited 2020 Aug 8 ];10:50-51
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India is a vast country, different in many ways from place to place, and it may seem presumptuous to give an opinion about anything after a short stay of only 3 months. However, if one has spent this time intensively occupied with one rela­tively small field like ophthalmo­logy, a few striking aspects impress themselves upon one's mind. Some of these might be worthwhile to mention in the interest of our speciality.

Every ophthalmologist in the world-if he knows anything else about India-has heard of the high incidence of cataract in this coun­try. Yet, if one actually sees the great number of people with mature cataracts that pass through any of the out-patient clinics of the major hospitals here, one cannot help be­ing impressed. I, for one, had also not realized that cataract occurs at such an early age. There must be a reason for this remarkable difference in the incidence of cataract, in comparison with other countries, and this difference could be the starting point of a major re­search project. Differences in diet and their possible relation to cataract should be investigated (vegetarian diet ? Spices ?), and biochemical studies on the normal and cataractous lens of Indians should be made. Is there, for in­stance, any relation between a qualitative or quantitative low protein diet and the reduced glutathione in the cataractous lens ? The influence of radiation might also be made the object of more studies, before one dismisses the whole subject as a racial difference. Modern biochemistry applied here probably has the greatest chances of coming up with some important findings.

Another field which seems to hold a great future in this country is cor­neal transplant surgery. All the literature on eye banks mentions that tine obtaining of donor material in India is practically impossible be­cause of religious objections. I have personally seen that this is not the case. At one major government hospital where I spent five weeks, and where a corneal transplant surgery unit has been in operation for the last nine months, we had no difficulty at all in getting eyes from unclaimed bodies at almost any time. It is probably more the reluct­ance of the surgeon who is not familiar with this type of surgery, rather than the difficulty of obtain­ing donor material which makes the operation so rare. And this is the country which has probably the greatest number of cases of corneal blindness in the world.

Trachoma, keratomalacia, infec­tious ulcers, phlyctenular keratitis, and many other diseases are responsible for this sad state of affairs. Of course, many of these, particularly all the staphylomas, cannot be cured by keratoplasty, but a great number can be improved remarkably, and this operation should be practised by at least one surgeon in each larger town, even if it is not as quick, easy and highly successful as cataract surgery. It may, however, be all the more re­warding if one does get a good result.-I would therefore like to urge any surgically inclined Indian ophthalmologist to make himself familiar with this type of surgery and to start a corneal transplant unit at his clinic.

Retinal detachment seems to have a significantly lower incidence in India than in western countries, but it does occur. As a matter of fact, the first patient I saw here was a bilateral aphake with detachments. Wherever there is a surgeon who does detachment surgery there are a number of cases, too. Generally I think Indian surgeons should again familiarize themselves more with recent techniques, in particular the scleral resections and encircling tube operation, and tackle more of their so-called "hopeless cases".

With the best intentions teaching of students and residents cannot be what we would like it to be when so many patients have to be seen every day by so few trained ophthalmologists. To take extra time, for instance, to examine a patient on the slit lamp which might be located in an inconvenient, far­away room, is often asking too much. But we all know that only by using the slit lamp can we practise up-to-date ophthalmology. And the use of this instrument, particularly in teaching institutions, has not been sufficiently encouraged. After all, we want to improve standards !

A last word on eye camps : I took part in two of these ventures, and they are a tremendous experi­ence for an outsider. They are very valuable both for the ophthalmolo­gist, who sees this vast scope of pathology, and for the patients, who otherwise would not get expert treatment. However, we have to realize that, when planning for the future, these camps are only a stop gap. Since it will take a long time to train a sufficient number of qualified ophthalmologists to staff the rural areas adequately, it might be more effective to make the villagers aware of the availability of good treatment in the city hospitals. There the care can necessarily be much better than in the make-shift arrangement of the camp, where sterility, post-operative care and good follow-up can never be up to standard. It will take some re­sourceful minds with insight into the psychology of the village people to find the right approach to this pro­blem.

These are only a few thoughts that come to my mind when I think back of my short time in India. I am very grateful for all the hos­pitality and kindness that I experi­enced in this country, and wish to emphasize that in many instances I was much impressed by the good ophthalmology, and in particular ocular surgery, that is being practis­ed here. If some of my remarks may help to stimulate thought, then this "one man's opinion" expressed here will serve its purpose.