|Year : 1989 | Volume
| Issue : 1 | Page : 41-45
Source of Support: None, Conflict of Interest: None
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Malik S. Presidential address. Indian J Ophthalmol 1989;37:41-5
It is a great honour you have bestowed on me in choosing me as your President for the year 1989-90. 1 do not know how to express my gratitude for the confidence you have reposed in me. Iassure you that l will fulfill my responsibilities to the best of my abilities and will strive to maintain the honour and dignity of our beloved fraternity.
At the Outset, I bow before my teachers, the late Prof. K.N. Mathur, Prof. L.P Agarwal and Prof. Avasthi who moulded my career and blessed me to rise in the field of Indian ophthalmology. Their encouragement at each level of my progress has enabled me to achieve more and more in the profession. I am indebted to my patients for their trust and confidence to inspire me to serve them better. To my students, I have only one word to say that they were intelligent and inquisitive to goad me all the time for the attainment of academic excellence for adequate transfer of skill to them.
As I was planning to prepare my address for this meeting, I went through the Presidential speeches delivered by my predecessors who had given valuable suggestions. I am disheartened to find that not much follow-up action was done to implement their advice. I have decided that we will have an implementation committee headed by one of the past presidents, in the implementation for various suggestions/recommendations made by the past Presidents. For this, I can not think of anyone better than our past present Prof. B.T. Maskati.
We are all aware of the multi-centric study conducted by Indian Council of Medical Research (1971-74) which estimated the number of blind persons (Visual acuity of 6/60 or less in the better eye), around 9 million (base year (1975). The most important cause of blindness is cataract which forms about 55% of the total blindness. It is unfortunate that we have not been able to solve this problem even though great efforts have been made by the Government of India in launching the programme for prevention of blindness. It has only touched the fringe of the problem as indicated by the annual performance of the cataract operations which has gone up from 0.55 million in 1981-82 to 1.22 million in 1985-86 and has fallen to 1.19 million in 1987-88.
Recently, the Indian Council of Medical Research Collaborative Study on the prevalence of cataract, reported a backlog of 7.53 million cases of blindness due to mature cataract. This estimate does not take into account the 52 million eyes which have immature cataract and 18 million with incipient cataract. Even if 5% of these immature cataracts mature in a year, there will be an addition of 2.5 million new cases every year. Added - to the backlog of 7.5 million cataracts, it comes to a staggering figure of 10 million cases
Is it impossible to handle the problem of this magnitude with the present facilities available or should we wait for better days when we will have many more ophthalmologists? Roughly there are about 6000 ophthalmologists, (conservative estimate) performing about one million operations per year which comes to 0.45 operations per day per surgeon which is an awfully small figure. This clearly indicates that the operative work has not been distributed equally and there are many surgeons who are not doing any surgery or very little surgery. If we can create a machinery in which a surgeon can operate atleast two cases per day on 300 working days in a year, it will enable us to handle the backlog as well as the new cases more effectively.
No ophthalmologists working with the Government should be posted to areas other than ophthalmology. It is a pity that many of the eye surgeons are asked to do duties other than the ophthalmic work, and are not being used in the prevention of blindness programme.
Camp Management - Infra-structure
It is suggested that the Government of India and the state governments' encourage voluntary agencies to create suitable machinery at the district and peripheral levels including tribal areas which will perform the formalities of setting up the camps. Once these jobs are completed as per the guidelines given from time to time, the paramedicals can do the presurgery screening. The ophthalmologists can arrive a day prior to the surgery for examining the cases selected and conduct surgeries the next day. The management of such a setup at the district and peripheral levels can be left to the voluntary organisations with proper checks and counter checks. This means a plan should be drawn up much in advance and the ophthalmologists are informed sufficiently ahead of time. Such a system can save the precious time of the surgeon for its better utilisation. The first dressing should he done by the surgeon or the resident doctor. This will enable the ophthalmologists to give undivided attention to postoperative care/OPD duties etc.
Helping Hill Areas
A scheme can be worked out to get the services of ophthalmologists for cataract surgery in the hilly areas. As mentioned earlier, the infrastructure to be created at the district and the peripheral levels in the plains to organise cataract camps should also work in the hilly areas during summer. After the surgery is over, the doctors can be given facilities to spend a few days in hilly areas as a sort of a holiday. Th is short period can be used by the surgeons for good follow-up of the operated cases. This will also create a good rapport between the cataract surgery team and the people.
Peripheral Cataract Hospitals
The current measures undertaken by the National Programme for Control of Blindness should continue. Small peripheral cataract hospitals should be set up at the Taluka level. These hospitals should send teams to screen villagers around and bring operable cases to the hospitals. After the surgery these patients should be sent back to their villages with assured follow-up work.
The endeavour of Lok Kalyan Samiti in the running of such a cataract hospital has been very useful.
A monetary incentive can also be considered for the ophthalmic surgeon doing cataract surgery as in the case of family planning programme. This can be Rs. 50/- for pre-surgical checkup and surgery of each case. The details can be worked out by mutual discussion between the Government and the surgeons. Similar incentives should be considered for the Government staff working at the district and medical college levels, etc.
Soft loans on Differential Rate of Interest
In view of the magnitude of blindness it will not be possible to handle the problem through routine Government institutions . Young ophthalmologist should be encouraged to settle in Taluka and Tehsil areas and banks should sanction loans on differential rate of interest to enable them to build small eye hospitals where they can help the poor by keeping 15% of their beds free. Such loans may also be sanctioned to young ophthalmologists for the purchase of modern equipments.
Our Immediate Past president Prof. Madan Mohan had discussed this with Mr. N.D. Tewari, former Finance Minister who had promised to look into this matter. I plan to pursue this matter further, with the Ministry of Finance.
Intraocular Implant Surgery and its Effect on Backlog of Cataract
The infra ocular implant surgery though becoming increasingly popular in India, takes a longer time than the routine cataract surgery and will thus increase the back log. Implant surgery is not possible in eye camps and less number of eye surgeons will be available to do cataract surgery as the intra ocular implant surgery is more remunerative. This will inhibit the surgeons from taking up rural work.
Are eye camps needed ?
It is often asked whether eye camps are needed ? I have no hesitation in saying that eye camps will remain necessary in this country for many more years to come. However, all such eye camps should follow the guidelins laid down by the National Society for the Prevention of Blindness and the Government of India in order to avert certain disasters which took place in the last few years. Many ophthalmologists who were doing relief work in this field have become hesitant to undertake rural work due to adverse comments in the press. l request the Government of India and the State Governments to see that their enthusiasm is not curbed. In fact the Governments should assure them full protection. I suggest that all eye surgeons who are going to operate in the rural areas should have a comprehensive medical insurance paid by their organisations so that they are well protected from medicolegal problems which may crop up at times.
Corneal blindness and eye banks
Blindness due to corneal diseases account for 25% cases in developing countries.
According to an estimate keratomalacia alone is responsible for causing blindness in 2.5 lakhs children all over the word every year. In developed countries the incidence of blindness due to keratomalacia is 1-3 persons per 1000 persons while in developing countries it is 10-13 persons per 1000 persons. In India it is estimated that every year we are adding 20,000 cases of blindness clue to keratomalacia. I have been receiving many letters from various doctors and social workers requesting the National Society for the Prevention of Blindness to provide vitamin A as it is not available liberally to all the people in the country. It is sad that we are not able to provide vitamin A. Its deficiency should be eliminated immediately if we want to prevent blindness due to keratomalacia. The State Governments and the Government of India should be requested to provide vitamin A at a highly subsidized rate or free of cost. There are about 80 eye banks in this country but their performance regarding the collection and distribution is most disappointing. It is to the credit of Times Eye Research Foundation that consciousness about eye donation has been aroused through the media. A large number of people are becoming aware of the importance of donating eyes. Unfortunately, corresponding efforts have not gone in establishing the infrastructure for collecting and distributing the eyes. It is a common observation that most of the institution - based eye banks are non-functional or are functioning at a very low key as the motivation to collect and distribute eyes does not exist. If the eye bank activities have to succeed, they should be left to voluntary sector. The eye bank at Dholka, Ahmedabad, which has been established by the Dholka Taluka branch of Indian Red Cross Society under the dynamic leadership of Mr. Gautam C, Mazmudar, Hony. Secretary and Mr. Laxman Bhai Patel, the Chairman, has clone outstandingsub work in the field of eye donation in India. I wish we can repeat such experiments at other places in our country. I have already requested the Indian Red Cross Society in Delhi to establish eye banks in each major city of the country so that the experience of Dholka Taluka branch can be repeated.
It is to the credit of Prof. R.P. Dhanda who had created awareness of corneal surgery in this country and has trained many corneal surgeons in the last few years. We are greatly indebted to him for his efforts in this direction.
Public awareness programme
Extensive educational programmes on eye health care with emphasis on those diseases which are responsible for irreparable loss of vision, should be undertaken. Fortunately, we have in this country television media which is the easiest and the best way to spread the message of prevention of blindness programme.
I suggest a Health Cell be formed with a health educator as its Chairman to organise health education programme for the public. The educational materials can be in the form of pamphlets, video films, short hand outs to the Press, TV spots etc.
Besides putting out health education materials through different media, this Cell should utilize the education system to reach eye health care messages through the children, particularly the ones in rural schools. Studies have shown that the messages reach the rural homes through the school children. The teachers should be given short orientation courses in eye health care so that he/she can detect deviations from normal eye health and report the findings to the school health authorities. At the same time, supplement ry readings materials on eye health should be prepared and supplied to all the schools through the educational system.
Intraocular implant surgery
It is to the credit of Prof. Daljit Singh who popularised intraocular implant surgery in this country on a large scale. It is essential for an ophthalmologist to get proper training in the intraocular implant surgery as without this training it will be difficult for him to meet public expectations. Cataract operation is bread and butter of an average ophthalmologist but with the coming in of the implants they are finding it difficult to cope with the demand.
Due to lack of adequate training facilities many of them make an attempt to do implant surgery without proper training and equipment and end up with disastrous results. It is essential for us to undertake multiple training programmes at convenient distances so that an average ophthalmologist can learn the techniques without sacrificing his practice. The All India Ophthalmological Society should conduct such seminars, symposia and workshops all over the country in collaboration with the local/regional societies. It would be better if we organise two days workshops at district levels in some of the hospitals.
Quality Control of Intraocular implant
The All India Ophthalmological Society should also request the Government of India to set up a statutory body to maintain quality control of intra-ocular implants which are being manufactured in India or are being imported from abroad. It has often been alleged that many foreign countries are dumping their implants which have been rejected by their quality control organisations. Efforts should be made to curb this tendency at the earliest opportunity.
Committee for Quality of Equipments
This Committee should look into the matter of quality control or various equipments. The manufacturers will be requested to expose their equipments for the scientific trial by ophthalmologists selected by the Committee. This will enable the Committee to select and recommend to the ophthalmologists the instruments found to be of high quality. We are fortunate that we have very good manufacturers in this country and they need our help and guidance and if such people approach this committee, it wilt be possible to locate ophthalmologists who have experience in this line and help the manufacturers to modify and improve the quality of their equipments/instruments. Interaction between the ophthalmologists and the manufacturers is essential for improvement and production of now equipments. I will request Prof. P. Avasthi to head this committee.
CUSTOMS DUTY EXEMPTION
I would like to congratulate Prof. P. Avasthi, Prof. D.B. Chandra, Prof. Madan Mohan, Dr. P.N. Nagpal Prof. B.T. Maskati and Dr. J. Agarwal who had worked hard with me in getting customs duty exemption on various ophthalmic instruments. This has helped the ophthalmologists to update their equipment. I would also like to make a special mention of our former Minister for Finance, Mr. N.D. Tewari whose positive approach and broad vision have shown the way to the officers of the Finance Ministry and Health Ministry for finally recommending the custom duty exemption. We should also request the Ministry of Finance to permit the import without custom duty of accessories and replacement of various ophthalmic instruments/equipments which had been exempted from custom duty.
Some of the sight saving drugs are not available in our country. The All India Ophthalmological Society will draw up a list of such drugs for customs duty exemption.
In order to coordinate the matter, it is proposed to form a committee under the Chairmanship of Prof. Madan Mohan, our immediate Past President. The members should send their suggestions to him. The committee may also look at the price structure of these drugs.
The All India Ophthalmological Society will soon be celebrating its Golden Jubilee in 1992. In retrospect we feel highly satisfied with the outstanding progress the society has made particularly in the last 10 years. The scientific activities of the society have shown phenomenal progress in the IAtt decade and the credit for this goes to Dr. Asutosh Sarkar, Prof. D.B. Chandra, Dr. P.N. Nagpal and Dr. j. Agarwal. All of them have made great efforts to improve the quality of scientific programme in this country. A special reference to Dr. Nagpal will not be out of place as I find him one of the most dynamic ophthalmologists in the country who had rendered great services to the Society and introduced a large number of new scientific programmes at various conferences of the All India Ophthalmological Society.
What should be our Aims now?
We should aim to achieve perfection and excellence in the spheres of ophthalmology. Our ophthalmologists should get an opportunity to achieve this excellence by getting themselves abreast with the new advances in the field of ophthalmology, must learn to operate, attend conferences and workshops and must subscribe to video films and scientific journals. It is sad that many of us do not like to spend money on such matters. My advice to young ophthalmologists is that your future is bright provided you have outstanding institutions both in the private and government sectors where you can learn from their significant contributions and improve your knowledge.
I have great appreciation for the work done by Prof L.P. Agarwal for setting the trends for modern training of post graduate students.
During the period I was the Professor and head of the Department of Ophthalmology at Maulana Azad Medical College and associated hospitals, New Delhi, I used to send my postgraduate students to the Institute of Ophthalmology, Aligarh; Sitapur Eye hospital, Medical college, Lucknow; Medical college, Agra to expose the young students to the type of work being done at places other than Delhi. I feel that we should now create four Travel Fellowships for those who have passed Master of Surgery examination to travel to various parts of the country. These travel fellowships can be ophthalmic pilgrimages to South, North, West or East to enable them to attend the most important institutions which are doing excellent work. They can stay for a period of one week at each institution. The main purpose of this is to enlighten young ophthalmologists before they settle down to practice. I will request Prof. A.K. Gupta, Chairman of the Academic Research Committee to develop the above mentioned programme.
The All India Ophthalmological Society will impart certain instruction courses along with regional and state level Conferences as I find that these conferences need help and guidance. The Society should also organise workshops of 2-3 days duration on various subjects in medical colleges especially which are still not well developed. This year we plan to hold a mini meeting of the AIOS at Srinagar on intraocular implant surgery. Prof. Manzoor Ahmed has agreed to shoulder this responsibility of organizing this meeting in the third week of September 1989.
It is unfortunate that many regional institutes and medical colleges which received grants from the Government of India, have not come up to the required expectation. I had raised this point at the meeting of the Central Coordination Committee (National Programme for Control of Blindness) and I sincerely feel than an independent audit team should be available to audit the activities of various institutions to find out the reasons for their not coining up to the expectations and helping these institutions to overcome the hurdles in their way.
1984 was a great year for All India Ophthalmological Society when we organised the Xth Congress of the Asia Pacific Academy of Ophthalmology. This has left a great impact on the minds of ophthalmologists all over the world. Innumerable letters of praise for the quality of presentation by our members and the flawless management of the Congress have been received. This was a great morale booster and has given impetus to the success of Indian ophthalmology. You will be pleased to know that the International Council of Ophthalmology, Advisory Committee of International Council of Ophthalmology and, Academia International have accepted our invitation to hold their meetings in India in 1992 during the Golden Jubilee celebrations of All India Ophthalmological Society. I congratulate Dr. P. Siva Reddy and Dr.P.N. Nagpal who have persuaded these organisations to hold their meetings in India. You will also be pleased to know that the Asia Pacific Intra-ocular Implants Association has also accepted our invitation to hold its meeting in Delhi in 1992. These events are going to give a great fillip to Indian Ophthalmology and I hope that the members will utilise these opportunities especially those who missed the 10th Congress of Asia Pacific Academy of Ophthalmology at Delhi.
Recently I have come across a case in which a firm has tried to cheat a young ophthalmologist by giving a second-hand equipment. This is a very serious matter and it is difficult for the young ophthalmologist to face such a situation alone. The All India Ophthalmological Society should have a cell where such complaints can be processed and i f found correct the All India Ophthalmological Society should atleast debar such firms from taking part in our scientific trade exhibitions during various conferences all over the country. This cell may also entertain complaints from the manufacturers and the dealers and help them in genuine cases. It will be fair to look into the complaints from both the sides. All India Ophthalmological Society has a moral force if not the judicial power, I wilt request our Past President Dr. D.B. Chandra to head this Cell.
Continuing Medical Education
Continuing medical education is essential for all the ophthalmologists so that they can look after patients in a more scientific way.
Goal-oriented workshops, seminars should be organised from time to time to update the. knowledge and improve the skill of the participants practising ophthalmologists. Such programmes should be short and the duration should be kept to the absolute minimum and time spent usefully. Formal functions for inauguration and valedictory etc should be dispensed with. The Guru Nanak Eye centre at New Delhi under the leadership of Prof. A.K. Gupta has set the trend for such goal-oriented workshops worthy of emulation,
It is observed that the officers working with the Government of India or the S tale Governments do not get an opportunity to attend these Conferences. The Governments should be made aware that it is in their interest that these officers attend All India Ophthalmological Society meetings. In fact I would suggest that the Government departments should allow atleast 75% of their staff to attend the annual conferences and the remaining people should be allowed to go to the State conferences and the regional conferences. TA/DA should be paid to them by the Government. Government should also depute the ophthalmologists working with them to higher centres of learning for a period of one month after every three years to enable them to update their knoweldge. These steps will give a boost to the quality care of the patients.
Indo-Japanese Ophthalmological Foundation
This Foundation was formed in 1985 under the dynamic leadership of Prof. D.B. Chandra as the President and myself as the Secretary General. Under the aegis of the Foundation, the Indian ophthalmologists are sent to Japan for training under Prof. A. Momose, Prof. A. Yamanaka, Prof. K. Oshima and other for a period of one month. So far we have sent 75 India eye surgeons to Japan for Training for a period of one month, three eyes surgeons for a period of three months and four senior professors for updating their knowledge in the field of ophthalmology. It gives a great opportunity to the Indian ophthalmologists especially the young ophthalmologists to update their knowledge and get training at the most modern, sophisticated and the best Institutions of the world, in the diagnosis and management of the various diseases of the eye.
We are also grateful to the Indian ophthalmologists settled in America for taking great interest in our deliberations and helping us in many ways. It also gives me pleasure to thank all other foreign ophthalmologists who have helped us from time to time.
Ophthalmic Society Headquarters
You will be pleased to know that the process for establishing ophthalmic headquarters in Delhi has started and I hope that the same should be ready by t992, the year of Golden Jubilee Celebrations of the All India Ophthalmological Society. I will be grateful if the Ophthalmological Societies of various states contribute to this Fund. The various areas in the building will be named after the donors. Madras Ophthalmological Society has always been a leader and I hope they will be able to contribute atleast Rs. One lakh towards this project as first installment. We plan to build deluxe rooms where any member can slay while in Delhi. These rooms can be named after individuals who donate Rs. 50,000/-.
Friends I am greatful to you for giving me a patient hearing. I hope with your co-operation and guidance, we will be able to achieve our goals. Let us rededicate ourselves to the cause of .preventions of blindness and promotion of eye health.
(Presidential Address, 47th AIOC, Madras, 1989)
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