|Year : 1991 | Volume
| Issue : 4 | Page : 147
Cataract surgery in Indian conditions
CBM Ophthalmic Institute, Little Flower Hospital, Angamally-683 572, Kerala, India
S T Fernandez
CBM Ophthalmic Institute, Little Flower Hospital, Angamally-683 572, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Fernandez S T. Cataract surgery in Indian conditions. Indian J Ophthalmol 1991;39:147
The incidence of cataract is still very high in our country and inspite of the excellent work done under the National Programme the backlog still remains high. Though the number of ophthalmologists have gone up and medical facilities have increased, the incidence of cataract has not come down considerably, perhaps because of the longevity of life which has now occured among our population. A concerted effort is required on the part of ophthalmic surgeons to tackle this problem.
Of late in many of our scientific meets, high tech surgery using sophisticated and costly instruments as practiced in the more advanced countries have been highlighted. Though we should strive to keep abreast of the modern developments, we should not forget that our priorities are slightly different from that of the more developed countries.
Cataract surgery as practiced in the Western countries have different indications than ours. Having almost normal visual acuity, the patients still undergo surgery because of the glare they experience while driving in the night. Driving especially in the fast moving traffic, is difficult for these people. In these countries, it is almost impossible to survive without one driving his own vehicle. We cannot blindly copy that indication in our country, in selecting cases.
The same is true as far as out patient cataract surgery is concerned. Due to heavy expenses involved in admission, it has become compulsory to do cataract surgery as an out patient procedure in U.S.A. Patients go back to their houses the same day of the surgery to be followed up frequently till the doctor is satisfied about the post operative condition. Our roads are bad - most of the people have to depend on the public transport system, the atmosphere is dusty - most of the people stay in houses that are not modern and hygienic, and the educational standards of our people are lower. So to blindly follow the western concept in our totally different circumstances is a matter that has to be judged with prudence
To make the surgery safe as an Out Patient procedure and to make the patient rehabilitate early, very sophisticated methods of surgery are undertaken in the more developed countries. The latest method is to do a small incision surgery of 2 or 3 mm. long. In this type of surgery the post-operative results are better and there will be least amount of astigmatism. Capsulorhexis, phaco ex
traction of the lens and foldable silicone lenses are all now introduced for excellent results and early rehabilitation. To undertake such sophisticated surgery, an excellent microscope which roughly cost Rs. 5,00,000.00, a phaco machine which will cost Rs. 10,00,000.00, an A Scan which will be about Rs. 2,00,000.00 and an Yag Laser costing Rs. 6,00,000.00 are essential basic instruments. Over and above these, high cost lenses, expensive Healon or methyl cellulose, and suture materials are all essential
It is obvious that only the reputed institutes in India, having sufficient grant from the government or voluntary agencies can afford to have this set up. Moreover the surgery is time consuming and require the services of an experienced surgeons. It is obvious therefore that only the rich and the privileged few in the society can benefit of such surgeries.
The vast majority still remains in the dark. The intra ocular lenses are here to stay. The high quality of vision resulting from such a surgery must benefit our poor labourers and farm workers, because it will help in the better utilisation of man power. Can we not offer these people a less sophisticated I.O.L. surgery without the use of high cost instruments? Can we not manufacture intra ocular lenses of excellent designs, cheap enough to be affordable for the poor? Can we not adopt simpler procedures which take minimum of time and use less expensive materials to give the benefits of surgery to majority of our people ? Are we not indulging ourselves too much on high tech sophisticated surgeries and exposing our youth to ideas which will be practically useless to our needs? These are some of the questions leaders in our profession have to address themselves to.
We have to find solutions to our problems which are quite different from those of the west.
Warning us about the western cultures influencing our society Mahatma Gandhi said.
"Let us keep our windows and doors wide open. Let the different cultures of the world pass by. But let us be watchful so that they do not carry us away from our own".
Perhaps these words are relevant in our scientific field as well