Correspondence Address:
Gullapalli N Rao
India

Full Text

As the 20th century draws to a close, there is an increasing accent on 'quality.' For those in the field of health care, 'quality of life' has become a major issue. Widespread epidemics of infectious pathologies and increasing incidence of iatrogenic diseases, especially in developing countries, is a reflection of compromise in quality assurance. The contents of this issue of the Journal present the diverse manifestations arising from such a compromise.

Acquired Immunodeficiency Syndrome (AIDS) is a new plague, threatening the very existence of human life. While sexual contact is the commonest form of transmission, poor standards of quality assurance in health care facilities is another important causative factor. Contaminated needles and blood, as well as poor systems of hospital waste disposal are major sources of such dissemination. The existing practices in most of our hospitals and clinics are a cause for concern. A complete overhaul of our health care facilities with institution of rigorous quality assurance measures is a prerequisite if we are to prevent the onslaught of AIDS at an accelerated pace. The review article, "AIDS and its Ocular Complications" by Rao focuses on the devastating effects of HIV infection on the eye and consequent ocular morbidity. Although several anti-retroviral agents are being used in the treatment of HIV infected patients, there is no effective treatment till date.

For the readers of this Journal, nothing is more distressing than the occurrence of a sight-threatening complication from the usage of a drug, which is a product of poor quality control. We are all cognizant of the epidemics of post- cataract surgery endophthalmitis and corneal oedema caused by the use of a noxious pharmacologic agent. To this plethora of complications arising from poor quality control is another set of problems arising from contaminated contact lens solutions. Gopinathan et al in their article on "Sterility and the Disinfection Potential of Indian Contact Lens Solutions" have clearly demonstrated that 'quality assurance' is a rarity confined to a handful of manufacturers of contact lens solutions. Infectious keratitis is a well-known complication of contact lens wear and a host of factors have been incriminated in its causation. For instance, contaminated contact lens care solutions can compound the problem by several folds. This behooves contact lens practitioners to become familiar with the quality of products to minimize the risk of complications.

Quality control in eye banking is another neglected area. Though there are over 100 eye banks spanning across the country, very few of them follow the aseptic measures in eye banking procedures. The article, "Donor Rim Contamination by Gentamicin-Resistance Organisms" clearly illustrates the bacterial load on donor corneas and the direct correlation between the quality of eye banking procedures and donor eye contamination. It is becoming increasingly evident that use of contaminated donor corneas increases the risk of postkeratoplasty endophthalmitis.

It is the responsibility of the physician 'to do no harm' to the patient. In the field of intraocular lens implantation, if the above principle were to be applied, the ophthalmologist should initiate measures to minimize the incidence of complications, such as, pseudophakic corneal oedema. These techniques should be performed only when one is equipped with proper training and infrastructure. This requires not only surgical know-how but also the ability to select appropriate materials to make this procedure successful.

Compromise in quality assurance is often rationalized under the guise of cost containment. On the contrary, quality assurance need not require financial resources but can emanate from right attitudes. Quality assurance should become an integral part of all health care facilities if we are to prevent blindness from AIDS, contact lens solutions, corneal transplantation, or intraocular lens implantation. Each of these is a preventable entity, and the popular adage,` prevention is better than cure," very aptly summarizes the message on the importance of 'quality assurance.