Model

for Eradication of
avoidable blindness through
skilling & Empowerment
Innovative approach for India

(c) 2016 Yogesh Kothari.

WHO Statistics
Total 280 mln people are visually impaired in world, out of it 39
million are blind
India is a home of 20% of total 39 million blind people in the world
43% of visual impairment is because of uncorrected refractive errors
33% due to unoperated cataract
Approximately 90% of people live in developing countries (and are at
risk of getting blind)
150 mln people suffer from poor vision (globally 2.3 billion) and
simple eye test and pair of glasses can save them from being blind
The root cause is non-availability of basic eye care to these people
(c) 2016 Yogesh Kothari.

Economic burden

Cumulative GDP impact 2010 to 2020 = $ 162 billion

India bears 20% of the burden of world blindness and impaired vision. Eliminating this scourge could enable over 90
million people to escape disability and poverty, and save tens of billions of dollars.

Global : Global Cost of Blindness and Visual Impairment

The total global cost of vision loss was estimated at around $3 trillion in 2010 for the 733 million people living with low
vision and blindness worldwide.
Source:http://www.bosch-eyecare.com/

(c) 2016 Yogesh Kothari.

Vision care HR gaps

15000 Ophthalmologists
4 yrs trained optometrist: 9000
2 years trained optometrist: 40000 approx.
Opticians: 80000 to 90000
According to WHO guideline of 1:10000, India will have continuous
shortfall of more than 70000 trained optometrists India's shortfall is
currently appears to be offset by 90000 Opticians
Source: Vision for India Report by IVI, Vision 2020

(c) 2016 Yogesh Kothari.

What various report says...

India doesn't need more doctors but empowered paramedics ( NIAHS
report 2009)
the opinion of 72 experts in the country over 40 years there is no
need to increase the number of doctors but instead improve the
quality and orientation of service provision towards better meeting
the health needs of the people and that, there is a dire need to focus
on increasing the quantum and quality of human resources for
nursing and paramedical/allied health services. ( NIAHS report 2009)

(c) 2016 Yogesh Kothari.

How people receive vision care?

76% people seeking eye care typically go directly to retail optician for
their vision care needs
Only 5% of market is served by organized optical retail (majority
based in Tire I and metro cities)
95% of market is served by unorganized/ standalone optical stores.
The eye care sector consist of: 10000 specialty centers: manned by
ophthalmologists and 90000 optical shops: manned by semi or
untrained opticians.
Source: Vision for India Report by IVI, Vision 2020

(c) 2016 Yogesh Kothari.

Why huge prevalence and risk of unnecessary

blindness?
To treat any condition, first step is detection
The rate of detection is directly proportional to rate of treatment and cure
Currently due to lack of trained manpower the rate of detection of refractive
errors is minuscule and thus risk of having more blind people is enormous.
India urgently needs large number of people trained to detect and treat refractive
errors and who are trained to refer patient who's vision doesn't improve with full
correction of refractive error to Optometrist or Ophthalmologist for further
investigation and treatment.
Many Optometrists/ Ophthalmologists join corporate and private hospitals due to
better career opportunities and this further enhances scarcity of skilled eye care
professionals where they are actually needed.
As number of Optometrists and Ophthalmologists is very small, they cannot reach
regularly in smaller cities, towns and villages where real intervention is needed.
(c) 2016 Yogesh Kothari.

Current roles and functions, training duration and service location

Professional

Current role

Core /expected role/

focus

Training duration

Current numbers

Geo. concentration

Ophthalmologist

Vision, refraction,
comprehensive eye
exam, spectacle
prescription, medicine,
surgery

Comprehensive clinical
exam, medication and
surgery

Min. 8 years of medical

education

15000

Big Cities, district places

Optometrist

Vision, refraction,
spectacle making ,
assisting doctor

Comprehensive eye check

up includes vision,
refraction, slit lamp,
cornea, retina, glaucoma,
low vision, orthoptics
(squint treatments),
pediatric and geriatric
optometry, handling
various tests, assist
doctors

4 years

9000

Mostly in Cities,
corporate jobs

Ophthalmic
technician/vision
technician/refractionis
t

Assisting
ophthalms/optoms, eye
camps, vision taking
refraction

Assisting optometrists
and ophthalmologists in
various procedures

2 year after 10th/12th

40000

Cities, tehsils/rural in case

of job at PHCs,
government service

Optician

Vision, eye testing for

spectacle number,
spectacle dispensing

Currently not considered

in any formal role

10th and above, learns

through apprenticeship,
informal training

90000

Virtually everywhere:
villages, tehsils, districts,
remote areas

(c) 2016 Yogesh Kothari.

Role analysis: Conflict and overlap

If we observe roles, we notice that vision taking and refraction (eye testing for
spectacle numbers) is common in all levels.
This procedure is done at every level
Thus if patient is referred, he undergoes same process min. 4 times to derive at
same conclusion.
This is sheer waste of costly skills.
If we add cost to create one ophthalmologist/optometrist who practically does
everything that ophthalmic technician/optician do as basic procedure, is a huge
degradation of role.
Thus creates deficient in manpower
Majority of Ophthalmologists and Optometrist are based at big cities.
Optometrists practically does the work of Optician as he works in corporate retail
chains or starts his optical shop.
(c) 2016 Yogesh Kothari.

The conflict of roles

The current system degrades the role of Ophthalmologist and
Optometrists
As they perform duties that could be performed by Optician or
Ophthalmic technician.
As described vision testing and refraction is Detection tool at first
stage of patient checking and that is commonly used by
Ophthalmologist to Optician
This is sheer waste of highly trained, skilled and costly manpower
This conflict creates bottleneck and turf war (in context to process
and role) among professionals.
(c) 2016 Yogesh Kothari.

Solution
Creating new manpower: costly and time consuming
Upskilling existing manpower: cheap and quick
We need to up-skill and empower existing manpower to perform basic
detection and treatment of refractive errors parallelly with highly trained
Ophthalmologists and Optometrists.
Make eye testing for correction of refractive errors and prescribing
refractive error correction as a basic and common skill that can be
performed by any level of eye care professional independently
Encourage Optometrists to perform higher level of skills in diagnosis and
treatment
Encourage Ophthalmologists to focus on surgical and medical skills
Removal of regulatory bottlenecks
(c) 2016 Yogesh Kothari.

Referral
Institutions
Skill levels
Specialist
Medical
and
surgical

Higher level of
intervention/
treatment

Ophthalmologists

Optometrist
Diagnostics and treatment

Ophthalmic technician at PHC level

Detection,
treatment and
referral

Optician

Detection &
Treatment
(c) 2016 Yogesh Kothari.

Benefits of Model
Clear demarcation of job role
Save wastage and degradation of higher level professional skills
Better skill utilization according to educational level and clinical skill of Optometrist and
Ophthalmologists.
Empower already existing Optician to perform and treat refractive errors through optical
correction ( who traditionally performs the same task)
Thus immediate availability of 90000 people capable of detection and referral.
Reduced burden on higher level services: Ophthalmologists, Optometrists, Pvt. and Government
hospitals.
Every level will treat as per its skill, competence and training thus filtered cases go up the skill
level and helps in better patient attention and treatment.
Save cost for the patient, timely detection of condition, timely treatment
Huge social impact: as avoidable blindness could be detected and treated faster
Economic benefits: due to saved costs and improved services
(c) 2016 Yogesh Kothari.

Why this model will work?

Self interest and opportunity to grow

Improved Social standing (as mentioned in NIAHS 2009 report)
Every level will get its due respect and recognition as they will practice at there level of skill.
Will drastically reduce burden on healthcare system as filtered cases will reach optometrist from
opticians and assistants and further filtered cases will reach Ophthalmologists and Specialists
Optometrists and Ophthalmologists can focus and practice their core skill areas thus patient
satisfaction and clinical results will improve.
They can devote more quality time in assessing, understanding and treating patients
This will help in huge improvement in patient care and patient satisfaction and finally convert into
better financial or other awards.
Healthcare system will work seamlessly and more patients will receive treatment as rate of
detection will increase.
The model by demarking the roles and making eye testing common will resolve ongoing conflicts
between various groups: ophthalmologist, optometrists, ophthalmic technicians etc.
(c) 2016 Yogesh Kothari.

How this model will work?

Factors for success:

Government policy for upskilling and empowerment
Policy: making eye testing and refraction as basic and compulsory skill for all levels.
Permission for all levels of eye care to perform this skill independently in order to make more
detection and referral cases
Implementation of policy through NSDC and HSSC
Registration and monitoring framework (eg. Regular daily online reporting of cases in simple
form)
Registration mechanism for Opticians at District headquarters or Central skill register
Separate registration for Optician and Optometrists to avoid overlap of role and conflict
Regulation to make sure to stop degradation of higher level of skill by working at lower level or
practicing lower level skill
Thus to ensure the education and skill level acquired by person is utilized for the same purpose.

(c) 2016 Yogesh Kothari.

Single factor that will make or break the

model
Regulatory will to make eye care sector streamlined by ignoring all
other vested factors
Strong will and regulations to implement the model
Successful management of vested interest groups, professional
groups and other factors by strict and Foot Down approach

(c) 2016 Yogesh Kothari.

Copyright information
The concepts, ideas and model presented here is a property of Mr.
Yogesh Kothari. Unauthorized use, copying and circulation is strictly
prohibited.
The presentation can be used by the authorized recipient for the
purpose it was sent.

(c) 2016 Yogesh Kothari.