In the discussions related to eye care in India and other developing countries, quality of eye care has become an important issue in recent times. However, when one observes the systems of eye care delivery, questions arise about the definition of "quality eye care." "Quality" is often mistakenly linked with "high-cost" modalities. While expensive, sophisticated technological tools undoubtedly add to the quality of eye care, equally critical are many inexpensive measures to improve the outcome. Let us examine, 'Cataract Surgery' as a case in point.

Surgical implantation of an intraocular lens is often equated with "quality eye care." Although this device has revolutionised cataract surgery, many other factors contribute to its success. These include proper preoperative evaluation, attention to every detail in the operating room including all aspects of asepsis, understanding of the surgical procedure and quality of postoperative care.

In the preoperative evaluation, every cataract patient should be subjected to routine slit-lamp biomicroscopy, applanation tonometry, and dilated fundus examination - a practice not commonly followed at present in most developing countries. Without this approach, identification of both subtle and obvious signs of the disease that are likely to compromise postoperative visual recovery, is difficult. Corneal endothelial distress, elevated intraocular pressure, iris neovascularisation, optic nerve and retinal pathology are some examples that can significantly affect the prognosis. The general feeling that the above mentioned steps in the preoperative evaluation are unnecessary, time-consuming, and expensive is without foundation.

Intraoperatively, even the most potent antibiotic is no equal to asepsis in the operating room. Isolation and disinfection of the operating room, usage of sterile gloves, and segregation of one patient from the next are all inexpensive yet very effective quality control measures. However, most ophthalmologic operating rooms in India do not implement these standards. Our emulation of the developed countries should not be limited to expensive equipment and surgical techniques, but should also extend to less expensive methods of quality control. Postoperative endophthalmitis continues to be a dreaded complication of intraocular surgery, but institution of rigorous quality control measures has significantly reduced the incidence. The review article in the "Current Ophthalmology" section of this issue of the Journal clearly highlights the complexity of treatment once postoperative infection occurs. Prevention is certainly better than cure!

Another critical component of "quality eye care" is the surgical technique itself. In postgraduate ophthalmology courses across the country, the training in cataract surgery is clearly inadequate. The recent introduction of "Training of Trainers Programme" for medical college faculty in States receiving World Bank assistance is an excellent strategy to not only enhance the skills of our ophthalmology teachers but also to have an impact on the education of future generations of ophthalmologists. As of now, the response to this is very discouraging. The failure of such programmes does not augur well for the future of postgraduate education in ophthalmology.

Postoperative care includes both routine regimen and prompt attention to complications. Successful surgical outcome depends as much on quality of postoperative care as on surgical dexterity. The diagnostic methodology used herein is as in preoperative evaluation, namely, slit-lamp biomicroscopy, applanation tonometry, and assessment of the posterior segment. Early recognition of any postoperative problem is possible only through these methods, as delay in the diagnosis will contribute to increased postoperative ocular morbidity.

Eye centres with optimal infrastructure should take the lead in promoting the concept of quality in every sphere of eye care. Cost containment should not be at the price of sight preservation. The treatment of postoperative endophthalmitis, for example, is far more expensive than the cost of scores of sterile gloves. "Quality eye care" is available and affordable and, wherever demanded, can be made accessible.