Mobile Eye Services - Experience of the Christian Medical College and Hospital, Ludhiana, Punjab
Dr. Arin Chatterjee, Chairman, Mobile Eye Services

Present Trends Regarding Eye Camps
In Punjab, it is now increasingly practiced to hold 'in-reach base hospital approach' in the cataract blindness control programme. Periodical screening camps are held and subsequently only the selected patients are admitted in the base hospital for surgery and other specialised treatment. This is because of various factors such as, microsurgeryfor cataract, high standards in aspects of operation room facilities, higher expenditure in outreach surgical camps, better communications and travel facilities available in most areas and availability of near adequate numbers of ophthalmic surgeons in this region. This trend is desirable and is in the right direction. These trends are also helpful irieducating the public to be quality conscious. To achieve this ideal mode of service we need the response from patients in accepting this system.

As there is no blanket policy from the health departments to discontinue surgical eye camps, the various philanthropicgroupscontinue to organise eye operation camps inviting renowned surgeons in this field with standard track records. So. till that time, we feel that eye surgery camps will continue and that the Christian Medical College and Hospital,beinga pioneer in this fieldwith Mobile Eye Services, providing comprehensive eye care with good track records, will also continue to hold surgical eyecamps. These are considered complementary to the existing local surgical facilities.

When surgical eye camps have been organised from our base hospital, once or tWicea year for over a decade,we have repeatedly come across patients with bilateraloperablecataractswithin one km distance of the town. What prevented them from attending one of the existing ophthalmic services of their choice in the town? It is very often the apathy, apprehension. poverty and such other factors which prevented them from coming out of their dark corners.

Patient's Attitude Wbne Attending an Eye Camp
When the surgical eye camps are held in their own area, patients feel comfortable and secure in the company of their own people and friends, in familiar surroundings. They repose their trust in the organising body for restoration of their eyesight.They expect the organisers to invite the right surgical team. Their feeling is - "if others are getting their eyesight restored in the camp surgery, I too should get my eyesight restored". The organisers do play an important part by making the patients comfortable by providing them with food and shelter. These organising bodies are the bridges between the patients and the surgical teams. Even when people have the purchasing power their priority lies elsewhere. They do not want to spend money to buy good eyesight even when this facilityexists within theirreach.This requires awareness and a change of attitude. Change takes time.

With the population explosion of the lower socio-economic groups and overall increase in longevity, age-related' cataract still remains the major cause of blindness, which is 'sight-restorable' blindness. Also there is an ever increasing backlog of age-related cataract.. Nearly 80 percent of our population is rural. As we complete 40 years of Mobile Eye Services, we still find the relevance of holding surgical eye camps in the rural areas. We come across patients with ocular morbidity which is preventable when attended to at an early stage. We notice that the existing facilities are not utilised by the patients. Through the Mobile Eye Services eye camp, referral services provide not only for patients with eye diseases but also for patients requiring treatment in other disciplines of medicine.(Ref.statistics in Table 1 and Figure 1)

Table 1
Pre-op visual acuity in the better eye of 27946 patients who underwent cataract surgery : 1988 - 1997.
Visual Acuity No. of Patients %  
6/6 - 6/18 4364 15.6 Normal
<6/18 - 6/60 8281 29.6 Visual Impairment (VI)
<6/60 - 3/60 3687 13.2 Severe Visual Impairment (VI)
<3/60 - N.P.L 11614 41.6 Blind (BL)
Total 27946 100.0  

Pre-op visual acuity in the better eye on 4 th post-op day with +9 D.Sph to 11 D.Sph in 27946 patients after cataract surgery : 1988 - 1997.
Visual Acuity
(Better Eye)
No. of Patients %  
6/6 - 6/18 10146 36.3 Normal
<6/18 - 6/60 15823 56.6 Visual Impairment (VI)
<6/60 - 3/60 955 3.4 Severe Visual Impairment (VI)
<3/60 - N.P.L 1022 3.7 Blind (BL)
Total 27946 100.0  

Why ECCE-IOL-PC in Eye Camps
As we have mentioned in previous years' reports the extra -capsular cataract extraction(ECCE)with intraocular lens implantation in the posterior chamber (PC) of the eye is the cataract surgery of today.Increasingly,intracapsular cataract surgery (ICCE) with aphakic glasses correction is considered out dated surgery. It is rightly said that in eyesight restoration cataract surgery alone is not enough. It needs cataract surgery plus proper refractive correction. For patients having surgery in the eye camps these are seldom available. Even +1O DS given to the patients are not only inadequate for most of them for quality vision, but, in course of time, become scratched, distorted and damaged defeating their very purpose. The facilities for their replacement are readily available. So why not "place the glasses within the eyes during the operations" that is the demand of most of the eye camp patients, and thus they would not need to look after their aphakic spectacles. Once we all agree ECCEwith IOL-PC is the surgery for cataract today, the patient, rich or poor, have the right to enjoy the benefit, irrespective of whether they have been operated upon in a base hospital or in an eye camp. Once the barriers are identified and removed it is hoped that all patients will have this modem remedy. We hope all cataract patients will get ECCE-IOL-PC by the 21st century.

Medical Education
It has been mentioned that "each time you perform cataract surgery,you restore the eyesight of one person. But if you teach quality cataract surgery to your fellow eye surgeons you will restore eye sight to millions". Keeping this in mind we at the Christian Medical College and Hospital, Ludhiana are multiplying our hands with a philosophy to "reach the unreached", adopting appropriate technology for the developing countries. Undergraduate medical studentsand post graduate trainees preparing for the DOMS and MS (Ophthalmology) get ample opportunity to observe ophthalmic morbidity in rural settings and participate in treatment programmes during their visits to the Mobile Eye Services eye camps.

Public Education on Eye Health care and Awareness
Eye camps set up with patients and their attendants provide ideal situations to discuss eye health care. During the primary school students eye screening programme similar talks aroused much interest among the students and the teachers. We hope with increasing awareness that the available ophthalmic facilities will no more remain underutilised in the future and that the people will be hospital-,minded to seek treatment at the earliest stage of an eye problem.

Eye Screening Programme among Primary School Students
One of the activities that the mobile unit is engaged is to Screen School Children for refractive errors. To find out visual and eye problems at an early stage, the school students' eye screening programme, especially among the primary school students in the age group offour to thirteen years, was conducted in five schools. Out of 2950 students examined,2154had defectivevisionand / or other eye problems.

Guidance to the Incurable Blind
The incurable blind identified in the rural areas during eye camps conductedby the Mobile Eye Services are referred to the Vocational Rehabilitation Training Centre for the BJ.ind(VRTC). This is a sister institution in Ludhiana,where they receive vocational guidance and training to develop self-confidenceunder the able guidance of the Director, Dr. Edward M Johnson. Thereby, they learn to live with dignity. Professor Dr. Arin Chatterjee, Chairman of the VRTCsince 1983,takes up the responsibility of examining the incurable blind ITomthe eye camp clinics before referring them to VRTC.