By Zeena Johar, President – ICTPH
We had the opportunity of visiting L V Prasad Eye Institute (LVPEI) on April 12th, 2011. Our opening meeting with Dr. G N Rao (Founder, LVPEI) was the perfect introduction to their ecosystem, allowing us an opportunity to comprehend Dr. Rao’s vision of establishing a Centre of Ophthalmic Excellence that guided his return to India in 1986, after a successful career in the United States as an academic ophthalmologist.
….And indeed his vision is now a reality, for almost over a million lives that are touched annually through their pyramidal ophthalmic healthcare delivery network.
The Centre of Excellence (CoE) in Hyderabad is equipped with state-of-the-art ophthalmic facilities ranging from paediatric ophthalmology, ocular oncology, corneal transplantation, cataract advances, glaucoma and retinopathy management to multiple other surgical and non-surgical interventions. A cross-subsidisation model is also seen in action as the free green-folder patients are guided through the same care-pathway as the blue-folder paid patients.
Apart from the CoE in Hyderabad the LVPEI System is now a network that spans two tertiary centres in Bhubaneswar and Visakhapatnam, 17 secondary and 63 primary care (vision) centres covering the remotest rural areas in the state of Andhra Pradesh, India.
In our conversation with Dr. Rao, he spoke about the role that the Andhra Pradesh Eye Disease Study (APEDS) conducted by LVPEI between 1996 and 2000 played in ascertaining that 60.3% of blindness and 85.7% of moderate visual impairment burden was attributable to cataract and refractive error alone. The APEDS revealed that uncorrected refractive error was one of the most common causes of visual impairment and second leading cause of treatable blindness. APEDS laid the foundation of the pyramidal model of eye-care service delivery, addressing equity and quality within a sustainable framework.
Unlike the CoE and the tertiary care facilities, housing multiple specialists, a secondary care centre is primarily managed by an ophthalmologist overseeing the activities of around 10 vision centres, whereas a vision centre, serving a population of 50,000 people is managed by a locally trained technician. Adapting the health extension worker model to eye-care delivery vision guardians primarily facilitate the task of routine comprehensive screening for eye-related problems, along with screening for disease conditions such as diabetes given eye-related complications. Home based rehabilitation programs are also anchored by these guardians, each one serving a population of 5,000 people.
The human resource challenge, at various levels of their delivery network is dealt through multiple diploma and degree programs offered by LVPEI. In partnership with The University of New South Wales, School of Optometry and Vision Science, Sydney, Australia, LVPEI offers a Master of Community Eye Health (MCEH), and a Graduate Diploma in Community Eye Health (GradDipCEH). Apart from these, multiple other ophthalmic fellowship programs are also offered by the institute.
Of keen interest to us, was the vision technicians’ one year course, offered to candidates who have successfully completed their senior secondary education. Courses like these offer immense potential towards a sustainable and scalable solution for localized ophthalmic care delivery in rural communities, through local ownership and credibility.
As a World Health Organization (WHO) Collaborating Centre for Prevention of Blindness, LVPEI offers comprehensive patient care, sight enhancement and rehabilitation services, and rural eye healthcare programs driven by evidence-based medicine guided by a methodological research driven approach.
A visit to LVPEI indeed was a remarkable experience, reinstating our belief that living a life with a vision beyond oneself, truly makes for a worthy journey!