Blindness
Each year an additional 1.8 to 2.2 million people are blinded by cataract. Indian ophthalmologists, with the assistance of non–governmental organizations like the World Bank, perform about 2 million cataract operations annually. The numbers are impressive, but it will be virtually impossible to eliminate the backlog if the number of annual surgeries does not increase. There is an estimated backlog of 22 million cataract patients in India, though not all these patients are blind.

Not all Indian ophthalmologists perform surgery, but according to several physicians interviewed for this article, intracapsular cataract extraction (ICCE) remains the most common cataract removal technique among those who do. It is used in about 60% of cases. Manual extracapsular cataract extraction (ECCE) with phacoemulsification is preferred, but because of the costs associated with the equipment and the availability of IOLs and surgical microscopes, ICCE remains standard.

Glaucoma is also a major problem in India. A study slated to appear in the Indian Journal of Ophthalmology found that the prevalence of all types of glaucoma in people between ages 30 and 60 is about 3.0%. Unlike the West, most glaucoma is a result of chronic angle closure (5:1 compared with open angle glaucoma). Another study suggests that glaucoma accounts for 13% of blindness in patients over age 30.

Corneal blindness accounts for 3% of blindness, and refractive errors account for 7%. Several physicians commented that ocular trauma in children is a persistent problem in India. The chances of a child sustaining serious trauma to the eye are more than the chances of contracting poliomyelitis during an epidemic.

Refractive Surgery
As India’s wealthy and middle classes expand, refractive surgery is becoming increasingly popular. In all, there are probably fewer than 10 excimer lasers in India and most are found in the larger cities of the South. Like other Western trends, laser in situ keratomileusis (LASIK) is catching on quickly in India, however, photo refractive keratectomy (PRK) and radial keratotomy which is declining in popularity but still routinely used remain popular.