The Deepening Divide: Disparities Between Ophthalmological Discovery and Delivery

SHRAVAN SAVANT

corrective lens
Photo by PH3 Christian Weibull, “Geraet beim Optiker” via Wikimedia Commons, Creative Commons Attribution.

A year ago I traveled to rural Chennai, India to serve as an ophthalmic volunteer. Blindness and low vision were rampant. Children struggling to read the board during school screenings had no easy access to glasses, like the kind I’d had as a kid. The elderly were plagued with cataracts that could be treated swiftly in the US. This experience convinced me that blindness is not simply a disease in need of a cure. Cures exist—just not for the residents of underprivileged communities like Chennai.

Understanding the Divide 

Balancing the competing priorities of scientific research and medical impact requires a panoramic perspective. The goal for researchers in the medical sciences is to explore the frontiers of innovation. Medical practitioners view discovery in a more pragmatic sense: how can these life-changing innovations be made available in a clinical setting?

There is an understandable delay between discovering new medical solutions in the lab and applying them in the clinic; what is newly discovered is subject to further testing, approvals, and trials before it can be introduced into hospitals worldwide. It takes an average of thirteen years for a drug to go from preclinical research to patient use.1 But even with this in mind, the divide that plagues ophthalmology today is not excusable by the norms of regulatory protocol.

Blindness by the Numbers 

According to the 2013 fact sheet released by the World Health Organization, of the 285 million people globally that suffer from visual impairment, 39 million people are blind, while another 246 million people suffer from moderate to severe vision loss. The same source indicates that 90% of people who are afflicted with visual impairment globally live in low- and middle-income countries. The first requirement, then, for a possible cure for blindness is that it be accessible in the most basic of infrastructure and resources with little to no financial dependency.

The second requirement for a solution to visual impairment stems from the causes of blindness. Patients with age-related cataracts account for 51% of the global blind population.2 Cataract is a clouding of the lens within the eye that occludes light from properly entering the eye and hitting the cornea, impairing vision.2 Untreated, the cataract may continue to mature until it blocks any light from entering the eye, inducing total blindness in the afflicted eye.3 The majority of those with moderate to severe visual impairment suffer from uncorrected refractive error. Uncorrected refractive error accounts for 43% of all visual impairment.4 Such refractive error manifests itself in conditions such as near-sightedness, far-sightedness or astigmatism.5

Rather than looking to push the boundaries of the undiscovered, researchers should analyze the environment and the demographic that they hope to affect.”

Based on these statistics, it is clear that the solution to blindness on the global scale will require tackling the two major ophthalmologic conditions, cataracts and uncorrected refractive error. Treatments to both of these conditions have already been discovered. Cataract removal surgery has evolved into a minimally invasive procedure with short recovery time with the advent of phacoemulsification, which uses ultrasound waves to break up the lens that is covered by the matured cataract.3 Refractive error is just the fancy name for the conditions of sightedness that glasses can fix. As many as 80% of visual impairment cases worldwide are preventable.4

Around the world, medical solutions to blindness are not limited by physiological incompatibility but by major barriers to healthcare delivery, such as affordability and the accessibility of ophthalmologic expertise. According to a 2007 study by Parikshit Gogate and Madan Deshpande of H.V. Desai Hospital and Praveen K. Nirmalan of the L. V. Prasad Eye Institute in India, the average cost of phacoemulsification per patient in India is well over double that of cheaper alternatives, such as manual small incision cataract surgery.6 But even those cheaper alternatives require hospitals, materials, and medical staff not always available in rural parts of the world. What will it take to bring these costs down? What will it take to bring the expertise of an ophthalmologist and optometrist into these developing areas? And more importantly, what will it take to bring sufficient medical infrastructure into these areas to deliver high-quality care? These economic questions remain unanswered, even as medical advances proceed.

The True Problem 

Access to basic ophthalmologic care is the true problem when it comes to curing blindness. What is the impact of the cutting-edge research carried out in laboratories across the world when solutions as simple as glasses and cataract surgeries have barely ameliorated the problems they were created to solve? This situation demonstrates that when it comes to medical advances, the lack of access to even the most basic of medical protocols or services is what truly sets the boundaries of scientific progress.

A fundamental shift must take place in the mindset of medical research when faced with a problem like blindness. Rather than looking to push the boundaries of the undiscovered, researchers should analyze the environment and the demographic that they hope to affect. The aim must be to overcome the limitations that globally stifle the impact of their research. The biggest medical innovations in the future will not only be the ones that redefine medical understanding, but also those that democratize access to crucial medical developments.

 Works Cited

  1. “FDA Drug Development Timeline Infographic.” Polycystic Kidney Disease Foundation, n.p., n.d. 25 June Web. 24 June 2014.
  2. “Priority Eye Diseases: Cataract.” World Health Organization. n.p. Updated October 2013. Web. 16 June 2014.
  3. Jacobs, Deborah. “Cataract in Adults.” Ed. Jonathan Trobe and Lee Park. UpToDate. Ed. Post TW. Updated 3 June 2014. Web. 22 June 2014.
  4. “Visual Impairment and Blindness.” World Health Organization. n.p. Updated October 2013. Web. 16 June 2014.
  5. What is a refractive error?” World Health Organization. n.p. 7 October 2013. Web. 16 June 2014.
  6. Gogate, P., M. Deshpande, and P. Nirmalan. “Why do phacoemulsification? Manual small-incision cataract surgery is almost as effective, but less expensive.” Ophthalmology, 114.5 (2007): 965-968.

Shravan Savant is a Brevia staff writer from the BS/MD Accelerated Degree program at Drexel University. He can be reached at shravsav@gmail.com.