New Delhi
If we must define India in one word, that word would be ‘diversity’. Like food, clothes, appearance, languages, cultures and traditions, optometry is no exception. Historically, the education levels, terminology, and scope of optometry practice in India have been diverse. Indian optometry makes an interesting case study and this article will shine a light on its current status.
Qualification process
To be an optometry graduate, individuals need to complete four years of university training following their high school education. There are some institutions that also offer a diploma in optometry, which is typically of two to three years duration.
Until 2021, there was no regulation for the profession of optometry, but in 2021 the National Commission for Allied and Healthcare professional act was passed.1 India is now going through a phase where state councils are being formed and optometrists will have to register. Soon there will be a common exit exam for all optometry graduates.
Currently, recommendations have also been given to the Ministry of Health and Family Welfare, India, for the optometry undergraduate course to be moved to five years instead of four. In the future, such a move will help increase clinical exposure and training and also pave the way for minimal therapeutic usage.
The recommendation of moving the undergraduate course into a five-year course is under discussion and expected to be finalised soon.
Work
Once optometrists graduate, they have many options available such as pursuing a post-graduate course, academia, owning and running their own practice or working under an optical retail chain, working in corporate optometry and/or as part of an eye hospital.
Once an optometrist gains experience there are also many NGOs such as Sight Savers and Mission For Vision that employ optometrists as project managers and in higher strategic decision-making positions as well. Most new graduates tend to work in hospitals and optical chains.
Given the varied level of optometry education and scope of practice in the country, it is not surprising that precise information about the services offered by optometrists is not available readily. In 2015, a survey-based study, which included responses of over 560 optometrists with a B optometry qualification provided some useful information on the practice pattern of these optometrists in India.
The top three modes of practice were hospital-based practice (44.8%), academia (42.8%), and optical retail (33.0%). Those involved in patient care provided refraction and routine eye examination (98.4%), contact lenses (70.3%), and optical dispensing (66.9%) as their top three services.
Mumbai
Relatively lower involvement was found in providing binocular-vision (45.1%) and low-vision services (30.2%) which are among the core optometric services.2 The work profile of an optometrist who works in optical chains is to perform a comprehensive eye exam (if the chain allows and is equipped with a slit lamp biomicroscope), and prescribe spectacles as well as contact lenses.
In a hospital setting, the optometrist gets exposed to various departments of the hospital, such as low vision, binocular vision, glaucoma, retina and anterior segment, etc. The optometrist performs comprehensive eye examinations, post operative work-up, and dispenses contact lenses including speciality lenses.
After graduation, many optometrists prefer to work in hospitals in order to expand their knowledge on patient care and gain expertise in managing ocular conditions.
Can UK qualified optometrists practice in India?
As of 2021, optometry graduates from the UK could practice in India, as there were no regulations in place. With the implementation of the NCAHP act 2021, however, optometrists who have graduated from outside India will soon be required to sit a written exam to practice in India. As of now, these new rules have not been implemented, but will be in the near future.
Arrangements may be based on mutual agreement with specific countries. For example: if Indian optometrists are allowed to sit an exam in order to practice in UK, similarly UK optometrists will be requested to sit an exam before they are allowed to practice in India. However, the above is speculation based on the NCAHP act 2021. Once the act is implemented, there will be more clarity on the above.
Challenges
Currently India is the most populous country in the world, and healthcare is one of the major focus areas. In eye care, cataract is a key concern.3 However, organisations like Vision 2020 India, have been providing healthcare solutions for the cause. Diabetes mellitus is on the rise and its effects on the eye, such as diabetic retinopathy are also of great concern.
India’s size and diversity means different population groups are exposed to different environmental risk factors; for example, different risks between those living in rural versus urbanised areas. It was found that the risk factor associated with cataract in rural India was HBA1c unlike in urban India where age and lower socio-economic status were the risk factors.3
A further consideration may be the range of climates to which different population groups are exposed, from Northern Himalayan snow through to arid and tropical regions in the South – each environment presenting a different eye care challenge.
Among paediatric age groups, as in the other parts of the world, myopia has drawn a great deal of attention. There have been publications indicating increases in refractive error post Covid-19.4 Various advocacy measures have been undertaken such as awareness films,5,6 and a white paper on myopia.7
Annual comprehensive eye examinations have not been made compulsory within the Indian public healthcare system, doing so could prevent delays in detection of eye conditions. Recently, however, a national health insurance scheme has been launched through the government (‘Ayushman Bharat’), through which eye care will be more widely available to all.8
Positives
In India there are two models of optometry undergraduate institutes. The first is where the optometry school is associated within an eye hospital. The other model is where a large University runs the school and for clinical exposure the students are sent to various local hospitals for externships.
Clinically, optometrists receive a great deal of exposure to patients as India has a large population. The eye conditions seen by optometrists are varied, which helps provide optometrists with more confidence in diagnosis. They become proficient in both anterior and posterior segment disease.
Optometrists are also exposed to many industry-organised education programs and local conferences during their undergraduate years. Previously, many foreign universities used to send their students to Indian hospitals for internships and observation as a way for students to gain increased exposure to various clinical cases.
Way forward
With the number of universities offering optometry courses growing every year, the challenge is to provide them with good faculties. A well trained optometry faculty is a challenge and so is the infrastructure in a few of these institutions. Indian optometry is at a critical juncture where, after years of consistent efforts from some independent optometrists and associations, the government is finally taking cognisance of this profession.
The optometrists in India will need to start focusing on their core competencies such as contact lenses, binocular vision, and low vision. With the prevalence of myopia expected to grow rapidly, optometrists have an opportunity to play a major role in offering myopia management/control strategies.
There are many reasons to be optimistic. There seems to be an ever-growing interest in myopia management, specialty contact lenses and binocular vision. Most education programs and conferences include dedicated sessions on these themes. As many of the institutions offer a Master’s program, the new generation of optometrists is keen to engage in optometric research.
The implementation of the national healthcare professional act is the shot in the arm that optometry needs. A regulated, legislated, profession, which was like a distant dream, seems to now be within touching distance.
- Nilesh Thite is currently working as the executive manager of educational programs at the International Association of Contact Lens Educators (IACLE). He is a consultant to Bausch + Lomb, India and also a director and co-founder of a unique educational initiative – Masterclass Optometry.
- Lakshmi Shinde is a graduate of the Elite school of optometry and holds an MSc from the university of New South Wales, Australia. She is a practicing optometrist at Shinde eye care centre, specialising in speciality contact lenses, is the executive manager of global educational programs for the International Association of Contact Lens Educators (IACLE), and CEO of Optometry Council of India (OCI) a self regulatory body.
References
- https://main.mohfw.gov.in/?q=newshighlights-46
- ThiteN, Jaggernath J, Chinanayi F et al. Pattern of Optometry Practices and range of optometry services in India. Optom and Vision Sci, 2015, Vol 92, No5.
- Singh, Sumeer, Pardhan, Shahina, Kulothungan, Vaitheeswaran et al. The prevalence and risk factors for cataract in rural and urban India. Indian Journal of Ophthalmology 67(4):p 477-483, April 2019. | DOI: 10.4103/ijo.IJO_1127_17
- Saara K, Swetha S, Subhiksha R, Amirthaa M, Anuradha N. Steep increase in myopia among public school-going children in South India after Covid-19 home confinement. Indian J Ophthalmol. 2022 Aug;70(8):3040-3044. doi: 10.4103/ijo.IJO_40_22. PMID: 35918969; PMCID: PMC9672782.
- https://www.youtube.com/watch?v=YvWJ4GxvCho
- https://www.youtube.com/watch?v=liEG9dle84k&t=58s
- https://cdn.optometrycouncilofindia.org/files/news-docs/iDwMU.pdf
- Narayanan R, Das A, Prinja S, Sharma N. Ophthalmology in Ayushman Bharat. IHOPE J Ophthalmol 2023;2:29-30.