Despite the very real threat of blindness, both government and private efforts to reach and convince cataract patients to avail of a one-time surgical solution have met with limited success in India. A concerned Mr. Oculus examines why…

Ancient Indian scriptures say the Brahmastra is the ultimate weapon to destroy the obstacle/enemy forces in one’s path. Down the ages, the word has emerged as a synonym for an unfailing solution to a persistent problem. Since we are focusing on cataracts- a condition caused due to the clouding of the eye lens due to ageing, genetics or trauma-I, Mr. Oculus, would not hesitate to cite surgery as not just the Brahmastra or the ultimate weapon, but indeed the only real solution to the multiple scourges of foggy and fading vision and impaired vision which are a fall-out of cataracts or motibindu.

Unlike the Brahmastra though, that causes great collateral damage when deployed, in this case collateral damage occurs when the surgery isn’t performed. In short, you can lose your ability to see properly, read, drive or appreciate the beauty and colour all around you as your vision fades.

The magnitude of the problem

To repeat the figures cited in my other blog, the National Blindness and Visual Impairment Survey India (2015-19) conducted by the Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, names cataracts as the number one cause of blindness for those above 50 years. The breakup of the figures explains further: Cataract is responsible for 66.2 per cent of total blindness, 80.7 per cent severe visual impairment and 70.2 per cent moderate impairment in just this age group.

When it comes to kids, cataract impacts 15 out of every 10, 000 babies in India. The causes of childhood cataract range from congenital and development issues to infections during pregnancy. Of the 3 lakh plus visually impaired kids, childhood cataract is the cause in over 14 per cent of the cases.

And we are not done counting the losses yet! Apart from the physical handicap of it, untreated cataracts can lead to social isolation, depression and familial stress. To say nothing of severely hampering one’s chances of earning a living. With so much at stake, you’d think the public would eagerly embrace surgery in large numbers. Yet sadly that is not the case. Lack of awareness and access to surgery is just part of the problem. A real fear of surgery and the myths surrounding it are another. The other issues are economic.


Analysing the complexity of the decision-making process

While study after study has explained and examined the close link between poverty and blindness, lack of information, access or transportation, gender discrimination between males and females and cost, a recent study conducted in Hyderabad, Andhra Pradesh explains why services offered through outreach screening are not taken up in the numbers that it should. It became imperative, therefore, to understand the decision-making process leading to either the patient’s yes or no to free or subsidized surgery services during screening camps. As many as 61 cataract patients from two eye hospitals in Hyderabad were interviewed using the method of convenience samplings. Two focus groups discussions with cataract patients and interviews with seven key informants helped analyse the information.

It was found that lack of money or access to personal money (as in the case of women) delayed the utilization of services. Other major barriers were the false sense of fatalism (“Kya karein? bhagwan ki marzi”) or ageism (“Umar ho gayi hai..to operation karane ka kya fayda”) and rumours associated with the negative outcome of surgery. Women, especially widows from remote areas, were not likely to bother with operation.

Thus, the study concluded that merely ensuring affordable eye care or making it easily accessible will not automatically increase the number of takers. Apart from this, dependence on the opinion of elder/more dominating family members, was a major factor that contributed to patients’ decisions. In other words, negativity from the family would directly change the patient’s decision to go in for the surgery. Finally, in the days to come, research needs to focus on underserved, marginalised or disempowered groups.


Losing out on income

Besides this, extensive counselling which is both compassionate and practical, will go a long way in assuring a poor patient that it is alright to lose out on a few day’s income and even pay a relative to do the house-work while they are recovering-because in the long-run, they will be able to earn far more and eventually make up for the loss and inconvenience of taking time off for this very critical surgery.


Not an act of God, but man

Also, please note, cataract surgery is a simple, largely painless and safe procedure with a whopping 98 per cent success rate, so please ignore the rumours surrounding it. The word ‘surgery’ does not translate to pain or inconvenience when it comes to cataract, so banish the fear please and listen to your ophthalmic surgeon!

When a person continues to wilfully choose blindness/impaired vision despite the availability of a permanent solution, it is a choice you have made for yourself-do not blame your fate or even God!

I urge you to get Cataract surgery before it is too late. Please do note, when left untreated for a long time, they can become “hyper-mature” a condition that makes it difficult to remove them and complicates the surgery, apart from lengthening the recovery time.

All this..for what ? To repeat the analogy of the Brahmastra, I would say the  timing of the surgery, the ultimate weapon against cataracts, is as important as the decision to go for it in the first place.

To hit a blind spot or to reach for the light-it’s over to you, dear wise reader!