A young man came to the emergency department of a city hospital with no vision in both eyes due to perforated eyeballs resulting from a car accident. A CT scan was done followed by microsurgery, to remove glass splinters and other foreign particles from the eyes. Two weeks after this, the ophthalmologist operated on the patient to remove the traumatic cataract, a natural consequence of such accidents. The opaque lenses of the damaged eyes were replaced with intra-ocular lens implants. At the end of a month, following the operation, the patient’s vision was restored completely.
An “ophthalmologist in India acts as both general physician and surgeon,” says Dr Parul Sharma, a senior eye surgeon heading the ophthalmology unit of Max Hospital, Gurgaon, who treated the young man mentioned in the case study. Sharma had primarily wanted to be a surgeon and zeroed in on ophthalmology “as it is very satisfying professionally, and takes lesser time to self-train as compared to other superspecialised surgical branches.”
Sharma completed her MBBS from Jawaharlal Nehru Medical College, Aligarh Muslim University, in the year 1993 and MS from the same institution in 1998.
She did her senior residency in Ram Manohar Lohia Hospital, New Delhi, for three years before doing short-term fellowships from Moorfield Eye Hospital,
London, and L V Prasad Eye Institute, Hyderabad. Her field of specialisation is cataract, refractive (freedom from glasses) and glaucoma.
Ophthalmologists examine the eye with special equipment and check visual acuity (the ability to see). If a patient’s visual acuity is less than normal, the ophthalmologist usually does a check to determine whether the decrease in vision can be corrected with glasses. If glasses don’t help the ophthalmologist performs the necessary operation such as removal of cataracts (clouding of the lens of an eye). S/he may perform other types of operation that include surgery to correct strabismus (eye misalignment) or other muscle imbalances of the eye, corneal transplants, and surgery to control glaucoma (increase in fluid in the eye). By examining the retina (back layer of the eye) s/he may discover signs of such diseases as diabetes, AIDS, and certain forms of anaemia that may cause changes in the appearance of the retina.
“Ophthalmology is a growing field with advancing technology, sophisticated equipment and sub and superspecialisation in techniques and healthcare procedures,” says Dr Rajan Malik, medical director, Drishti Eye Laser Centre, New Delhi. And the scope of work of an ophthalmologist in India is enormous. “About 16 million blind persons and more than 60 million visually impaired live in the country, giving ophthalmologists an opportunity to treat the most challenging eye diseases,” says Sharma.
There is, however, a shortage of ophthalmologists in the country. “Nearly 900 ophthalmologists are trained in India every year. At present there are about 14,000 trained ophthalmologists in the country. It has been estimated that India needs 25,000 ophthalmologists by 2020,” says Malik. Agrees Sharma. “The problem is twofold — one, the number of ophthalmologists is low and two, they are not evenly distributed among the urban and rural sectors,” she says.
Dr R Sahai, CMO, Safdarjung Hospital, New Delhi, considers the concentration of ophthalmologists in urban areas as a challenge that needs to be addressed immediately. However, the future of the profession, experts feel, is bright.
What's it about?
Ophthalmology is all about investigation, diagnosis, prevention and treatment — both medical and surgical — of diseases pertaining to the eye. The word ophthalmology comes from the Greek words ophthalmos meaning eye and logos, meaning word, thought or discourse. An ophthalmologist is a physician with special training in the medical and surgical care of the eye and visual system. They study the techniques for the prevention of eye disease and injury
6.30 am: Yoga/ morning walk
8 am: Leave for work
8.30 am to 10am: Operate on patients
10 am to 1 pm: Treat patients in OPD
2 pm to 5 pm: Work varies, depending on requirement — OT /Lasers/meetings/clinical CME etc. Or go home to spend time with daughter
5 pm to 8 pm: Treat patients in OPD
9 pm: Call it a day
At entry level one can expect a monthly salary between Rs 40,000 and Rs 60,000, which can rise to Rs 1 lakh to Rs 2 lakh a month. At a senior level one can expect a monthly salary above Rs 5 lakh a month in a private set-up, and not more than Rs 2 lakh a month in government set-up
. S/he should have an aptitude for surgery
. S/he should have good hand-eye coordination, which is essential in microsurgery
. S/he should be dedicated, calm and ever ready to relate to the patient’s need
How do I get there?
Take up physics, chemistry, biology at the plus-two level. Take the pre-medical entrance examination conducted by the Central and state bodies. Complete MBBS after you have cracked the entrance examination. After completing MBBS and compulsory resident internship, sit for the postgraduate entrance exams at national or state level. There are three-year postgraduate degree (MD, MS) and two-year postgraduate diploma programmes (DO, DOMS). A three-year course, Diplomate of National Board (DNB), is also available at various medical colleges and some private eye institutes through admission
Institutes & urls
. Dr. R P Centre for Ophthalmic Sciences, AIIMS, New Delhi;
. Sankara Nethralaya, Chennai;
. L V Prasad Eye Institute, Hyderabad;
. Aravind Eye Hospital, Madurai;
. Postgraduate Institute of Medical Education and Research, Chandigarh
Pros & cons
A sense of gratification on being a sight restorer
Not too demanding working hours
Not many emergencies (good especially for women as they can maintain a balance managing both home and work)
There are not adequate numbers of institutes in India giving high-end training
Basic postgraduate degree is usually not sufficient to start practising with confidence
Eye care at par with world standards
A senior doctor talks about the opportunities and challenges
Is the quality of eye care one gets in the country up to world standards? If not, why?
Indian eye care is definitely at par with international standards. With the availability of all recent advancements in the fields of medicines and equipment, we are able to provide quality services to our patients. However, lack of uniform spread of infrastructure limits the availability of the very best of care to the masses.
Apart from eye hospitals/hospitals where can an ophthalmologist find employment?
Most of the ophthalmologists are either attached to a medical institution or are self-employed. Apart from these an ophthalmologist may seek employment in a pharmaceutical company dedicated to manufacturing products for eye disorders.
How important is the role of an ophthalmologist in the medical set-up that is there in India?
An ophthalmologist is the caregiver to the population affected by various eye disorders. Different eye disorders are prevalent amongst various age groups, for example congenital eye disorders and tumors in children, refractive errors and squint in the young, and cataract, presbyopia, glaucoma and retinal disorders in elderly people. The eyes are one of the most exposed organs of our body, and an ophthalmologist is also associated with management of patients with eye damage due to trauma and accidents.
The human eye is also commonly affected by various systemic conditions, both genetic and acquired, that affect other parts of the body. The ophthalmologist works hand in hand with the general physician for management of these patients. Prevention of blindness is the most cost-effective public health intervention worldwide.
Are Indians aware of the importance of eye care to the extent it is needed?
Awareness and education play a vital role in the cure of numerous conditions such as glaucoma (a condition that causes silent and gradually progressive blindness), childhood corneal blindness (which can be effectively prevented by adequate dietary intake of vitamin A), retinoblastoma (a potentially lethal eye tumor occurring in children), and many more. The awareness of the Indian population about common eye disorders has dramatically improved over the last decade. Awareness about communicable eye diseases like trachoma and common eye flu, has improved the general sanitation and ocular hygiene measures taken by the Indian population, which has translated to a reduced frequency of such patients. But, there still is a lot of scope for improvement.
How is an ophthalmologist different from an optometrist?
Optometrists are qualified personnel who perform the basic checkup of the patients, which include history-taking, performing basic examination, and certain tests such as assessment of the spectacle power, measurement of the intra-ocular pressure etc. An optometrist takes care of the various equipment in an eye clinic. A good and reliable checkup by an optometrist is like winning half the battle.
The ophthalmologist confirms the optometrist’s findings and supplements them with certain procedures if need be. Prescription of medications and any surgical procedures are however performed by the ophthalmologist only.
Dr Pawan Goyal Interviewed by Pranab Ghosh