Lecture: National Program Strategies Beyond COVID-19

The efforts of the National Program for Control of Blindness and Visual Impairment, towards implementation of the program is also an important consideration in order not to lose momentum that has been gained painstakingly over the decades. This presentation shall present directions to be taken for the country going forward in the National Program.

Lecturer: Dr. Praveen Vashist, Head – Community Ophthalmology, RPC, AIIMS, New Delhi

Transcript

Dr. Praveen Vashist: And today I’ve been asked to present about the strategies related to national program and that’s beyond the COVID-2019. So, I’ll be sharing the — some of my, like the guidelines which I have been presented given by the Government of India and, some of my views like to build these things. And let me be very clear, the data which we will be presenting that may change with time, and well you can see the daily data is changing. So, you have to refer to your country local authority news for the latest data and all these little new guidelines.

As you can see, today we have crossed 80,014 COVID-19 cases in our country probably. I remember around 28th off March, when we start tracking this thing day by day. There are only 250 cases and the Government of India started lock down. So, that since then probably most of us are feeling panicky what will happen to us. And when we talk about our hospital especially our institute AIMS, Apex healthcare institute in the country probably it has turned into most of the cold corona cases, most of the routine services had been stop stopped i-Care services routine, OPD routine services are not there only emergencies are being permitted

And at this stage at this point of point after 15 days of locked down, and we’re more than 80,000 cases now probably the initiative which have been taken by all this so that we can think of like normalizing our services, how we can adopt through the routine channel. That is something a very good initiative, and I’ll try that I’ll be able to help country in a way that we can try and come back to the routine system.

As for the National program is concern, you know, India is the first country to start the national program for Control of Blindness way back in 1976. And it is basically program where it’s monitored the program, evaluate the policies it’s a provide budget to various segment of people, it is a guide and support also. And the people are looking forward to national program like what are the guidelines that can be like provided by the programs for actually for the services that can be seen as a routine process can be evolved. The goal of the national program for Control of Blindness is to achieve to a level of blindness of less than 0.3% by the year 2000 and which was revised to 2020. And in fact as for the National Health Policy by 2025, where we are keeping up came that it will reduce to 0.25%. Whereas, if we take with the global strategy, the WHO adopted universal I-HEALTH, that’s a global action plan, and that was in. And the goal of that plan was that we should be able to reduce the prevalence of avoidable blindness, avoidable visual impairment by 25% by the year 2019 taking a baseline as 2010.

So, this is another initiative the national program was initially talking about the blindness where WHO said, we should look for visually impaired. If you could see the trends of blindness in our country when program was started at that time the prevalence of blindness was 1.38%. Though our goal was to achieve 2.3% but even 2007, we reach to a level of 1% of blindness. But the difference was here the definition of blind was presenting weasel equity less than 6/60 instead of less than 3/60. And at that time that the NPCB showed that there are around 12 million blind people in India. Whereas we recently conducted national blindness survey and as I mentioned there two different targets related to blindness prevalence and related to visual impairment. WHO gave figures about the visually impairment India’s 5.3% and blindness is 0.66%.

The national survey which was probably one the largest survey conducted in 31 district all over the country and short covered 93,000 people and that showed the prevalence of blindness has reduced to 0.36% nearly 47.3% reduction in blindness. And prevalence of visual impairment is 2.55%, nearly 51.9% reduction against the target of 25% reduction. If you see the causes of blindness and visual impairment, this is very clear the cataract is still the major cause. The previous survey finding was responsive in 2001 to the responsible for nearly 62% of blindness and currently it is 66% of blindness. The second important purge which is emerges basically but the corneal opacity which is known pro committed corneal opacity responsible for nearly 7.4% blindness. The another important thing is the Cataract surgical complications now nearly 7.2% off the blindness is due to complications.

So, you can understand our main emphasis is towards Cataract and Cataract surgical complications and Cornel blindness. Another finding that segregate the defective whereas is no more important cause of blindness though it is important cause of visual impairment but definitely not for blindness. And also the diabetic retinopathy, it is a huge burden but as well as blindness due to dearest consent it is just 1.2%. So, still the Government of India the plan that we should it lasts part of reason quantity program and NPCB program the government attracted the most important one, Refractive Errors and Low Vision born in blindness including Glaucoma, then Childhood Blindness Glaucoma and Diabetic Retinopathy.

If I had to need to summarize the key activity the National Program for Control of Blindness and Visual Impairment India, the first is the free Cataract Surgeries available to the people in the country. Second is the school vision screening program for refractive error especially for myopia, where free Spectacles are distributed to School children. Third is for corneal blindness which is with the corneal blindness, the collection of donated eyes free Keratoplasty surgeries, then diagnosis and treatment for their Squint Glaucoma, Low Vision, childhood blindness and ROP. Then infrastructure up-gradation in terms of vision centers, eyes banks, operation theaters and wards, training of eye surgeons and paramedical ophthalmic assistant, information, education and communications for prevention and promotion of eye health and also monitoring program to workshops and training programs and all those things.

One thing which I would like to mention is the like WHO want that Glaucoma should be eliminated by 2020. And on that Sierra reason probably India and Myanmar, they are the only two countries which have not yet declared Glaucoma adaptation. Probably what we need is to show that Glaucoma is eliminated and for this nearly a survey is required in 200 district, and Government of India is planning to go do survey in recent future. And I believe even after this COVID pandemic this may be feasible and we’ll try all that they should be able to declare that India is Glaucoma free.

Some achievement of the National Program for control blindness, I’m just talking about the — what were the achievement this year and other target current here. The Cataract surgery is probably the most important part of the national program. And you can see against the target of 67 lakh surgeries. The previous year we got 66.9 lakh surgeries. That’s something we are achieving target for cataract surgeries. And we have to see whether it is feasible even after this COVID pandemic or not. For other disease like DR, Glaucoma, ROP and Paediatric surgeries and Keratoplasty and VR Surgeries, probably you can see against the target of 6 lakh. We have covered 6.14 lakh from, like it is much more the targets. And this achievement is significant because in previous years this number was much less. Spectacle for school children, the target caps are 10 lakhs. And in fact what we have achieved last year is 8.82 lakhs nearby around 88% of target had been achieved and as well as corneal this Collection of Donated Eyes concerned it is 68,000.9 and the targets are 70,000 for 2019-20.

I discussed with Dr. Pamela Gupta DDT, and she said the target for the next year or nearly capped as nearly 10% are being capped nearly 10% more than the current targets. But we have to plan to achieve strategist. In fact this is just lecture where we can think some of the method like in spite of government COVID-19, how we should be able to achieve this thing.

What government is providing funds to NPCBs for cataract surgeries, these 2000 rupees even for other surgeries is this 2000 that is for DR, childhood blindness, glaucoma, surgery or laser. Then for character plaster, it is 7,500. And for cataract surgeries, for DR, childhood blindness schoolchildren for and for prospect with big glasses both they’re providing 350 rupees per spectacles. And for cornea collection, if it is — it is 2000 in eye banks and in 1000 rupees for eye donation centers. So, these are the things which are prepared.

But when we talk about COVID, the Government of India recently, they have come out with some guidelines for functions and these guidelines, they like, brought recently on 8th of May only. I’ll be covering these guidelines so that each and every person should be aware that what Government of India is planning at this stage. One thing is very clear that all Eye Care facilities, they’re now open to carry out routine clinical activities including OPDs, IPDs and surgical procedures in all areas except in the containment areas and red zone. So, this is something of very good news. In fact there were some confusion The BPMS are still are not aware. Let me tell you, the Government of India send instructions to all the state form officers about these guidelines and probably now each and every NGO, they’re free to start surgical procedures and OPDs in their areas.

But they have to take care of all the precautions, precautions related to social distancing, wearing of masks, face shields and goggles as for the guidelines, frequent washing of hands, hand rubs, these special guidelines are also available for all these things. And yesterday Dr. Umang Mathur very clearly mentioned all these things in his lecture about the system changes. And it is being advised that there should be a, like minimum time should be given to patient on the premises and the guidelines related to social distancing norm that is minimum 1 to 2 meter distant, minimum 1 meter, ideally 2 meters and between 1 to 2 meters is — should be there and in between patients. And it is expected that all the institutes, all the state, they will provide guidelines SOPs relate to these guidelines to their hospitals and they should be strictly enforced.

This is also advice that the agency should ensure minimum touch of their OPD Cards, Trial Frames, Trial lenses and other paraphernalia’s being used in Eye OPDs and their frequent disinfections. This they have to ensure so that the COVID infection should remain minimal as much as possible it should not spread to other people. The patient should wear not only the health care profession, the patient should wear the face covering and then they use hand rub before entering to OPDs and only patient who do not have symptoms, they should be allowed to enter or OPD for that specific caution have should not there.

And especially performers are there, consent forms are there for the patient and this is very essentially required because they need to disclaim the responsibilities from development of future Corona infections in their patients then that legal aspects into this thing. It is expected that all the agencies, they should take proper consent and consent forms have been given by All India of Ophthalmic Society and these are special set of questions are there, which was told yesterday. We need to be asked from each and every patient was attending OPD and also the surgical services.

But one thing is Government of India is very clear that outreach camps are not allowed at this stage because the reason is very clear, it’s mainly to overcrowding the guidelines to social distancing may not be maintained. So, outreach camps at this point they are being like differed probably for at least next two months. But we’re waiting for the next guidelines, let’s see if it will 2 months 3 months or 6 months. And also mobile vans also because it was expected when we’re sending mobile vans, again, the people, they collect and this again social distancing measures are not being taken care of that’s why the government want that even at this stage mobile vans should not be sending the feed. But they are very clear. That’s time for tele of technology and tele consultation, tele medicine guidelines have already been given by the Government of India. It is expected that people should explore opportunities for tele of technology and tele consultations and specially in the difficult areas. And for IEC messages, health education etc. it was suggested to use distal means the tele health means instead of collecting people at common place.

For eye banking, the Government of India is very clear that eyeball retrieval is not permitted from homes at this stage. However, the Hospital Cornea Retrial Program, it can be continued in non covid-19 patients, dead patients and it should be mainly used for therapeutic purposes instead of optical purposes. Beside this, during surgical procedures the surgeons and the OT teams, they should follow the guidelines and precaution. There are no separate guidelines for cataract surgeries, you know, the surgeries said the Government of India given general guidelines they should need to follow. But one thing is very clear that pre surgical COVID-19 test from patient is not mandatory. It depends on the institute themselves if they are interested, they can go for this test. But the, as per the official NPC guidelines, this pre COVID surgical — this pre surgical COVID test is not mandatory. And this is something very positive. This has happened, actually all the institute especially in Ganga Ram Institute, I could see the guidelines of pre COVID test is necessary for every, before every admission and that was creating a lot of panic among the healthcare providers. So, ultimately now the government is very clear such test is not required before surgery.

This is a slide which is probably looks very, like heavy slide related to PTs these guidelines that are given by Government of India. Infinite huge guidelines I’m summarizing these in one slide. And the most important point is that this is related to the ophthalmic OPDs and ICUs in critical care in lab. Here in ophthalmic OPDs, they are probably coming in this moderate risk zone and when it is moderate risk, what is expected that use N95 mask if some aerosol generation procedure is being used, goggles and then face shield is to be used when some fluid is expected and latex examination gloves. These four things have been recommended as per the guidelines. But in case it is other services like health test registration counters or even the pharmacy ward, general emergency lab, radio diagnosis or blood bank, it — all these things have been considered as mild risk and what you need is just to think that triple layer medical mask and latex examination gloves, mask and gloves. Here you don’t need N95 masks. Probably only the emergency areas where patient with secured to rest acute respiratory illness are there, they are taken as high risk. And there, they — you need full complement of PPEs.

So, what I want to say is that as far as Eye Care is concerned, probably you don’t need full complement of PPEs as per Government of India guidelines but what you needed maximum is that N95 masks, goggles, face shield and latex examination gloves. What we are finding is many agencies, many, like people who are preparing equipment for Eye Care, they’re already providing equipment with this facial that this is being now started. And when it — when we talk about the supportive staff, the administrative in financial and unique, they just need face cover they don’t even need triple layer mask or latex something.

So, probably looks odd but it’s very simple that moderate risk it is basic, you need all these gadgets and when his mildness, it’s only the triple layer medical mask and latex examination gloves. But Government of India is also very clear that all the standard precautions to be followed at all times and PPEs are not the alternative to basic preventing public health measures such as that maintaining distances or respiratory etiquettes which must be followed all the times and also the laid down protocol for disposing of PPEs. These guidelines are there. It is suggested that glove should be thrown into the red bins and the rest of the things like mask, et cetera, they should be in the yellow bins.

In addition, it is expected that patient and attendance, they almost wear face cover. Beside this, government, if any COVID-19 patient is detected in your facility, there are certain guidelines for that also and it is expected all the health care staff. They are involved, they are in contact patients, they should obey those guidelines. And here, this is actually something very panicky for our Eye Care providers because, you know, they are having a fear. Any such patient is in identified who’s found positive. Probably they have to close their shutdown, their services or something. And it is suggested in fact Dr. Umang Mathur suggested these things very well yesterday that you can keep two different, two or three different teams in your institutes and there will be working at one time but their problem is that when we have only one off technologies or one team only then probably you don’t need to take all the precautions related to these PPEs and it is really difficult and panicky for all of us.

Our RTC2R were probably most of are available that all of us, all healthcare staff in fact everyone, they must have this RTC2R COVID-19 tracking app in their mobile phones with the location enable. And in fact this is very useful. Even I’m using it. It gives so many things. It give health education about COVID, Statistics COVID the most important thing is if any COVID patient is around it gives that these lots of patients, these number of people, they have shown symptoms positive for ready to COVID or their high risk and even these are the COVID cases. And I expect that all of us should use these RTC2R app in our mobile phones.

There are some guidelines have been developed by All India Ophthalmic Society. And I’m very happy with how the team from or the nearly more than 200 people they have worked together. There are huge guidelines and 16 different chapters and covering almost everything related to clinical aspect of Eye Care. In fact there are committees related to guidelines for Committee Eye-Health programs and in fact we have developed consensus among Vision 2020 groups, National Program for Control Blindness and various Committee of Ophthalmic expert from RPCenters and from major NGOs. So, I’ll be summarizing some aspect related to these guidelines in relation to Committee Eye Care Programs. And these guidelines have been developed based on different zones whether it is green zones. It is very clear when they’re no confirmed cases for 21 days it is taken as green zones, red zones when there are high doubling rates in any area, it is red zones and orange in between. And Government of India has specified containment zones in the red zone districts, they are the basically hotspot where actual cases have been identified and the contacts have been seen. Probably these are the areas which were very risky and we need to be very careful while working in these areas.

This is one slide which was prepared after a lot of discussion and I think can be useful, what services can be started in different areas, different zones. As far as Primary Eye Care Centers and Region Centers are concerned, everything, everyone is very clear that Region centers should be started immediately in all the zones, in green zones or in red zones except in the containment zones which are very small areas in some districts. The transport facility for camp patient, they’re advisable in green zones in or in red zones because of the locked down areas there these facilities are still not been permitted but definitely the green zones they can be started. Mobile vans, some of us were very keen that these should be allowed in growing green zones. But many experts, they wanted that even we should avoid it because when we have mobile ban clinics, the chances of these social distancing measures will be difficult to maintain. So at this stage we have decided, we should not advise mobile bans and even the Government of India has come out with the same guidelines. So, mobile bans are not permitted at this stage. But we’re hoping that very soon they will be allowed as far as the comprehensive Eye Camps are concerned most of the NGOs hospitals, they were conducting camps in remote and underserved areas but the government and the group is very clear about these things that these camps should not be advice.

When we discuss about how long should we take, for some people we’re clear that at least two months and of course we are hoping that COVID, the number will come down but if it is not then we have, way may have to wait for this, for six months also. It all depends around the number of COVID cases whether the curve is getting flattened or not. As far as the reflection facilities are concerned except in the containment zones, it was advised that we should start reflection services in all even in red zones. Region Cataract Surgeries, even the Government guidelines are saying that it should be allowed except in the containment zone, should be permitted. And the Tele-Ophthalmology. Now this thing is very clear other things are not available in containment but Tele-Ophthalmology, tele-consultant see are definitely advisable even in containment zones.

For Cataract Surgery, in fact this is one area where government has not yet given any special guidelines. And they said if camps are not there, patient for surgeries can be admitted from the vision centers. And of course the government, they will be happy to provide a refund for these surgeries. As for the NPCB guidelines, only camps are not required, patient admitted to the vision centers can also be like given reinvestment. Of course, the areas guidelines are very clear about Cataracts surgeries, what precautions to be taken I suggest that all of you must read those guidelines for that then you should be able to start the service in your hospital.

And in fact when we, this is probably the most important aspect like India we were looking that India should be Cataract Blindness Backlog Free county. Cataract is still the major cause of blindness. And, you know, the major problem in relation to cataract is the current situation, the COVID. One area is the demand for Cataract surgery, we can easily see that demand is reduced. You can see that patient are usually old age patient. More than 60% Cataract surgeries are being conducted in 60-plus age group and that is the risk group for COVID. Patient they have fear, might not come for the surgery and this is a major fear actually. And what we need is we need to generate demand for this probably the best ways to use the health care volunteers in the country, they should screen patient by house to house screening and they should even create awareness about COVID as well as awareness among these patients, that all the precautions are being taken for surgeries and the chances spreads are almost negligible or minimal. Then this is probably the only way at this stage that creating awareness, counseling, guidance of people so that they should come to hospital for Cataract surgeries.

Another important issue is that visibility of high volume Cataract surgeries at this stage because of the PPS issues, Corona issues, one thing is very clear the institute which were having a model of high volume Cataract surgeries. It will be very difficult for them because it is advice that we should wait for nearly 10-15 minutes maybe up to 20 minutes after every surgeries, only one table should be there. So, all those guidelines are there and we assume that the number will be reduced significantly. What we need is that more and more service providers need for more second level eye hospital in the country. Though we have a huge number of second level hospitals but still it is expected that there should be some norms. At present we say that there should be one second level hospital for 5 lakhs population but what we expecting that this norm should relax and we should have more number of second level hospitals, so that the Cataract that give facility should be available near to the patient especially in the underserved rural areas.

And of course they will need to work towards, if we were looking for these services, infrastructure, equipment, human resource and the Cataract surgical service. So, all these things at this stage probably we’re doing very less number surgery but in due course of time more centers may be required. Quality is an important issue that will always remain but the most important issue is the sustainability for Cataract surgeries. And I believe each and every institute at this stage is thinking how to get the cost for Cataract surgeries. I have a very strong doubt whether NPC will be able to PCS will be held in this regard because probably most of the budget will go into other sectors at this stage to stand in the economy of the country and even in health care probably is more into COVID areas. Eye Care may not be that much important at this stage. So, getting fund through NPC maybe difficult.

And the only option, the best possible option which I feel is the Ayushman Bharat that all the surgeries cataract surgeries which we are doing at this stage of will be doing, should be part of the Ayushman Bharat. In fact a few last years there are lot of issues, some of the states they have stopped Cataract as part of the Ayushman Bharat Scheme. In fact, my suggestion, my request Government of India that it should remain in all the state, Cataract should be part of it. And in fact what we’re expecting that Cataract and other packages should be reconsidered and more amounts should be given for these surgeries to end use. This is the best possible solution for us and it is requested from Region 2020, from Government of India NPCB that all of us try our level best to go for advocacy into this area that Cataract and other procedure should remain as part of Ayushman Bharat Engolfment.

Another important area is the strengthening primary Eye Care in fact, in last few lectures whether it is Dr. Umang, Dr. [indiscernible] [00:30:05], even Dr. [indiscernible] [00:30:07], they’ve promoted this thing that we need to go more close to the people. And when we talk about primary Eye Care, it is basically three different components are there.

One is the Vision Center which we’re expecting that, one Vision Center should be there for every 50,000 population. Then Health and Wellness Centers which were expected should be there for every 5000 population. Vision center is being managed by paramedical Ophthalmic assistant and, Health and Wellness Centers, basically it is the ANM- multi level health workers. And one, one person, one Medical Officer or nurses were also there in the Health and Wellness Centers as per the Ayushman Bharat Scheme.

And the third group is basically the, at the, the community level, it is ASHA workers and Anganwadi workers and school teachers. They’re working for every 1000 population. You can easily see the health sector in our country. In 2004, when Vision 2020 right to sight was adopted, at that time what we were thinking that, we’ll have nearly 20,000 Vision Centers in our country. And even at this stage what we’re saying that there’re hardly 4000 Vision Centers. So, it is very clear. It is the right time, and you know it is opportunity for us to strengthen our primary Eye Care Centre services especially the Vision Centers in our country. And it should be at least 20,000 Vision Centers that required.

And Vision Centers can be both the type. It can be integrated Vision Centers which is, with the primary health care system, which is basically Government of India strategy. And also the stand alone Vision Centers Primary Eye Care, where most of the NGOs, they developed primary Eye Care, and both are valid. Probably what we need is more and more a census centers in our country. The activities which can be performed in the Vision Center immediately, at this stage, are basically early detection and treatment of cases, and first line management of all the emergency cases and their reference. Vision testing and refraction is very much possible and can be allowed with all the precautions. Dispensing of spectacles, if it is feasible, should be started immediately by most of the centers. Then a refer and triage of individuals who need surgery. The triage is very important that we should not refer patients with fever, cough, et cetera, to hospitals, so that is extremely important, and post-operative follow-up.

And the last component which I personally feel is very important is basically you need to develop the primary Eye Care volunteers, whether ASHA or other volunteers with the help of tele-health training. It’s the right time that we need to train these people. As I mentioned Health and Wellness Center, it is probably the one of the major initiative a Government of India right now. They are planning to develop 1, 50,000 Health and Wellness Centers in our country by the year 2022. Already in March 2019, there are 29,414 centers were there. And they are actually developing with the Right test. And as far as Eye Care is concerned, there was a committee which was developed and the task was there already submitted their recommendations. And probably they’re very soon, these guidelines will be there at the portal also. And what we recommended that, most of the primary Eye Care activities should be initiated at sub-center or these Health and Wellness Centers

Health and Wellness Centers they worked, about the ASHA workers for 5000 populations. And nearly five of ASHA workers work under each in centers, and many activities can be started under Health and Wellness Centers. For the ASHA workers probably we are very clear. Already we have more than one million ASHA workers in our country. And it is necessary that ASHA workers should be trained in Eye Cares, they should be in involve in Eye Health Education and awareness programs. They should be able to identify a blind and visually impaired cases and even patient with common ocular morbidities. And the most important thing can, they can do is, they can timely refer the patient to all our Vision Centers and hospitals.

In fact, we have a very good initiative taken at the center. And what we realize that ASHA workers, they definitely need training. One day training is sufficient for ASHA workers, as far as basic primary Eye Care is concerned. The key issue with ASHA workers is they are very poor in record. If you expect they will maintain record it is very, very difficult. They’re not good in taking vision of blind or visually impaired. They find difficulty space issues, their social issues also there. And also they are not very much ready in coming patients to hospital, with hospital to coming with the patient to hospital for Cataract surgeries, But as soon as other activities are concerned, probably awareness generation with terminate profile access, mobilizing patient from Vision Center to the Vision Centers for referral services. ASHA was, they work excellent.

The only thing what we need is that we need to provide them good incentives. And Delhi government, they have taken such initiative. The incentives are being provided separately. Beside the National Health program, probably I request that most of the SPOs, they now take this initiative to involve ASHA workers into Eye Care, fix some incentives especially related to Cataract and for refractive errors and Diabetics for these ASHA workers. And, and it is the right time that such they should be promoted and they should be involved into Eye Care.

Some of the NGOs, they find difficulties in working in working with ASHA, that ASHA is being not allowed working with the NGOs. Probably there are so many group of other volunteers are there. And some of the institute, they have shown very good models related to involvement of volunteered in Eye Care. They can be the Anganwadi worker, the school teachers, community volunteers, Panchayat leaders, NGO workers, health workers and even the RMPs under practitioners, they can be helpful as primary Eye Care force. It is a right time that all these people they should be involved into [indiscernible] [00:36:08]

And the most important aspect and even the Government of India is also very clear as far as COVID is concerned, what we need is strengthening our Tele-ophthalmology. There are specific guidelines out there for tele-medicine, tle-consultation. I hope that these guidelines should be followed by all the practitioners. A Tele-ophthalmology, it is being permuted now. Till now Dr Mote mentioned that hardly 1% people, they use Tele-ophthalmology, but probably it is right time that we have to go ahead besides ROP India. It is essential that Tele-ophthalmology should, should this facility should be developed in Vision Centers. Through Vision Centers, ophthalmology, they are sitting at the base hospital, and actually they’re providing guidance to optometrist and patient through Tele-ophthalmology. This is the future and we need best model for Tele-ophthalmology, simplest model for Tele-ophthalmology. You can use WhatsApp, you can use simple, simple method so that services should be available to the patients.

And of course, the electronic medical records that should be taken care off that they are best if we’re using Tele-ophthalmology. And yesterday Dr. Umang also mentioned about this thing. What we need that this, this should be taken care off. What I personally feel is that it is, it is the COVID-19 is going to stay for some time. We’re 80,000. As the AIMS that they mention that the peak we observe in June or July, so number can increase to any extent. But probably what we need is we need to learn to live with COVID. We need to know what new normal in our hand. So, new normal as for everyone is concerned is that maintaining social distance, a distance off ideally 2 meters or at least 1 meters distance, hand washing with soaps and use of sanitizers, probably you can see it everyone using. Everyone using mask, use of disinfectants sprays, some travel restrictions and avoid social gathering. This is the new normal for everyone. And as far as the Eye Care is concerned, the new normal is the instruments and then is essential need for Tele-ophthalmology and patient education to tele-health. And this is the new normal in health care. If we adopt these things, whatever the COVID is, probably what I feel is that we will be able to achieve what we want to, that is the normal Eye Care services in our country. Thank you very much. Thank you.

Female Speaker: So, Sir, Ms. Umar has asked, how can we calculate the unilateral and bilateral cataracts especially for people about 50 years of age?

Dr. Praveen Vashist: Yeah, Umar. Actually there are certain methods, and, you know, certain axel-base apps are there, which are being used. In fact people, we have used, we have given these numbers to Government of India, based on the prevalence of cataract, prevalence of unilateral-bilateral cataract. You know, the prevalence is actually based on the surveys which we conduct, and based on that prevalence, we apply those numbers to overall population. And the — in fact certain apps are there. We are using those things and were submitted to Government of India about the numbers. Probably number which is required to eliminate cataract blindness, it’s very high. In fact I don’t want to say figure right now. But the Government of India is currently looking forward towards around 75 lakhs surgeries and different institutes, different states, district they have been given number accordingly. But definitely, we have different methods and it is not possible to give all the details are like. Yes. Next?

Female Speaker: Sir, Ms. Pooja is asking, will the pandemic effect funding for national programs.

Dr. Praveen Vashist: This is something one caution which even at this stage no one is aware. But, yes, as I mentioned, quite expected that the national program may be affected. What we’re expecting that they should increase because the cost of surgery will increase. They should increase the amount, the reimbursement for cataract surgery. Probably at least, that will not happen if they’re not be doing. They may not even anything is actually. Parents, currently, this is the thought, but we are not very sure about the future action. It all depends on the status of pandemic another. Next please.

Female Speaker: Sir, how many times can N95 masks be used after air drying in OPD?

Dr. Praveen Vashist: See, as for the guidelines which are being used in AIMS. They said, they’re set to five masks. And every fifth day, you need to change the mask. And they said after five times, that after 20 days, you need to reuse them to accept. So, one mask after four days and five times, this is the norm which is being used in AIMS right now. Next?

Female Speaker: So, next is a little, I mean, I don’t know how much we can predict. But Ms. Elizabeth wants to know if government. When is it that the government is likely to grant permissions for outreach camps?
Dr. Praveen Vashist: Hi, Elizabeth. Yeah, you know, in our discussion with the ministry team. They said it is at least two months, but you know this is very difficult. We are not sure about the status of the pandemic right now. If it is, the number will increase, I believe the chances are less. Yesterday, Umang was talking about it may not be permitted, see around for six months. So, we are not sure. But definitely, it is very clear for next two months. It may not be direct, it may take six months. It may take one year. But for next two, three months. Probably it’s different. Next please.

Female Speaker: So, Dr. Jib is asking is it possible to eliminate glaucoma particularly for the, from the underdeveloped and developing countries. You know where sanitation and hygiene remains a big challenge?

Dr. Praveen Vashist: And, Dr. Jib. In fact, I would like to clarify this thing. As with trachoma status in India is concern. The glaucoma and Children has already been eliminated. The prevalence which we got is around 0.7%. And the WHO guidelines for elimination glaucoma and Children is 5%. So, it was eliminated way back. But we’re proving it right now. As well as try case is consent, the guidelines are it should be less than, less than two per 1000 cases about 15 years of age. And we are quite near to that number. And possibly if you do survey at this stage, we can say that it is eliminated. You know, the only issue is that the guidelines, the elimination do not mean it is zero. There’s some specific number is there and India is definitely very close to elimination at this stage. Next please?

Female Speaker: Sir, you know, around Aaogya Setu app. If you have, I mean is the government also planning to make something around similar to an Aaogya Setu to support the blind and visual, low vision patients, since it is not accessible app as if now.

Dr. Praveen Vashist: See, I’m not aware at this stage. But the way government has taken this issue, Aarogya Setu app and probably people are working on this. And there are certain apps available for the blind and visually impaired patients. And I hope in near future, it will be there because people already working on it. But I’m not sure what stage they are and when it will be start. Next please?

Female Speaker: So, COVID-19 is of course impacted the Eye Care system…

Dr. Praveen Vashist: The precautions?

Female Speaker: Yes, yes, yes. How do you manage the post COVID-19?

Dr. Praveen Vashist: How do you plan to manage the post COVID-19 impact particularly in the Eye Care services? They probably discussion is everyone is thinking about discussion how will we manage the impact of something. Probably, the only thing is that we should start to normalize. Go back to our services as early as possible. Most of the institutes, they have started there Eye Care services. And in fact, even in AIMS, we’re sitting here at Epics Institute with our Eye Care services, routine Eye Care services will be started soon, maybe tomorrow itself. So, and I believe once we’ll start our service, probably the impact will be taken care. Next please.

Female Speaker: So, given that the outreach cannot be conducted, given the guidelines, so how can surgeries be booked in NPCB program?

Dr. Praveen Vashist: You know, as I mentioned in my lecture also, it is not necessary that if you’re booking surgeries than the NPCB program. They have to be camps. In fact, Government of India permits the these two vision centers also. If you’re saying that you have a fixed facility vision centers and the fiction have been booked through vision centers, definitely you will be given funds. Even if patient is coming for free surgery directly to your base hospital, yes, it can be booked and NPCB will provide funds. In fact this was cleared by [indiscernible] [00:45:28] one of the session. So, be clear it is not, camps are not essential. Says these done for free surgeries through a routine patient OPD patients or through vision centers, they are permitted for reimbursement. Next please?

Female Speaker: Sir, other any particular norms for transportation between, you know, from base hospital to vision centers, or the norms…

Dr. Praveen Vashist: See the norms were traveling as of transportation are very clear that you need to maintain the guidelines ready to social distancing, the rest is same. And in green areas, it is already permissible. In red zones probably in few days, we’re expecting that this thing will be allowed. But, yes except the social distancing norms and wearing masks. These are the common, I said the new normal, that need to be made. Next please.

Female Speaker: Sir, particularly for the field level health workers, you know, what kind of preventive measures you think they should take like a three-ply mask, cotton mask, gloves, and a cap is enough or more is required?

Dr. Praveen Vashist: I believe for free level they are taken. It’s part of the low risk with a three-ply mask and gloves, these two things are sufficient for them at this stage. We’ll, just for the guides. Next please.

Female Speaker: So, is there any research initiated by the epicenter in ophthalmology in COVID-19?

Dr. Praveen Vashist: Actually, yes, some proposal have been submitted to our research section. And specially, proposal have been submitted to conjunctivitis, prevalence of conjunctivitis among convey patient. That is being taken care and that’s one proposal which is now somebody didn’t approved. And this few studies related to impact of COVID-19 on there like a routine services as well as on their, like the health a care and especially psychological expects that has been taken care. Nearly 3000 different projects have been submitted to research section in all the fields. I’m not aware of all those things, but definitely conjunctivitis and COVID that has been taken care that I’m afraid. Next please.

Female Speaker: Sir, given that the mobility is a challenge as if now. So, mobile vision centers, do they make better senses at this particular scenario compared to static vision centers?

Dr. Praveen Vashist: Who has asked this question?

Female Speaker: Prashant.

Dr. Praveen Vashist: This is Prashant. So Prashant, in fact, I also had the similar opinion that we should start mobile vision centers that should be permitted and you are very clear because of the mobility issues. But, what the group felt is that it is very difficult. Mobile vision centers I have been assumed as, as I can convinced that they are actually being used for the patients or the team members. And ultimately a camp is being organized. So, the issues related to social distancing are difficult. In fact, what we wanted divide that one mobile vision centers which has been routinely providing services as vision center only. And if we can fix number of patients say 20 patient in that reason centers per day, that can be a process or something. We hope that ministry will come out guidelines related to the mobile vision centers very soon, and they will also permit mobile vision centers. This is the need of that. And we should — we feel that it should be initiated at the next. Next please.

Female Speaker: Sir, the clarification, can outreach programs the organizing green zones?

Dr. Praveen Vashist: Again, and as I mentioned in my presentation even in green zones, you know outreach program means we’re talking about eye camps. Even in green zones, they are not permitted right at this stage. Next please.

Female Speaker: Sir, all the hospitals are in preparation of making modifications for preparing to start OPD in cataract surgeries. It’s going to be a huge investment for endurance trust hospitals. And then, with reduced surgery that’s going to affect them badly. So, how government is going to help them or are there any government plans that you think in where you would like to share that how the government will help these and use or trust hospitals?

Dr. Praveen Vashist: In fact, this is the key concern, not only for eye hospitals. In fact, eye hospital stumps very back in number actually. There are other issues beyond health also which are important for our country. In fact, what I personally feel is that Government of India is currently not thinking everything about all these aspects. They are more into major areas of actually not only health care but other areas. And as far as health care, it is the COVID related issues which are more important. But very soon, say in one or two months, during then things will settle down as part of COVID. Probably, I personally feel now health care, Eye Care, will be given importance in future. So, after 2 to three months. And we are trying our level best through R.P. Centre. Chief R.P Centre is basically adviser to Government of India for national program. And we are working in this direction that some package, something should be started for the people, for the NGO workers, who are actually providing services. You know, 60% of the Cataract surgeries are being provided through NGOs, and just 40% by the government sector. And it is essential right now that we should think about those NGOs. And more package of good package should be arranged. But at this stage what I feel the easiest thing is that providing more fund for cataract surgery. And that is feasible in Ayushman Bharat. In Ayushman Bharat, you are providing amount upto ₹7000 whereas in PCP, it is just ₹2000. So, if we get more amount for Cataract surgery through Ayushman Bharat, probably this is one of the area where we can think of covering up some of the expense. Let’s hope for the best. Next please?

Female Speaker: So there are a few questions around asymptomatic COVID patients. And how do we deal with them?

Dr. Praveen Vashist: Either them interacting with the staff. And they need to deal with the staff or the vision centers. See if a symptomatic COVID patient is there That means a symptomatic but he is identified positive in sample. For those patients as well as government guidelines and concerned, they are very clear that such patients should be like, they can be sent for home isolation. And in case their contacts are there, they should be screened for COVID test after five days of contact. Minimum 5 to 15 days of contact. They should be actually tested once. And if they are found positive then again the measures of isolation for instance should be adopted. So it is very clear. That’s the key reason that everyone is tense. In case they find any patient which are asymptomatic and found positive, what will happen to their services? Their staff like, got in contact with such patient. They need to be quarantined. They need to be isolated if they are find positive. So, that is the panic and everyone is worried about these things. But currently these are the guidelines, quarantine, isolation. And let’s see how these guidelines changes in future. We are not very sure.about these things. And there is no solution for this thing at this stage. Next please?

Female Speaker: Sir, what do you think are the areas of innovation post COVID in Ophthalmology particularly?

Dr. Praveen Vashist: So, I very clear, one clear cut area is basically use of Teleophthalmology. Telehealth Network for training programs, etcetera. That is one area which is very important. For effective area, Dr. Umang Mathur, he — yesterday mentioned that there will be some other methods can be started for Tele-screening of children for vision impairment or refractive error or something. Probably that is one area. And so this is one common area and strengthening primary Eye Care, that is the key for future action. And you know, all the agencies were, and the equipment, they are manufacturing equipment Dr. Praveen Vashist: They are coming out to the new type of equipment which have the automatic shields, etcetera. This is also a small innovation and automatically people will. They don’t need to use other PPS. And that even though shield will prevent people from COVID or something. It’s something small innovations. Let us see what new we will get. I’m not very clear about at this stage but hoping for some more research and innovations in this area. Next please?

Female Speaker: Sir, are there any particular guidelines for running vision centers at this time?

Dr. Praveen Vashist: See, as soon as guidelines for vision center are concerned, only thing is this AIOS guidelines which have been prepared so far. And as I mentioned in Chapter 16 of those guidelines that cover the vision center component, and in fact it has mentioned in details what precautions to be taken when patient is there, what PP is to be used? And while doing refreshing a sector, what precautions should be taken? So, these are the guidelines which are currently available with us. In fact those guidelines are being submitted to Government of India. If it’s planned and hopefully Government of India will provide additional guidelines along with this one very soon. But at present, the officially too, Government of India, we don’t have guideline. AIOS has given guidelines. Next please?

Female Speaker: Sir, what could be done in states where Cataract surgery are not covered under Ayushman Bharat schemes? If MPCB budget reduced too. What will be the options then for the NGOs?

Dr. Praveen Vashist: See, MPCB budget reduced. It is already low actually. ₹ 2000 is very low for Cataract surgery or whatever. And I don’t think they will reduce beyond this one. This is very clear. Below 2000, it will not be there. But even 2000 is very low. And what we are expecting at this stage is that, in fact I am very clear. We try our best. All the people who are working in Eye Care, that stage which we are but I’m not covering a Cataract as part of Ayushman Bharat. They should also cover Ayushman, the static surgery as part of Ayushman. Not only Cataract surgeries. Currently 42 — 40 procedures have been involved. As well like it its concern. We are expecting that these procedures should increase to nearly 60 to 70 procedures. And in fact, I hope that such kind of like initiative will be taken and advocacy even done this regard very soon. Next please?

Female Speaker: Sir, given the COVID and again given the financial stress that hospitals are facing, immediately after the lock down, there would be a lot of like paid services hospitals would rather prefer patients who can bear the cost of surgeries. So, what happens to the ones who are marginalized and will go and take an initiative in this regard?

Dr. Praveen Vashist: See, such kind of initiatives are very broad initiatives. It is not only in the Eye Care, that will be in all type of health cares. Private institutes probably we are thinking is that currently a patient with fever for one or two day fever, they are not usually admitted with. Now they will be admitted and its costs may be we will be charge huge amount. And probably whatever guidelines will be there, there will be comprehensive guidelines to health care. But at this stage, the government is probably not thinking about those. The current status is very clear. It is the COVID. And beyond COVID, definitely the way at this stage Government off India is bringing out guidelines. You know, every day you get one or two new guidelines. And I’m sure they are so active at this stage. And very soon shall guidelines will be there related to cost restrictions or something as far as a health care is concerned by private or other parties. Next please?

Female Speaker: Sir, what will be the scope often Optometrist for the optometrists in the country post COVID-19?

Dr. Praveen Vashist: See, I personally believe there will not be any change. It will be totele-normal after a few months. And scope will remain as it is. What is there, in fact when we are talking about strengthening primary Eye Care services, strengthening in vision centers. And if such initiative be taken as the high level probably, government is very clear. In fact as what National Health Policy which came in 2017, it was very clear that more and more fun should be given to primary health care. And primary Eye Care is component of primary health care. And now if you think of strengthening our primary Eye Care through vision centers, we are very clear. As far as Optometrist are concerned more and more opportunities should be appointed, should be part of the system as far as Eye Care is concerned if they like to go to vision centers. Another issue in our country is that, the Optometrist who were well trained they avoid going to remote areas that need to be taken care. But I personally feel, as far as the Optometrist branch is concerned, they should feel that it is an opportunity for them that COVID will bring out something more from them. And more opportunities will be there for Optometrist in our country. Next please?

Female Speaker: Sir, should reflective services resumed with proper precautions?

Dr. Praveen Vashist: Your document refracted a reflections, definitely, as I mentioned, with the precautions. In fact, when we are thinking of surgeries and everything, then reflection should be resumed as early as visible. Just take specific precautions. And those precautions are very well given in AIUS guidelines. Even in community of the Vision Centre guidelines given in AIOS guidelines. So, please follow those guidelines and start doing refractive. In fact, what maybe there then, initially we’ll be doing less number of infections and slowly and slowly that number will come to the norm. But of course, all the guidelines related to social distancing, mask, et cetera, but those need to be followed. In fact, careful cleaning of your like the equipment’s, that is also very, very essentially required. And all those things are given in great details in those kinds. Next please, where is Anu, I can’t see Anu actually.

Female Speaker: It is great. So, she’s saying that the deaths around, for the people who have been infected with COVID-19 is more with the elders, with the people who are more than 45 years, 60 years. Should we have an Eye Care strategy particularly for them, for that age group?:

Dr. Praveen Vashist: See, that is, it’s not 45 actually. It is beyond 60 years of age. In fact, when we’re looking at this Indian data, it is beyond 70 years of age is more less out there. As far as this world report on vision is concerned. I don’t think there will be a separate guidelines relate to these things. But definitely as I mentioned, this is very important that people will — it’s not in the service provider. It is basically the demands will be less because people will be having some kind of fear at least that they go to hospital, they may be infected with COVID virus. So, there we need to start some kind of system of counseling of such group of patients in the system, so that they should overcome their fear, their attention and should come for surgery. But for as far as world vision of report is concerned, I don’t think that will — they will not come out with this again [indiscernible] [01:00:10]. Next please.

Female Speaker: So, given the fact that vision centers play a critical rule at this time and anyways and like beyond also, is Government of India giving any help, support and deployment of vision centers, particularly now?

Dr. Praveen Vashist: See, as per the current strategy, they are already giving help of ₹1 rupees for starting vision center in remote areas, of one lakh rupees. In fact, I personally feel there should be a major strategies that NGO’s, they should be permitted to work in primary health centers which are being managed under the Government of India under the district programs so that infrastructure issues should be taken care by the government, and the human resource and training component and service delivery component will be taken care by the NGO. Such kind of policy is required in our country, and that is the, actually, a PPD model which we should look for in our country. Otherwise, it will remain like this, we every five year in national program. We’re looking forward for five thousand Vision Centers, and the number of Vision Centers were not increasing. Even at this stage by the year 2020, we wanted 20,000 Vision Centers and we just have hardly 4000 Vision Centers. So, until and unless we will not involve NGO’s to provide primary Eye Care in government facilities, this issue will not be resolved. It is a need of that at the stage. Next please.

Female Speaker: Sir, although Dr. Mathur had asked this question very well, I mean he had described it very well yesterday. But I’ll just, since this question has again come up. You know, for the low vision patients, mobility’s is critical and anyways it’s critical and given this COVID social distancing, it is a bigger challenge. So, what is your take on this?

Dr. Praveen Vashist: See, it is definitely a major challenge even if a doctor gave a full lecture on this thing that how to take care of such patients who are having visually impaired and the issue which was discussed. Can we develop some kind off apps in their mobiles? In fact, I discussed this thing with one of my partners working in low vision. In fact, yes, such apps are available and they can be downloaded and they can measure a distance of say up to one meter. Kind of, you know, vibration can be there in their mobile phones with this thing. So such kind of things are coming up, but people are not aware of these things, but I believe that COVID will help them to know all these things, the apps and such kind of apps and probably more and more people will use such apps now and then. And of course, lot of initiatives are required at the government level also or for such patients. Let’s hope so that something will be done. But it is one of the major challenge at this stage. And I believe our people who are visually impaired or blind at this stage, they’re suffering lot and we need to actually immediately inspect. Next please.

Female Speaker: So, sir, for the ISE, you know, will there be any specialized activities or material in the coming days in the field of Community Ophthalmology keeping you in the COVID situation? All the government is I think given certain, yeah.

Dr. Praveen Vashist: You know, not about Community Ophthalmology but as well as COVID is concerned, I was just looking after what I see strategy has been adopted. In fact, it will surprised you to know that training have been arranged for most of the field workers, company workers, volunteers, ASHA workers in relation to training all these people in COVID. And that is to tele-health system and it is opportunity for us for using the same model, same system for our Community Ophthalmologic programs. And very soon, in fact, I’m very clear we will be showing such kind of models very soon for our people our volunteers who were working committee. And such models can be used by other centers also. So, now we have learned through COVID. This is something positive that, yes this is feasible and we’ll try such exercise in our areas like, next please.

Female Speaker: Can we use N95 mask for a longer period by decontamination under UV light?

Dr. Praveen Vashist: See, I’m not very clear about this answer because as soon as UV light decontamination is concerned, there are some specific guidelines about time of exposure or something. I’m not very sure about the response for this.

Female Speaker: Next is, again, sir, around school screening. Obviously again, the schools are shut. But what was your take on the school screening Eye programs post lockdown?

Dr. Praveen Vashist: As far as school Eye screening is concerned. This is one area which is very important. And what I feel is that, that people are talking a lot the new guidelines or something. You know, school is that area which will be open only when we have some kind of like the COVID pandemic will be like restricted or it will come down. Besides that point, probably schools will not be opened. And after that, my personal opinion is that if we follow the standard guidelines, the social distancing and care of mask, everything, I believe school vision screening program can be adopted. Only thing is that such business need to be taken here. Some of the people are thinking that we should have a new guidelines for school business screening or something.

Probably if we, this universal procedures if that they can be included on those guidelines I believe in the teachers can be used for primary screening. There should not be much problem. But let’s see how things happen. I don’t think there should be a separate guidelines for this thing. This should be taken into a normal thing very soon, very clearly as soon as school will open, probably will be providing routine services. This is my say at this stage. Of course, we can think of some methods, some new techniques, but probably that will come slowly as per routine not because of pandemic that we need to take something extra. I’m very clear the school reason is, will be a normal practice once school will open. Otherwise, if some issues will be there, government probably will not open school itself. Next please.
Female Speaker: So, mobile cataract surgical programs, has it been stopped as of now or and if so then when will it be started again?

Dr. Praveen Vashist: What do you mean by mobile surgical, that means surgery in mobile vans, probably that’s — it was, it was stopped in 2001. In fact, in one or two state they were doing this thing but it was not officially allowed as per NPCB is concerned. So, we are not committing any surgeries in mobile cam or something that was practiced before 2001. Now, it is expected that we should approach, use and reach an approach where you can conduct screening and vision centers. Now instead off camps I’m saying it is vision centers, patient can be brought to base hospital in green zones. Of course, in red zones, we have to wait until the routine transport services will start. And then, surgery should be done at the base hospital around it. This is the norm at the stage and I don’t think that mobile surgeries at surgical camps will be allowed then. Next please.

Female Speaker: Sir, you know, lot of hospitals are producing sort of in-house PPE’s or of course, some, or others are procuring PPEs. Are there any guidelines that they can refer to either by producing or procuring the PPEs?

Dr. Praveen Vashist: Government of India has a list of nearly, say, initially per list of nearly 100 PPE providers. Probably more and more and coming. Probably that list should be there everywhere in all the districts now. And they need, no need for a national level guidelines for these things. Probably the district level authorities will be having the exact number, details of this thing. Initially, they are the issue but now Government of India is already preparing more than, say, 2 lakh PPE’s per day. So now there’s not the issue of providing PPE’s. That’s freely available. Next please?

Female Speaker: Sir, in terms of trainings and fellowships program of course the online trainings and all are always possible. But let’s say, internship for Optometry students or Ophthalmologist fellowships and OPD’s. Are there any guidelines and what is your take in it?

Dr. Praveen Vashist: So far there are no such guidelines. But, you know, you went in exams where like our doctors are being tested. Now, we are using online system to have their examination MD ophthalmological. So, probably more and more things will be online now. And of course, when — let’s see how it will resolve. Reflection is one thing which we need to train in patients and probably it will be resolved soon. But at present there are no such guidelines. Next please?

Female Speaker: Sir, for the home, what’s your take on the home services for patients follow-up check on, you know, it can reduce the cost, et cetera. So, home services of patient’s follow-up particularly may be in the green zones or in the orange zones.

Dr. Praveen Vashist: Home services means?

Female Speaker: Sir, for the follow-ups. I think so. After emergency, sir, emergency later surgery if a patient has to follow-up. And it, if it happens to be a green zone, home services for follow-up, does it make a better choice or?

Dr. Praveen Vashist: I could not understand home services. We recommend the Tele Consultation Services. Tele consultation is definitely, it is there. I don’t know, home is the doctor going to the patient’s home. That probably is not feasible. It is basically Tele Consultation Services. And it is being adopted everywhere now even in AIMS, we have started Tele Consultation, free Tele Consultation for the patients. Our residents are doing it right now in our system. Next please?

Female Speaker: Sir, what type of social marketing is necessary? Okay, so what kind of awareness trials can we do with the patients that are on COVID 19 to change their behavior?

Dr. Praveen Vashist: Yes. I think every day, everywhere we are listening the same things. It is basically social distancing, use of mask at level guidelines. All these are the common thing right now and probably everywhere aware. And the best part is that such kind of behavior has been changed now. When I see people around me, everyone is wearing mask. People are concerned now on social distancing. People are using disinfectants everywhere. So, I think, of course in remote rural areas also, our teams, our volunteers, our ASHA workers are now being involved into such kind of training programs and specific guidelines have been issued for this. But these things are minor things, difficult to adopt. But the best part is that people are adopting all these things. Otherwise, it was so difficult for us to wear mask full day in office. But we are practicing it right. Next please?

Female Speaker: Sir, is there any advisory or plan of the government, you know, to cover the larger — well, I’ll just read it out, I’m trying to make sense of it. Is there any advice Gohash’s (phonetics) question?

Dr. Praveen Vashist: Plan for government, how they would cover the large pendency of urgent cataract service during or after COVID. Now that’s something difficult to answer at this stage. You know, it is not that if we have providers they will provide surgeries. It is the demand which is also restricted. I have a very strong doubt that patients will come for cataract surgery. It will be very difficult to counsel patients now. Yes, government need to take certain actions so that we should achieve our targets of eliminating cataract blindness.

But at this stage, I am also not very clear. But that we will have such guidelines or not in fact very clearly when we ask by National Program for Control of Blindness about guidelines for cataract surgeries. They’re very clear at this stage. They’re not issuing any guidelines. The guidelines which are being issued for other surgeries they need to be followed. But definitely we’ll have meeting very soon. In fact, there is a committee related to this thing under the Government of India. And also, I’m one of the member and we’ll decide something special how we can achieve cataract surgery.
But the target for cataract surgeries for the areas, but that will come out. But at this stage, I don’t have a very clear cut solution because of the status of pandemic at this stage in our government. Next please?

Female Speaker: Sir, for the stand alone or integrated vision centers, how can the quality be monitored?

Dr. Praveen Vashist: Whether it is for integrated or stand alone or the both?

Female Speaker: Both.

Dr. Praveen Vashist: Hello? You know, the Optometrist training is the key component and government has given guidelines a minimum two-year trained optometrist should be there in vision centers, this is one. The as far as integrated vision centers are there, we’re expecting the medical officer in charge who’s there in the center, he will take care of the most of the quality issues. For stand alone vision center, it is expected that the Ophthalmologist should visit once in a week or maybe less but they should visit and monitor the services there. These are the standard guidelines. In fact, there are monitoring procedures. Daily checking of the patient’s data, patient’s diagnosis, what the optometrist will need. Those things can be checked on routine basis. Actually on a daily basis in the afternoon and optometrist they come out, but of course, the training part in a training and actually supervision. These are the two things which need to be taken care at all aspects. And it is very much feasible. We have tried. We have running 28 vision center right now. And it is very much possible to monitor these vision centers. There is not much different than recovered and post forward in this year. Next please?

Female Speaker: Sir, this is the last question.

Dr. Praveen Vashist: Bharat Ayush, the direction has been sent to the SPO’s and the decision from officers as far as the starting of services are being consult. As far as vision center reimbursement is concerned, probably you are not part of that meeting when we had meeting with Pramila Gupta. And it is very clear. She herself mentioned that vision center patient will be allowed for reimbursement. And of course, we will request her again that even such direction should be sent to all SPO’s and DPM’s so that they can follow these guidelines which are being taught at the national level by the policy makers. Thank you, thank you.

Female Speaker: Thank you so much, sir. This was more than 50 questions about doctor…

Dr. Praveen Vashist: Okay, [Overlapping Conversation] [01:18:07] I’m sorry I was not very comfortable in answering many questions because the reason is very clear. No one is very clear about what will happen. But I put the answer as far as my knowledge is concerned. But the best part is I really thank the Orbis and the Cybersight that they have taken such good initiative. I don’t know about others but this set of five lectures, they have helped me a lot. I will listen to all five lectures and probably the lectures covered by Dr. Shamanna, Mr. Tulsi Das, Dr. [indiscernible] [01:18:50] I’m extremely informative, very clear cut. This is probably one of the best efforts that have been taken by NGO at this COVID era. And we hope that similar initiative will be taken in future. Thank you, thank you very much. It was really nice. I thank everyone for giving me opportunity to be a part of this program. Thank you very much. Thank you, ma’am.

Female Speaker: Thank you so much, sir. Thank you everyone for your active participation. And we sincerely hope that you found all the discussions very informative and thought provoking. Thank you so much. Please take care. Stay safe and continue on locking possibilities.

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May 16, 2020

Last Updated: September 12, 2022

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