8. Visit to the Optometry School and Community Centres

After an enjoyable but tough week comprised mainly of early mornings and long days, spending time across a range of disciplines - it was arranged for us to travel out into the community. We visited the Bausch and Lomb school of Optometry and some of the primary and secondary centres, which are part of the LVPEI network. Why’s it always the case that when you know you have to be up bright and early, you continuously wake up throughout the night? I’m sure I’m not the only one who suffers from this issue time and time again. I wonder if there’s any science behind it? After a broken night of sleep, the painful yet familiar screeching of my iPhone alarm echoing around the room prompted the start of my day at 6am. I lay in bed for a good 15 minutes or so trying to get both my eyes to open and stay open - a task that seemed much harder than it sounds. I think my mood improved slightly as I went into the bathroom to realise I hadn’t been chewed on by mosquitos overnight, with no new bites immediately apparent. I thank one of my peers for lending me a small bottle of citronella oil, which I dotted around my room - known to repel mosquito’s. In other news, I should probably start charging for my travel tips, could become quite a profitable idea. After a quick shower to refresh and wake myself up, I dressed and met my colleague’s downstairs, where a car was arranged to collect us.

If I’m completely honest, I hadn’t been looking forward to this day as much as the other days that we had planned for us, due to the fact we would be spending around 8 hours of the day in a car. However, now that I’ve returned and made it back in one piece after travelling these Indian roads, I am glad we decided to go; as this trip proved to be extremely eye-opening and insightful. Our first stop off of the day was at the Bausch and Lomb Optometry school, located around 15km from the main centre of excellence here in Hyderabad. The campus is relatively small, but the greenery and bright coloured flowers that surround the buildings create a beautiful scenic view. The equipment on campus was of a high standard, with many of the diagnostic machinery being the same – if not better – than what we have at University. There were specific rooms designated to certain tasks, such as keratometry, slit lamp and focimetry. In addition to this, there were a small number of testing rooms that students would typically use in their final years of study, that would allow them to put together a full routine for an eye examination. The campus also included onsite single-sex accommodation for the students, a canteen and library. A new contact lens manufacturing lab had recently been opened, which was used mainly to make scleral lenses as these had previously been ordered from Boston, America, with waiting times being up to 2-3 weeks. Now however, with the new on-site lab, scleral lenses can be dispensed on the same day for half the cost.

It was explained that 3 programmes are offered here; a BSc in Optometry (4 years), a Diploma programme (3 years) and a Vision Technician scheme (1 year). Each of these programmes have small intakes of around 30-40 students per year, who are all trained to a great standard in their chosen area and placed into roles within this field. Interestingly, those who study a 1-year vision technician course are offered the opportunity to be placed back into their local community in a primary care setting, where they will run their own small practice. Here, the vision technicians would carry out simple refractive techniques to give patients accurate prescriptions and help them choose glasses suitable for their needs. As part of the LVP network, these primary care centres’ have iPad’s where they can take images of certain things that they’re unsure off and send this on, which will be received by an ophthalmologist in the tele-communication department at the centre of excellence. It will then be decided whether this patient should be prescribed any medication or referred to one of the secondary or tertiary centres to receive more extensive treatment – and the information will be conveyed back to the vision technician within a matter of moments. This for me, represents efficiency at its highest level, as it would be difficult for many of these patients to travel to another centre to be told they did not need treatment, and with a large proportion of these individuals receiving daily incomes it would be of a huge disadvantage economically to do so. Many of these primary centres also have regular shuttles throughout the week, which can take patients to the centre of excellence if required.

Set up of primary centre testing room

We were able to visit a primary care centre, which consisted of testing room and reception room that included a small range of spectacle frames for patients to choose from. I was shocked to see how cheap everything was, with frames ranging from 80-290 rupees (£1-£3.50) and single vision lenses being only 200 rupees (£2.50). This is a huge contrast from the frames we sell at Specsavers, with our cheapest frame being £25 and our most expensive designer frames being £169 – bearing in mind that Specsavers are considered the most affordable when compared to the large multiples. It emphasised the case that much more priority is given to patient care, rather than driving sales as a business to make money. Each of the vision technicians receives a monthly income from LVPEI, and the money they make from glasses is used to cover maintenance of the store. Typically, a primary care centre will see around 5-10 patients a day – and the one we were able to visit today had a board up that showed their statistics from the previous month. 66 patients had been screened, 18 required glasses, with 16 of these actually purchasing them. A total of 8 patients were referred for further care, however only 4 of these actually attended their scheduled appointments at their specified centres.

Moving on, we visited 2 secondary centres, which were extremely similar to one another with a high standard of care maintained throughout. They each consisted of multiple testing rooms used to screen the patients, operating theatres, a few beds for overnight stays and 2 separate waiting rooms – one for non-paying customers, and a slightly more comfortable one for paying customers. I found it intriguing how again, there were no trained optometrists as such; instead there were vision technicians who had a minimum of 5 years’ experience within the community, and an onsite ophthalmologist. One of the directors at the secondary centre’s explained how a simple consultation and screening costs each paying patient 100 rupees (£1.25). About 60% of their simple consultations were paying patients, with 40% being non-paying; this dramatically drops to about 25% of patients paying for surgery and 75% of surgeries unfunded. Again, reiterating the point I made earlier that the focus here really is on patient care. There is an option to be a ‘supporter’, which is a category that pays twice as much, however waiting times are shortened and you get a more luxurious waiting area – though these patients still see the same professionals and receive the same level of care.

I think it’s quite impressive how LVPEI have developed this incredible network of ocular care that spreads throughout Hyderabad and its neighbouring areas, ensuring eyecare is available, accessible and affordable to all. I love how all barriers that may have existed, which would prevent patients from visiting these institutes, have been removed – such as allowing patients to receive care free of charge where necessary, but also having individuals within villages and communities who screen patients and then refer them on to other levels of the pyramid system.

Tomorrow is Sunday, and my ONE day of rest before the second and final week of my placement! I’m looking forward the most to not having to set an alarm, and sleep until my body naturally feels it is time to wake up once I’ve gained an adequate amount of shut eye. I’m planning on going to have a little look at the city, scoffing down some lovely biryani that this city is so well known for, and being a tourist!