Corneal diseases are coming into sight

“I can’t see anything in my left eye. The bright light hurts. It's painful. Very painful. I am living in such a challenging situation because of this” says Pramila Naskar, a homemaker from Bangaon town in West Bengal’s South 24 Parganas district. Pramila, in her early forties, is speaking to us at a weekly cornea clinic in the Regional Institute of Ophthalmology, Kolkata, where she has come down for treatment.

I could easily empathise with Pramila Naskar. The more so as loss of sight even in one eye is a terrifying prospect for a photographer. I had a corneal ulcer in my left eye in 2007 and was on the verge of going blind. I was living overseas at the time and had to fly back to India for treatment. For one and a half months, I endured a torturous rehabilitation procedure before regaining full vision. And yet, a decade and a half after recovery, I still harbour a fear of going blind. I keep visualising how agonising it must be for a photographer to lose his sight.

Globally, according to the World Health Organisation (WHO) "at least 2.2 billion people have a near or distant vision impairment. In at least 1 billion – or almost half – of these cases, vision impairment could have been prevented or has yet to be addressed…”

The second most common cause of blindness worldwide, behind cataracts, is corneal diseases. The epidemiology of corneal blindness is complex and includes a wide range of inflammatory and viral eye conditions that result in corneal scarring, which eventually causes functional blindness. Additionally, the frequency of corneal disease varies from country to country.

A 2018 study in the International Journal of Medical Science and Clinical Invention estimated that India had approximately 6.8 million people with less than 6/60 vision in at least one eye due to corneal diseases; of these, about a million had a bilateral involvement. Normally, 6/60 vision means a person can see at 6 metres what someone with normal vision could see from 60 metres away. The study also expected that number could touch 10.6 million by 2020 – but no clear updates appear to be available.

A review article in the Indian Journal of Opthalmology says “Corneal blindness (CB) in India is 1.2 million, which is 0.36 per cent of total blindness; about 25,000 to 30,000 people are added every year.” The Regional Institute of Ophthalmology (RIO) was founded in Kolkata Medical College in 1978. RIO has experienced considerable growth under the stewardship of Prof. Asim Kumar Ghosh, the institute's current director. The RIO's cornea clinic, held just once a week, sees over 150 patients on just that single day.

This clinic, run by Dr. Ashis Majumdar and his associates, helps those who are most in need. Dr. Ashish told me, referring to my own case, “though you had developed a corneal ulcer from a fake contact lens solution, the term ’corneal blindness’ describes a variety of eye conditions that alter the transparency of the cornea, leading to scarring and blindness. The leading causes of corneal blindness include infectious causes, i.e., due to bacteria, viruses, fungi, and protozoa. The most common predisposing factors are trauma, contact lens usage, or the use of steroid medications. The various other diseases included are trachoma, and dry eye disease.”

Niranjan Mandal, in his mid-forties, was standing quietly in a corner of the RIO’s cornea clinic. He had black glasses on. “The cornea of my left eye was damaged,” he told me. “The pain is gone. But vision is still blurred. Doctor said, it can't be recovered fully. I work as a labourer in a construction company and if I can't see properly in both eyes, it will be tough for me to continue in the same profession.”

While talking to Niranjan, I heard another doctor gently scolding a patient, Sheikh Zahangir, in his late thirties: “Why did you discontinue treatment even after I told you not to. Now you are dropping in here after 2 months. I am sorry to say, you will never get back your full vision in your right eye”.

The same concern echoes in the voice of Dr. Ashish. He says “on many occasions we have noticed, the eye could have been saved if the patient was brought in on time. Recovering from corneal damage is a long and tedious process and discontinuation in treatment can lead to blindness.”

But there are intractable factors behind patients being irregular in their visits to the RIO. Take Narayan Sanyal, in his late fifties, who told us, “I live in a far-away place [Khanakul] in Hooghly district. For me it's better to go to a local doctor [ a quack] for check-ups. I know that doctor is not worthy but what to do? I ignore the pain and keep working. If I come here, it costs me roughly 400 rupees each time. I can't afford that”.

Pushparani Devi from Pathorprotima block of South 24 Parganas, faces similar difficulties. She has lived in a slum with her two children for the past 10 years and works as a domestic help. She said “I made the mistake of ignoring the redness in my left eye. And I went for a check-up with a local doctor. Then it became serious. I had to stop working. Then I came here [RIO]. Thanks to the doctors here, after 3 months of regular check-ups, I got back my vision. Now I need surgery [a corneal transplant] to ensure full vision. So, I am waiting for my date.”

The operation called a cornea transplant involves removing all or part of a damaged cornea and replacing it with healthy donor tissue. The terms keratoplasty and corneal graft are frequently used to describe corneal transplants. It can be used to cure serious infections or damage, improve vision, and alleviate discomfort. Dr. Ashish, performs around 4 to 16 corneal transplants in a month. It's a critical procedure which takes 45 minutes to 3 hours. Dr. Ashish says “the success rate after transplant is very high. And patients easily go back to their work. The problem is something else. There’s a supply and demand gap which affects us. Families should come forward with eye donations.”  There's a huge demand-supply gap in Bengal as well as in India. 

RIO Director Dr. Asim Ghosh has this message to give: “Please note that most people do not require corneal transplant. Please do not ignore initial symptoms. Please check your local ophthalmologist first. So many patients come to us and we feel bad when we see them come in at the very last moment and ask us to save the eye. As doctors it hurts us to see this.”

Also, says Dr. Ghosh, “make sure you have a healthy lifestyle. Keep a check on the sugar level. Diabetes makes our treatment for cornea & other eye related disorders more complex.”

“Back in the hospital corridor I meet Avarani Chatterjee, in her early sixties. She clearly looked joyful: “Hello, I don't have to come here again. Doctor said my eyes are fine. Now I can spend time with my granddaughter and see my favourite serial on TV.”