A comparison of French painter Claude Monet´s paintings before and after he contracted cataract described the extent of damage caused to the vision of most patients. Prof. Balasubramanian adopted this approach of explanation using vivid images throughout his presentation. The lecture was about one of the most prevalent eye conditions in India- cataract. That there are some 50 million people in India suffering from eye disorders, with over 60% of them having cataract, set the tone for what was a thoroughly enlightening lecture.
The functions of the various parts of the eye were described. How the cornea focuses the image and how the eye lens accommodates. The deterioration of the tissue around the eye is the major cause of cataract. The tissue cannot be regenerated due to which the process is not reversible. A key component of the lens are crystallins, proteins that can be categorized as α and β. Mutations in the proteins are the major cause for cataract. The most prevalent form of cataract in India is the nuclear cataract and as the name suggests, there is loss of vision at the centre, although peripheral vision persists.
Cataract cases have been found to be age related. There is decreased transmission of light with age which results in increased glare. Insoluble protein accumulates and precipitates, this leads to lens hardening. There is browning of the lens and more light is required to read. Accommodation of the lens gets weakened. The age dependence of transmission of light was shown with the use of graphs and comparative study, further elucidating the relation.
The mechanism for the damage of the lens can be attributed to photochemical oxidative changes. There is also a possibility of a sugar based reaction with proteins called caramelisation. Studies are still going on to describe the exact damage mechanism.
The best option when one contracts cataract is the intra ocular transplant. The main issue of concern is post operative care. The disadvantage of the one day eye camps lies in the fact that there is no follow up after the surgery. Thus, the LV Prasad Eye Institute trains people in an area or a village to check for symptoms of cataract, refer patients to hospitals and educate them about post operative care. The objective of the Institute is to reach out to 50 Million cataract patient through a very innovative pyramidal set up by 2020. On the bottom most rung of the pyramid are the vision guardians, trainees who do preliminary check ups and send patients for further referrals. Then comes the vision centre where trainees are given a diploma after being taught how to use some basic instruments, no surgery is performed though. Followed by the secondary service centre (50 of which have been established by LV Prasad Eye Institute), the tertiary service centre and finally the centre of excellence. This model has a very inclusive approach, where communities will get involved in a self help organizational manner, and promises to have an impact through out the country.