SEASONAL (MONTHLY) VARIATION AMONGST REPORTED CATARACT SURGERIES IN INDIA R. Jose, Sandeep Sa !de"a. Available from: ksos.in/ksosjournal/journalsub/Journal_Article_20_329.

pdf Email: drsandeepsachdeva@gmail.com In#$od% #&on Eye care service in India has grown tremendously over the past three decade since the inception of the national programme in 197 . !ational "rogram for #ontrol of $lindness %!"#$&' (overnment of India with the implementation of Eleventh five year plan %)**7+1)& has become more comprehensive than ever before paving way for ma,ing available level appropriate eye care service to entire segment of population. 1 -he availability of e.pertise' infrastructure and technology is comparable to any of the developed nations in combating e.isting / future challenges of blindness such as diabetic retinopathy' glaucoma' retinopathy of prematurity' corneal blindness to name a few. Ca#a$a # s%$'& a( o%#p%# Advances in the treatment of cataract across the globe have been availability of low cost high 0uality intra ocular lens %I12& and newer techni0ues li,e small incision cataract surgery %3I#3& / phacoemulsification. 4a5or cause of blindness in India as throughout the globe is cataract and surgery remains the only solution till date. 6ith increase in awareness / demand for high 0uality services' there is a rising trend of people undergoing surgeries much before significant vision impairment due to aggressive outreach screening7mobili8ing activities of government7!(17private sector. 3entinel 3urveillance 9nits %339& under !"#$ have reported cataract surgery being underta,en in patients at a much earlier time than blindness has developed which is consistent with phenomenon seen in other parts of the world. ) #ountry performed :.; million cataract surgeries with 9<.*= intra+ocular lens %I12& implantation and #ataract 3urgical >ate %#3>& of more than :***7million population for the year )**;+*9. -he cataract surgical output has witnessed an upward graph from *.: million in 19;)' ).7 million in 199 through <.< million in )**1+*) to present status.

C!a((en'es o) e*e a$e se$"& es Inspite of phenomenal growth in health system development' information / communication technology' physical and financial performance' the challenge of reaching the poor' rural' hilly' tribal or underserved population is an area of concern / remains to be overcome significantly even today. -hese challenges include but not limited to issues related to finances' gender' community beliefs' lac, of transportation' dependency on others for escort and other barriers to availability / access to service as nearly 7*= of the population in India resides in rural areas. -he efforts' strategies and resources of !ational "rogramme for #ontrol of $lindness %!"#$&' (overnment of India are directed to reach such population and ma,e available level appropriate eye care services to largest section of society in an effective / efficient manner. +a ,'$o%nd #ataract surgery is a day+care elective procedure and can be successfully performed any time during the year without any ris, of additional complications. ?owever' there are various reasons including the beliefs prevalent amongst community to avoid surgery during the period of summer and monsoon i.e. timeframe corresponding to months of April to 3eptember. -hus from health system perspective this becomes a lean period as patients tend to floc, during winter seasons. -he principles of health economics indicate that such health practices results in under utili8ation of services and wastage of resources at one end and overcrowding' undue strain on health system' with a possibility of compromising 0uality of care and iatrogenic infection at other end. Ideally' from the health systems perspective cataract surgery performance should be spread evenly through out the year that would in+turn result in saving huge resources directly or indirectly. -he ob5ective of this paper was to analy8e the proportion %=& of cataract surgeries underta,en by respective 3tates79-s in the country during the months of April to 3eptember and 1ctober to 4arch. All 3tates and 9nion -erritory %9-s& submit monthly performance report of cataract surgery to !"#$' !ew @elhi. -he performance reports from various 3tates79-s in India for the financial year )**;+*9 was re+confirmed' analy8ed and presented according to decreasing

order of fre0uency %April to 3eptember& so as to gauge the scale of community acceptance for cataract surgery during reference period. Res%(#s and d&s %ss&on It was found out that 4eghalaya' -amil !adu' "uducherry / Andhra "radesh had performed at least :*= of the total cataract surgeries during the months of April to 3eptember while the populous states li,e 4adhya "radesh' 9ttar "radesh' $ihar' #hhattisgarh and Ahar,hand performed only upto ) = during the same period. -he proportion of performance for rest of the 3tates79-s varied between these two ends %-able 1&. -he findings reflect upon distinct developmental phases or transition amongst various 3tates79-s in the country as being witnessed in other spheres of life. -he plausible comple.' interlin,ed and multi+factorial issues behind this diverse spectrum range from socio+economic factor as more than *= of the sown area in the country is dependent on rainfall / the entire households are engaged in agricultural practices' e.treme weather conditions' literacy status' cultural practices' intensity of social mobili8ation7information' education / communication %IE#& activities for dismantling wrong beliefs' creating demands for cataract surgeries' promotion of best practices and7or other factors li,e governance or substantial presence or conspicuous absence of functional public+private partnership instruments. 1ther reason could be Btarget+oriented approachC for performance prevailing among government functionaries in some of the under+developed states that is s,ewed during later months of financial year. 3ome of the studies in the western countries have attributed one of the reasons of lower upta,e of elective cataract surgery during summer season %Auly to 3eptember& to vacation period of specialists. D'< ?owever' it may not be critical factor in India. -his paper presents the snapshot for the year )**;+*9 and as India evolves and traverses through time' we would be witnessing evenly spread of cataract surgeries through out the year especially the northern / central belt resulting in fair distribution and consumption of scarce financial / human resources.

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Re)e$en es/ 1. Aose >' >athore A3' >a5she,ar H' 3achdeva 3. 3alient features of the !ational "rogram for #ontrol of $lindness during the JI th five+year plan period. Indian A 1phthalmol )**9K:7: DD9+<* ). Allen Loster' #lare (ilbert' (ordon Aohnson. #hanging "attern in (lobal $lindness: 199;+)**;. #ommunity Eye ?ealth A 3ep )**;K )1 % 7&: D7+D; D. Alan 4 2eong' Eric A #righton' >ahim 4oineddin' 4uhammad 4amdani' >oss E( 9pshur. -ime series analysis of age related cataract hospitali8ations and phacoemulsification. $4# 1pthalmology )** K :) <. "ettinger !. 6inter "ressures. 2a8y days of summer. ?ealth 3erv A 1999' 1*9: ) +)7