Vision Neglect in India: Why Eye Care Takes a Backseat Until It's Too Late
In India, a troubling pattern persists in healthcare priorities. While fever, stomach pain, or a persistent cough prompt immediate visits to the doctor, eye health is routinely pushed aside. Most people adopt a wait-and-watch approach, often delaying critical eye examinations until symptoms severely disrupt daily life. This cultural hesitation towards proactive eye care has created a silent epidemic of preventable vision impairment across the nation.
The Dangerous Mindset of "I Can Still Manage"
Blurry vision is frequently dismissed as a natural consequence of aging. Headaches, watery eyes, or general eye strain are commonly attributed to excessive screen time or sleep deprivation. Many individuals simply adjust to declining vision, finding workarounds for difficulties in reading or discomfort while driving at night. For numerous families, comprehensive eye care is perceived as a luxury, reserved only for emergencies when something goes seriously wrong. This normalization of visual discomfort allows underlying conditions to progress unchecked.
Common Eye Diseases People Consistently Overlook
Refractive Errors: Conditions like near-sightedness and far-sightedness are incredibly prevalent. Children struggle to see classroom blackboards, while adults squint at smartphone screens. Yet, many endure years without corrective glasses or with outdated prescriptions, unknowingly straining their eyes.
Cataracts: This remains one of the leading causes of vision loss in India. The eye's lens gradually becomes cloudy, causing vision to appear foggy or yellowish. Because this deterioration happens slowly, people adapt to progressively poorer vision, often seeking help only at advanced stages.
Dry Eyes: Increasingly common due to prolonged screen exposure and urban pollution, symptoms like burning, redness, and a gritty sensation are frequently ignored as minor irritations.
Eye Infections: Conditions like conjunctivitis spread rapidly, especially during seasonal changes. Many rely on home remedies instead of consulting medical professionals, risking complications.
How Diabetes Quietly and Steadily Damages Vision
Diabetes affects far more than blood sugar levels; it systematically damages blood vessels throughout the body, including those in the eyes. Diabetic retinopathy has emerged as a primary cause of vision loss among working-age adults in India. With one of the world's largest diabetic populations, regular eye screenings remain alarmingly low, allowing this condition to advance silently.
Glaucoma: The Silent and Insidious Thief of Sight
Glaucoma is particularly frightening because it erodes vision slowly and painlessly. It typically begins with peripheral vision loss, which goes unnoticed as central vision remains intact for extended periods. Increased pressure inside the eye damages the optic nerve irreversibly. Early detection is crucial to slow or halt progression, yet a significant number of glaucoma cases in India are undiagnosed until substantial vision is permanently lost.
The Magnitude of India's Vision Impairment Crisis
Millions of Indians live with some form of vision impairment. Cataracts account for a substantial portion of preventable blindness. Diabetic eye disease is rising sharply alongside the diabetes epidemic. Glaucoma affects several million individuals, with most unaware of their condition. The tragedy is that many of these issues are either preventable or manageable with early intervention.
Compounding this problem, diabetes and glaucoma often co-occur. Research indicates diabetes raises the risk of primary open-angle glaucoma by approximately 40%, attributed to vascular changes and elevated intraocular pressure. Studies reveal stronger correlations in type 2 diabetes and longer disease duration. A 2015 Indian hospital-based cross-sectional study of 841 type 2 diabetics found a 15.6% glaucoma prevalence, identifying longer diabetes duration as a key predictive factor. These findings were published in the Oman Journal of Ophthalmology.
Expert Insights: Protecting Vision from Dual Threats
TOI Health consulted Dr. Sudhamathi Kalluri, Senior Consultant Ophthalmologist at Dr. Agarwals Eye Hospital in Gurgaon, on safeguarding vision against the combined risks of diabetes and glaucoma.
Diabetes and Glaucoma Risk: "There is a significant, nearly two-fold increased risk of developing glaucoma in diabetic individuals compared to the general population," explains Dr. Kalluri. "Consistently elevated blood sugar damages small blood vessels supplying the optic nerve, impairs eye fluid drainage, and raises intraocular pressure, all contributing to glaucoma, especially primary open-angle glaucoma."
She adds that poorly managed, long-standing diabetes can reduce the optic nerve's tolerance to normal eye pressure, accelerating disease onset. Consequently, diabetic patients may develop glaucoma at a younger age than non-diabetics.
Early Warning Signs: Dr. Kalluri cautions that glaucoma in diabetic patients often progresses asymptomatically. Initial indicators might include slight vision alterations, frequent vision fluctuations, eye soreness, or gradual peripheral vision loss. "Symptoms are easily missed, making regular eye check-ups essential for early detection," she emphasizes. "Waiting for clear symptoms is dangerous, as glaucoma-induced vision loss is irreversible."
Blood Pressure's Critical Role: Both high and low blood pressure can influence glaucoma risk. High BP may increase eye pressure, a major glaucoma factor. Ocular perfusion pressure—the balance between blood pressure and intraocular pressure—is crucial. Extremely high or low BP (especially nocturnal dips) can reduce blood flow to the optic nerve, causing damage and hastening glaucoma progression. Chronic hypertension may harden blood vessels, impairing nutrient supply to the optic nerve.
Hypertension can also increase aqueous humour production or hinder its drainage, elevating intraocular pressure. A 10 mmHg rise in BP can increase IOP by approximately 0.26 mmHg. Blood pressure fluctuations may cause sudden optic nerve damage, underscoring the need for stable BP management in diabetic glaucoma patients.
Common Misconceptions: One prevalent myth is that controlling diabetes alone prevents glaucoma. While they share risk factors like age, genetics, and hypertension, glaucoma requires separate monitoring and treatment regardless of blood sugar control. Another fallacy is that glaucoma-related vision loss is reversible; in reality, optic nerve damage is permanent, though treatment can prevent or slow further deterioration.
Impact of Age and Diabetes Duration: Glaucoma risk and severity escalate with age and longer diabetes duration. Prolonged exposure to high blood sugar accelerates optic nerve damage. Regular eye exams, good glycemic control, a healthy lifestyle, and smoking avoidance can significantly mitigate complications. Patients over 40 and those with long-standing diabetes should undergo more frequent screenings to catch glaucoma early.
Ideal Care Routine for Dual Diagnosis: For patients with both diabetes and glaucoma, optimal care involves stringent blood sugar regulation and frequent eye check-ups to monitor eye pressure, optic nerve health, and retinal changes. Glaucoma medications must be taken as prescribed, and self-medication—particularly with steroids—should be avoided. Lifestyle interventions like regular exercise, balanced nutrition, and stress management support overall eye health. Coordinated care between physicians and ophthalmologists yields better long-term outcomes.
Medical experts consulted: This article incorporates expert insights shared with TOI Health by Dr. Sudhamathi Kalluri, Senior Consultant Ophthalmologist at Dr. Agarwals Eye Hospital, Gurgaon. Inputs addressed the scale of vision impairment in India and protective measures against diabetes and glaucoma-related vision loss.
