Infectious keratitis is a leading cause of corneal blindness globally, with a disproportionate burden in populous, developing countries like India. An infection is often the result of an untreated corneal abrasion and may ultimately develop into a corneal ulcer. 

Approximately 2 million people in India will develop a corneal ulcer each year. It is estimated that 195,000, which is 90%, of corneal blind people in Uttar Pradesh, are blind due to a corneal ulcer. 

When vision is lost due to an ulcer, a corneal transplant is the only treatment. However, this comes with the risk of corneal infection or ulceration owing to poor surgical outcomes. This leads to a high incidence of graft failure or opacity. 

Blindness caused by infectious keratitis is largely preventable, avoiding the need for a corneal transplant entirely. The World Health Organization recommends reporting to an eye care provider within 7 days of ocular trauma to manage infection and studies suggest that ointment applied soon after an abrasion could dramatically lower the incidence of ulcers. 

The importance of timely care of a corneal abrasion is well documented, however, several factors contribute to patients not getting the care they need. 

To reduce corneal ulcer rates in the Sitapur district, Uttar Pradesh, Sitapur Eye Hospital in coordination with its partner Sightlife has launched a Corneal Blindness Prevention Program. This prevention program has increased awareness, and care capacity and established a referral network to reduce corneal ulcer rates in Sitapur. 

‘Seeing’ signs early

There are several reasons why patients never detect early signs of infectious keratitis. Additionally, multiple factors contribute to patients not getting the care they need. This includes a lack of awareness and opportunity for appropriate treatment, limited access to well-trained medical professionals and medicines, and poor awareness about the severity. 

According to Sitapur Eye Hospital, “Considering the high cost of treating corneal ulcer and the resulting blindness, investing in prevention is the most cost-effective approach to reducing corneal blindness in India. Early intervention has the potential to restrict the growing number of corneal blind patients in India and identify patients for appropriate treatment and management.” 

Working along with Sightlife, the world's leading eye bank and global nonprofit organization dedicated to eliminating corneal blindness, the duo began increasing awareness in the Sitapur district. 

They spoke about early and appropriate first aid for corneal abrasions amongst residents, Panchayati Raj Institutions, Village Health and Sanitation Committees, block development officers, ASHA workers, Anganwadi workers, medical shop owners and rural medical practitioners. 

Giving sight

After the inauguration of a new eye bank, transplant numbers have been growing steadily. To further strengthen its efforts in Uttar Pradesh, SightLife is adopting a comprehensive approach through which it is working on prevention, policy-related issues, awareness creation, and surgeon capacity building.

The program is focused on key beneficiary groups that are at high risk of infectious keratitis such as females, people from rural areas, agricultural workers, and those with less education. During the pilot stage, the target population were the residents in the Biswan block of Sitapur, now it has scaled up to two more blocks -- Laharpur and Tambaur.

Primary care on the management of corneal ulcers is provided by Vision centers of Sitapur Eye hospital. Health workers in Primary health centers and Community health centers will be trained in first aid care. 

For secondary and tertiary care patients can visit Sitapur Eye Hospital. ASHA workers will be trained on when, how and ,where to refer cornea patients as needed. Referred cases will be tracked and followed up on by program staff.

By December 2022, ASHA workers have screened over 50,000 patients, treated 34,533 corneal abrasion patients and saved an equal number of patients from losing their vision.