President Dr. R. Ramakrishnan's Message

Respected Chief Guest of the function, Padma Shri. Manohar Devadoss; Guests of Honour Dr. Lalit Varma, President – AIOS; Dr. Ramani, Director, Sankara Eye Hospitals; dear Dr. Mohan Rajan, Immediate Past President; Organising Committee Chairman Dr.Sundar; Secretary Dr. J.K.Reddy, Dr.Sathyan; Scientific Committee Chairman; seniors; colleagues; invited guests; dignitaries on and off the dais, a very warm good evening to all of you.

Today is one of the most important and memorable days in my life. My sincere thanks to the Almighty and members of the TNOA family for placing trust on me to lead this organization. I am truly humbled to take up this post, which has been so far decorated by stalwarts in the field of ophthalmology. TNOA is 69 years old now; it was formed in the year I was born. Many eminent personalities have put in their efforts and time to make TNOA one of the strong and meaningful associations in our country.

We are now a family of more than 3000 life members and TNOA is probably the second largest state association in the country. At this juncture, I have to thank my parent organization Aravind Eye Hospital and its leaders, our founder, late Dr. G. Venkataswamy, Dr. P. Namperumalsamy, Dr. G. Natchiar and others for nurturing, mentoring and moulding me to what I am today. I also thank our Chairman Dr. R.D. Ravindran for his constant encouragement.

My family has always been a constant source of support to me. My mother and my wife Saradha were always there to guide me at every step of my life. My father in law and my mother in law, aged 96 and 94 respectively and living independently, have taught me life's most important lessons.

On this occasion, it is my duty to congratulate and thank the past presidents, Dr. Mohan Rajan and Dr. Thangavelu; Secretary, Mr. Madhavan; Treasurer, Dr. Loganathan; ARC Chairman, Dr. Rajasekar; President elect, Dr. Nirmal Fredrick; Editor, Dr. Sharmila and other office bearers of TNOA for their tremendous work. Dr. Mohan Rajan needs a special mention for his tireless work in organizing continuing academic and social activities throughout his term and transforming TNOA into a vibrant organization.

Dear Friends..

Ophthalmology has grown by leaps and bounds over the past four decades. One of the reasons for this growth is the pioneering efforts by eminent ophthalmologists of South India who envisioned a future where people don't have to remain blind needlessly. Until then ophthalmology was not considered as a "stylish speciality”.

The general notion was that because the eye is very small, ophthalmic clinics do not have much prospects to develop and will have only very little to offer, either career wise or financially. Through the focused efforts and dedicated practice of many stalwart ophthalmologists, ophthalmology opened up vast possibilities. Their openness in sharing their knowledge and skills with budding ophthalmologists led to them introducing many training programmes in ophthalmology. The trainees in turn started their own clinics thereby contributing to providing comprehensive and quality eye care for all. Gradually, ophthalmology became a highly sought after medical speciality. Ophthalmic services too started gaining popularity amongst the general public.

Changing Trends

About four decades back, our focus was only on cataract. Many of the speciality eye diseases that are very common now were not given much importance. Revolutionary developments in diagnostics now help in providing better care for patients and treatment of many eye conditions before they get to an advanced state, where the possibility of restoring vision, often is almost nil. Ophthalmic research has gained momentum and unravelled the mystery behind various blinding eye conditions; new treatment modalities have emerged. Technology is increasingly being utilised to its fullest potential to aid in patient care. As a result of these, the spectrum of conditions that we can treat and the quality of care have gone up.

Doctor-patient Relationship

Amidst these developments which are all extremely essential, I feel that we are losing something very precious - the connection with the patient. As the practice flourishes, our focus is to cater to more and more patients. It has become practically impossible for us to spend time with patients, talk to them more personally so as to know the person beyond his or her eye problem. This has resulted in a lack of human touch in the care-giving process. Patient has merely become a client for a doctor. A doctor-patient relationship has reduced to a vendor-client association. Everything is considered purely from a business point of view. Human relations and values do not seem to have a role to play there. Today's patients are knowledgeable and highly demanding. Earlier, they had complete trust in the doctors and would sincerely follow their advice. But, nowadays, patients question the doctor.

The effectiveness and success of our work depend on how well the patients trust us and follow our advice. Recognizing this reality, we need to pause and reflect on what we should do to regain the trust of the people we serve.

Reaching the Unreached

Tamil Nadu holds a special place as far as ophthalmology is concerned. The second oldest eye hospital in the world is the RIO in Chennai. We are blessed to have many eye care providers in the government/non-government sectors who are doing wonderful service to the community by providing high quality eye care and developing postgraduates and fellows through training. Despite all these, we are yet to reach a great majority of the population who are in need of eye care services.

There are around 24,000 ophthalmologists in our country, with a doctor-population ratio of 1: 60,000; in contrast to 1: 15,000 in the USA. Our lower density of ophthalmologists is further compounded by the fact that many of them are settled in urban areas. It is the responsibility of all of us to create alternate arrangements like setting up primary vision centres in rural areas to cater to the eye care needs of the people there.

Recently the Govt. of Tamil Nadu concluded a survey of blindness and visual impairment covering every district in our state. This is the very first time such a state-wide eye care survey is done. We now have evidence of magnitude of blindness and visual impairment and their causes in each district. The World Health Organization, for the very first time in the history of eye care has proposed a vision of less than 6/12 as the threshold for intervention for cataract surgery or refractive error correction. At the national level, we have also agreed to double the effective coverage of cataract and refractive error services. In line with the theme for the current year “Synergy through Unity", all of these offer us a unique opportunity to join hands with the government for enhancing eye care in Tamil Nadu.

Hidden Pathology

Even though we have done enough work in tackling cataract blindness, posterior segment diseases like glaucoma, DR & ARMD are on the increasing trend. Because of their silent nature, most patients seek medical advice in the advanced stage. Creating awareness in the community and comprehensive eye examination will help in early diagnosis of these conditions, treating them and thus preventing people from going blind. We can enhance eye screening initiatives in the community by involving non-ophthalmologists like general physicians, diabetes specialists, geriatricians etc. As the survival rates of preterm babies improve due to advances in neonatal care, the number of infants at risk for ROP is increasing. Adequate training of doctors in the management of ROP and improving diagnostic & treatment facilities are very important in all the districts.

Strengthening Community Outreach Programme

Community outreach is the backbone of the eye care delivery model for most of the government and non-governmental organizations for more than half a century. Most of the eye camps conducted focus on cataract screening. It is time we transformed these camps into comprehensive ones in an effort to address eye problems holistically. Technology can be utilised to increase the efficiency of these camps. Use of portable, non-mydriatic fundus camera, virtual visual fields, handheld slit lamp, mobile-aided devices have demonstrated higher detection of posterior segment disease like glaucoma, DR, etc.

Human Resources

All of these require skilled human resources. Hence training of ophthalmologists and allied ophthalmic personnel is of paramount importance. Recently, the Government of India has brought in a new act through the parliament to regularise the training and certification of allied health workers. In ophthalmology, three positions have been recognised by the government, namely Optometrist, Ophthalmic Assistant and Vision Technician. This new initiative gives eye hospitals an opportunity to provide in-house training and develop paramedics. Major institutions can provide short term training in medical retina, glaucoma etc and observation opportunities for interested ophthalmologists and residents. This will definitely help the doctors to update their diagnostic skills, identify problems at an early stage and treat them appropriately.

During this year, our team will continue some of the academic activities of the Immediate Past President, Dr. Mohan Rajan. In addition, we will have the following activities:

1. Conduct of awareness programmes on occasions such as National Eye Donation Fortnight, World Glaucoma Week, World Diabetes Day, Fire Safety Awareness, Road Safety Week etc.

2. Having Journal Club as a regular programme to motivate young ophthalmologists to do meaningful research and come out with publications.

3. Monthly Grand Rounds in collaboration with major eye institutions in the state for the benefit of the residents.

4. Case presentations and discussions by Postgraduates and Fellows in various specialities of ophthalmology

5. ARC programmes (in-person) in two tier cities periodically

Let us join hands with the government to make sure that quality eye care is made accessible affordable to all sections of the society. With the cooperation, guidance and blessings of our seniors, colleagues, NGOs, friends and trade partners, we will do our best to make our state a role model in providing comprehensive ophthalmic care to all.

Thank you again

Dr. R. Ramakrishnan,
TNOA 2022 - 2023