Preventive eye care needs to become the norm, not the exception late

India has an estimated 12 million people living with glaucoma, yet a large proportion remain undiagnosed. From a healthcare system perspective, what are the key barriers preventing early glaucoma detection in India?

Twelve million people and the majority have no idea. That number should alarm us, but the more uncomfortable truth is that this situation is entirely preventable. The barriers are layered. Glaucoma screening is simply not part of how most people think about routine eye care in India. People visit when something bothers them, not before. At the system level, specialised diagnostic equipment rarely reaches smaller towns and rural areas where a large proportion of the at-risk population lives. And awareness among patients, among families, and sometimes even at the primary care level remains incomplete. Preventive eye care needs to become the norm, not the exception. Until glaucoma testing is built into routine examinations, we will keep finding the disease too late.

Glaucoma often progresses without noticeable symptoms until advanced stages. How does this asymptomatic nature contribute to delayed diagnosis in routine clinical practice, particularly at the primary and secondary care levels?

The cruelty of glaucoma is that it gives almost no warning. No pain, no dramatic change in vision — patients feel perfectly fine until the optic nerve has already lost fibres it will never recover. In clinical practice at the primary and secondary levels, this creates a specific problem: if the focus of a visit is correcting glasses or managing an eye infection, glaucoma simply does not enter the conversation. And unless a clinician actively looks for it — checking optic nerve health, measuring pressure, assessing risk factors — it will not be found. By the time a patient comes in with a genuine visual complaint, the window for early intervention has often already closed. A vision test alone is not a glaucoma check, and that distinction needs to reach every eye clinic in the country.

Advanced diagnostic tools such as OCT imaging and visual field testing are increasingly available. Why does glaucoma continue to remain underdiagnosed despite these technologies?

The technology exists. That is not the problem. OCT imaging and visual field testing are genuinely powerful tools, but their impact depends entirely on where they sit and how consistently they are used. In well-equipped urban centres, these tools change the trajectory of diagnosis completely. But in the smaller clinics and peripheral facilities where millions of Indians actually receive eye care, they are either absent or used only when glaucoma is already strongly suspected — which defeats the point of early detection. There is also a behavioural dimension. Patients who are not in discomfort do not push for detailed testing, and clinicians under time pressure tend to focus on presenting complaints. Technology improves outcomes only when it is supported by training, awareness and a culture of proactive screening.

From a hospital systems perspective, how can stronger referral pathways and screening protocols within eye care networks improve glaucoma detection rates?

The infrastructure for better detection already exists within our networks — what it needs is intentional design. If any patient above forty, or with diabetes, a family history of glaucoma, or high myopia, is automatically triaged for a glaucoma evaluation rather than a standard vision check alone, detection rates will shift meaningfully. Clear referral pathways matter just as much. A general ophthalmologist or optometrist who spots a suspicious optic nerve needs a fast, frictionless route to a specialist — not a process that takes weeks and depends on the patient following up themselves. Digital records and structured review protocols can close the gap further by ensuring patients do not fall through the cracks between appointments. Systematic beats optional every time.

As initiatives like World Glaucoma Week highlight the need for awareness, what practical steps can healthcare institutions take to translate awareness into sustained glaucoma screening programmes?

World Glaucoma Week opens a door. The question is what we build behind it. Awareness alone does not protect vision — action does. The practical step is making the campaign a reason for people to actually come in, and then making sure that when they do, they receive a proper evaluation, not just a pamphlet. Institutions that run community screening camps, partner with local clinics, and embed glaucoma checks into every comprehensive eye examination are the ones converting awareness into outcomes. The message has to land clearly: glaucoma develops without pain or obvious symptoms, which means that feeling fine is not proof that vision is safe. When patients understand this genuinely, they make the appointment. Our job is to make that appointment easy to access and worth attending.

[email protected]

[email protected]