Commentary: Ophthalmology training programs: Optimization of human resource to supplement clinical expertise and strengthen eye care delivery systems.

Preventable blindness is a significant public health concern, especially in developing countries. According to the National Blindness and Visual Impairment Survey (2015–2019), there are an estimated 35 million people who are visually impaired and 4.95 million people who are blind.[1] As per recent estimates by the World Health Organization (WHO), about 285 million people globally are visually impaired, of whom 39 million are blind.[2] The numbers are projected to increase in the future. Several initiatives have been taken up against the backdrop of high prevalence of preventable blindness including the initiation of the National Program for Control of Blindness (NPCB) in 1976. A joint global initiative called VISION 2020 was adopted in 1999[3] by the International Agency for the Prevention of Blindness (IAPB) and the WHO and is based on a three-pronged approach[4] that targets the elimination of preventable or avoidable blindness by the year 2020: affordable disease control, human resource development, and primary health care delivery principles. Of the three main principles, human resource development remains an integral component and a challenging endeavor. There is a substantial disparity between the need and distribution of skilled eye health personnel in developing nations[5] compared to the magnitude of eye care burden. The clinical acumen of eye specialists plays an important role in promoting not just the basic tenets of community ophthalmology but also targeted, need-based service delivery. In addition to providing health care services, they also shoulder the managerial responsibility to synchronize the team approach with other healthcare professionals. This calls for adequate training to achieve optimal service delivery and quality eye care. Skilled ophthalmic human resources are essential to tackle anticipated eye care burden, more so in developing countries. Global, national, and regional surveys have been taken up over time to assess the size and composition of the ophthalmic workforce. These surveys have provided an insight into the unmet need of the services. With respect to ophthalmologists, data studied from 193 countries indicate uneven geographic spread and practice patterns of the world’s two lakh ophthalmologists.[5] Other studies from South Asian countries show imbalances and discrepancies in allied ophthalmic personnel and ophthalmologists.[6] These indicate that the training aspects and number of trained workforce available is lagging behind in meeting the demands. Strengthening human resource involved in eye care delivery includes the entire ophthalmic workforce.[7] This includes ophthalmic assistants, outreach workers, instrument technicians, eye bank staff, and facility administrators and managers. Developing effective training strategies plays a key role in efficient care practices and benefit the population in general. Competent mechanisms to exploit the available human resources at all levels of eye care, namely, primary, secondary, and tertiary levels[7] is essential to provide quality care. This justifies the development of training programs to supplement skills across all categories of eye care professionals. These skills not only help in service delivery but also aid in career advancement of the individual. This would also help in stabilization of the workforce. The training curriculum of the International Council of Ophthalmology for community eye health has highlighted and stressed the importance of community and clinical interface.[8] Ophthalmology as a specialty has seen numerous advancements, with ophthalmic procedures having seen remarkable improvements in techniques, but training in the field has suffered and has not kept pace with the postgraduate curriculum focused on theory rather than requisite competency in surgical field (which is not assessed in residency).[9] To bridge the gap and to acquire surgical proficiency and enhance their surgical skills, ophthalmologists seek out additional training. Subspecialty training is almost non-existent except in a handful of medical colleges with a primary focus on cataract surgery training. There is also a need to customize surgical training to meet the needs of the ophthalmologist and add on to existing skills and clinical expertise owing to the variability in training obtained at the residency level.[910] This would help in minimizing attrition. Training has also seen a downward trend in the post-COVID-19 era. Well-structured and standardized training programs help in ensuring quality eye care and minimizing the eye care burden. Although there are a few published studies evaluating residency programs,[9] there is paucity of such studies on training programs designed for ophthalmologists post residency. This study highlights the role of training institutes in India to cater to health care training needs globally.[11] This article will surely pave the way for more such studies, with many institutions coming forward with evaluation of impact and contribution in imparting training. Studies similar to the present study are important to assess and draw comparisons from prevailing trends.