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Innovation

Aravind eye care system

ABSTRACT
Aravind Eye Hospital was founded in 1976, by Dr. G. Venkataswamy, a man known to most of us simply as Dr. V. In an eleven bed hospital
manned by 4 medical officers, he saw the potential for what is today, one of the largest facilities in the world for eye care. Over the years, this
organization has evolved into a sophisticated system dedicated to compassionate service for sight. The Aravind Eye Care System now serves
as a model, for India, and the rest of the world.

Keywords: Diseases in epidemic proportions and illiteracy, GOVEL Trust, low per capita income

ARAVIND EYE CARE SERVICES
The problem of avoidable blindness rapidly escalating
remained a major cause of concern in the Indian healthcare
scenario. In a developing country, the government alone
cannot meet the health needs of all due to a number
of challenges such as growing population, inadequate
infrastructure, low per capita income, aging population,
diseases in epidemic proportions and illiteracy.
Realizing this, Dr. Venkataswamy [Figure 1] wished to
establish an alternate health care model that could
supplement the efforts of the government and also be
self‑supporting. Following his retirement at age 58 in 1976,
he established the GOVEL Trust under which Aravind Eye
Hospitals were founded. Dr. G. Venkataswamy, a man known
to most of us simply as Dr. V. In an 11 bed hospital [Figure 2]
manned by 4 medical officers, he saw the potential for
what is today, one of the largest facilities in the world for
eye care. Over the years, this organization has evolved
into a sophisticated system dedicated to compassionate
service for sight. The Aravind Eye Care System now serves
as a model, for India, and the rest of the world. Aravind
Eye Hospital has over the past 40 years handled more than
48 million outpatient visits and performed 5.5 million
surgeries. Now, each day across all its facilities, Aravind
sees about 12,500 outpatient visits and performs around
1500 surgeries. Close to 2600 eye camps are conducted
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every year that takes quality eye care to the rural masses.
Now the Aravind Eye Care System includes 5 tertiary
care centers, 6 secondary care centers, 6 outpatient eye
examination clinics and 62 vision centers [Figure 3]. As a
result of a unique fee system and effective management,
the organization is able to provide free eye care to 50%
of its patients from the revenue generated from its 50%
paying patients. With 1% of the country’s ophthalmic
workforce, Aravind accounts for 5% of the ophthalmic
surgeries performed.
EXTENDING THE REACH OF QUALITY EYE CARE TO THE
POOR AND NEEDY (COMMUNITY OUTREACH)
An integral part of Aravind Eye Care Services (AECS) is its
community outreach programs which take eye care service
to the doorstep of the community. These camps also serve to
educate the local community on eye care. Toward this end,
several comprehensive eye care programs are organized.
It ensures that people in all age groups are covered under
these programs.
Kalpana Narendran
Head of Cataract an IOL Services and Department of
Paediatric Ophthalmology and Strabismus, Aravind Eye
Hospital, Coimbatore, Tamil Nadu, India
Address for correspondence: Dr. Kalpana Narendran,
Aravind Eye Hospital, Avinashi Road, Civil Aerodrome Post,
Coimbatore ‑ 641 014, Tamil Nadu, India.
E‑mail: kalpana@cbe.aravind.org
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DOI:
10.4103/kjo.kjo_66_17 How to cite this article: Narendran K. Aravind eye care system. Kerala J
Ophthalmol 2017;29:116‑120.

116 © 2017 Kerala Journal of Ophthalmology | Published by Wolters Kluwer - Medknow

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Narendran: Aravind eye care system
COMPREHENSIVE SCREENING EYE CAMPS
The clinical team (made up of ophthalmologists and
paramedical) examines all patients for eye problems with
basic required instruments and equipment which include
dilation and fundus examination to some extent. Refraction is
also done in the camp and eyeglasses are offered at affordable
prices to support the service delivery system. People who
need cataract surgery are counseled and transported to the
base hospital. No surgery is performed at the camp [Figure 4].
DIABETIC RETINOPATHY SCREENING CAMPS
According to the World Health Organization, 180 million
people are affected by type 2 (formerly called adult‑onset)
diabetes worldwide, 41.9 million in India alone, the largest
diabetic population of any nation in the world. These figures
are expected to double by 2030. Various studies conducted in
India show that 15%–20% of the diabetic population develops
diabetic retinopathy (DR) [Figure 5].
Figure 1: Dr.Venkataswamy
Figure 3: AECS Hospitals
Kerala Journal of Ophthalmology / Volume 29 / Issue 2 / May‑August 2017
DR screening camps are often held in conjunction with
general hospitals (diabetes clinics) and diabetic associations
and include a large community education component. Since
screening people for this disease requires special medical
expertise, DR screening camps are specialized exclusively in
the diagnosis and treatment of this disease. However, whereas
the focus is on detecting DR before it causes irreversible
blindness (and this sometimes means detecting diabetes in
patients who don’t know they have it), patients who suffer
from other eye disorders will also be referred to the eye care
institution, eye clinic or specialty ophthalmology practice.
WORKPLACE‑BASED SCREENING EYE CAMPS
It is estimated that 153 million people in the world have a
visual impairment due to uncorrected refractive errors (visual
acuity <6/18 or <20/60 in the better eye) and that is excluding
presbyopia. In an aging world, the magnitude of uncorrected
presbyopia is unimaginable. Since this is a problem among
working populations, refractive error camps can be held for
the sole purpose of screening and dispensing eyeglasses to
large numbers of patients at one time. Industries and other
fields of work that are likely to cause seeing disorders (or that
are likely to suffer losses due to workers with poor vision) are
also prime targets for this type of outreach camp.
Refractive error screening camps are conducted very similarly
to cataract or comprehensive screening camps. Every patient
is subjected to the same series of eye examinations, in the
same order as in a regular screening camp Indeed, assessment
Figure 2: Aravind Eye Hospital as eleven bedded Hospital
Figure 4: Outreach Camp
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Narendran: Aravind eye care system
Figure 5: DR Camp
of individuals who have refractive errors, particularly
those aged 50 years or above, provides an opportunity for
identifying other potentially blinding conditions before they
cause visual loss (such as cataract, glaucoma and DR).
SCHOOL CHILDREN SCREENING EYE CAMPS
Globally, the uncorrected refractive error is the main
cause of vision impairment in children aged 6–15 years
and the prevalence of myopia (short‑sightedness) is
increasing dramatically among children. Outreach in schools
concentrates on refractive error, which can lead to a lack of
academic success in school. Students with other eye ailments
are also noted and referred to the base hospital.
Aravind prefers to conduct a short term orientation (about
a day) for the teachers in the school premises based on
1:200 teacher‑children ratio. The training covers anatomy
and physiology of eye, common eye disorders among the
children and visual acuity measurement. This exposure helps
the teachers to conduct a preliminary assessment on the
school children as a whole. This kind of assessment helps the
Aravind Medical team to conduct detailed eye examination
on the children identified with eye problems. Furthermore,
the training for teachers helps to gain good ownership of
the screening process effectively.
PAEDIATRIC SCREENING EYE CAMPS (0–5 YEARS)
A child goes blind somewhere in the world every minute, yet
much childhood blindness is preventable or treatable. Pediatric
screening eye camps target babies and preschool‑aged
children and their parents, to educate about prevention
(measles, harmful traditional eye remedies, eye safety) and
to detect eye defects (congenital or traumatic), childhood
118 Kerala Journal of Ophthalmology / Volume 29 / Issue 2 / May‑August 2017
illnesses and nutritional deficiencies that can lead to
blindness:
• Vitamin A deficiency
• Corneal scarring
• Congenital and traumatic cataract
• Congenital glaucoma and retinopathy of prematurity
• Serious refractive errors.
The process in a pediatric screening eye camp is quite similar
to that of other screening camps. A major challenge of this
type of camp is how to get more children with eye defects
attending the camps. One way is through greater eye health
education, targeted at young parents. Another way is to work
with primary health centers, children health centers, family
physicians, pediatricians, maternity clinics, preschools, etc.
EXTENDING EYE CARE SERVICE DELIVERY TO REMOTE AND
RURAL COMMUNITIES (VISION CENTERS)
Even after doing a lot of community outreach activity, we
reached only 7% of those in need of eye care, those with rarer
eye conditions were not reached, in which Vision Center
Concept was developed. Vision centers are small, permanent
facilities set up to extend eye care service delivery to remote
and rural communities, with the objective of increasing the
uptake of comprehensive primary eye care. Aravinds Vision
Centers offer innovative internet‑based information technology
that allows patients in rural areas to be remotely diagnosed
by ophthalmologists at the base hospital [Figure 6]. Via
high‑speed wireless video‑conferencing, doctors can consult
with hundreds of rural patients per day, providing high‑quality
eye care while eliminating the need for patients to travel to
the hospital (unless more advanced treatment is needed).
L I O N S A R AV I N D I N S T I T U T E O F C O M M U N I T Y
OPHTHALMOLOGY ‑ EDUCATION AND TRAINING
In early 90’s Dr. V received many request from worldwide
for proactive eye care delivery model to be engaged in
their place, To address this Lions Aravind Institute of
Community Ophthalmology (LAICO), established in 1992
with the support of the Lions Club International Sight
First Programme and Seva Sight Programme, is Asia’s first
international training facility for blindness prevention
workers from India and other parts of the world. It
contributes to improving the quality of eye care services
through teaching, training, research, and consultancy.
Each year close to 300 ophthalmologists, 600 paramedical
workers, and 200 eye care management professionals
receive training in various aspects of eye care. Around
8,300 candidates from 100 countries have been trained so
far at Aravind.
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Narendran: Aravind eye care system
AMRF ‑ RESEARCH
The research activities at Aravind reflect Aravind’s
commitment to finding new ways to reduce the burden
of blindness. The combination of high clinical load,
extensive community participation, and access to a large
network of eye hospitals provides ideal opportunities for
conducting clinical, laboratory, population‑based studies,
and social and health systems research. Research at Aravind
provides evidence and evolves methods to translate
existing evidence and knowledge into effective action.
Currently, research is happening in the four areas: basic
and translational research, clinical research, operations
research and product development. Altogether 119 papers
have been published, and 17 scholars have received PhD
from the Institute.
AUROLAB ‑ OPHTHALMIC MANUFACTURING
In the early 1990s, there was a great deal of debate about the
relevance of intraocular lens (IOL) to developing countries.
Although widely accepted as a better procedure, it was argued
that developing countries should not go in for it as the IOLs
were expensive. Taking on this challenge, in 1992, Aurolab
Aravind’s manufacturing arm was established as a nonprofit
charitable trust for manufacturing ophthalmic consumables.
Aurolab brought down the price of intraocular lenses to
one‑–tenth of the then market price. Aurolab products are
exported to 120 countries around the world and accounts
for a total of 7.8% of global share of intraocular lenses and
have also diversified into manufacturing suture needles,
pharmaceuticals, blades, equipment and so on [Figure 7].
CONSULTANCY AND CAPACITY BUILDING
Often times, real issues in eye care are not relating to
ophthalmology but lack of enabling environment ‑ under‑
Figure 6: Vision Centre
Kerala Journal of Ophthalmology / Volume 29 / Issue 2 / May‑August 2017
utilization of existing infrastructure and resources, creating the
demand, lack of good supply chain, policies, and procedures
that could be addressed by good program design, governance,
and efficient management. To address this existing scenario,
LAICO partners with the international nongovernmental
organizations like Lions Clubs International Foundation,
Sight Savers International, CBM International, International
Eye Foundation, ORBIS International, Right to Sight, Seva
Foundation, WHO and other eye hospitals [Figure 8]. LAICO
provides its expertise and support to the eye hospitals through
structured consultancy and capacity building process. LAICO
teams conduct needs assessment visits to the hospitals to gain a
better understanding of the working systems and management
structure. This enables to establish a framework for capacity
building specific to each hospital. LAICO, Aravind’s training
and consulting arm helps develop eye hospitals across the
world through a structured process of consultancy and capacity
building and now works with over 335 eye hospitals worldwide.
ARAVIND EYE BANKS
In India, the need for corneas for sight‑restoring surgeries is
1 lakh/year. According to the Eye Bank Association of India,
the number of eyes collected in 2010 is 41,549. Moreover,
more important is the fact that of this total, only a little more
than 10,000 meet all the criteria of medical standards as per
the requirement for quality control of eye banks.
Started in 1998 at Madurai with just a collection of 253 eyes,
now the eye banks across the Aravind Hospitals procure more
than 4000 eyes and perform about 1400 corneal transplants
annually. Eyeballs which cannot be used for transplants
are effectively used for various research and development
programs. Eye banks across the Aravind centers help reduce
corneal blindness. In the year‑ending March 2017, more
than 5300 eyes were collected and 2,700 eyes were utilized
for surgery.
Figure 7: Aurolab
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Narendran: Aravind eye care system

postgraduates and 1471 fellows). AECS offers long term

fellowship programs in all subspecialties and also short
term courses in ophthalmology.

Aravind Eye Care System will remember the year 2006

Figure 8: LAICO
POSTGRADUATE AND FELLOWSHIP PROGRAMS
Aravind has launched its postgraduate programs to
develop a cader of the well‑trained ophthalmic human
resource. These training program has been evolved to an
international standard over years with its well organized
and structure modules. Interactions with faculty, didactic
lectures, grand rounds, and journal club discussions give
ample opportunities for them to become an excellent
ophthalmic clinician and an efficient surgeon. So far,
we have trained 9983 eye care professionals (922
as the year it lost its founder, the legendary Padmashree
Dr. G. Venkataswamy on July 7. Dr V’s life was a long
dedication to serving the Divine through work in the field
of eye care. His tireless vision, inspiring leadership as well as
his selflessness and humility shaped Aravind into all that it
is today. The Organization has evolved into a sophisticated
system dedicated to compassionate service for sight. The
Aravind Eye Care System now serves as a model, for India,
and the rest of the world and working towards his Mission
“To Eliminate Needless Blindness.”
“Intelligence and capability are not enough. There must also
be the joy of doing something beautiful”
‑ Dr. G. Venkataswamy
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.

120 Kerala Journal of Ophthalmology / Volume 29 / Issue 2 / May‑August 2017