India is the fastest growing economy in the world and has a tremendous unmet need for ophthalmic care. The country is also home to approximately 30 percent of the world’s blind people, about half of whom are blind from cataracts, and is seeing rising numbers of people with glaucoma or retinal disease as people live longer. By 2022, over 145 million Indians will be age 60 or over.
Additional factors expected to fuel India’s ophthalmic market growth include an upsurge in dietary change-related eye diseases, growing incidence of myopia, a growing middle class, and improved access to care.
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MARKET OVERVIEW OF OPHTHALMOLOGY IN THE WORLD
- According to various studies conducted across the globe, the prevalence of dry eye disease is estimated to be in the range of 8% to 34%. (Dry Eye Disease Market -2017-2025, Transparency Market Research, 2018)
- About 285 million people are visually impaired worldwide: 39 million are blind and 246 million have low vision.
- About 90 per cent of the world’s visually impaired people live in developing countries.
- Globally, uncorrected refractive errors are the main cause of visual impairment
- 65 per cent of visually impaired and 82 per cent of blind people are over 50 years of age, although this age group comprises only 20 per cent of the world population.(World Sight Day 2017: Statistics and facts about visual impairment and tips to protect your eyes, India Today, 2017)
HISTORY OF OPHTHALMOLOGY
- In the Ebers Papyrus from ancient Egypt dating to 1550 BC, a section is devoted to eye diseases.
- He dissected the eyes of animals, and discovering three layers (not two), found that the fluid was of a constant consistency with the lens forming (or congealing) after death, and the surrounding layers were seen to be juxtaposed.
- Celsus the Greek philosopher of the 2nd century AD gave a detailed description of cataract surgery by the couching
- The Indian surgeon Sushruta wrote Sushruta Samhita in Sanskrit in about 6th century CE which describes 76 ocular diseases (of these 51 surgical) as well as several ophthalmological surgical instruments and techniques. His description of cataract surgery was compatible with the method of couching. He has been described as one of the first cataract surgeons.
- Ibn al-Haytham(Alhazen), in his Book of Optics explained that vision occurs when light bounces on an object and then is directed to one’s eyes
- Ibn al-Nafis, an Arabic native of Damascus, wrote a large textbook, The Polished Book on Experimental Ophthalmology, divided into two parts, On the Theory of Ophthalmology and Simple and Compounded Ophthalmic Drugs
- In the 17th and 18th centuries, hand lenses were used by Malpighi, and microscopes by Leeuwenhoek, preparations for fixing the eye for study by Ruysch, and later the freezing of the eye by Petit. This allowed for detailed study of the eye and an advanced model.
- Georg Joseph Beer(1763–1821) was an Austrian ophthalmologist and leader of the First Viennese School of Medicine. He introduced a flap operation for treatment of cataract (Beer’s operation), as well as popularizing the instrument used to perform the surgery (Beer’s knife)
- The first ophthalmic surgeon in Great Britain was John Freke, appointed to the position by the Governors of St Bartholomew’s Hospital in 1727.
- A major breakthrough came with the appointment of Baron Michael Johann Baptist de Wenzel (1724–90), a German who became oculist to King George III of England in 1772.His skill at removing cataract legitimized the field.
- The first dedicated ophthalmic hospital opened in 1805 in London; it is now called Moorfields Eye Hospital.
- The prominent opticians of the late 19th and early 20th centuries included Ernst Abbe(1840–1905), a co-owner of at the Zeiss Jena factories in Germany where he developed numerous optical instruments.
- Hermann von Helmholtz(1821-1894) was a polymath who made contributions to many fields of science and invented the ophthalmoscope in 1851.
- German ophthalmologist, Gerhard Meyer-Schwickerath- In 1946, he conducted the first experiments on light coagulation.
- In 1949, he performed the first successful treatment of a retinal detachment with a light beam (light coagulation) by with a self-constructed device on the roof of the ophthalmic clinic at the University of Hamburg-Eppendorf.
- Marshall M. Parks was the “father of pediatric ophthalmology”.
- José Ignacio Barraquer(1916–1998) (Spain) was the “father of modern refractive surgery”. In the 1960s, he developed lamellar techniques, including keratomileusis and keratophakia, as well as the first microkeratome and corneal microlathe.
- Frank M Polack(1929 – 2007) was an American ophthalmologist who designed the Polack forceps for corneal transplants.
- Tadeusz Krwawicz(Poland), in 1961, developed the first cryoprobe for intracapsular cataract extraction
- Svyatoslav Fyodorov(Russia) was the “father of ophthalmic microsurgery”. He improved and popularized the radial keratotomy, invented a surgical cure for cataract, and developed the scleroplasty.
- Charles Kelman(United States) developed the ultrasound and mechanized irrigation and aspiration system for phacoemulsification, first allowing cataract extraction through a small incision.
- Ioannis Pallikaris(Greece) performed the first laser-assisted intrastromal keratomileusis (LASIK) surgery
1. Phakonit and microphakonit
Prof. Amar Agarwal used a 0.7-mm phaco needle tip with a 0.7-mm irrigating chopper to remove cataracts through the smallest incision possible. The instruments were made with the help of Larry Laks from MicroSurgical Technology; U.S.A. Prof. Agarwal termed this as microphakonit to differentiate it from the 0.9-mm phakonit.
2. Smartphone-enabled screening
Researchers (Mr. Robert Chang and Mr. David Myung) at the Stanford University School of Medicine have developed two inexpensive adapters that enable a Smartphone to capture high-quality images of the front and back of the eye. Priced at Rs. 1.8 lakhs, the device can be used to screen for corneal and retinal pathologies related to diabetic retinopathy, cataracts, and glaucoma. An Android app tracks patient history, stores images, enables annotations and generates reports. The firm has placed around 150 units of the device in the market place; clients include Mohan Diabetic Centre and Aravind Eye care, who have taken it as a part of their screening model.
3. Preventing blindness in babies
Nearly 30% of premature births who are born with a body weight of less than 2 kgs will have vision impairment. Out of a 100 prematurely born babies, 8-10% will have the condition. If treated correctly, the success rate is upwards of 95%. A device called the Retscan (priced at around $100,000 or approximately Rs. 66 lakh) is used for paediatric scanning, to detect Retinopathy of Prematurity (ROP).
Two Indian firms, Forus and Remidio are taking on the Retscan with their own paediatric screening solutions. The Forus screening device, called Neo, is at a prototype level and is being tested with KIDROP. The Forus solution is aiming for a price of one-sixth the cost of the Retscan.
EYE DISEASES PREVALENCE IN INDIA
- The prevalence of Dry Eye Diseases (DED) is greatly influenced by geographic location, climatic conditions, and lifestyle of the people and ranges from 5% to 35%.
- The prevalence of cataract increases with age and is higher in women than in men.
- The prevalence of any Diabetic Retinopathy (DR) in those with Type 1 diabetes is 56%, and in Type 2 diabetes is 30.3% (According to the UK National diabetic retinopathy screening service).
- Unskilled and semi-skilled workers, and lower socioeconomic classes, such as labourers, had a higher prevalence of ocular trauma.
- The lifetime prevalence of ocular trauma is higher than for diseases like glaucoma, age-related macular degeneration, or diabetic retinopathy.
- The prevalence of Primary Open- Angle Glaucoma (POAG) in rural south India among 40+ populations are estimated to be 1.7% in the ACES study.(Glaucoam: An emerging peril, Epidemiology study of ocular trauma in an urban slum population, Prevalence of ocular trauma in hospitals, Prevalence of Cataract in an older population in india)
OPHTHALMIC CASES IMPACT ON ECONOMY OF INDIA.
- The total health expenditure to 2.5% of gross domestic product (GDP) by 2025, from the current 1.15%
- There is also an economic cost associated with vision impairment for the nation: globally, poor vision results in an economic productivity loss of $275 billion
- Indian workers, the WHO concluded that good eye care and vision correction led to an increase by over 30% in their incomes and by over 25% in productivity. (Treating 2 Lakh Eyes in a Year! Here’s How India Makes It Happen)
- The budgetary allocation for the disabled shot up to `361.9 6 crore this fiscal, from `202 crore in 2012-13.
- Out of pocket medical expenses make up about 62% of all healthcare costs in India
GOVERNMENT POLICIES FOR VISUALLY DISABLEDS IN INDIA
- Government is also planning to introduce set-top boxes to make TV programmes more useful for the visually impaired.
- Content on government website will also be converted from text to speech mode through screen reader programmes for the visually impaired.
- Comprehensive Education Scheme for Disabled Children:This scheme provides books, uniforms, stationery, special learning equipment, accessible infrastructure, transport facilities, as well as scholarships to the differently abled children. The visually impaired students also get other additional benefits like as exemption from doing mathematical and pictorial questions. Students with visual impairment, learning disabilities, and orthopaedic disabilities can also take the help of readers or scribes during examination time. Extra time in examinations is provided for students. These students are also exempted from third language and modification of curriculum so that they do not face additional problems in completing their education.
- Scheme of Integrated Education for the Disabled Children:Integrated Education for Disabled Children Scheme (IEDC) is a central government sponsored scheme run by the Directorate of Education. The scheme provides educational opportunities for disabled children in common schools. Integrating differently abled children in general schools give a boost to their self-esteem. Benefits include providing allowances for books and stationary, uniform, transport, escort reader, and specialised equipment used by the differently abled child etc. (7 Government Initiatives That Aim to Improve Lives of People with Disabilities)
In Government jobs
- Students are provided 3% reservation in seats in government and government-aided schools and educational institutes.
- There is reservation of 3% posts in positions in Groups A, B, C and D in Government services.
- The differently abled people are also exempted from payment of application fees and examination fees.
- The government has also set up various vocational rehabilitation centres for persons with disabilities.
(Government schemes to help the differently abled in India)
GLOBAL MARKET OF OPHTHALMOLOGY
- The global ophthalmology drugs and devices market is expected to grow at a CAGR of 7% for the forecasted period of 2015-2021.
- The global ophthalmic devices market is expected to grow at a CAGR of 5.5% in the first half of the forecast period. The market is expected to grow at a CAGR of 6.9% from 2018-2028. In 2017, the surgical devices submarket held 25% of the ophthalmic devices market.
- The cataract surgery devices segment accounted for the major share in the ophthalmic surgical devices market, and is expected to continue its dominance throughout the forecast period. This segment is expected to grow at a CAGR of 4.8% during 2016-2022, owing to high prevalence of cataract worldwide.
- In 2015, North America Accounted for nearly one-third of the global market, owing to the high prevalence of various eye diseases in the region. Europe holds the second position in the global ophthalmic devices market.
- Currently, in terms of shipment volume, the vision care devices segment dominates the global market with a share of 65%.(Global Ophthalmic Devices Market 2018-2028,Global Ophthalmology Devices Market to reach US$18.28 bn by 2018 owing to Rise in Aging Population)
- The global ophthalmic lasers market is anticipated to reach USD 1.6 billion by 2025.
- Vision loss is a serious problem among people suffering from glaucoma, cataract, age-related macular degeneration (AMD), and diabetic retinopathy. This commonly occurs among the geriatric population. American Academy of Ophthalmology stated that, around 1.3 million U.S. populations are blind. (Ophthalmic Lasers Market Worth $1.6 Billion By 2025 | CAGR: 5.9%)
- In 2050, an estimated 7.32 million people in the United States will have POAG (Primary Open Angle Glaucoma), with the highest number among populations aged 70 to 79 years (32%), women (50%), and Hispanics (50%).
- During the next 40 years, the highest per capita POAG burden will double in New Mexico, Texas, and Florida.
(US Eye Disease Statistics)
- The global ophthalmic drugs market is expected to register a CAGR of 4.15% during the forecast period of 2018–2023.(Ophthalmic Drugs Market – Segmented by Drugs and Geography – Growth, Trends, and Forecast (2018 – 2023))
- Transparency Market Research estimates that the dry eye disease market will expand at a CAGR of 4.5% over the forecast period between 2017 and 2025. Escalating at this pace, the market, which had a valuation of US$ 5,045.2 Mn in 2016 in terms of revenue, is projected to rise to US$ 7,780.0 Mn by 2025. (Dry Eye Disease Market -2017-2025, Transparency Market Research, 2018)
OPHTHALMOLOGY MARKET OF INDIA
- Market Scope forecasts that India’s US$1.3 billion ophthalmic market will grow at a compound annual growth rate (CAGR) of 6.8% a year to $US1.8 billion by 2022.
- Indian ophthalmic surgeons are expected to perform an estimated 7.1 million cataract procedures in the coming year, making cataract the largest overall ophthalmic market in the country.
- Revenues from cataract surgery in India are expected to generate more than a quarter of the total ophthalmic market revenues in the country.
- The diagnostic equipment market is the second largest ophthalmic market in India and is expected to reach nearly $257 million in 2022.
- Market Scope forecasts that India’s glaucoma market will increase to US$296.5 million by 2021 at a CAGR of 10.8 percent.
- Market Scope estimates that India’s cataract market will total US$533.7 million by 2021, growing at a CAGR of 9.3 percent.
- Growth of 4.8% will be driven by expansion of telemedicine, advancements to automate medical records, enhanced imaging technologies, consolidations of hospitals, and a rise in Indian companies entering the market.(India Ophthalmic Market Forecast to Reach $1.8 Billion by 2022)
OPHTHALMOLOGY MARKET CHALLENGES IN INDIA
- Lack of Infrastructure and manpower to provide the necessary treatment
- Lack of awareness regarding ophthalmic disorders among the population
MARKET DRIVERS FOR OPHTHALMOLOGY MARKET IN INDIA
- High rates of eye disease
- Increasing aging population
- Access to high technology which would help in early diagnosis and treatments
LIST OF EYE HOSPITALS IN INDIA
1. Dr. R.P.Centre for ophthalmic sciences A.I.I.M.S – New Delhi
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, named after the first President of India, Dr. Rajendra Prasad, was established on the 10th of March, 1967 as a National centre for ophthalmic science, to provide state of the art patient care, expand human resources for medical education and undertake research to find solutions to eye health problems of national importance.
2. L.V.Prasad eye hospital – Hyderabad
L V Prasad Eye Institute is a comprehensive eye health facility and ocular Tissue Engineering research center, jointly founded by Dr. Gullapalli N Rao and Ramesh Prasad, son of L.V. Prasad in 1987.With its main campus located in Hyderabad, India. It is a not-for-profit, non-government eye care institution.
3. Sankara Nethralaya – Chennai
Sankara Nethralaya (SN) is a not-for-profit missionary institution for ophthalmic care (i.e., an eye hospital) in Chennai, India. In “Sankara Nethralaya” Sankara is a reference to Shiva and Nethralaya means “The Temple of the Eye”. Sankara Nethralaya receives patients from India and internationally.
4. Aravind Eye HospitaL – Madurai
Aravind Eye Care Hospital, a non-profit ophthalmological hospital with several locations in India.It was founded by Dr. Govindappa Venkataswamy in 1976.
5. Vision Foundation of India
It is an initiative created by Dr. Kulin Kothari and the Bombay City Eye Institute & research centre in 1993, with a vision to eradicate blindness and eye disease from the marginalized sections of society. It is a Non-profit organization.
6. Indo American Eye care Organization (IAEO)
It is a charitable non-profit organization established to prevent curable blindness in India. It is registered in the state of Michigan, USA, and certified as a 501(c)(3) organization by IRS. IAEO partners with the local super specialty eye care centres throughout India to provide these eye care services.
7. Smt. Lilavati Mohanlal Shah (Bilimorawala) Eye Hospital, Dudhia Talao, Navsari- Gujarat
Rotary Club of Navsari founded the Smt. Lilavati Mohanlal Shah (Billimorawala) Eye Hospital, (REI) in 1977, a non-profit eye hospital– to provide world-class eye care to people suffering from eye related problems that can be easily cured. 150-bed eye hospital with 5 full-equipped Operation Theatres.
8. Sundrani Charitable Eye Hospital- Uttar Pradesh
Founded in 1977, with a vision to provide quality eye care to the impoverished, our non-profit, non-commercial organization has helped thousands avail treatments that they would otherwise find unaffordable.
Seva is a global non-profit eye care organization that transforms lives and strengthens communities by restoring sight and preventing blindness. Seva works with local communities around the world.
10. Mahatme Eye Bank & Eye Hospital -Nagpur
It is run by S. M. M. Eye welfare charitable trust. The S. Mahatme Memorial Eye welfare charitable trust was formulated in the year 1986.
11. Dr. Shroff’s Charity Eye Hospital- New Delhi
It is one of the best eye hospitals in New Delhi which is established 100 years before. The hospital started 1914 by Dr. S P Shroff. Shroff eye hospital provides all kinds of specialty and advanced treatment in ophthalmology. Recently “The Week Magazine” reported that it is the 3rd best eye hospitals in north India by Nielsen survey.
Private Eye Hospitals
1. H.V.Desai eye hospital, Hadapsar – Pune
200 beds eye hospital set up in the year 2000, has now become a base for all prevention of blindness activities as well as vital research in eye care under one roof.
2. Centre for sight – New Delhi
Established in 1996, by Dr. Mahipal Sachdev, eminent ophthalmologist and a Padmashree awardee, Centre for Sight is instrumental in changing the face and service standards of eye care in the country.
3. Dr Agarwal’s Eye Hospital
Dr.Agarwal’s Eye Hospital was founded byLate Dr.J.Agarwal (recipient of the Padma Bhushan award) and his wife Dr. T.Agarwal in Chennai, India, in 1957.
4. Eye Health Clinic – Noida
Eye Health Clinic, a facility which provides Comprehensive Eye Care within a friendly environment by experienced professional eye surgeons, assisted by efficient staff, modern equipment and latest state-of-the-art eye evaluation and management facilities, with emphasis on TOTAL eye care solutions for all needs under one roof.
5. Eye 7 – New Delhi
Eye7 is a chain of super specialty ophthalmology hospital. The vision of the Eye7 group, under his capable leadership, is to provide affordable and quality eye health care with compassion and using the latest technology.
6. Aditya Jyot Eye Hospital – Mumbai
Aditya Jyot Eye Hospital has more than two decades of services with more than 100 years of combined experienced hands in eye care.
- The only hospital in India to be Full Member of World Association of Eye Hospital (WAEH).
- 1stEye hospital in Mumbai to get NABH Accreditation
Only Eye Hospital Offering 24*7 Services
- In a country of over 1.35 billion people, there should be at least one ophthalmologist for every 20,000 people, according to WHO. India has only an estimated 10,000 surgeons. The same is true with optometrists; 20,000 are needed, but there are only 2,000 available to practice.
- And By 2022, over 145 million Indians will be age 60 or over, this increases the rate of eye diseases.
- Vast population suffer with eye diseases in India and also looking at the estimations the number is increasing, hence it is essential to provide the population with facilities and resources to tackle the diseases.
Are you planning to build or restructure or venture in Ophthalmology in India? Looking for information about the major healthcare players in Government, Private diagnostic centres that are available in India? Are you looking to find out which part of the city’s is best to venture in or what all facilities are available and what all should be planned for new setup? In this article Hospaccx Healthcare Consultancy has mapped all on major players in terms of Ophthalmology facilities and healthcare scenario in India.
Below is the superficial and macro level survey if you need a refined market and financial feasibility or any other study related to healthcare is required you can contact Hospaccx Healthcare business consulting Pvt. ltd on firstname.lastname@example.org or email@example.com Or you can visit our website on www.hhbc.in