India , as a rapidly developing nation presents contrasts in every sphere of life .Even as urban India develops at a pace at par with the best in the world, rural India continues to lag behind in basic amenities ,economic growth and infrastructure. Health care sector in India reflects the same contrasting scenario. Health care delivery systems target the largely urban population while the rural areas still have a pathetic doctor to population ratio. Eye care services show the same disparity with 80 % of ophthalmologists in the country practicing in the cities while 70% of our population lives in the villages. This situation is even more unfavourable in the case of specialists in retinal disorders and glaucoma .

Eye health of our population has been forefront of our heath care planning prgrammes in the last several decades. In India in the NPCB survey which was conducted between 1987 and 1989 it was found that cataract was the cause of blindness in 80% of people. In a small subset of people, glaucoma, retinal pathologies and corneal blindness were also found. After this, the Ministry of Health driven programmes for eradication of cataract blindness ,channelised through NPCB has brought down the prevalence of cataract related blindness. This was largely possible through large number of cataract screening camps in the rural areas with low cost and free cataract surgeries. However little has been done to eradicate blindness secondary to corneal pathologies, glaucoma and retinal disorders. The cataract screening camps concentrated on identifying cataract in the target population while other disorders like diabetic retinopathy, age related macular degeneration and other retinal disorders and potentially blinding disorders like glaucoma went largely undetected. This was partly because of the lack of appropriately trained manpower and partly because the screening and detection of the retinal disorders require costly and sophisticated equipment for imaging and treatment.

It is in this existing situation where there is a need for a comprehensive programme, which aims at diagnosing as well as managing all cases of eye morbidity that the relevance of teleophthalmology comes into significance. Teleophthalmology ensures that highly sophisticated equipment can be used for imaging the eye and teleconnectivity ensures that all eye related disorders are diagnosed and management decided by trained ophthalmologists in the superspeciality hospital.

Amrita Institute of Medical Sciences and Research Centre has a dedicated team of physicians, nurses and other healthcare professionals who provide an extraordinary level of knowledge, skill and compassion to every patient we serve. We welcome patients from all over the world and do our best to insure the greatest patient comfort while providing outstanding comprehensive care. To ameliorate the problems caused by blindness Amrita Institute of Medical Sciences and Research Centre has always been a committed organization and till date has screened more than 45000 patients and performed more than 8000 free cataract surgeries.

AIMS has won acclaim for its highly sophisticated surgical and diagnostic capabilities. Now many departments are being appreciated for their role in providing free or low-cost community-based programmes and medical camps. Outreach medical services, health awareness campaigns, and projects for the poor in the remote parts of India and abroad ensure that AIMS facilities reach the wider community in India and even outside.

Prevention of vision loss by telescreening using a trained optometrist in various strata of population is the key aim of Amrita teleophthalmology project. In anterior segment diseases of the eye like corneal opacities, ulcers, glaucoma and cataract, a picture will be taken and the images transmitted to the central telemedicine hub. In diabetic retinopathy, it will be providing screening facilities using fundus camera and video indirect ophthalmoscopy. Tertiary care services like flourescein angiography, Optical coherence tomography, laser photocoagulation and vitreous surgery will be provided for those who have been picked up by telescreening. In age related macular degeneration (AMD) telescreening will help us pick up the cases of AMD early enough so that the management is optimized. After viewing the transmitted fundus picture a decision to advise fluorescein angiography and Optical Coherence Tomography (OCT) will be made.

Secondary aims include reduction of visual morbidity by giving low vision aids, training of trainers in Diabetic retinopathy and glaucoma and creating an awareness regarding these diseases among the public.

Four camps are conducted each week for eye evaluation in areas far and near. In near by places the equipment will be moved in a mobile van. To far away places, the equipment and the team will move either in train or by air. We aim to screen at least 200 patients in each of these tele ophthal programmes. This will account for 120,000 ophthalmology patients who may be having multitude of problems like cataract, corneal pathologies, glaucoma, diabetic retinopathy, age related macular degeneration at the end of the project period.We shall be evaluating all patients attending our camps with visual acuity, intraocular pressure, anterior segment examination and retinal evaluation. A technician will be taking the photographs of the anterior segment and the retina and these will be transmitted to the telemedicine hub. A qualified ophthalmologist at the HUB will be reading these pictures, grading them and advising the technician on further management. If the patient requires treatment, he will be referred to the base centre for treatment.

The van will be equipped with modern equipments like autorefractometer for assessing refractive errors, slitlamp camera for viewing and photographing the front of the eye, nonmydriatic fundus camera for imaging the back of the eye, direct and indirect ophthalmoscopes for examination and tonometer for assessing eye pressure and screening for glaucoma.The van will have facility for realtime transmission of the images.Tele-connectivity will be established using VSAT link, provided by Indian Space Research Organization (ISRO). The satellite link is via INSAT 3A using extended C band at a bandwidth of 384kbps.

All patents with reduced vision with any significant anterior segment disorder will be referred to AIMS for further management. Treatment of diabetic retinopathy will be planned and carried out in the hospital. Those patients having no or mild retinopathy will be guided for regular follow up at the local health care center. Patients having other ocular diseases apart from diabetic retinopathy will undergo necessary investigations such as fundus fluorescein angiography and optical coherence tomography in the mobile telemedicine unit. As per the advice of vireo-retinal consultant viewing these images in the AIMS telemedicine HUB, treatment in the form of laser photocoagulation and/or surgery be advised to get treated at convenient local eye care center or if possible at AIMS. All patients with significant sight damage will receive low vision aids & guidance for rehabilitation through mobile van service during the screening process itself.

In short, teleophthalmology services represents the blending of cutting edge technology and compassionate health care services to Indias rural poor. It ensures adequate dissemination of high technology equipment for diagnosis and treatment while harnessing available manpower and allowing rural India to use the services of highly specialized doctors. It provides comprehensive eyecare services where the previous efforts in community services have been lacking and represents one of the ideal vehicles for dispensing effective and affordable eye care to the remote corners of a country like India, the land of stark contrasts.

The camp jointly organized by JSS and AIMS, kochi was aimed at increasing the health awareness, providing health checkup for 300 families, house visits and provide free medications and clothing to the tribal people. The vast majority of people living in these high ranges are basically farmers, their spectrum of health problems ranged from anemia, fungal infections to viral fever etc. Much of life style diseases like Hypertension, obesity, and diabetes were surprisingly low compared to the urban population.

We had an elaborate insight into their culture, lifestyle, agriculture, food habits, home remedies and more importantly the human values, shared goals to struggle and float high traversing the seasons of life, sending a beautiful message of love across the mankind. Idukki, which is geographically known for its mountains, hills, valleys, dense forests, waterfalls, game sanctuaries, wild flora and fauna, congenial and cool hospital weather has a huge potential for tourism and forest based industries. Agriculture is the main occupation of the people in the district with diary being the main supplementary source of income for the farmers. There were also women's of kudumbashree involved in making handicrafts and idols to earn their living. The climate and the fertile soil have favoured the agro cultivation more suitable for plantation crops like tea, coffee, cardamom, pepper, floriculture, mushroom cultivation, medicinal plants, vanilla cultivation etc. All these provide an aesthetic sense, adding beauty to the natural wealth of our country.

The people here live harmoniously with the nature without harming the ecosystem and the natural habitats of the wild flora and fauna, as they are aware of the sensitive behaviour of animals, fear of extinction and extreme climatic conditions already taking a toll on these species. They give a message of awakening to the need to conserve and protect the wild flora and fauna. Interacting with the people and community leaders gave us valuable information into their life and provides them with valuable support and advices to attain a healthy, hygienic environment to live.

Bringing medical care to these far reaching land at the grass root level, is a challenge, and that's what AIMS has done in the past few years since its inception with the grace of our beloved "AMMA".

In the next 6 days the doctors treated more than 500 patients. On the fourth day the team went to a village, Baddipara, 4 km away, by walk to conduct a medical camp there. They saw about 100 patients there and came back by nightfall. In spite of the poor living condition at the camp site, the team pulled on with a smile. They had to move to the terrace of the school as their living area was crawling with insects.

Their next stop was an adivasi village named Deulbari, which was deep in the Sunderban forests. They started off on a launch, with one of the forest officers accompanying them. They reached the village the next day and immediately started seeing patients.

Hundreds of patients were seen the first day. Two children presented with diarrhea and severe dehydration. They were treated with IV fluids and medicines. Once they recovered, they were sent home with oral medications & ORS.

That night at around 2 am, frantic shouting and banging on their door woke them up. They were told that a patient was sick and unresponsive in the village. They immediately rushed to the place and found a woman who was having diarrhea in hypovolemic shock. She was brought to the camp and started on IV fluids. She recovered by next morning. Two other patients were also brought in the morning with similar complaints.

Swamiji and the devotees distributed clothes to the villagers. The villagers were full of good words for the team. In all 324 patients were treated in this remote forest village.

Their team also included Uday Das Gupta, Varma, Suresh, Narayana, Mohan, Vishwanath, Dutta, Saravana, Binu, Bappi and Sappan

Stanley is the youngest deceased organ donor in Kerala. His organs were used to give a new life to Mr Rajendran (45) who was suffering form end stage liver disease and Ms Honey Prabhakumar (22) and Mrs Indhu (42) who were suffering from end stage Renal disease. All are recovering very well after their surgeries savouring their new found life.

There are approximately 30 brain dead donors in Kerala every month, but rather than do something good with the organs of these donors such as give a second life to 150 others, we burn them or bury them. When Stanley's parents see the five people who have had another chance at life, they will comfort in the fact that Stanley is fulfilling his wishes through them. Telling his story is our way of honouring him.

When 16-year-old Stanley George died, he gave a share of his life to five people by donating organs to somebody in need. "We fulfilled his wish and donated his liver, kidneys and eyes to five different people in three hospitals in the city"said his father Kurian Thoombunkal of Changanassery at the press conference. AIMS Medical Director Dr.Prem Nair, Dr.V.N.Unni, Dr.Suresh and Dr.Sudheendran also spoke at the press conference.