A critical look at the ophthalmological preparations in the national list of essential medicines of India 2011
Consultant Ophthalmologist and Medical Retina Specialist, Vasan Eye Care Hospital, Puducherry, India
V B Prakash
No.7, Main road, Thiru Nagar, Moolakulam, Pondicherry - 605 010
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Prakash V B. A critical look at the ophthalmological preparations in the national list of essential medicines of India 2011.J Postgrad Med 2013;59:159-160
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Prakash V B. A critical look at the ophthalmological preparations in the national list of essential medicines of India 2011. J Postgrad Med [serial online] 2013 [cited 2020 Apr 5 ];59:159-160
Available from: http://www.jpgmonline.com/text.asp?2013/59/2/159/113812
The National List of Essential Medicines of India (NLEMI) 2011 was revised and released in June 2011,  citing 348 medicines under different categories and headings. These medicines are to be made available at the specified levels of health-care in India, to ensure that the public has access to essential medicines for the benefit of the common man. The list has been put together after extensive thought and deliberation in order to ensure that all health-care facilities have adequate ammunition against the common diseases in our country. The section covering the specialty of Ophthalmology consists of 17 drugs under different categories. Although the list seems complete by and large, there are some aspects, which need to be revisited.
It is observed that there is no mention of tear substitutes, which was omitted from the NLEMI 2003  also. Tear substitutes such as 1% carboxymethylcellulose sodium eyedrops are essential in the treatment of the dry eye syndrome, a condition, which is prevalent especially in rural India.  In addition to bringing relief to the many who are unfortunate to suffer from this malady, these lubricants also serve as adjuvant therapy to a variety of ocular conditions-from allergic conjunctivitis to corneal abrasions. Similarly, the antibacterials listed in the anti-infectives section, has neglected mentioning any medication for trachoma, which is a one of the target areas of the "Vision 2020: The Right to Sight."  Trachoma is endemic in India and yet again it will be the rural populace who will bear the brunt of this omission. Perhaps oral azithromycin warrants a repetition here as this antibiotic has been recommended by the World Health Organization (WHO) in the "SAFE" strategy against trachoma, to prevent avoidable blindness.  Although the anti-infectives rightly lists topical antibacterials and antifungals, it strangely makes no mention of any ocular anti-viral agent. It is of interest to note that acyclovir eye ointment, vital in the treatment of epithelial viral keratitis, has found a place in the 17 th WHO model list of essential medicines.  It's absence in our list of essential medicines; therefore seems to be an obtrusive oversight, which has been mentioned by earlier authors.  In the section titled anti-inflammatory agents, there has been an inclusion of both prednisolone sodium phosphate and prednisolone acetate, which have been shown to be comparably efficacious.  While preparing an essential medicines list, only one drug of a particular class is selected and differing strengths of that drug may be included in order to keep the total number of drugs on the list as low as possible. For example, two strengths of prednisolone acetate could have been listed (0.12% and 1%). This would ensure that the principles of selection of essential medicines are retained. Furthermore, in Sections 21.2 and 21.4, the spellings of the subheadings need to be rectified appropriately.
The NLEMI 2011 mentions that the list has been prepared with a view of addressing the burden of "cost, safety, and efficacy" of medicines provided to the public. Because lubricating eye drops score well in these three key areas, one might wonder if it is not worthwhile to add a lubricant while excluding one of the steroid agents. For patients with trachoma or viral corneal ulcers who can benefit from topical anti-viral therapy, appropriate antimicrobials merit inclusion, at least to be made necessarily available in tertiary care hospitals. Perhaps the NLEMI 2011 needs further perusal to remedy such faux pas.
The author gratefully acknowledges the expert opinion of Dr. Rathinam Sivakumar MNAMS, PhD, Head of uveitis service, Aravind Eye Hospital and PG Institute of Ophthalmology, Madurai, Tamil Nadu.
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