A simple procedure by a skilled eye surgeon is all it takes:
Last week when the spotlight fell on the world’s visually impaired, it underlined a tragic fact: A large percentage of the blind population in the impoverished South Asian region including Sri Lanka, suffers from preventable blindness. The condition, known as cataract which contributes to a major portion of blindness can however be reversed with a simple operation performed by a skilled eye surgeon which will help restore sight in a few minutes.
 Dr Kapila Edussuriya |
Admittedly, other factors also contribute to visual impairment which is still high in this country, especially, among the elders. But many of these conditions are treatable and preventable with early detection and screening.
The Sunday Observer spoke to Community Ophthalmologist Dr Kapila Edussuriya from the Kandy Teaching Hospital to find out the causes of visual impairment and what can be done to prevent them.
Excerpts…
Q: World Vision Day on October 13 focused global attention on the world’s visually impaired. What is visual impairment in simple laymen language?
A. Laymen define visual impairment as a decrease in vision, whatever the cause. To a clinician however, it has a more scientific meaning, which I will explain later.
Q: How many people in Sri Lanka are blind or have visual impairment? Have any surveys been done recently?
A. The Ministry of Health and College of Ophthalmologists recently concluded a survey on visual impairment in Sri Lanka and found that 1.7% over the age of 40 were categorized as blind on presentation. A further 17% were visually impaired. Cataract blindness which is one of the most preventable causes of blindness accounted for 66% of this blindness. The rapidly changing pyramid of aging in the population in Sri Lanka making the elders’ group more significantly represented has led to a large number of persons requiring cataract surgery.
Q:What is Low Vision? How is it caused?
A. Low vision is a vision that makes it difficult for the affected person to carry out daily living tasks after all treatment options have been exhausted. The scientific definition is more precise and is a vision of less than 6/18 in the better eye after the best correction. This definition excludes the blind. Low vision can originate at birth or acquired due to a multitude of eye conditions. The commonest seen in Sri Lanka is Un-corrected Refractive Errors, followed by Untreated Cataracts, Diabetic Retinopathy, Glaucoma and a number of retinal conditions.
Q: It has been reported that out of this number an estimated 150,000 persons suffer from cataract blindness. Explain what cataract blindness is. How does it occur? How is it detected (symptoms?)
A. Cataract is the gradual opacification of the lens of the eye. It is a normal aging process. Just like a camera lens the lens of the eye must have the quality of transferring the rays of light to the retina in a way that an image can be constructed. When the lens opacifies the light rays cannot focus on the retina and results in a blur, similar to looking through a frosted glass. This results in loss of productive vision. Confirmation of the condition can be done by a medical officer who would then refer the client to a consultant ophthalmologist for further investigations.
Q: Who (age-wise) are most at risk of getting cataract blindness?
A. Everyone over 40 years is at risk. Just as our hair turns grey so does the lens opacity. This progression continues till the vision is impaired to the extent of blindness which manifests usually above 60 years of age.
Q: Is it curable or reversible with the proper treatment? If so how? What is the normal procedure an eye surgeon follows?
A. The condition is fully treatable. An appropriate lens can be implanted in the eye. It takes around 10 minutes and is a very skilled procedure done under microscopic magnification with micro instruments.
Once detected a screening for co-existing diseases are done and when they are under control, measurements of the eye will be taken for calculation of required lens power. The surgeon can decide on the exact technique of surgery depending on many clinical features.
The more superior phaco emulsification technique gives immediate results, having minimal post-operative effects, while the older extra capsular cataract extraction has a slightly longer recovery period.
Q: In the past, after a cataract operation, patients were given spectacles to wear. Today, intraocular lens are implanted in the operated eye during surgery. What are intro-ocular lens? How much do they cost? Are they a lifetime investment?
A. An intraocular lens is a piece of plastic ground to a specific power. It is designed to give clarity as near to the natural lens as possible. Its design incorporates many features to prevent complications as well as ease of surgeon’s use. Prices vary according to the features offered. Currently these lenses are available in all hospitals throughout the country free of charge. Once implanted these lens remain stable throughout life.
Q: Is it a painful procedure? Do patients have to be hospitalised?
A. This procedure is done under a locally infiltrated anesthetic or instilled anesthetic drop. Once the area designated is suitably numbed the surgeon is free to conduct the surgery. The surgeon makes the decision whether the patient should stay in hospital after surgery, or could be discharged immediately. The only reason to keep the patient would be in anticipation of a complication. A routine post op evaluation is conducted on the day after surgery.
Q:Today, we see more and more younger children wearing spectacles due to some kind of visual defect. Is it an emerging trend? What are the interventions in place?
A. The demand for corrective spectacles has increased globally, due to better detection rates as well as consumer demand. Recent evidence shows children who read a lot have a higher chance of developing short sightedness. Current trends of computer games and more indoor based lifestyles have increased the numbers of young children developing myopia (shortsightedness).
The School Medical Inspection policy of the Ministry of Health has incorporated vision screening in their examination process which has been very useful in early detection. This process has been in place from the early 70s. Under The V2020 Project children in many parts of the country have been provided with free spectacles and the program will be expanded in the future.
Q: You mentioned myopia. How do you recognise the symptoms in a child? Are they easy to identify?
A. The symptoms are easily noticeable by parents and teachers. A child performing badly in school is definitely a suspect, children running up to the board, screwing up their eyes, missing words from the blackboard, missing their homework, avoiding outdoor activities, headaches and unable to align their writing on a page should definitely be investigated.
Q: Can early detection prevent these conditions from progressing? What happens if the child is not treated early? Can it lead to blindness?
A. The most important advantage of early detection is being able to see clearly. Children with good eyesight will also enjoy better education prospects and be able to attend school regularly. If the child loses out on work due to poor vision it would be very difficult to catch up. Refractive errors are by far the commonest cause of VI in children. But screening may reveal a hint of other harmful conditions which need to be excluded in a child.
This includes Paediatric Cataracts (Children born with Lens Opacities), Cancers in the eye, severe allergies and retinal diseases.
Refractive errors themselves rarely cause blindness but may lead to blunting of vision if one eye is more affected than the other. The term coined for this is Amblyopia.
Q: Some babies are born blind. Why? Can blindness be inherited i.e. if both or one parent is blind?
A. Many factors contribute to a child to be born blind. Sometimes, the ocular apparatus is not formed. Sometimes, it may be formed with defects in them, or the very advanced circuitry of the eye may be flawed. These usually happen due to defective genes or other stresses affecting the foetus. Since the gene composition is from one’s parents if the parent genes are defective the offspring can be affected.
Q: Vision 2020 Sri Lanka has been spearheading a program to eliminate or reduce blindness, especially, preventable blindness. What are your goals? Are we close to realizing them?
A. V2020 is a partnership between the Ministry of Health, College of Ophthalmologists and eye care providing non-governmental organizations.
The priority areas identified are, Cataract blindness, Glaucoma and diabetes causing impairment, childhood blindness, Low vision and refractive errors.
To all these areas, a focal person from the College of Ophthalmologists is appointed.
He/she works with the Community Ophthalmologists of the V 2020 Secretariat (all trained offshore in community eye care at WHO training centres) to identify the problems in providing care and secure funding or raise funds for better service.
Q: What would you say are the gaps in ophthalmic services for the general public in Sri Lanka at present? Are there enough eye physicians, surgeons, trained nurses? Are there ongoing training programs for medical officers, midwives and grassroots level personnel who are the first point of contact for underprivileged persons with visual defects?
A. The latest survey shows that 2 million people above 40 years require ophthalmic care. So we still have a long way to go to prevent visual impairment. The way forward in this setting would be maximum utilization of the existing resources.
This would mean new protocols and breaking many red tapes, but if we are to make this system of eye care cost effective the management should certainly look at this seriously as has our neighbouring countries.