EyeWorld Asia-Pacific March 2016 Issue

46 EWAP Cataract/IOL March 2016 by Lauren Lipuma EyeWorld Contributing Writer Global cataract blindness: a burden and an opportunity Individual surgeons can use their skills to help clear the worldwide backlog of cataract surgeries C ataracts are the leading cause of blindness around the globe. According to the World Health Organization (WHO), cataracts are responsible for bilateral sight loss in 20 million individuals worldwide. While cataracts are operable and surgery often has a high success rate, the vast majority of individuals blind from cataracts live in developing countries and face significant barriers to accessing quality healthcare. Specifically, in many of these countries, eyecare is expensive and hard to find—there are often too few doctors and eyecare programs are significantly underfunded. Breaking down these barriers may seem like a challenge suited only for national and regional governments, but physicians from any country can use their skills to combat this growing problem. Here, two prominent ophthalmologists and active volunteer surgeons share their views on how individual surgeons can dedicate their time to best serve the eyecare needs of patients around the globe. Scope of the problem Part of the reason that little attention and few resources are allocated to fighting cataract blindness in developing countries is a lack of understanding of how blindness affects individuals, families, and communities, said Matt Oliva , MD , associate clinical professor, Casey Eye Institute, and in private practice, Medford, Ore. Dr. Oliva is a board member of the Himalayan Cataract Project (HCP). The HCP is a non-profit organization that has been providing quality eyecare to rural areas of Africa and Asia for more than 20 years. In 2012, the HCP enlisted the RAND Corporation—a non-profit research institute—to measure the costs of blindness to individuals and communities in rural Ethiopia. “We found that blindness has significant negative impacts, including being less likely to work, having limited participation in social events, having a reduced body mass index, having a negative effect on mental health, and being more likely to be divorced or separated,” Dr. Oliva said. “Households with blind individuals were economically disadvantaged compared to other households. The study highlighted that blindness not only leads to individual human suffering, but also affects family members and the entire community considerably.” The HCP study and other studies have found that there is also a considerable gender gap when it comes to accessing eyecare, with women being more likely to be blind from cataracts but less able to access surgical treatments, Dr. Oliva said. Blindness impacts women more than men indirectly as well. In developing countries, it is usually the youngest female relative who cares for a blind individual, and therefore that granddaughter or niece can’t go to school or work, said Bala Ambati , MD , professor and director of cornea research, Moran Eye Center, University of Utah, Salt Lake City, and a volunteer with the ORBIS Flying Eye Hospital. The HCP study also found that restoring sight with cataract surgery in rural populations leads to dramatic improvements in basic functioning, physical and mental health, and community participation. “We hope that publicizing the economic and social impacts of restoring sight will lead health officials to invest more toward providing cataract surgical services in the world,” Dr. Oliva said. Efforts underway Most projections estimate that the backlog of cataract surgeries will grow, primarily due to the aging of the population, especially in Asia and Africa, Dr. Oliva said. “We are struggling to meet this demand, as there remains, especially in sub-Saharan Africa, a lack of infrastructure and manpower to address the issue,” he said. Fortunately, successful blindness reduction programs already exist in some regions of the world. These include the Aravind Eye Care System and LV Prasad Eye Institute in India, the Tilganga Institute of Ophthalmology in Nepal (supported by HCP), ORBIS, Project Hope, Sight for the Sightless, and Moran Eye Center’s Global Outreach Division, according to Drs. Oliva and Ambati. “India is a great success story, with cataract surgical rates improving dramatically in the last 25 years,” Dr. Ambati said. Currently, physicians and other healthcare providers are using these programs as models of efficient and high quality service delivery that can be exported to areas where infrastructure and funding are lacking—most notably in sub-Saharan Africa, Dr. Oliva said. “Ethiopia is a country where I work regularly and I anticipate will have a doubling of the number of cataract surgeries in the next 5 years.” What can individual surgeons do? According to Drs. Oliva and Ambati, surgeons can do many things to get involved and help combat global cataract blindness. Becoming proficient in manual