Category Archives: Blindness
Late last year, I had the opportunity to meet Valieth and Susana, two young sisters who had been identified through a community screening. They both had congenital cataracts. We arrived at their home and were greeted by the girl’s grandmother Fausta. As the she told us about their life and the challenges that she faced trying to take care of two young girls, she soon broke down in tears.
Fausta told me about the Bible verse that has helped her get through the hard times and give her the strength she needed and it is a verse that I have reflected on many times since my visit. James 1:12 Blessed is the man who remains steadfast under trial, for when he has stood the test he will receive the crown of life which God has promised to those who love him.
Although I knew that the surgery for the girls would not be some magical fix for the family’s hard life, I knew that it would ease the burdens they face and provide the girls with a brighter future, giving the girls an opportunity when they grow up to repay their grandmother for her love and kindness.
When I returned to meet them at the end of June, I was not disappointed. I was greeted by the Fausta and the girls, who skipped and danced around me. Smiles beamed from their faces and I could see instantly that the support that CBM had given for the surgery was life changing. They were delighted with the teddy bears that had been given to CBM by one of our supporters and continued to play as I talked to Fausta, and I knew that for Valieth and Susana that life had changed for the better.
I showed the family a printed version of their story with photos from last year, and they gathered around remembering the day that they had travelled to hospital and had their sight restored. I also shared with Fausta prayers from supporters in the UK for which she was truly touched. I felt humbled by the thanks that she gave to CBM and wished that our supporters could feel this joy first hand.
The girls have been back to the hospital for follow up, but will need to go again, it is likely that they will both need glasses and Valieth will potentially need more treatment on one of her eyes to ensure she has the best vision possible. But the future is looking brighter now, the girls are enrolled in school and are fulfilling Fausta’s dream of getting an education.
Glaucoma is the second leading cause of blindness worldwide, after cataract. But unlike cataract, the blindness caused by glaucoma is irreversible. That’s why identifying the condition early and treating it effectively is vital to save sight.
In this blog, the second in our series showcasing how CBM is helping achieve the Vision 2020 targets towards eliminating avoidable blindness, CBM glaucoma specialist Heiko Philippin, who is based in Tanzania, East Africa, talks about his work treating glaucoma in Africa.
I started working at KCMC in Tanzania in December 2009. Each year, we carry out around 2,500 glaucoma examinations, some of the patients come repeatedly – so 1000-1500 patients with glaucoma each year. Around 100 or less would be children with paediatric glaucoma.
The main challenges are that patients present late – there are numerous different reasons for this – and that treatment options can be limited.
CBM is supporting the management and treatment of glaucoma at a number of different levels. Treating glaucoma is challenging – the condition requires life-long treatment and follow up. In large parts of Africa, we do not have all of the treatment options available as in Europe for example, though at KCMC we have a reasonable amount of treatment options, especially now also with the new laser treatment.
The appropriate treatment option depends on the age group, the stage of glaucoma and the amount of eye pressure reduction which is necessary. We usually start with eye drops or laser, if these are not feasible or not enough then surgical options come into place, mainly a procedure called trabeculectomy. Shunts, which reduce the pressure, are usually only used in desperate cases.
The choice of eye drops is limited in Africa compared to in Europe. In a lot of areas in this region, we only have one type of drop available, while in Europe there are 6 different groups of eye drops available. Over the years things have definitely improved in larger urban centres, though. At KCMC we can offer 4 different types of eyedrops, but this is not common.
The second group of treatment is laser – this is also limited – and the last treatment option is surgery. The most common is trabeculectomy; we can offer our services at similar standards as in any other country.
The next improvement is that we are planning to offer tubes (shunts) which reduce the eye pressure. Aravind in India has now developed a low cost shunt. Often the patient will have tried eye drops and laser before this option
CBM has helped with the procurement of eye drops, which are often not part of standard procurement, and has helped finance larger equipment, which would not be possible otherwise.
CBM has also supported training – I have received specialist training and now offer fellowships in Glaucoma to doctors in Sub Saharan Africa. CBM also offers training to ophthalmologists including the treatment of glaucoma.
I am currently running a trial for a treatment called Selective Laser Trabeculoplasty (SLT), thanks to a joint grant from Standard Chartered’s Seeing is Believing programme and CBM. SLT has been in use in the UK and elsewhere for several years, but this is the first time it is being trialled in Sub-Saharan Africa. We want to find out if the laser treatment is equal or better than the standard treatment which is currently available here. If it is equal or better, then the laser treatment will offer pressure reduction for one or probably more years without the need for the patient to come back every few months for eye drops. Patients are often not able to take the eye drops for different reasons, so we are hoping that the overall treatment of glaucoma will improve.
Of the patients I see, 100 or less are children. They often have a different type of glaucoma, they can have congenital glaucoma or secondary glaucoma due to other eye problems, both are challenging to treat.
I see a lot of patients who are blind according to the WHO definition – visual acuity of less than 3/60 – roughly they could count fingers up at a distance of 3 meters. If you use this definition then a lot of my patients I see are legally blind.
Glaucoma patients who have low vision or even have no visual function left, who cannot differentiate between light and darkness we refer to the low vision department, where we advise on low-vision devices so that they are able to do daily activities better. We can also assist for example in using a cane so they can move around more safely, and we refer them to CBM partners, Tanzanian Society for the Blind.
By Professor Allen Foster, Professor of International Eye Health, Co-Director of the International Centre for Eye Health for London School of Hygiene and Tropical Medicine and former President of CBM International.
The World Health Organisation in 2010 estimated that there are 39 million blind people in the world, but in 80% of these cases the blindness can be prevented or treated. In the year 2000 the WHO together with a group of International Non-Government Organisations, including CBM, launched “VISION 2020 – the right to sight”, a 20 year initiative to eliminate avoidable blindness in the world. So what are the results?
There have been good successes, in fact in 2000 the projected number of blind people in the world for 2010 was well over 50 million, so the actual 2010 figure of 39 million has to be seen as an improvement. There have been good results to control diseases like river blindness (onchocerciasis), vitamin A deficiency (in children) and trachoma, all of which were major causes of blindness in poor countries. There have also been improvements in the delivery of eye care services generally around the world, but particularly in the middle income countries of Asia and Latin America. However the fact remains that about half of all blindness, around 20 million people, is due to cataract which is very treatable.
Cataract occurs when the clear lens in the eye opacifies, becoming like a frosted window. There are a variety of causes, but most cataract is associated with the aging process – the older we get the more likely we are to develop cataracts.
The good news is that the cataract can be removed and its function to focus light on the retina can be replaced by a small artificial lens placed inside the eye (intra-ocular lens) at the time of surgery. The operation is safe and has a very high success rate so that most people have excellent restoration of sight providing the eye has no other problems.
So if the operation is so good why are there 20 million people around the world blind with cataract? The main reason is poverty. Many low income countries do not have enough trained eye specialists. For example in the UK there are about 20 eye specialists for every million people while most African countries have only 1 to 3 eye specialists per million people; and those that are available, for family reasons, tend to work in larger cities which is often far away from poor people living in rural areas.
In order to make cataract surgery available to blind people CBM has been supporting the training of ophthalmologists, cataract surgeons, eye assistants and nurses throughout Africa for many years. A lot has already been achieved; for example in Tanzania there used to be 5 ophthalmologists when CBM started to support eye training and now there are 35 together with over 60 trained cataract surgeons and more than 300 eye nurses / assistants; however there is much more to be done if the goal of VISION 2020 to eliminate avoidable blindness by 2020 is achieved.
It is estimated that Africa needs another 2,000 eye specialists (to achieve 4 specialists per million population) by 2020, but at present less than 100 are being trained each year. Without the eye surgeons, people will not be able to receive cataract surgery and the problem of blindness from cataract will continue. CBM in partnership with other like-minded organisations and Ministries of Health in Africa is seeking to address this urgent health need to train eye health workers for low income countries particularly in Africa.
Professor Dr. Allen Foster, former CBM International President (2006-13) and Medical Consultant/Director (1985-2005), is Professor in International Eye Health and Co-Director of the International Centre for Eye Health at the London School of Hygiene and Tropical Medicine. From 1975-1985, Allen was a general medical officer in a mission hospital in Tanzania. In 1998 he received an O.B.E. (Order of the British Empire) ‘For services to Ophthalmology in the developing world’.
In March, I visited Ivory Coast in West Africa to monitor the progress of our project to scale up the prevention of blindness in the country. This is one of several CBM projects co-funded by Standard Chartered’s Seeing is Believing Programme.
The aim of our programme in Ivory Coast is to increase the number of people who receive cataract surgery to restore their sight. The catchment area of the project includes 7 hospitals, covering a population of around 5.4 million. In that area, an estimated 31,500 are blind due to cataract, according to Ivory Coast’s Eye Health Strategic Plan 2013-16. Cataracts can be easily treated with a simple surgical procedure – but for most Ivorians, sight saving treatment is out of reach because there aren’t enough suitable facilities or trained doctors.
In a poor country like Ivory Coast, where nearly 1 in 4 people lives on less than $1.25 a day, losing your sight is a terrifying prospect. At the COMB hospital in Dabou, I met Seydou, who was waiting to undergo cataract surgery. Seydou was forced to give up his job as a minibus taxi driver three months ago, when sight loss in one eye meant that he couldn’t judge the distance between his taxi and other cars. With little or no support available from the state, he had to rely on family and friends to support him, his wife and his seven children. For him, the surgery was life-changing – very soon he will be working again, regaining his independence and the chance to escape poverty.
Another patient I met at COMB hospital was Ndri Kouassi. In his 70s, the former draughtsman became completely blind due to cataract four years ago. It was a traumatic experience; he became completely dependent on family members. In hospital, before surgery, he seemed vulnerable and lost; his wife held his arm to guide him but he often stumbled. A few days later I met him at his home. With his sight restored, he was a changed man, laughing and confident. Now he could see his children and grandchildren, he explained, he was no longer in the wilderness.
CBM has been working with COMB hospital for many years and the hospital is playing a key role in our programme, hosting a training programme for eye-specialists in carrying out cataract surgery. Once they’ve completed their 6 month training programme, these doctors will work at one of four new cataract surgery facilities that CBM is setting up and equipping at regional hospitals. By the end of the four year programme, we expect to have trained 42 ophthalmologists and increased the number of cataract surgeries by 200%.
Currently many patients have to travel miles to get the surgery they need. I met one elderly lady who was staying with relatives so that she could get to hospital for surgery. I was struck by the dedication of her daughters, who had made the long, difficult journey with her so that their mother could have her sight restored. But for many people who have lost much of their sight, such a journey would be impossible. Equipping regional hospitals and training doctors to work in them is vital if eyecare services are to be accessible to those that need them most.
Ivory Coast is one of the poorest countries in the world – the UN’s places it at 168 of 186 countries in its Human Development Index. CBM’s four year project is co-funded by Standard Chartered Bank’s Seeing is Believing Programme.
I’m the Programme Manager for CBM UK and I visited Luz and her family when I was in Peru. I am enclosing a short report that I wrote after my visit.…
I met Jeick and his mother Luz at their home in Lima, Peru, where they live with Luz’s mother, four brothers and sisters and their children. A small space for such a large family.
Luz explained about the traumatic birth of Jeick which resulted in him being born prematurely at 27 weeks, weighing just over 1kg. Luz became upset as she described the experience which bought back memories of how she felt at the time, not knowing if her son was going to live or die, let alone see.
Luz had to leave Jeick in hospital after just three days, where he stayed for a further two months. She struggled to look after her other two children and visit the hospital every day to see Jeick. It took Luz an hour and a half to reach the hospital each day and the costs soon started to add up.
Luz showed us photos of Jeick from when he was born and still in an incubator. He looked so tiny and vulnerable.
Jeick was regularly screened for ROP where staff had been trained by CBM’s partners in Lima. At three months old he was diagnosed with ROP and given an urgent appointment. But by this point Luz could not afford to pay for the transport to hospital and so they could not make this first appointment.
When we stepped in to pay for her transport, our ophthalmologist was able to urgently conduct the laser treatment and after a short stay in hospital Jeick was able to return home.
It’s been over four months now since Jeick had his treatment and his vision continues to develop extremely well; early signs are that he will have good eye sight and potentially not even require glasses.
Luz told us how thankful she was for the treatment and support she received from CBM It was a real inspiration to meet Luz and hear about her experience and how CBM had made such a vital difference to their lives – not only had we provided sight saving treatment, but we also supported Luz in the rehabilitation process. Luz says she is very grateful for the treatment that Jeick received thanks to the programme and is very happy that her “angelito de diós” (little angel of God) is doing so well now.
Seeing Jeick now, you would never know what a traumatic experience he and his family went through. A real pleasure to see such a happy family.
Mary is young and had been at school until just over a year ago. Now she is totally blind. The brittle undiagnosed Diabetes had metabolically robbed her of her sight in a matter of months. Her sugar was so high when she came to Nkhoma, we had to spend 2 weeks controlling it even before it was safe to think of operating.
Next week we have another Salima session. An extra ambulance of patients from the Lakeshore every day, referred by one of our close partners Malawi Council for the Handicapped, MACOHA. So a busy week ahead screening and helping two hundred or so people from Salima District, around a two hour drive from Nkhoma.
Mr Kambewa, the fantastic Clinical Officer and Cataract Surgeon here at Nkhoma, does a large amount of the work in theatre. Operating patients cataracts with high quality and high volume!
One of the jobs that falls on me however is operating all glaucoma patients (the surgery is a bit longer… around 30 minutes instead of 8 minutes for cataract surgery, and a bit more tricky with all the small stitches); and also all the patients who need cataract surgery, but have only ‘one eye’, in that the other is blind from a cause that we cannot treat.
There are some fantastic new estimates coming out of the WHO that 39.8 million people are blind worldwide; which is a decrease of just over 5 million (13%) in the past 6 years!
Around 80% of blindness is avoidable (as in treatable or preventable); and 90% of blind people live in low income countries.
We are winning the war on blindness!
Thursday 14th is World Sight Day! An international day of awareness to focus attention on the global issue of avoidable blindness and visual impairment.
80% of global blindness is avoidable.
4% of the World’s population are blind or severely visually impaired. That’s four times the population of the UK! It’s truly staggering, but we are also celebrating. Yes there is a lot of need indeed, but we are winning the war on blindness.
The famous ophthalmologist John Sandford-Smith MBE wrote the book on Eye Disease in Hot Climates, and I can see why he chose the title. These last two weeks it has really started getting hot. And dry and windy.
Jacaranda trees are in full bloom, and signify the start of the hot spell of October, before the amazing flame trees blaze across the countryside in November to announce the start of the heavy rains and spectacular electric thunderstorms in December. The regular rains will only begin around Christmas time, but the next few months are among the most incredible in rural Africa. I’ll get some shots of this remarkable change over the next few weeks to show.
We went into a village the other side of Lilongwe on Monday to see a couple of patients that had been to Nkhoma, and others that could come for help. The picture Katrin took was amazing and it really stunned me.