What contribution can a Europaean paediatric ophthalmologist make to paediatric cataract surgery in developing countries?

Session Details

Session Title: Orbis Free Paper session

Session Date/Time: Monday 15/09/2014 | 11:45-12:45

Paper Time: 12:15

Venue: Capital Suite 14 (Level 3)

First Author: : G.Woodruff UK

Co Author(s): :                  

Abstract Details

Purpose:

Worldwide, approaching 1 million children are blind because of untreated or ineffectively treated cataract. In the UK, the median outcome in bilateral congenital cataract is 6/18, whereas it is estimated that the majority of children with advanced cataract in low income countries remain blind due to either lack of treatment, or ineffective treatment. The management of paediatric cataract has been identified as a high priority by the World Health Organisation as part of the Vision2020 initiative. However, paediatric cataract surgery in developing countries presents challenges which a western paediatric ophthalmologist is unfamiliar with. The purpose of this study was to investigate the educational value of a visit from a UK paediatric ophthalmologist to the care of paediatric cataract in hospitals with limited resources serving poor communities in Africa and South Asia.

Setting:

Educational visits lasting from 4 to 21 days to 8 different hospitals centres in Africa, and South Asia that undertake cataract surgery for children.

Methods:

At each centre the principal contribution of the visiting ophthalmologist was classified into: Didactic teaching of microsurgical skills in the operating theatre, sharing surgical experience on a peer to peer basis in the operating theatre, clinical teaching of paediatric ophthalmology to residents in an outpatient setting, teaching ancillary staff responsible for screening and providing information to parents and other carers, directive suggestion of new management structures or organisation, sharing experience of management structure on a peer to peer basis, presentation of formal lectures, and co-authorship of academic work . A semi structured interview was used to assess the usefulness of each category of teaching.

Results:

Didactic teaching of microsurgical skills was never appropriate in the centres visited. This was because of the high number (80) (range 40-120) of cases operated on annually by each host surgeon and because of the unfamiliar operating conditions. Cohesive visco-elastic (14mg/ml) was available at only one centre, folding intra-ocular lenses available in only 3 of 7 centres and general anaesthesia available in only 4 of 7 centres. Sharing of surgical experience in the operating theatre was judged at all 8 centres to be the most useful part of the visit by both host and visiting surgeon. Comparison with UK experience led to close analysis of the operating conditions. General anaesthesia, trypan blue, cohesive visco-elastic, 20-gauge capsulorhexis forceps, an AC maintainer, and adjusting the infusion bag height, was found to provide conditions in which the anterior chamber remained deep at all times, and the pupil remained widely dilated throughout; thus, posterior capsulorhexis, anterior vitrectomy and placement of an intraocular lens within the bag became a realistic goal in children down to 9 months of age. Academic collaboration in two centres resulted in one paper presented at an international meeting and one grant application and this was highly valued.

Conclusions:

UK ophthalmologists have much to offer paediatric cataract surgery in low income countries. However an experienced UK paediatric cataract surgeon is unlikely to have the volume of experience of their host at paediatric cataract surgery. Nevertheless, the experience of ideal operating conditions in the UK may allow the UK surgeon to share the expectation of much better operating conditions. Ensuring the availability of appropriate instruments and materials before the visit will allow many paediatric cataract surgeons in developing countries to experience unrivalled operating conditions and set new standards of expectation. This may provide an achievable step forward in paediatric cataract surgery in developing countries in the light of the high priority all international eye charities are currently giving to paediatric cataract surgery.

Financial Interest:

NONE