For World Glaucoma Week, Mark S. Rakoczy on advancing glaucoma care in Southern Haiti…
The sights and sounds that stick with me the most are the ones that keep me up at night as an optometrist. An elderly gentleman, shuffling his way into our eye clinic on the arm of his daughter. As he reaches for a place to sit, he is unsuccessful, unable to see. Examination reveals that it is too late for him… never will his sight return. Or of a young man in his 30’s, after being examined by a colleague next to me, weeping openly, grieving the loss of his sight forever. He has been told before that there is nothing that can be done, but this time it seems, he grasps that it is certain. Tears well up in all nearby. Then there are the patients who look healthy, until you look into their eye and see, unbeknownst to them, the ravages of glaucoma that make your heart drop. Preventable in the right circumstances.
Glaucoma can be a devastating disease. It can rob you of your sight, without even a knock at the door, before your house of vision is left smouldering from fire. The World Health Organization estimates that 4.5 million people are blind from primary glaucoma. BLIND, not just affected by it.
In Haiti, lack of access to care, or affordability of that care and the medications to treat it, make glaucoma all the more ominous of a disease. Glaucoma needs a lifetime of treatment and there is “no one and done” fix to prevent blindness.
Selective Laser Trabeculoplasty or SLT is a form of laser surgery that is used to lower the intraocular pressure in the eye. Lowering the pressure in the eye is the only form of treatment that can make a difference. The more advanced the disease, the lower the pressure needs to be, to prevent progression. It can help eliminate or reduce the number of medications a patient might need, thus lowering the economic burden. Unfortunately, it can lose its effectiveness over time, but it can be repeated. Ten million people, two SLTs in Haiti.
VOSH-Pennsylvania has been traveling to Haiti since 2007. With four to six week- long clinics per year, they have had an influential role in helping to alleviate refractive error with delivery of eyewear, and blindness from cataracts and glaucoma, through its referral relationship with local ophthalmologists and volunteers from Surgical Eye Expeditions.
VOSH-Pennsylvania, through the help of VOSH/International and Optometry Giving Sight, plans to place an SLT at the University of Haiti Medical School in Port-au-Prince. Plans are to set up a social clinic in conjunction with the Optometry school there and place the SLT there. Training for the staff and ophthalmology residents will be planned, so treatment of patients can begin. This will also provide optometry students education on its use, so they can make proper referrals in the future.
Prevention of blindness can make a big difference in peoples lives… the ability to support their family, to see the world, to make a difference.
Image on top: This young fellow has congenital glaucoma in his right eye, left side of picture…. right eye is larger and blind. Could only be helped if caught right away and still not a great prognosis…. not something for use of an SLT