Author: Dr. Sukheshni Nand
Cataracts occurs when proteins in the lens of the eye become bent and mis-shaped causing a sufferer’s vision to become cloudy and blurred . According to WHO: “Cataract is clouding of the lens of the eye which impedes the passage of light . Although most cases of cataract are related to the aging process, occasionally children can be born with the condition, or a cataract may develop after eye injuries, inflammation, and some other eye diseases such as glaucoma and diabetes”. The development of cataracts can be prevented or delayed by reducing cigarette smoking and ultraviolet light . The treatment of cataract is surgical and successful in restoring sight and this done by removing the opaque or clouded lens and replacing it with an artificial intraocular lens .
While cataracts can be surgically removed, in many countries barriers exist that prevent patients to access surgery such as financial instability, limited access to eye care facilities and even limited advancements in the country to perform such surgeries . Hence due to these limitations, in many remote parts of the developing world, people remain blind from cataracts . As people in the world live longer, the number of people with cataract is anticipated to grow. Cataract is evidently an important cause of low vision in developing countries such as the Pacific Island Nations. The percentage of blindness due to cataract amid all eye diseases ranges from 5% in developed countries to 50% or more in poor and/or remote regions .
The Republic of Fiji is an incredibly diverse, vibrant island nation in the South Pacific. The country consists of 330 islands, only 110 of which are inhabited . Most of the population lives on the two largest islands, Viti Levu and Vanua Levu. For Fijians living outside of these major islands, medical and eye- care is chiefly inaccessible . Majority of the country’s eye care workers are based in Suva, and outreach teams have to travel frequently to rural areas to reach people in need . According to Foundation NZ, smaller eye clinics throughout Fiji are under-resourced, and travel costs, plus the physical difficulty of getting around, are barriers for many people . Visiting an eye clinic might mean traveling from one island to another via ferry, which costs about $20 per journey . Unfortunately, only seven ophthalmologists serve all 110 inhabited islands . Almost 70,000 residents suffer from blindness, most of which is caused by cataracts . In 2005, SEE Internation held their first program in Fiji. Since then, SEE has hosted 5-8 programs each year, providing free, sight-restoring surgery to over 500 blind Fijians in need .
Cataract surgery is conducted at three base hospitals and a camera and laser supports the diabetes program at three hospitals . In the west, diabetes services include outreach screening and laser clinics. However in the central division, only screening is conducted during the outreach . Patients with sight-threatening retinopathy are referred to the clinic at the Pacific Eye Institute and the CWM Hospital for tertiary treatment and laser . Guidelines for Diabetic Retinopathy Screening (an initiative of the Fred Hollows Foundation NZ), have been developed. Optometrists work in private practice, while ophthalmic nurses are trained to refract .
In 2002, the only eye care training for doctors in the Pacific was in Papua New Guinea. In 2006, Foundation NZ built the Pacific Eye Institute in Suva . The Pacific Eye Institute offers a full range of eye-care services at Suva’s public hospital; and provides eye care training for doctors and nurses from across the Pacific region . Made up of trained Pacific Island doctors and nurses, the team travels around the region providing eye care services to people in need . Furthermore in 2012, Fiji’s Minister for Health signed a Declaration of Support for VISION 2020, (following advocacy by IAPB) . Work continues to deliver eye care across the country with close collaboration between the Ministry of Health and NGOs . “Fiji’s capital Suva is home to the Pacific Eye Institute (PEI), a regional training institute for ophthalmic doctors, nurses and mid-level personnel. IAPB’s sub-regional work is also coordinated from Fiji” .
Additionally, in 2015 Foundation NZ launched a full-service Mobile Eye Clinic that travelled around Fiji’s two main islands . The service has improved access to eye care in remote areas, with screening teams travelling ahead to small villages and referring patients to the nearby Mobile Eye Clinic for treatment . Foundation-trained eye doctors are now based in Lautoka (West) and Labasa (North of Fiji). As stated by Foundation NZ, the Mobile Eye Clinic team had a 21 per cent increase in patients seen in 2019 compared to 2018. They performed 614 sight-saving surgeries and dispensed 6,079 spectacles .
Furthermore, in 2018 Optometrists from China provided some much needed and free surgeries in Fiji . The team conducted 69 cataract eye surgeries for free at the Pacific Eye Institute (PEI)/CWMH Eye Centre . Each of these surgeries would normally cost US$1600 (FJ$3416). This showed the strengthened collaboration between the Ministry of Health and Medical Services and the Zhongshan Ophthalmic Centre of Guangdong province from China . As part of their visit here, the team also shared their skills and expertise with the local staff at Pacific Eye Institute (PEI) . In addition, they have also donated some consumables and medicines to PEI to assist with eye care treatments. The screenings for the 69 patients who underwent the surgeries have been done by the PEI .
In a study published in Nature, University of California San Diego scientist Ling Zhao and her colleagues were able to isolate genes linked to cataract formation . Using an eyedrop containing the compound lanosterol, they were able to treat and in some cases reverse cataracts in dogs and rabbits after just six days . The study raises the prospect that it might be possible to prevent or even reverse cataracts in humans using similar topical eyedrop treatments . This was a crucial study as the usual treatment to remove the damaged lens and replace it with a plastic replica was expensive and limited in developing countries . In developing countries such as the Pacific Island Nations, as the population ages, and more patients need surgery, eye clinics could struggle to cope .
In conclusion, cataracts blindness is a frequent cause of blindness in developing countries and affects many children. Fiji is not spared from this debilitating health issue. Access to facilities and qualified doctors is extremely difficult and expensive; and many Fijians live in isolated communities . Numerous families with low income cannot afford to pay for cataract surgery and this significantly affects the education potential, work capacity and the quality of life . Therefore, it is essential to advocate for the elimination of barriers to eye care services, as well as to provide guidance and technical support towards the development of comprehensive eye care systems. Hence, addressing the burden of cataract and other chronic eye diseases. Factors such as lack of awareness, shortage of trained eye health personnel, limited accessibility, high cost of treatment, and poor surgical outcomes are significant barriers to cataract elimination . Other limitations are lack of public health resources and political will to address cataract. Collaborative efforts between the government and multi-sectorial organizations (such as NGOs) must increase to develop a comprehensive strategy for cataract-service delivery. Collective efforts is needed that can integrate availability, affordability, accessibility, and acceptability of cataract care. All in support of the uptake of high-quality, low-cost cataract service models in the Pacific.
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