1. Eye care in the Tropics for Non-ophthalmologists Sam Powdrill University of Kentucky Previously at Tenwek Hospital, Kenya

2. Tenwek Hospital

3. Objectives • Define blindness from a community perspective • Understand the burden of avoidable blindness in our world • Exposure to the most common causes of visual impairment and World blindness • Gain an understanding of current prevention of blindness efforts and methods

4. 50 million blind in our world • 600 people go blind every hour • Half of these are blind from cataract • 90% live in the developing world

5. 80% of developing world blindness is avoidable • 60% Treatable • 20 % Preventable

6. Many in Kenya are Blind • Out of 100 people • 1 is blind in both eyes • 3 more have significant loss of vision • 2 of these could see again with surgery

7. So, How can you make a difference?

8. Start with a community assessment.How big is the problem?

9. Causes of World Blindess • In millions • Cataract 25 • Trachoma 7 • Glaucoma 5 • Refractive errors 5 • Diabetes 2.5 • Vit A def 1 • Macular deg. 1 • Oncho 0.5 • Injuries 0.5 • Leprosy 0.25 • Retinal 5 Trachoma

10. 1 in 1000 blind 1 in 100 blind another 1% severely visually impaired Eye Care United States Africa • 1 eye doctor for 1million people • 1 eye doctor for 20,000 people • 300 cataracts done per 1 million people • 5800 cataracts done per 1 million people

11. Size of the problem in the local community • Immediate catchment of approximately 1,000,000 people • 1% blind • 1% severely visually impaired • Half of these are from cataract • Estimated 2000 new cases for cataract surgery annually • One eye surgeon

12. Profile of Blindness in Western Kenya

13. Estimated Profile of Blindness in Maasai and Pokot areas Corneal causes are increased by trachoma

14. Pokot Kipsigis kisii Tenwek Hospital Maasai

15. Tenwek Eye Unit • The main eye care provider for 1 million rural people • 9, 000 cataract operations needing to be done now • 800 new cataract cases per year • Only one eye surgeon on staff

17. Screening for cataract surgery at an outlying center

18. Here the gift of sight is a privilege that many do not have

21. Portable Scanoptics microscope

23. Most cataracts are very dense and phaco is both difficult and costly on these lenses.

24. Frown incision allows for a suture-less extracapsular procedure to to remove the nucleus through a wide tunnel

25. Linear capsulotomy with 26 ga needle. Continuous capsulorhexis if adequate visibility

26. Nucleus delivered by hydrodissection

27. Lens in place after completion of capsulorhexis wound closed and tight without suture

28. Anterior Chamber Lens implant • Aphakia • Posterior capsule complications

29. old glasses

30. new glasses

31. Optical workshop

32. Anterior lens placed under visco-elastic through a clear corneal temporal incisionThe patient had previous intracapsular surgery without an intraocular lens

33. Large numbers of people are blind from cataract Many do not come because of: • Availability • Bad outcomes • Cost • Distance • Escort • Fear

34. Service to Patient • Available • Acceptable • Appropriate • Affordable Alma Atta – health for all by 2000

35. Mobile Surgery Taking eye surgery to a community that does not have a functioning static service within reach of the local people

36. Considerations in Mobile surgery • Patient Profile • Personnel • Physical factors • Procedure • Price

37. Personnel • A local person health provider doing screening ahead of time • Translators • Patient attendants • Mid level eye care provider - screening • Equipment person / circulator • Scrub technician • Surgeon

38. Physical challenges • Transport – patients and surgery team • Local Facility – cleanliness, water, food, power source • Instrument maintenance and care

40. tonometry on a church bench

49. LOKORI