Volume 183 - Issue 9
Sight-seeing in the Solomon Islands
Author: Stephen E Cains
Med J Aust 2005; 183 (9): 492-494. || doi: 10.5694/j.1326-5377.2005.tb07136.x
Published online: 7 November 2005
Published online: 7 November 2005
Stephen E Cains
Medical Director, The Fred Hollows Foundation, Locked Bag 3100, Burwood, NSW 1805. scainsAThollows.org
To the Editor: I read with interest the personal perspective by Baker, describing her recent visit as part of an ophthalmic surgical team.1 Such teams from Australia have a long and creditable record of service in the Pacific, and their work has been of great value to the people in the countries involved, and of considerable personal satisfaction to those who have taken part in them.
The experience of ophthalmic surgeons working with The Fred Hollows Foundation in developing countries certainly confirms Baker’s observations that the density of the cataracts found in these circumstances commonly makes them unsuitable for phacoemulsification. This does not, however, lead to the conclusion that modern small-incision surgery is not suitable for cataract patients in the developing world.
Sutureless small-incision cataract surgery (SSICS) by manual means has been practised in many parts of the developing world for many years, with a range of techniques being used to extract the nucleus without phacoemulsification.2,3 Such techniques have been shown to give better uncorrected vision when compared with standard extra-capsular surgery, and are quick4 and economical, with fewer problems requiring follow-up than extracapsular surgery.5 The Fred Hollows Foundation, along with many other non-government organisations and authorities, is actively teaching and promoting the use of SSICS in its programs as the operation of choice for cataract extraction in the developing world.
In light of this, I was surprised to see mention of the introduction of phacoemulsification to the Solomons by the team. Not only is this procedure not suitable for a large proportion of the presenting cataracts, but the cost of equipment and consumables in phacoemulsification is several times that of SSICS, and the time taken for surgery is often longer.
In an environment where people suffer vision impairment simply from lack of glasses, and where surgeons are available who can perform modern small-incision sutureless cataract surgery, I wonder if this is an appropriate technology to introduce to the region.
References
- Baker ML. Sight-seeing in the Solomon Islands. Med J Aust 2005; 182: 633-644. CBBHABGB
- Ruit S, Paudyal G, Gurung R, et al. An innovation in developing world cataract surgery: sutureless extracapsular cataract extraction with intraocular lens implantation. Clin Exper Ophthalmol 2000; 28: 274-279. CBBFAGFC
- Hennig A .Sutureless non-phaco cataract surgery: a solution to reduce worldwide cataract blindness? Community Eye Health J 2003; 16: 49-51. CBBDFFBE
- Balent LC, Narendrum K, Patel S, et al. High volume sutureless intraocular lens surgery in a rural eye camp in India. Ophthalmic Surg Lasers Imaging 2001; 32: 446-455. CBBBBIDH
- Gogate PM, Despande M, Wormald RP. Is manual small incision cataract surgery affordable in the developing countries? A cost comparison with extracapsular cataract extraction. Br J Ophthalmol 2003; 87: 843-846. i1091551