‘Eye care not accorded proper attention by govt, health managers’
Dr Barka David Lass is an ophthalmologist and the medical director of Jordan Eye Hospital in Dogon-Karfe, Jos, Plateau State. In this interview, he speaks on tackling eye care challenges in the country, recognizing a quack and what to note when buying medicated eye glasses. What are the major areas of concern on eye care […]
Dr Barka David Lass is an ophthalmologist and the medical director of Jordan Eye Hospital in Dogon-Karfe, Jos, Plateau State. In this interview, he speaks on tackling eye care challenges in the country, recognizing a quack and what to note when buying medicated eye glasses.
What are the major areas of concern on eye care in the country, and how do you think they can be tackled?
There are many concerns regarding the delivery of eye care in Nigeria. One of them is the gross inadequacy of eye care facilities both in terms of number and spread. We have very few facilities providing eye care in the country and these few facilities are located in the big cities.
Most rural areas do not have eye care facilities thereby making it extremely difficult for the rural dwellers to access eye care. The few facilities in the cities are also very expensive, making it difficult for the poor to access their services. This lack of access to care will encourage people with eye problems to resort to alternative care including traditional eye care practices.
Another concern that is closely related to the one above is the lack of highly specialized eye cares in the country. Very few facilities provide some of these services in the country.
You need to go to the Indian Embassy and see the number of Nigerians seeking medical visas to India for highly specialized care in India. There is need to strategically develop regional centers of highly specialized cares if not state centers.
Most of the eye care services that we provide in this country are mainly curative with little or no emphasis on preventive or rehabilitative eye care services. A person who becomes blind in this country is relegated to traditional methods of management of blindness which is either being kept at home or to resort to street begging.
This should not be the case in this age and time where a blind person can live a relatively independent and fulfilled life by means of different kinds of non-visual aids. The situation is even worse for people with low- vision who are traditionally treated the same way with those who are blind. People with low-vision can be made to live a productive and independent life with the help of visual and non-visual aids.
Most of the preventive eye care programs like the trachoma control, river blindness control, vitamin A distribution and school eye health programs are largely non- governmental organizations (NGO) driven. The NGOs initiate and sustain these programs with little or no input from the government.
Eye care delivery has not found the relevance it deserves before government and health care managers in this country. Visit the eye unit of a general hospital and see what we have in terms of infrastructure, equipment and human resource relative to other units of the hospital. Yet, eye care delivery offers some of the most cost effective interventions and good return on investment in health care delivery.
Several Nigerians suffer from glaucoma and cataract. What is your advice in preventing these diseases?
Cataract and glaucoma are the leading cause of avoidable blindness in Nigeria and the world over.
Cataract is a medical condition in which the natural transparent lens in the eye becomes opaque resulting in the impairment of the transmission of light to the back of the eye where images are formed on the nerves for onward transmission to the brain where they are interpreted as different objects and colors.
As the opacity of the lens increases, there is progressive painless loss of vision until a point is reached where objects and colors cannot be seen except for the perception of light.
There are many causes of cataract. These can generally be classified into two. Primary cataracts in which the exact cause of the cataract is unknown and secondary cataracts in which the cataract is attributable to known causes such as trauma to the eye, use of steroid eye drops, inflammation of the eye and diseases like diabetes.
Primary cataract cannot be prevented but modulation of some of the known risk factors can delay the onset or retard the progression of the cataract. Secondary cataracts on the other hand can be prevented by avoiding the precipitants of the cataracts.
These can be done through the avoidance of the indiscriminate use of eye drops containing steroids, prevention of trauma to the eye, appropriate treatment of inflammation of the eye, adequate treatment of diseases such as diabetes among many other options.
Blindness from cataract irrespective of the cause can be prevented through early detection and appropriate surgery
Glaucoma is a group of diseases that cause blindness by destroying the nerves at the back of the eyes. Patients will commonly present with painless progressive loss of vision. Like in the discussion on cataract above, causes of glaucoma can either be primary (unknown) with similar secondary causes like steroid use, eye trauma, eye inflammation, cataract and diseases like diabetes and myopia.
Primary glaucoma cannot be prevented but secondary glaucoma can be prevented through several means as discussed above.
Unlike in the case of cataract, blindness from glaucoma is irreversible. Nerves do not regenerate therefore whatever is lost before diagnosis cannot be recovered. However, early diagnosis of glaucoma and appropriate treatment will help prevent or delay the onset of blindness.
What is the effect of buying eye glasses not prescribed by experts?
It is important to differentiate between plain and corrective (medicated) eye glasses. Medicated eye glasses are glasses with different powers designed to correct errors of refractions of the eye. Since these glasses have specific powers, they are meant to correct for specific errors of refraction.
The expert is trained to determine the refractive error of a patient and match it with the appropriate power of the glasses to achieve optimum correction of refractive error that will result in best corrected vision.
Any mismatch between the refractive error of a patient and the glasses will result in sub-optimal vision with unpleasant side effects/consequences. Some of the side effects or consequences will include not getting value for the money spent, dizziness and headaches (tension headaches, migraine). Headaches can cause anxiety and sleep disturbances which can in turn make the control of certain systemic illnesses like hypertension and diabetes difficult. The possible side effects of a mismatch of correction are endless.
What do you think is the reasons some Nigerian ophthalmologists and optometrists do not operate within international best practices till date, with some still using touch lights to examine patients?
There are many possible reasons militating against the delivery of quality eye care services in our country. Some of these will include the following:
The high cost of ophthalmic equipment makes it difficult for most facilities to adequately equip their practices with relevant and up to date technology in eye care.
Closely related to this is the high cost of maintenance of these equipment. It is very difficult to find trained technicians in this country who can service and maintain most of the highly specialized equipment in ophthalmology.
I do not know of any sale or service outlet of any of the major manufacturers of ophthalmic equipment in this country. Most of their regional offices are in north or south Africa. This makes it difficult for the maintenance and repair of equipment bought through the regional offices. In some situation, the cost of transporting this equipment to the regional offices for repair or that of bringing technicians from the regional offices will not be too different from the cost of purchasing a new one.
There is also a lack of facilities for additional specialized training in Nigeria. A practitioner (ophthalmologist, optometrist) will have to go abroad to obtain added skills beyond the postgraduate training obtainable here. The cost of doing this is quite high and the opportunities are few.
What services do you offer at Jordan Eye Hospital?
The hospital became operational this year. Our mission is to provide quality and compassionate eye care services. We intend to do this through the provision of services that are guided by internationally accepted best practices together with appropriate relevant technology and a high ethical standard of medical practice.
With the rate of quackery in the health industry, how can Nigerians identify a genuine ophthalmologist and optometrist?
This is a very difficult thing to do in our country where everyone who works in the health system is called and considered to be a doctor. It is therefore quite easy for people who work within the health system to claim to be ophthalmologists or optometrists and be patronized by the general public.
The risk of exposure to quack practice is less in established hospitals whether private or public. These established hospitals will ensure that only qualified ophthalmologists and optometrists are employed and that their annual license to practice are up to date.
The risk of exposure to quack practice is high in one-man private practices, small clinics and in eye care outreaches. In these situations, people should request to see a copy of the registrations of these outfits/organizations with the Corporate Affairs Commission, respective state ministries of health and the annual license to practise for the individuals attending to the patients.