Eye defect cases low but doctors not idle

Access to education, finding a good job and being accepted in society is a struggle for most of the blind people across the country and Africa today.
An optician checks a patient’s eye at Dr Agarwal’s Eye Hospital in Remera.   The New Times/ T. Kisambira.
An optician checks a patient’s eye at Dr Agarwal’s Eye Hospital in Remera. The New Times/ T. Kisambira.

Access to education, finding a good job and being accepted in society is a struggle for most of the blind people across the country and Africa today.

Men, women, and children with bloodshot eyes, swollen faces and rashes sit in a dimly-lit waiting room at the Kanombe Military Hospital eye clinic in Rwanda. They are eager to get the service and have a shot at life’s joys that they miss because of the ailment.

“People are getting more aware and more patients now have access to eye care services,” said Dr John Nkurikiye, an ophthalmologist consultant at Dr Agarwal’s Eye Hospital in Remera Sector, Kigali.

Retinal dystrophies affect more than 40 million people worldwide. The global cost of these debilitating disorders could be as high as $20 billion annually, underscoring the need for swift actions to raise awareness of prevention, diagnosis and treatment options.

As we start the World Retina Week, today, Retina International, with its 32 member organisations and leading eye-care service providers and advocates from 32 countries, are calling on patients and their friends and families, eye-care professionals, vision researchers and scientific and medical funding bodies to think about what they can do to hasten the pace of progress towards the complete removal of avoidable blindness and worldwide availability of safe and effective treatments.

This is a crucial time for patients, clinicians and research sponsors as comprehensive diagnostic data and clinical trial data have the ability to alter the prognosis for millions of patients who are experiencing sight-loss attributable to retinal disorders.

In Rwanda, about 0.5 per cent of the population is blind, that is, between 50,000 and 60,000 blind people.

According to the ophthalmologist, most of the blindness cases are caused by cataracts and glaucoma diseases.

A cataract is a clouding that develops in the crystalline lens of the eye or in its envelope, varying in degree from slight to complete opacity and obstructing the passage of light.

“Although vision can be restored in most people with cataracts, cataracts are still the most common cause of blindness in Rwanda,” he said.

Eye cataracts

Most cataracts are related to aging. Cataracts are very common in older people. By age 80, many either have some degree of cataract or have already undergone cataract surgery in one or both eyes. By age 95, this percentage increases to almost 100 per cent.

A cataract can occur in either one or both eyes. Individuals with a cataract in one eye usually go on to develop a cataract in the other eye as well. A cataract is not contagious and cannot spread from one eye to the other or from person to person. Cataracts do not cause the eye to tear abnormally. They are neither painful nor make the eye itchy or red.

“The other main cause of blindness is Glaucoma which is a group of diseases that affects the optic nerves and if not detected early leads to blindness,” said Dr Nkurikiye.

“It is also difficult for one to know whether they have it unless they go for regular screening because it is not painful or visible.”

Nkurikiye advises that once people reach a certain age go for regular screening especially in cases where members of one’s family line once suffered from it.

“There are some genetic factors that make it run in families and other unknown factors we can’t explain since it is a group of diseases. And for it, once you go blind you cannot treat it,” he explains.

The doctor however said that Rwanda was fortunate not to have reported cases of Trachoma and river blindness which are the world’s major causes of blindness today.

“Trachoma is common in congested places with limited access to clean water and is spread by flies,” he said.

Coming to back to the last but minor issues that cause blindness in Rwanda, the doctor says many people with refractive errors in that they can either not see far or near are not aware that they can buy glasses and solve the problem for once and for all.

“This is quite a serious issue which we need to address.”

The ministry of health last November started looking at how Rwandans would have access to eye care services much easily than before by piloting trainings of ophthalmologists and nurses in all health centres, district and referral hospitals countrywide.

“They trained two nurses from each of the 30 districts’ health centres who would then be able to dispense glasses and treat some minor problems and then know how and when to refer specific problems to the district hospitals,” he said.

“At the district level, we have ophthalmic technicians trained at the Kigali Health Institute that are capable of treating around 70 per cent of all eye problems in Rwanda.

“To add to that, eight of them recently completed training under the Rwanda International Institute of Ophthalmology to get them certified by the International Council of Eye Professionals in Ophthalmology which they all passed,” he said, adding that the country needs to look at carrying out 15,000 operations every year to treat cataracts in order to stop avoidable blindness in society.

Currently, the country carries out less than 4,000 operations every year.

“The ideal situation is to have every ophthalmologist do 1,000 operations a year if we are to achieve the removal of avoidable blindness by the year 2020,” he says.

To get there, the whole system has to work together because ophthalmology is a very hi-tech venture.

Fortunately, the medical insurance is there for everyone more so the rural folks who can now access eye care services.

The wonder clinic

The purpose of setting up Dr Agarwal Eye Hospital in Kigali was to ensure Rwandans stop going for special treatment outside the country and Dr Nkurikiye is happy they have achieved that.

With an estimated $6 million (about Rwf4 billion) invested in the hospital, the hospital is rather targeting patients from seven countries around East and central Africa.

The hospital is equipped with state-of-the-art technology for performing surgery related to cataract, retina, glaucoma and other eye ailments with the techniques matching the international standards comparable to those in Europe and South Africa.

Dr Agarwal’s Eye Hospital has more than 60 hospitals worldwide with 350 consultant ophthalmologists and it aims at becoming a referral centre for subspecialty care for East and Central Africa.

Dr Agarwal’s Eye Hospital provides some of the services that are not found in the region like “Digital angiography; OCT full range; Phaconit (pinhole cataract surgery); Glued IOL; Macula Hole surgery; Lamellar Cornea grafts and Riboflavin Ultra-violet Collagen Cross-linking for keratoconus”.

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