Organization draws on global resources to eradicate blindness

SEE International helps surgical clinics treat cataracts at host sites.

Issue: April 25, 2008

ByErin L. Boyle

John A. Hovanesian

Potential patients will often travel long distances, by any means possible – foot, cart, train or motor vehicle – simply to learn if they are eligible for cataract surgery at one of Surgical Eye Expeditions International’s clinics.

“In many cases, these patients literally have one chance in their lifetime to have their vision restored,” Harry S. Brown, MD, FACS, founder, president and chief operating officer emeritus of SEE International, said in an interview with Ocular Surgery News. “They will go to extraordinary lengths to get in that line.”

After individuals are screened, they learn if they have cataracts, which are operated on by SEE International volunteers. Free sight-restoring surgery for cataract patients in developing nations often has life-altering impacts on those individuals, making the work of outreach groups that facilitate that service vital, Dr. Brown said.

The organization

Dr. Brown founded SEE International 34 years ago after traveling the world and observing ophthalmic techniques used in different countries. When he returned to the United States and began his practice in Santa Barbara, Calif., in the early 1970s, he said he realized that he wanted to retain international connections and continue performing cataract surgery around the globe.

He began the group by soliciting assistance from fellow Santa Barbara physicians who took part in ophthalmic outreach expeditions to Mexico. The group grew and quickly identified the need for cataract surgery the world over, he said. In addition to coordinating two clinics in Mexico every year, the organization now sponsors clinics in 75 countries.

The organization works as a facilitating agency, organizing clinics after physicians offer a location as a host site, according to Dr. Brown. In addition to the volunteer physicians from SEE International, local physicians also perform surgery at the clinics. Host physicians screen patients before the arrival of participating ophthalmologists and provide postoperative care, he said.

“We only go to countries at the invitation of the local eye surgeons, with approval of the health and civic authorities in that region,” Dr. Brown said. “The local doctors in the second- and third-world countries can’t operate in a vacuum. They have to have the support of the hospital administrators, the operating room supervisors, social service agencies, various government officials, to provide the local support for the clinics.”

Once a host site has been established, SEE International coordinates the necessary documentation for participating physicians, from securing visas to coordinating the delivery of donated medical supplies to host sites, Dr. Brown said.

Physicians

SEE International volunteers take part in 70 to 100 expeditions a year, performing cataract surgery and delivering other ocular treatment. Last year, volunteers performed more than 9,300 surgeries, 95% of which were the removal of dense, white cataracts. Since its inception, SEE International volunteers have performed more than 360,000 sight-restoring operations.

More than 600 physicians worldwide donate their time to the organization, Dr. Brown said, adding that the organization’s ranks include ophthalmologists from Asia, Africa, Latin America, Eastern Europe and the Pan-Pacific region.

John Arendshorst, MD, examines a patient in Siliguri, India on an expedition with SEE Inter-national.

Image: Arendshorst J

David Whiting, MD, who practices in Minnesota, is one of the volunteers. He traveled to Mexico in November for his first clinic. He and other visiting ophthalmologists performed surgery on 65 patients in 4 days. After that successful experience, he said he plans to take part in the next clinic there in May.

In a telephone interview, Dr. Whiting said he always felt a need to give back to the community. He chose to volunteer with SEE International because it allows him to continue working at his practice without having to organize the outreach clinic himself.

“It’s almost unheard of for me to be able to drop into a place like San Blas, Mexico, which is effectively off the map, and in the course of 4 days, travel there, see a couple hundred people with help of several surgeons and do surgery on 65 people,” he said. “And we do good surgery, with good equipment and have good surgical help in a safe environment in a well-stocked operating room. Then [I] get on a plane and go back home and am back to work Monday morning.”

Once at the clinics, operating conditions in developing countries can sometimes be challenging, according to John Arendshorst, MD, who has been on three expeditions with SEE International, including two to India. He said he has experienced unreliable electricity, limited hot water and other infrastructure challenges.

Supplies are also sometimes limited and may not include many of the microsurgical devices or disposable items that physicians typically use in the United States. Dr. Arendshorst said he developed a new appreciation for his microscope and other surgical equipment after his first clinic.

Not only can performing very dense lens surgery on the high volume of patients who attend the clinics prove challenging, the overall experience of participating in the clinics can also be difficult, he said.

“Everything is more extreme than you are used to experiencing. Hot is hotter. Cold is colder. Dust is dustier. Beauty is more beautiful,” Dr. Arendshorst told OSN. “Within these extremes, you’re just trying to make this whole system of microsurgery work. It’s always exhausting and fascinating.”

Patients

Those cared for at SEE International-sponsored clinics often have bilateral cataracts that are so dense and opaque that these patients have been blind for years, Deep Dudeja, MD, said in a telephone interview. He has participated in four expeditions with SEE International and has cared for patients of all ages whose lives have been debilitated by low vision.

Not only are patients’ lives affected by the cataracts but also those who care for them, including children, parents and other relatives. Many patients require someone to lead them into the clinic. Removing dense cataracts and restoring patients’ vision allows patients and caretakers to regain their freedom, he said.

Dr. Dudeja, who is originally from New Delhi, India, said returning there to help brings him great satisfaction. Being able to speak the country’s official language, Hindi, especially assists him in communicating with patients. He said they have told him repeatedly how grateful that they are for the clinics.

“Their gratitude is there toward you just for being there,” he said. “Even if you just examine them and let them know they’re not candidates for cataract surgery, you still see the same gratitude in their eyes, in their face, in their posture, just saying, ‘Thank you for at least looking at me, taking care of me, or at least telling me what’s going on.’”

Some patients will even wait outside the clinic until he leaves so that they can see who restored their vision, he said.

“It is a wonderful experience, nothing I can describe in words,” he said. “It is only a scratch in the surface that I can make. I think if I can do that, I’ll be happy with myself, at least.”

For more information:

John Arendshorst, MD, can be reached at Holland Eye Surgery and Laser Center, 999 S. Washington Ave., Holland, MI 49423; 616-396-3553; e-mail: jarendshorst@charter.net.

Harry S. Brown, MD, FACS, can be reached at 7200 Hollister Ave., Unit A, Goleta, CA 93117-2807; 805-963-3303; e-mail: hsbrown.md@cox.net.

Deep Dudeja, MD, can be reached at 731 N. Beach Blvd., Suite 120, La Habra, CA 90631; 562-694-2500; e-mail: dudejamd@yahoo.com.

David Whiting, MD, can be reached at Joffe MediCenter, 2311 Wayzata Blvd. S., Minneapolis, MN 55405; 612-377-5192; e-mail: dwhiting@joffemedicenter.com.

Erin L. Boyle is an OSN Staff Writer who covers all aspects of ophthalmology