Staff, training needed to reduce Africa's cataract caseload

HONG KONG — While safe and affordable manual small-incision cataract surgery is helping to reduce the high number of cataract cases in Africa, more staff and more training are needed to reduce the caseload there, according to a physician.

"Just surgery alone is not enough," Geoffrey Tabin, MD, said here at the World Ophthalmology Congress. "We need to have a team approach, and we need to train [auxiliary] personnel."

Dr. Tabin, founder and co-director of the nonprofit organization the Himalayan Cataract Project, spoke about the high incidence of cataracts in Africa. The World Health Organization estimates that there are 3.5 million people in Africa who are blind from cataracts.

He said a more staff-based approach must be taken to address the full scope of treating preventable blindness in Africa and the developing world. The key will be reaching those in rural areas who need surgery and utilizing the ophthalmic staff to reach out to those who need care in remote regions, he said.

"One of the big problems is reaching the unreachable people," he said. "Right now, the majority of people who are blind die before they ever reach a doctor."

He said the establishment of primary eye care centers in rural areas in Africa with small groups of well-trained personnel could be the most effective way to reach cataract patients who might not otherwise receive surgery, Dr. Tabin said.

Even though many surgeries must be performed to reduce the rates of preventable blindness in Africa, the quality of cataract surgery is more important than quantity, Dr. Tabin said. He predicted that focusing on the quality of cataract surgery will "fuel" quantity.

Small-incision cataract surgery (SICS) is an excellent option for achieving quality surgeries in large quantities because it is fast and safe and has low complications and good visual results, he said. He called SICS "the cataract surgery of choice" in Africa.

In addition, more subspecialists are needed in Africa to address other causes of blindness and educate future physicians, Dr. Tabin said.

For instance, he said there is only one pediatric subspecialist in Tanzania, two retina specialists in Kenya and no cornea specialists in all of East Africa. An increased focus on ophthalmic subspecialties could help address the need for preventable blindness treatment, Dr. Tabin said.