- Email: [email protected]
The Mobile Eye Hospital: Reply
VOL. 87, NO. 5
725
CORRESPONDENCE
The Mobile Eye Hospital Editor: In his editorial, "New initiatives in the war on blindness" (Am. J. Ophthalmol. 87:103, 1979), Alfred Sommer, celebrated the hopeful new step of the World Health Organization and the International Agen cy for the Prevention of Blindness toward a global attack on a shameful scourge in human existence, the continuing plight of those with curable or preventable blind ness. The new initiatives confirm a strate gy which uses the Mobile Eye Hospital developed in rural India over 30 years ago. The strategy is to combat blindness not only through education in preventive measures but also through treatment and cure. The Mobile Eye Hospital was devised in direct response to existing realities. Most villages of developing countries still lack primary health care facilities and personnel. Even in developing countries with good facilities, many potential pa tients either are unaware of their availa bility or are unwilling to travel to one. The Mobile Eye Hospital brings modern eye service of the highest standards to such rural populations. The program and services are fully described in our mono graph, "The Curable Blind: A Guide for Establishing and Maintaining Mobile Eye Hospitals" (Rambo and Ghatterjee; Philadelphia; Rambo Committee for Cur able Blind, Inc., 1974). After an advance public relations effort, a highly experi enced and adequately equipped cadre of eye specialists and support personnel es tablish the Mobile Eye Hospital site at a locally provided school or temple. The work of the Mobile Eye Hospital team includes: screening and case finding, treatment (cataract extraction, general and plastic ophthalmic surgery, refraction, and optical service), consumer education (for example, nutrition and hygiene in
struction for blindness prevention), pro vider education, and survey: remember ing that all other aims are secondary to the aim of restoring sight to the curably blind. The Mobile Eye Hospital not only serves large groups of people economical ly with rapid delivery of ophthalmic ser vices, but its success rates match or ex ceed those of modern Western hospitals. The hope for sight offered to the cur able blind by the Mobile Eye Hospital galvanizes local community interest and support that would otherwise not be forthcoming. Restoring sight to the cur able blind appears to me not only the most humane but also the most effective strategy in establishing programs for nu trition and hygiene training to prevent blindness due to malnutrition and infec tion. Bravo for the World Health Organiza tion and the International Agency for the Prevention of Blindness in their new ini tiatives in the global war on blindness! V I C T O R C. R A M B O ,
Philadelphia,
M.D.
Pennsylvania
Reply Editor: Removing the vast numbers of blinding cataracts afflicting inhabitants of develop ing countries is certainly an urgent priori ty of the war on blindness. The Mobile Eye Hospital scheme, pioneered by Dr. Rambo, has restored sight to countless villagers throughout India, Pakistan, and Bangladesh, and these efforts are rapidly being expanded. In the past, all operations were carried out by fully trained ophthalmologists. Unfortunately, in many areas of the world there is a critical shortage of eye surgeons. Some African countries do not have even one eye surgeon. New initiatives are re quired to alleviate the problem: heavy use
726
AMERICAN JOURNAL OF OPHTHALMOLOGY
of highly trained auxiliaries permits Dr. Christy and his colleague in Taxila, Paki stan, to perform over 10,000 cataract oper ations per year in their stationary village hospital. (Dr. Christy alone sometimes performs over 200 cataract operations a day.) Dr. Randy Whitfield and his col leagues are training highly selected "technicians" to remove cataracts in Kenya; and a program is underway to train general medical doctors in Bangla desh to staff rural cataract camps. In every instance it is clearly understood that the operations will be supervised, if not actu ally performed, by ophthalmic surgeons. Whereas some might shudder at the thought of cataract surgery being per formed by anyone less qualified that a fully trained ophthalmologist, something must be done to alleviate this enormous problem. Because of lack of sophisticated instruments, sutures and antibiotics, the primitive facilities in which the opera tions must be performed, and deficiencies in personal hygiene and presence of concommitant ocular diseases in these pa tients, the results will surely not match those of modern ophthalmic institutions. But with adequate training, supervision, and attention to details, cataract camps already achieve a success rate of 90 to 95%. If 90% of the millions presently blinded by cataracts can be rehabilitated the results will have been worth the price. A L F R E D SOMMER,
M.D.
Bandung,Indonesia
Preoperative and Postoperative Visual Acuity Editor: When T H E J O U R N A L publishes articles describing the results of the various methods of cataract extraction, the au thors usually furnish the postoperative
MAY, 1979
visual acuity, but seldom give the preop erative visual acuity. This omission limits the usefulness of the information. I be lieve it would be scientifically more valid to know what change occurred in the visual acuity after the operation. I suggest that you institute an editorial policy in which authors submit both pre- and post operative visual acuity. IRVIN S. T A Y L O R ,
M.D.
Scarsdale, New York
Risk: Benefit Ratio for Implant Surgery Editor: In the article, "Medicolegal hazards of intraocular lens implanting" (Am. J. Ophthalmol. 86:496, 1978), Jerome W. Bettman has succinctly pointed out the medi colegal hazards of intraocular lens im planting. With his vast knowledge in the medicolegal field, Dr. Bettman has writ ten a timely article, one which outlines vital guidelines for every implant sur geon. In the discussion of the risks :benefit ratio, he points out an area that presents a potential hazard to implant surgeons. To illustrate the principle, Dr. Bettman quotes from material published under my name in the American Intraocular Im plant Society Journal 3:119,1977, in which 30 patients of the reported 103 were operated on with 6/18 (20/60) re corded visual acuity or better. Particular ly well taken is the admonition "the anlage for litigation is present and, if the surgical result is not good, beware." However several factors regarding the original publication were not known to its readers. Because of misunderstanding, the material in the American Intraocular Implant Society Journal was printed without my knowledge or my approval. The statistics submitted at the request of
725
CORRESPONDENCE
The Mobile Eye Hospital Editor: In his editorial, "New initiatives in the war on blindness" (Am. J. Ophthalmol. 87:103, 1979), Alfred Sommer, celebrated the hopeful new step of the World Health Organization and the International Agen cy for the Prevention of Blindness toward a global attack on a shameful scourge in human existence, the continuing plight of those with curable or preventable blind ness. The new initiatives confirm a strate gy which uses the Mobile Eye Hospital developed in rural India over 30 years ago. The strategy is to combat blindness not only through education in preventive measures but also through treatment and cure. The Mobile Eye Hospital was devised in direct response to existing realities. Most villages of developing countries still lack primary health care facilities and personnel. Even in developing countries with good facilities, many potential pa tients either are unaware of their availa bility or are unwilling to travel to one. The Mobile Eye Hospital brings modern eye service of the highest standards to such rural populations. The program and services are fully described in our mono graph, "The Curable Blind: A Guide for Establishing and Maintaining Mobile Eye Hospitals" (Rambo and Ghatterjee; Philadelphia; Rambo Committee for Cur able Blind, Inc., 1974). After an advance public relations effort, a highly experi enced and adequately equipped cadre of eye specialists and support personnel es tablish the Mobile Eye Hospital site at a locally provided school or temple. The work of the Mobile Eye Hospital team includes: screening and case finding, treatment (cataract extraction, general and plastic ophthalmic surgery, refraction, and optical service), consumer education (for example, nutrition and hygiene in
struction for blindness prevention), pro vider education, and survey: remember ing that all other aims are secondary to the aim of restoring sight to the curably blind. The Mobile Eye Hospital not only serves large groups of people economical ly with rapid delivery of ophthalmic ser vices, but its success rates match or ex ceed those of modern Western hospitals. The hope for sight offered to the cur able blind by the Mobile Eye Hospital galvanizes local community interest and support that would otherwise not be forthcoming. Restoring sight to the cur able blind appears to me not only the most humane but also the most effective strategy in establishing programs for nu trition and hygiene training to prevent blindness due to malnutrition and infec tion. Bravo for the World Health Organiza tion and the International Agency for the Prevention of Blindness in their new ini tiatives in the global war on blindness! V I C T O R C. R A M B O ,
Philadelphia,
M.D.
Pennsylvania
Reply Editor: Removing the vast numbers of blinding cataracts afflicting inhabitants of develop ing countries is certainly an urgent priori ty of the war on blindness. The Mobile Eye Hospital scheme, pioneered by Dr. Rambo, has restored sight to countless villagers throughout India, Pakistan, and Bangladesh, and these efforts are rapidly being expanded. In the past, all operations were carried out by fully trained ophthalmologists. Unfortunately, in many areas of the world there is a critical shortage of eye surgeons. Some African countries do not have even one eye surgeon. New initiatives are re quired to alleviate the problem: heavy use
726
AMERICAN JOURNAL OF OPHTHALMOLOGY
of highly trained auxiliaries permits Dr. Christy and his colleague in Taxila, Paki stan, to perform over 10,000 cataract oper ations per year in their stationary village hospital. (Dr. Christy alone sometimes performs over 200 cataract operations a day.) Dr. Randy Whitfield and his col leagues are training highly selected "technicians" to remove cataracts in Kenya; and a program is underway to train general medical doctors in Bangla desh to staff rural cataract camps. In every instance it is clearly understood that the operations will be supervised, if not actu ally performed, by ophthalmic surgeons. Whereas some might shudder at the thought of cataract surgery being per formed by anyone less qualified that a fully trained ophthalmologist, something must be done to alleviate this enormous problem. Because of lack of sophisticated instruments, sutures and antibiotics, the primitive facilities in which the opera tions must be performed, and deficiencies in personal hygiene and presence of concommitant ocular diseases in these pa tients, the results will surely not match those of modern ophthalmic institutions. But with adequate training, supervision, and attention to details, cataract camps already achieve a success rate of 90 to 95%. If 90% of the millions presently blinded by cataracts can be rehabilitated the results will have been worth the price. A L F R E D SOMMER,
M.D.
Bandung,Indonesia
Preoperative and Postoperative Visual Acuity Editor: When T H E J O U R N A L publishes articles describing the results of the various methods of cataract extraction, the au thors usually furnish the postoperative
MAY, 1979
visual acuity, but seldom give the preop erative visual acuity. This omission limits the usefulness of the information. I be lieve it would be scientifically more valid to know what change occurred in the visual acuity after the operation. I suggest that you institute an editorial policy in which authors submit both pre- and post operative visual acuity. IRVIN S. T A Y L O R ,
M.D.
Scarsdale, New York
Risk: Benefit Ratio for Implant Surgery Editor: In the article, "Medicolegal hazards of intraocular lens implanting" (Am. J. Ophthalmol. 86:496, 1978), Jerome W. Bettman has succinctly pointed out the medi colegal hazards of intraocular lens im planting. With his vast knowledge in the medicolegal field, Dr. Bettman has writ ten a timely article, one which outlines vital guidelines for every implant sur geon. In the discussion of the risks :benefit ratio, he points out an area that presents a potential hazard to implant surgeons. To illustrate the principle, Dr. Bettman quotes from material published under my name in the American Intraocular Im plant Society Journal 3:119,1977, in which 30 patients of the reported 103 were operated on with 6/18 (20/60) re corded visual acuity or better. Particular ly well taken is the admonition "the anlage for litigation is present and, if the surgical result is not good, beware." However several factors regarding the original publication were not known to its readers. Because of misunderstanding, the material in the American Intraocular Implant Society Journal was printed without my knowledge or my approval. The statistics submitted at the request of