Eliminating uncertainty from the postoperative care regiment by providing inflammation control with a depot steroid can make a significant difference for patients in complicated situations.
Special to Ophthalmology Times®
According to the World Health Organization (WHO), cataracts cause one-third of worldwide blindness, affecting about 65.2 million people, as well as moderate-to-severe vision loss in 52.6 million others, 99% of whom live in developing countries.1
With these statistics, those of us interested in “giving back” have our work cut out for us. In my case, that comes in the form of helping people with limited access to ophthalmic surgical care in less-developed areas around the world, including Kenya, Guatemala, Honduras, and the Caribbean. My most recent mission was to the island of St. Vincent, north of Trinidad and Tobago in the Caribbean.
For me, this is a familiar locale because almost every May since 2003, I have traveled there along with my family and a contingent of colleagues, including Indiana ophthalmic surgeon Eric Purdy, MD. The mission is partially supported by the Lions Club of St. Vincent and the Lions Club of Fort Wayne, IN, as well as by ophthalmic companies that donate pharmaceuticals and supplies used during the week-long mission.
Related: Personalizing cataract surgery
Over the years, we have established a reliable routine. We spend a day setting up a pop-up clinic and then another evaluating the surgical needs of the patients referred to us by the local ophthalmologists.
Generally, about 250 patients present for screening and approximately 80 to 100 surgeries are scheduled. We spend five days performing mostly cataract surgery, along with a few corneal cases.
When we first started going to St. Vincent, there was a handful of private ophthalmologists who referred patients to us, but there was no ophthalmologist dedicated to indigent patient care. This situation presented a problem because we had to lobby hard for the private ophthalmologists to provide follow-up care.
Today, there are four ophthalmologists who care for patients in need, including Orly Adams, MD, who was born and raised in St. Vincent and returned there to practice after being trained in Cuba and Mexico.
Dr. Adams and his colleagues perform the pre- and postoperative care, and we work with them on current medical trends in eye care as part of our educational support, which is a critically important element of the mission.
These ophthalmologists help to decrease the load of patients waiting for surgery throughout the year, but unfortunately because they do not have sufficient access to equipment or dedicated operating room time, the number of cases they can complete throughout the year is about the same as the amount we complete there in a week.
Postoperative care is historically challenging in surgical mission work. In areas that lack good access to cataract surgery, the cataracts we remove tend to be very dense, which increases the patient’s risk of postoperative inflammation.
Typically, when our mission is complete, we simply have to hope that the patients will follow through with our instructions to apply topical steroid drops four times a day for four weeks to address that inflammation.
Often, the only access they have to postoperative medications is what we give them, so if they run out, misplace the drops, or the bottle becomes contaminated, they may not have any way to replace them. In some cases, patients may not have the ability to properly store their drops.
Confusion can also arise because we distribute several different-looking bottles, as we are relying on whatever has been donated to us for the mission.
Therefore, the local ophthalmologists who are caring for these patients in the postoperative period may have difficulty understanding exactly what regimen each patient is on, given the variability in what medications have been donated and distributed.
SEE International. Cataracts. https://www.seeintl.org/cataracts/. Accessed January 21, 2020.
DEXYCU [package insert]. Watertown, MA: EyePoint Pharmaceuticals Inc; December 2018.