Monitoring Visual Outcomes of Cataract Surgery performed by a Non-physician Cataract Surgeon, at New Sight Eye Center, Paynesville City, Liberia

Transcription

1 Monitoring Visual Outcomes of Cataract Surgery performed by a Non-physician Cataract Surgeon, at New Sight Eye Center, Paynesville City, Liberia Presentation at Unite For Sight, Global Health & Innovation Conference on April , Yale University, New Haven, Connecticut, USA By: Robert F. Dolo Founder & Executive Director New Sight Eye Center Paynesville City, Montserrado County, Liberia

2 Map of Liberia Map of Africa Montserrado County, Project Location Liberia Population: 3.8 million Growth rate: 2.1 % Magnitude of blindness: 0.5% (RAAB 2012) Cataract: 60.4% Glaucoma 16%. Source: RAAB Survey 2012, MOHSW

3 About Blindness in Liberia Patients awaiting cataract operation Incidence Blind due to Cataract. Liberia 60.4% 0.5% Source of blindness The problem of cataract blindness. The size of the reservoir represents the number of people already blind with cataract (prevalence or backlog). The water pulling into the reservoir represents the extra or new number of people going blind from cataract (incidence). The taps out of the reservoir represent: a) the people who have been successfully treated for cataract and now see. b) those people who die of age or disease while still blind. Cataract is the leading cause of blindness in Liberia accounting for 60.4%.

4 Surgeons Performing Cataract Operation in Liberia Category of Eye Surgeon Available Number Routinely performing cataract operation Number doing small incision sutureless Cataract operation Ophthalmologists Non-Physician Cataract Surgeon 5 3 1

5 Background (N.S.E.C.) N.S.E.C. Is a local nongovernmental organization (NGO). Founded 2009 and officially launched August Governance & Leadership: Board of Directors, Ophthalmologist, Cataract Surgeon, Ophthalmic Nurses, refractionist, Professional Nurses, Accountant and support staff Goal: The principal goal of New Sight Eye Center is to provide affordable, accessible, available, comprehensive and quality eye health care services for all. Our Mission is to reduce preventable blindness and visual impairment in rural and urban communities within Liberia through community based eye health services, sight restoring surgery and eye health education

6 N.S.E.C. Program Components Routine eye examination, treatment and surgery at the center in Paynesville City, Montserrado County Medical (eye screening & treatment) and surgical (perform cataract and other surgeries) outreaches in urban and rural communities School eye health screening and health education program Professional development and training of community eye health workers

7 Purpose of Monitoring Cataract Surgery Outcomes: Encourage eye surgeons to monitor their results over time. Identify causes of poor outcome and help address causes to improve future outcome. To enhance the quality of cataract surgery. Monitor cataract surgical uptake based on the output of surgeon.

8 MCSO v2.4 software Open-source software developed to facilitate monitoring of cataract surgery outcomes. The software was supported by the Christoffel Blinden Mission, Sight Savers International, West African Health Organization and the London School of Hygiene and Tropical Medicine. Exclusion criteria: Age 0-19 years, Traumatic cataracts and complicated cataracts Outcome depends on: skills and knowledge of eye surgeon surgical technique used : Small Incision Sutureless Cataract Extraction surgical facilities, environment and post-operative care optical correction provided patient-related risk factors, like ocular co-morbidity (glaucoma, age-related macula degeneration, etc.)

9 WHO guidelines on Visual Outcome of Cataract Surgery POST-OPERATIVE ACUITY Presenting BEST CORRECTION GOOD 20/20 20/60 ft >80% > 90% BORDERLINE <20/60 20/200ft <15% <5% POOR <20/200 <5% <5% Presenting = Presenting VA in the operated eye with available correction Best = Best VA in operated eye, with full refraction or pinhole

10 Data Collection Surgeon: Non Physician Cataract Surgeon Location: New Sight Eye Center, Liberia. Number of eye operation performed: 937 ( ) Number of cataract surgery performed : 695 ( age years) Total data entered into MCSO v2.4 : 377 persons with uncomplicated Cataract

11 New Sight Eye Center Eye Operations 2012 and TOTAL OPERATIONS CATARACT OPERATIONS

12 Age range and gender of operated patients Male Female Respondents Age Range

13 Number of Operation for first and second eye First Eye 49 Second eye

14 ADMISSION AND FOLLOW UP Admission 1-3 weeks follow up 4-11 weeks follow up 12+weeks follow up

15 Total Proportion of known ocular pathology in operated eye Pathology in operated eye Number % of all operations Retinal disease Glaucoma Other pathology Corneal Scar Old Iritis 3 0.8

16 <20/200 ft Poor 85.9 % Visual acuity in the operated eye pre-op and follow up Visual Acuity Pre-op % Admission N=377 WHO norms on post -op Visual Outcomes Presenting % Best % Week 1 to 2years N=279 Presenting % Best % 20/20-20/60 ft Good 1.9 % >80 > <20/60-20/200ft Borderline 12.2 % <15 <

17 Observations and comments 1. The standard posterior chamber lens power were inserted ( 19D-22D) without doing the A/B scan biometry Retrobulbar anaesthesia injection was administered Duration of surgical procedure per eye is 15 minutes 10 0 Discharge 1-3 weeks follow up 4-11 weeks follow up 12+ weeks follow up 5. No accommodation or inpatients admission for operated patients ( all patients are treated as OPD) Good outcome Borderline outcome

18 Best corrected vision after 2years Visual Acuity SICS+ PC IOL Good 93.5 % INTRAOCULAR LENS INSERTED IN OPERATED EYE Borderline 6.5 % Poor 0 % 0 PC IOL Inserted AC IOL Inserted No IOL Inserted

19 Discussion 1. Task shifting: The shortages and misdistributions of ophthalmologists in developing countries are huge. Shift tasks from highly specialized--expensive-- health workers to less specialized-- more readily available and less expensive-- workers. Please visit the link below Non physician Cataract Surgeon (NPCS) help increases access to high quality cataract surgery. The cataract surgical rate ( CSR) at NSEC increase in 2013 to 432 from 263 in Cataract surgeons, like ophthalmologists or any other professionals, can only perform to their capacity if given adequate support within a well-functioning program % of patients came at New Sight Eye Center with poor vision and 93.5% of patients had good outcomes following cataract surgery at NSEC

20 Activities / impacts Visual Acuity at Outreach Health Education at outreach Training conducted by an American Ophthalmologist to a NPCS and Liberian Ophthalmologist

21 Outreach Team in Grand Cape Mount County

22 Standing in the Middle is Mr. Sampson Norma, 41 years old blessed with 3 children.

23 Departure for Outreach Health Education at outreach

24 Registration at Outreach Visual testing at Outreach Eye Examination and Diagnosis Dispense Medication & glasses

25 Before Cataract Operation Thanks After Cataract operation Website: newsighteyecenter.org Contact #: