WORLDEYES Controlling Mass Blindness in Asia

In an era of rapid economic development and technological breakthroughs, basic health care is easily forgotten. The advances in technology and the benefits of modern ophthalmology are yet to reach a large proportion of the estimated 180 million people worldwide who are visually disabled depriving them of the right to normal vision.

The result is that for nearly 40 to 45 million of these less fortunate people, there is no difference between a radio and a television. More than half of the world's blind people live in Asia, where operating microscopes, lasers, intra-ocular implants and vitrectomy still reach less than 5% of the population.

During the past 50 years the entire pattern of blindness has changed. The causes of mass blindness have shifted from infection and malnutrition to cataract, glaucoma, and retinal diseases. While most international organisations share the same dedication towards helping people with eye disease, they often have their own objectives and special interests, and there may sometimes be disagreement about the best approach.

A group of ophthalmologists based in Singapore has recognised the importance of the role of ophthalmologists in preventing blindness due to cataract. It has become clear that blindness from infection and malnutrition is under control, while blindness from other eye diseases is on the increase, and requires the care of qualified ophthalmologists.

Against this scenario the World Cataract Eye Surgeons Society (WORLDCATS) was formed. WORLDCATS, mooted at the Singapore National Eye Centre's first international meeting in 1993, was registered on 3 June 1994.

WORLDCATS was proposed as an international movement of ophthalmologists dedicated to the control of mass cataract blindness in developing countries, particularly in Asia. The society was founded by Professor Arthur SM Lim, who has worked towards the elimination of the most common cause of curable blindness cataract blindness. In 1998, WORLDCATS changed its name to WORLDEYES, and the organisation now works with other causes of blindness as well as cataract.

An Interview with . . .

Professor Arthur SM Lim
Founder President of WORLDEYES
Singapore National Eye Centre
Singapore

Q: WORLDEYES has grown into an international movement in the prevention of blindness. How did it all start?

Prof. Lim: The term 'prevention of blindness' should be changed to 'ophthalmic care and reconstruction of the eye' because the whole pattern of blindness has changed. 50 years ago, eye diseases caused by infection (onchocerciasis, trachoma and corneal ulcers) and malnutrition (keratomalacia) or optic atrophy were the primary causes of blindness. Today cataract, glaucoma, and retinal disease, particularly diabetic retinopathy, are the major causes of blindness.

All of these diseases require treatment from ophthalmologists. Yet most of the international organisations involved in this field are manned by public health workers, nutritionists and infectious disease specialists, while the ophthalmologists are less involved. In my opinion, the blindness rate will continue to increase, possibly doubling every 10 years, and without the involvement of ophthalmologists, outdated cataract operations and glaucoma treatments will continue.¹

Unfortunately, there is some friction between the ophthalmologists in Asia and non-governmental organisations (NGOs), as the ophthalmologists are concerned about outdated treatments, while the NGOs find it difficult to modernise treatments without the collaboration of the ophthalmologists. It was for this reason that an international organisation of ophthalmologists was formed in 1993.

WORLDCATS was proposed as an international movement of eye surgeons dedicated to the control of mass cataract blindness in developing countries. The ophthalmologists contributed their time to help the less privileged by working to prevent blindness and restore sight.

Q: Why did WORLDCATS change its name to WORLDEYES?

Prof. Lim: WORLDCATS started as an international movement of eye surgeons dedicated to the control of mass cataract blindness. However, along with the objective of controlling cataract blindness, WORLDCATS recognised the need to control other causes of blindness such as glaucoma and diabetic retinopathy, as well as treating other conditions such as severe trauma to the eye and corneal disease requiring transplantation. Our activities have stimulated the interest of ophthalmologists around the world. Today, WORLDEYES has more than 1000 supporters in 94 countries and the number is constantly increasing.

Q: What are the main objectives of WORLDEYES?

Prof. Lim: A major problem in the control of mass cataract blindness in Asia is the lack of eye surgeons in some countries there are simply not enough. When we started WORLDCATS, we were convinced that our approach needed to be different from that of most organisations, i.e. going to a place and performing eye surgery. We decided that the best approach is to teach modern eye surgery to local ophthalmologists.

Teaching good quality eye surgery to colleagues in less developed countries will ultimately restore vision to more blind people than simply going to a country to perform surgery. The basis of our approach is based on this well known saying - "If you operate on one man, you restore vision to one man, but if you teach your colleagues how to perform low cost cataract surgery, they will solve the problem of cataract blindness in the world."

In line with this approach, the objectives of WORLDEYES are as follows:

• To perform one million cataract surgeries with implants during the next 10 years by the united efforts of 2000 volunteer eye surgeons.
• To promote training and skills transfer in surgical expertise in developing countries.
• To promote quality assurance in eye surgery worldwide.

Q: Are the supporters of WORLDEYES all ophthalmologists?

Prof. Lim: Almost all of our supporters are ophthalmologists, although there are a few who are not eye surgeons but are interested in the work that we are doing. WORLDEYES has tremendous potential as the society provides an opportunity for eye surgeons to contribute towards the control of mass blindness by volunteering their time and skills.

Q: Which countries are the focus for WORLDEYES?

Prof. Lim: Currently, our focus is in Asia, and China in particular. We need to consolidate our efforts in Asia to begin with. As we grow and increase our international membership, we will look to other areas where blindness is a continuing problem.

Q: How do you approach achieving your objectives?

Prof. Lim: The goal is to complete 500 cataract operations in 5 years for each volunteer ophthalmologist and their team. In the process, local eye surgeons will also be trained. Training of eye surgeons entails upgrading their standards and skills, demonstrating that results can be obtained without the need of expensive equipment. The concept when going to an area is to demonstrate a technique. The equipment used for surgery should be affordable, therefore, it is important that equipment that is already available in the country is used. The purpose of the committee is to ensure that the relevant approaches to disease management are taught.

We have built 5 centres in China for training eye surgeons and are looking at building centres in other countries. These centres have received strong support from the local governments.

The International Intraocular Implant Training Centre in Tianjin has performed more than 50,000 implant surgeries, while another 70,000 implants have been performed by the 16 hospitals affiliated to it. The centre has trained more than 2000 eye surgeons throughout China.

The Xiamen Eye Centre, completed at a cost of S$57 million, was officially opened in November 1997. The centre is intended to be the premier eye centre in China. The world cataract Intraocular Lens Implant Training Centre situated in Jinan has performed almost 10,000 implant surgeries since its inception in 1996.

Q: What happens to the local eye surgeons once they are trained?

Prof. Lim: The objectives for the centres are to train Chinese ophthalmologists in implant surgery with an emphasis on high-quality and low-cost techniques, and to work with and supervise ophthalmologists in the regional hospitals who are responsible for treating the thousands of patients with visual impairment. The trainees at these centres come from all over China and perform extended implant surgery in their own localities. Some have set up training facilities in their areas to extend the skills they have acquired to their colleagues. It is hoped that the world will adopt the Tianjin centre as the model to solve the problem of mass cataract blindness.

Q: What are your plans for helping other countries in Asia?

Prof. Lim: Countries or organisations requiring assistance from WORLDEYES are invited to communicate their needs to the WORLDEYES Secretariat. WORLDEYES plans to expand its activities to other countries in the future. For example, India has a huge population and a massive problem with blindness.

Q: How do you fund the projects?

Prof. Lim: Ophthalmologists contribute their time and skills for free. WORLDEYES also appeals for the participation of nurses, administrators, and paramedical staff. Manufacturers of microscopes, intraocular lens implants and instrument corporations as well as service clubs are also welcome to help the project. The funds for organisation, equipment, and infrastructure come from international foundations and voluntary organisations, and corporate and individual donors committed to the cause of alleviating mass blindness.

Q: How do you see the future for WORLDEYES?

Prof. Lim: A major problem in the control of mass blindness is the lack of eye surgeons. Blindness is a massive global problem that can only be solved through the combined efforts of NGOs and eye surgeons. Various international organisations have tackled the non-surgical causes of blindness related to improving primary health care and using intracapsular extraction without implants.

WORLDEYES intends to complement the work of these organisations. WORLDEYES has a large pool of eye surgeons who are committed and dedicated to the cause of combating mass blindness. The services of this large pool of eye surgeons can be tapped for the benefit of those less privileged. Being an Asian initiative has given an additional stimulus and impetus for Asian ophthalmologists to respond.

WORLDEYES is not just another international organisation. It is about a willingness to help the less fortunate, providing an opportunity for eye surgeons to utilise their skills and contribute their time for the benefit of those less fortunate than they are.

The misery of millions of people with cataract blindness continues to increase in the poorest areas of the world at a time when medical advances make low-cost restoration of normal vision possible. United, we can hope that the millions of victims with vision impaired by eye disease will be able to look into the 21st century and see.

Reference

1. Lim ASM (Ed). The human right to normal vision? Singapore; World Scientific Publishing Co. Pte Ltd., 1997.