- Associated Press - Sunday, April 30, 2017

PARKERSBURG, W.Va. (AP) - Cataracts are the leading cause of curable blindness in the world.

Many countries do not have the finances or health systems in place to treat the poor who have cataracts, said Dr. David George, a local ophthalmologist.

In January, George with two friends, Dr. John Pajka of Lima, Ohio, and Dr. Robert Derick of Columbus, went on a mission trip to Nicaragua, one of the poorest countries in this hemisphere. They were joined by a support staff from Physicians Outpatient Surgery Center in Belpre.

The team performed 193 surgeries at no charge for poor and blind patients in Nicaragua.

George has been doing mission work in Nicaragua since 2001 and this was his 12th trip. His first mission trip was to Brazil in 1999.

The next mission trip was to Jamaica in February. Dr. Scott Strickler, another local ophthalmologist, joined Pajka and Derick to perform 170 surgeries.

“The cases were challenging, but when we take the patches off the next day it is so rewarding seeing their vision restored,” Strickler said.

The third mission was in March to Bolivia. George also participated in the mission.

The United States has an ophthalmologist, an eye doctor, for every 1,711 people, George said. The city of Tarija, Bolivia, has a population of 230,000 and has not one eye surgeon, said George.

While blindness due to cataracts is unheard of in developed countries, it is prevalent in Tarija, he said.

George, along with two Ohio State University alumni friends, Dr. Charlotte Agnone and Pajka, and a team of nine support staff, made the 31-hour journey from Ohio before the work even started in Bolivia.

“On arrival, we began work immediately setting up our equipment and examining patients wanting cataract surgery,” George said. “The team worked late into the night getting patients selected for surgery.”

Mission trips are challenging and rarely go as planned, George said.

Transferring 21 suitcases containing the equipment and supplies for 152 cataract surgeries on through five flights was difficult. Clearing them through customs was a concern with the fear critical supplies would be confiscated, he said.

As the surgeons scrubbed for the first case, it was discovered only one of the two autoclaves brought on the mission was functional. Subsequently, a power transformer caught fire.

Later, a ground loop in the microscope was discovered as the culprit for an electrical shock a surgeon sustained when a foot touched the damp operating room floor, George said.

Some of the challenges were more humorous.

On the first day of surgery, George and Agnone were picked up at their hotel by a local volunteer, Luis.

A few hundred yards into the eight-mile drive to the hospital, his car broke down. After numerous failed attempts to restart the car, Luis flagged down the next car on the road convincing a total stranger to take the doctors to the hospital, George said.

“After traveling less than a mile, Luis drove up behind with horn blasting and emergency lights flashing. His car now working, the doctors got back in the car with him, only to be sitting alongside the road less than a mile later when his car broke down again,” George said. “After a ride with yet another stranger in a car far less road worthy than Luis’, the doctors arrived at the hospital significantly later than the rest of the team.”

Each day when the doctors arrived, patients and family members were lined up out the door, extending into the courtyard and down the street, George said. Many had traveled days on rumor there were doctors who could cure their blindness.

The first surgical day was the longest. Fifty cataract surgeries were performed working from 8 a.m. until after midnight. These surgeries in Tarija were extremely difficult and often high risk, George said.

Some of the hardest cases were the Chapaca’s, indigenous people from the countryside and often speaking only local dialect of a non-Latin derivation, making communication impossible.

Pajka, George and Agnone have done mission work in Nicaragua, Jamaica, Brazil and Haiti and believe the cataracts in Bolivia are the most difficult for two reasons. The cataracts are dense due to the advanced stage, making the lens difficult to break and remove, and there is an unexpected high prevalence of pseudoexfoliation in Bolivia, a disease that weakens the support structure of the lens and cataract, making the cataract more challenging.

Pseudoexfoliation is believed to be genetic in origin, taught in medical school and ophthalmology residency to be most commonly found in patients of Scandinavian decent, George said.

It has never been reported to be of high prevalence in South America, but with the experience of two mission trips to Tarija, they found an extremely high prevalence and advanced degree of pseudoexfoliation in hundreds of encountered patients.

When the lens support structure is weak, there is a risk the cataractous lens will fall into the back of the eye. In the U.S., this infrequently occurs and when it does, a retinal surgeon performs a second procedure, George said.

If the lens is not removed from the back of the eye, vision loss can occur for several reasons. When a weak support system is encountered in Bolivia, the cataract must be removed through a large incision, procedure called an extracapsular cataract extraction, so the lens does not fall backward, particularly since there are no retinal surgeons in the country, George said.

The procedure becomes difficult and takes much longer than small incision surgery and requires a far longer recovery period and less optimal unaided visual outcome, no small inconvenience for a people who cannot take time off or afford glasses, he said.

Subsequent days in Bolivia started with the doctors seeing all of the post-op patients from the prior day of surgery. Instructions were given to the entire group. Sitting side by side on plastic chairs, each one was examined with portable equipment, given post-op drops and a follow-up appointment with the local non-surgical eye doctor.

After three days of surgery, 152 surgeries were completed in two operating rooms.

For George, the best part of this trip was taking his daughter Monica and watching her be part in this wonderful experience helping others, he said.

George and Strickler have a dream of helping develop ophthalmology care in countries like Bolivia and Nicaragua.

A common theme continues to limit progress in these countries. Although their respective governments speak of care for everyone, they do not give the eye hospitals funding to do cataract surgery, George said.

In the past, at Centro Nacional de Oftalmologica, the only ophthalmology hospital in Nicaragua for the poor, doctors said they helped institute a system where patients were charged a nominal fee based on what they could afford to pay.

These fees helped cover the cost of cataract surgery for patients who could pay nothing. At one point, local ophthalmologists were performing over 900 cataract surgeries a year with this system, George said.

Subsequently, a president was elected who stopped this program, stating care should be free for all. Now, there is no money to sustain the program and the indigent receive minimal cataract surgery, George said.

Cataracts remain the leading cause of blindness in the world, accounting for 51 percent of all blindness and affecting 20 million people, George said.

“Treatment for this reversible blindness continues to be largely unmet in many countries. The economic impact is significant as blind people cannot work and usually rely on others, most often family, for their care; these family members cannot work as they are caretakers for their blind relative,” George said.

George, Strickler, Pajka, Agnone and Derick said they continue to advocate for self-sustaining programs in these countries with the hope that teams of local eye surgeons can be taught the skills necessary to care for the people of their country.

George said Noemi Caiazzo, a Christian missionary in Managua, Nicaragua, helps local doctors organize the trips. She also works with the North Parkersburg Baptist Church on several initiatives, he said.


Information from: News and Sentinel (Parkersburg, W.Va.), https://www.newsandsentinel.com

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