International Ophthalmology Question

[idoktor]

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I understand that a cornea fellowship is probably most useful when it comes to doing international work in ophthalmology, but does anyone know if there are opportunities for vitreoretinal trained ophthalmologists doing charity work in places like africa, india, south america, or china? can they still do cataracts in such a setting?

 

[RestoreSight]

Not sure why do you think a cornea fellowship would be most useful? Cataracts are the number 1 cause of worldwide blindness followed by glaucoma at #2 and trachoma at #3 and comprehensive ophthalmologists can adequately treat all 3. Its also important to remember that in many developing countries access to phaco machines is difficult. Often they perform small incision cataract surgery (SICS) or alternatives that are less high-tech. I have witnessed a vitreoretinal specialist from a distinguished US institution attempt SICS in Ghana without proper training and he gave a patient a vitreous hemorrhage in the process. Just because you are trained in the US doesn't mean those skills automatically transfer to all other clinical settings, irregardless of your fellowship training.

 

[idoktor]

potential transplant for bad trachoma or s/p bad infectious keratitis

 

[RestoreSight]

potential transplant for bad trachoma or s/p bad infectious keratitis

Cornea transplants are difficult in developing countries. There is poor access to eyebanks and storage and transport from the US is not an efficient process. Once the patient has the transplant they need close follow up and this is often not possible with short outreaches. It is true that cornea damage due to trachoma is a serious problem, but treatment is aimed at prevention (hygiene, good exams, antibiotics) not cornea transplants.

If you want to learn more about treatments for eye diseases in developing countries two resources come to mind. The first is the WHO Vision 2020: The Right to Sight initiative (http://www.vision2020.org/main.cfm) which outlines in a tiered structure what are considered interventions with the highest potential impact. You'll see cataract is considered "highest yield" due to the number of interventions available (except appropriate manpower). The second is an excellent textbook called "Eye Diseases in Hot Climates" by John Sanford-Smith which describes in detail the most common causes of worldwide blindness and interventions that can lead to sustainable differences. There is tremendous opportunity for ophthalmologists in the international sector, but a basic knowledge of conditions on the ground in each specific nation is needed if you want to make a real difference. Best of luck.