MOST of us take the gift of eyesight for granted and have no idea what it’s like for those who cannot see.
There are actually many people who see the world through blurred images and the degree of vision obscurity varies from person to person.
The sad fact is some people with poor eyesight are suffering needlessly, especially when they can get some form of help. For them, the greatest obstacles are the physical distance from available medical attention and, more crucially, the inability to pay for treatment.
This is particularly true of people living in remote and isolated areas accessible only by boats plying upriver from the river mouth and through small tributaries to reach their far-flung destinations.
A case in point is Betong Division and its surrounding areas.
Betong Division is divided into three broad topographical regions – coastal or riverine, midland, and inland or hilly interior.
The coastal or riverine region is made up mainly of peat swamp with very limited arable land for agriculture or any form farming.
There has been a prevalence of blindness among people, aged 40 and above, who suffer from bad vision, caused mainly by cataracts or pterygium. If one has more than one of these eye growths, the plural form of the word is pterygia.
A number of them are suspected to have glaucoma or simply refractive errors. In many such cases, all that’s needed are prescription lenses to significantly restore vision.
A patient undergoes a post-op check.
Primary concern
According to Andrew Chioh from Lions Club of Kuching Metro (LCKM), the primary concern has been the extent of ophthalmological coverage required for efficient implementation and evaluation of ocular health programmes.
To address the problem, Ministry of Health Cataract Clinic (4K M) was formed. It is an outreach eye healthcare programme for cataract service, provided by Ophthalmology and Optometry Services under the Health Ministry.
4K M and LCKM have been collaborating with Deputy Chief Minister Datuk Amar Douglas Uggah Embas on the project for 11 times since the programme’s inception on Sept 12, 2013.
Chioh said the first trial run was held at Betong Hospital on Aug 23-25, 2013, where 31 patients were given premium brand and quality Intraocular Lenses (IOLs) sponsored by Uggah.
The fifth year of the project – the 11th Betong Cataract Camp – was held from Feb 22-24 this year. This collaboration recognises that multiple efforts and approaches were needed to address eye health problems in Betong Division.
One week before their scheduled cataract operations, patients, attending preliminary eye screenings, were evaluated for vision (refractive error) and eye problems.
Those requiring surgery primarily for cataracts and pterygium were advised to go through with it.
Chioh said 158 people were screened for eye diseases at Betong Hospital in just three and a half days – from Feb 12-15. Thirty-nine patients were recommended for cataract surgery.
Scheduled surgery patients had to go through a painless ultrasound test (A-scan biometry), performed by doctors or optometrist to measure the size and shape of the eye.
This helps to determine eye length for calculating intraocular lens power and the total refractive power of the emmetropic eye to get the right type of IOL for implantation.
Another 10 patients were recommended for pterygium surgery from a total of 25 identified. Two of the cataract patients were self-paying.
Dr Chua (front second left) and his volunteers during an eye operation.
Of the total of 38 poor patients, 37 needed IOLs while one had an operation on both eyes. The premium brand and quality IOLs were all sponsored by Uggah.
In all, 36 cataract and 10 pterygium patients underwent operation to restore their vision. One cataract patient who needed more complex surgery was referred to the Sarawak General Hospital (SGH).
Cost-effective system
Chioh said 4K M helped the remote communities by strengthening the existing channels of eye healthcare provision and working to devise and maintain a cost-effective health system.
Eye healthcare has also been included in the strategic planning framework to acknowledge the significant economic and social impact of blindness on people.
According to Chioh, cataract is a common eye condition where the lens becomes clouded.
This disease can be a natural part of aging, affecting everyone at some point in life. The surgery to treat the condition entails only the removal of the diseased lens and replacement with a mono-focal artificial lens.
While post-surgery patients are found to still rely on reading glasses, new technology, focusing on replacement lenses, promises to eliminate this need altogether.
Patients wait their turn for screening.
Cataract surgery is one of the most cost-effective interventions available, delivering high quality treatments with consistently high success rates.
Cataracts remain the single biggest cause of avoidable blindness and the Cataract Camp avails eye health services even to people living in the most remote areas.
Such efforts should be sustained to help prevent the population at large from losing their sight unnecessarily.
Chioh said a pterygium is caused primarily by ultraviolet rays (UV rays). It’s a sun-related eye disease where a wing/wedge-shaped bump on the eyeball starts to appear on the white of the eye (sclera) and can invade the cornea.
“Though it’s commonly called surfer’s eye, one doesn’t have to be a surfer or even see the ocean to get pterygium.
“Being under bright sunlight for long hours, especially when one is outdoor or in the water which reflects the sun’s harmful UV rays, increases the risk.”
Chioh (front left), his volunteers, and a group of patients.
Benign growth
Pterygium is benign (non-cancerous) unwanted growth of tissue on the front of the eye which can permanently disfigure the eye. The cornea is the clear front covering of the eye commonly on the nasal side.
A growth of the conjunctiva over the cornea is a progressive disease, leading in advanced stages to visual impairment, restriction of ocular motility, chronic inflammation and cosmetic concerns.
A pterygium usually doesn’t cause problems or require treatment but can be removed if it interferes with vision. It can also cause discomfort and blurred vision.
For pterygium, surgery is required and the most common procedure of attaching conjunctival autografts to the sclera is through suturing (stitching) or fibrin glue.
Pterygium excision can be performed in a minor operating room. To prevent regrowth after a pterygium is surgically removed, ophthalmologists may suture (stitch) or glue a piece of surface eye tissue onto the affected area.
This method, called autologous conjunctival autografting, has been shown to safely and effectively reduce the risk of pterygium recurrence.
It’s important to note pterygium removal can induce astigmatism, especially in patients who already have the condition.
Surgery for pterygium removal usually lasts no longer than 30 minutes after which patients will likely need to wear an eye-patch for protection for a day or two and should be able to return to work or take part in normal activities the following day.
The 4K M bus.
Free eye screenings
Over the past five years, 4K M has been scheduling weekly free eye screenings on a biannual basis before Cataract Camps were held at hospitals in Lundu, Bau, Serian, Sri Aman, Betong, Saratok and Simunjan.
Chioh said 4K M’s aim had always been to improve and restore vision as well as identify other eye diseases.
He revealed 4K M is now trying to reach out to the remote population of Betong Division and the aforementioned areas.
The programme, he added, would be held biannually in which scheduled eye screenings would be followed by operations a week later.
However, he admitted the remoteness of these locations and the unavailability of eye specialists posed a big challenge to organising Cataract Camps.
Based on an article titled ‘Estimates of visual impairment and its causes from the National Eye Survey in Malaysia (NESII)’ published on June 26, 2018, an overall 86.3 per cent of the causes of blindness were avoidable.
Cataract surgical coverage (CSC) in persons for blindness, severe visual impairment and moderate visual impairment was 90, 86 and 66 per cent respectively.
The article concluded there was a need to increase patients’ education and further expand ophthalmological services to reduce avoidable blindness even more in Malaysia.
Chioh pointed out that according to a World Health Organisation (WHO) publication, dated Oct 11, 2018, on its website, about 80 per cent of vision impairment globally is considered avoidable.
“There are effective interventions available to prevent and treat eye diseases. For example, refractive errors can be corrected with glasses while cataract surgery can restore vision.
“Vision rehabilitation is also effective in improving functioning for people with an irreversible vision impairment.”
According to him, prevention of blindness as well as cataract awareness require the assistance from all forms of media, including radio, print and social platforms. Such efforts are made in hopes to raise more awareness of eye diseases.
Leading cause
Cataracts have been the leading cause of bilateral blindness (both eyes). Blindness can be total or near total. It may be congenital or acquired and can interfere with one’s daily routines.
There are a variety of causes that can lead to blindness. The prevalence of blindness and low vision in this region depends on socioeconomic status, availability of medical and healthcare facilities and literacy of the population.
Chioh believed visual impairment had drastically impacted many lives as those affected had to depend heavily on others to carry out their daily routines.
This, unfortunately, would place a burden on someone – be it a family member, a relative, or a friend, he noted.
Chioh also said eye healthcare in Betong Division was only available during visits by ophthalmologists or optometrists.
“Generally, eye screening can first be rendered by medical officers or medical assistants who will then refer cases for further procedure, if required.”
He lamented that 4K M surgical instruments were over five years old and there was concern that they needed to be replaced and/or upgraded.
He said LCKM was grateful to the Cataract Camp volunteers, donors, and supporters who had been helping with this life-changing work.
He added that the volunteers had put their heart into everything they had done at preliminary eye screenings and Cataract Camps.
The volunteers are from SGH Ophthalmology Department, including ophthalmologists, optometrists, nursing sisters, staff nurses, nurses, and medical assistants.
“Never doubt this small group of thoughtful, committed citizens can change the world.
“They are volunteering continuously. It’s only when they have given their time without hesitation and thinking about gain that they truly know what their contributions mean. The volunteers are giving their time and labour and expecting very little in return,” Chioh stressed.
The recent 11th Betong Cataract Camp was again led by Dr Intan Gudom (retired head of SGH Ophthalmology Department). He was assisted by ophthalmologists Dr Faith Ho and Dr Chua Lausane, and Dr Mohd Asri Mohd Afandi – a medical doctor.
Others in this team of specialists were two staff nurses – Ngui Mui Yan and Serene Wanny Gemong, and paramedics Ayub @ Uyub Subieb, Khaijuddin Ahmad, Sylvester Chabok, and Abdul Mutalib Abdul Razak.
The continuation of the Cataract Camp is largely attributed to the efforts of Dr Intan and Malaysia 4K M coordinator Dr Mohamad Aziz Salowi.
Both proposed and presented 4K M to the Health Ministry and have also participated actively in Cataract Camps at various locations.
“The compassion these volunteers show to the people they are helping is an inspiration. They have treated every patient with respect and kindness no matter the situation,” said Chioh.
“They know how stressful it can be for the people in need of their services. Their words and deeds go a long way to help patients keep their dignity. The works of these volunteers have not gone unnoticed.”
On the second day of the 11th Cataract Camp, Uggah was present and briefed by Dr Intan and Dr Ho on the patients’ conditions and visual acuity outcome.
The Deputy Chief Minister also learned of the need to upgrade the 4K M surgical instruments.
Chioh said Uggah was personally met and thanked by patients and their families for his contributions.
One patient from Remabong, Betong, had two cataracts. Gandun Jimbau, 73, met Uggah on her one-day post ops screening and expressed her joy at being able to see clearly again.
Also present were Betong Resident Friday Belik, political secretary Richard Rapu, and Betong District Council secretary Charlie Keling.
Chioh said LCKM is thankful to Uggah for sponsoring premium IOLs, adding that the club looked forward to Uggah’s continued support not only in providing IOLs for needy cataract patients but also Fibrin Sealant for pterygium patients.
The next preliminary eye screenings at Betong Hospital will be from July 29 to Aug 2.
The 12th Betong Cataract Camp is scheduled from Aug 6-8.