Seeing is believing: cataract care in Myanmar

Published in The Myanmar Times on 22 June 2015

A cataract in the human eye. Source: Wikicommons
A cataract in the human eye. Source: Wikicommons

Although no data exists as to the prevalence of cataracts among Myanmar’s population, experts say more needs to be done to raise awareness about the condition, particularly as it can cause progressive deterioration of vision if left untreated.

Globally, cataracts are the leading cause of blindness and account for more than one-third of the world’s visually impaired people, who number some 20 million. According to the World Health Organization, the vast majority of untreated cases are in developing countries, due to lower levels of access to diagnosis and treatment.

Cataracts are a clouding of the eye’s natural lens, which results in an opaque, brown or milky white colouring which obscures vision. It often occurs as we age, because the lens protein is prone to degrading over time. A person’s eyesight can deteriorate in a variety of ways as a result of cataracts, including a fading of colours, blurred vision and what is known as glare – an extra sensitivity to light.

Cataracts can be present from birth as a result of a congenital condition, or result from an injury that inflicts trauma on the eye. However the onset of cataracts can also be brought about by lifestyle-related factors or the misuse of certain medications.

Myanmar Eye Centre is a private eye clinic in Yangon that was established seven years ago. It currently has six eye specialists, who are known as ophthalmologists. Approximately one-fifth of its patients – which number around 50 a day – are affected by problems associated with cataracts.

“Most patients complain of having poor vision that has deteriorated gradually, or experiencing glare, such as when they stare into the lights of an oncoming car at night,” said optometrist Dr Phyo Thiri Aye.

Diagnosis of cataracts requires an eye exam: Although surgery does not need to follow immediately afterward, an operation is the only means of restoring sight and must not be left too late. Contrary to some beliefs, neither eye drops nor oral medicine can be used to prevent or cure cataracts: Surgery is the only treatment possible, and it’s better done sooner than later.

“Cataracts grow denser over time, which makes surgery more complicated because it requires a large rather than a small incision,” said Dr Khin Thida Oo.

The procedure involves removing the cloudy lens and replacing it with an artificial one, which stays in the eye forever more. Dr Khin Thida Oo said that surgery should take place as soon as the deterioration in sight leads to difficulty carrying out daily activities.

According to the eye specialists at Myanmar Eye Centre, surgery is more frequently delayed among Myanmar’s rural population, due to lower awareness about the risks of leaving cataracts untreated as well less access to medical care.

Also complicating matters in remote areas of Myanmar are “quack healers” – hucksters trained in neither modern nor traditional medical practices – who are known to continue to carry out a form of treatment that dates back to ancient Greece called “couching”: hitting the lens with a pointed object with such force that it causes the entire lens to dislodge from where it is attached within the eyeball and fall to the cavity in the back of the eye. As well as being extremely painful, couching has very high risk of severe infection of the entire eye and, most often, requires very thick glasses afterward, as you no longer have the eye’s natural lens to rely on.

“We’ve had some patients come in from rural areas that have undergone this procedure,” said Dr Aye Thi Han, adding that the patients find it difficult to perform necessary visual tasks in the aftermath.

Any means of shielding the eyes from exposure to direct sunlight will work to delay the onset of cataracts and is therefore recommended.

“The greater an individual’s exposure to UV rays, the greater the risk of developing cataracts,” Dr Aye Thi Han said.

Eye-test equipment at Myanmar Eye Centre
Eye-test equipment at Myanmar Eye Centre

Sunglasses that provide UV protection are one of the most common methods. Although sunglasses are unpopular in Myanmar, fortunately doctors agree that the ubiquitous sun umbrella does an equally good job. Those who are most exposed to the risks associated with prolonged exposure to direct sunlight are engaged in farming – a group that makes up two-thirds of Myanmar’s workforce. An added aggravation is the fact that Myanmar is located in a region where ozone depletion is higher than the norm, as is the number of sunlight hours.

While men and women are equally predisposed to developing cataracts, certain cultural factors suggest there may be a higher prevalence here among men.

“Women are more likely to stay indoors and men are more often working in occupations where injuries to the eyes can occur,” said Dr Aye Thi Han.

Those who consume alcohol and tobacco also place themselves at higher risk, with cases of cataracts occurring in people as young as 40, according to the doctors at Myanmar Eye Centre.

There is a further dangerous practice that may make Myanmar’s population more susceptible to cataracts: the misuse of certain medications.

“It’s a cultural thing in Myanmar for someone who goes to see a doctor to want to leave with some sort of medication, even if there’s nothing wrong with them,” said Dr Phyo Thiri Aye.

Even more alarming are the effects of corticosteroids, which are strictly intended for a confined period of use.

“Corticosteroids are a good and useful medication for certain problems, such as inflammation or an infection like pink eye. But if misused, they can have a dangerous effect that includes both cataracts and glaucoma,” said Dr Khin Thida Oo.

Corticosteroids can be bought over the counter without a prescription in Myanmar, which causes medical experts to worry that large numbers of people are self-medicating to detrimental effect.

“Steroid eye drops can be used to treat pink eye and they’ll think, ‘Oh this is working well, so it’s okay.’ But pharmacies shouldn’t be dispensing this type of medication without a prescription and patients shouldn’t be using it without being monitored by an eye doctor,” said Dr Khin Thida Oo.

For more information, contact the Myanmar Eye Centre helpline on 09-31311304.

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