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Cornea disorders top cause of blindness

By Vision Reporter

Added 7th September 2008 03:00 AM

WHEN Pius Kabala, 18, developed itchy eyes, the diagnosis pointed to an allergy. Years later, when he joined secondary school, the itching persisted. An examination revealed that the eyes had developed scars.

WHEN Pius Kabala, 18, developed itchy eyes, the diagnosis pointed to an allergy. Years later, when he joined secondary school, the itching persisted. An examination revealed that the eyes had developed scars.

By Raymond Baguma and Joseph Kariuki

WHEN Pius Kabala, 18, developed itchy eyes, the diagnosis pointed to an allergy. Years later, when he joined secondary school, the itching persisted. An examination revealed that the eyes had developed scars.

Doctors said the condition could not be corrected by wearing glasses because the problem was on the cornea. The cornea is the eye’s outermost layer. “It is the clear, dome-shaped surface that covers the eye,” according to Medlineplus, a US online health resource.

“I could not see clearly with the scars. It is only an operation which could help,” says Kabala. Later, he dropped out of school after completing S.4 at St. Catherine’s College, Kampala.

Because of lack of money, Kabala lost hope of treatment. Coupled with the failing sight, he dropped out of school and plans were being made for him to do a course in reading braille and training in computer and writing for the blind.

The same fate befell Victoria Nalwanga, 16, an S.4 student at Gayaza High School, when she was in primary. “I used to watch television but I could not see clearly.

I also wanted to have spectacles and was happy when I got them,” says Nalwanga who confesses that teenagers sometimes think spectacles are fun to have.

Her father Ddamulira Ssembajjwe says: “Her problem began like somebody who needed spectacles. In S.1 her eyesight became poorer and at the eye clinic, they prescribed strong lenses.”

After seeking specialised eye treatment for long, both Kabala and Nalwanga were diagnosed with a deforming cornea but due to lack of surgery facilities, they could not be operated upon in Uganda: “They would alert us of visiting doctors in Tanzania or Kenya, but said these countries were also overwhelmed by patients,” says Kabala.

Kabala, Nalwanga and others should not resign to a life of blindness. In much of the world, damaged corneas are routinely replaced, but not in Uganda and other parts of the Sub–Saharan Africa.

For this procedure to become available, new surgical facilities and procedures for obtaining replacement corneas should be got.

Dr. Juliet Otiti-Sengeri, an ophthalmologist at Mulago Hospital, says of the 300,000 blind people in Uganda, 90,000 are due to cornea-related diseases. Ten out of 90,000 cornea patients get help in two years.

In 2006, Nalwanga was one of the five lucky patients out of the long list of 90,000 to undergo a corneal transplant during Orbis Saving Sight Worldwide’s maiden visit to Uganda.

Kabala also benefited recently when the team made their second visit in the country. Only five more patients benefited.

The operation which is done inside their DC-10 aircraft lasts between 15 minutes to one hour and the transplants stays in the eye for life, according to Dr. Gogate Parikshait, a volunteer doctor with Orbis.

Orbis Saving Life Worldwide is a global effort. The United Airlines donated the plane which is used as a flying hospital. In any hospital establishment, a corneal transplant costs $10,000 (sh16m) while a cataract operation costs $5,000 (sh8m).

The money is a donation to Orbis and is solely used for the patients. The doctors have to pay for their tickets and upkeep, according to Dr. Justin Arbuckle from the Storm Eye Institute of South Carolina US.

They first arrived in Uganda in 2006 for the groundbreaking eye treatment programme during which they performed the first corneal transplant. The second visit was last month.

Lack of a tissue transplant law leading to blindness
A corneal transplant involves replacing a diseased or scarred cornea with a new one. When the cornea becomes cloudy, light cannot penetrate the eye to reach the light-sensitive retina. Poor vision or blindness may result.

In corneal transplant surgery, the surgeon removes the central portion of the cloudy cornea and replaces it with a clear one, usually donated through an eye bank from a dead person. A trephine, an instrument like a cookie cutter, is used to remove the cloudy cornea.

The surgeon places the new cornea in the opening and sews it with a very fine thread. The thread stays in for months or even years until the eye heals properly (removing the thread is simple and can easily be done by an ophthalmologist.

Following surgery, eye drops are needed for several months to aid healing. Although there is a law in the offing to address issues of organ transplant, Amandua is non-committal on a time limit when Ugandans will benefit from the law.

“We also have to establish an eye bank for corneas and allow for harvesting of cornea from willing donors once they die,” says Dr. Jacinto Amandua, a commissioner in charge of health services at the health ministry.

The only African country with an eye bank is Ethiopia and it was set up by Orbis.

“The Government is working on a directive to allow us harvest tissue unless the relative refuses. We need legislation to harvest tissue,” says Otiti-Sengeri.

She adds that after being trained by the Orbis team, Uganda’s eye doctors are ready to do any form of eye treatment. “The start-up costs are not high. We need legislation and to encourage people to donate,” she says. “But the technical know-how is in place.”

During Orbis’ two-week stay in the country, 40 ophthalmologists from the regional hospitals such as Mbarara, Mbale, Masaka and Fort Portal were trained.

They also trained clinical officers. The beneficiaries were selected by Mulago and Mengo eye clinics and the doctors recommended patients, basing on cases with the best prognosis.

Causes of diseases that may affect the cornea
There are a number of diseases and disorders that may affect the cornea says Otiti-Sengeri, but the most common is keratoconus.

It refers to a condition when the eye’s cornea is altered into a shape of a cone.
“A normal cornea has a dome shape. But an abnormal one loses its thickness and becomes like a cone.

As the disease progresses, the cornea becomes perforated and gets a scar.” She says the cornea disorder can start from eight years to 11. Initially, it presents as short sightedness.

But the cornea changes shape as the person grows. A cornea disorder develops because of allergies and as patients rub their eyes, they (eyes) tend to get the shape of a cone. Cornea scars can also be caused by trauma.

Of the estimated 300,000 people with blindness, 150,000 are due to cataracts. Also, 80,000 of blindness cases are due to glaucoma and 60,000 are due to trachoma, the rest is due to HIV/AIDS, diabetes and other causes according to data at the health ministry.

Dr. Amandua warns that eye infections are rising. Most eye patients need transplants but have to go abroad. It costs about sh40m to have one cornea transplant in Britain.

Other causes are physical injuries of the eye and infections if not well handled. One can also develop a cornea disorder due to virus or bacteria infections that form a wound or a corneal ulcer.

“Some people get self-medication or traditional eye medicines which just make disorder worse,” says Otiti-Sengeri. “Opthamoligists giving wrong drugs can also lead to scarring of the cornea.”

Prevention of Eye Infection
One should get the right medical advice.
Self-treatment is not useful.
The eye has sensitive PH so that when it is subjected to anything, it is damaged. It lacks ability to regenerate and you need to seek the right help.

Use protective eye wear when dealing with objects that can prick the eye, especially stone blasts or welding.

Use seat belts while travelling to avoid accidents that can injure the eye.
Good nutrition is also essential in controlling eye infections.

Good hygiene which includes washing your hands to avoid transfer of bacteria to the eye.
Seek treatment early.

Cornea disorders top cause of blindness

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