Keywords: Cataract Extraction/methods;
J Comm Eye Health 2001;14(38): 30
LETTERS TO THE EDITOR
Cataract surgery
Dear Editor
I am now retired 11 years after 35 years practice in India, much of it in cataract work among rural communities. The letter by John Sandford-Smith and its subject captured my interest as I had prepared a similar article while I was on a working visit back to my old territory in 1992. My thesis was, and still is, akin to the subject of John Sandford-Smith's letter (J Comm Eye Health 2000; 13: 62).
In some parts of India, the mounting backlog of cataract patients is indeed being brought under control with the use of surgery by ECCE + IOL insertion. Around Delhi is one such area. However, in many rural areas cataract surgery of any sort remains unavailable at the local level. Government eye doctors rarely ever visit such places. All my work was in the State of Bihar, the area now known as Jharkhand. Towards the end of the '80s when ECCE-IOL was becoming available in India, a team capable of this method came our way for a week. The results were indeed good, but each operation had lasted 15-20 minutes, and some of the day's prepared patients had to be put off until the next day. We had been used to ECCE or sometimes ICCE with no implants and no sutures. One extraction was completed in 3-5 minutes. Yet the overall incidence of cataract in the area was not being reduced. If we had all switched to the new team's technique then, numerically, many patients would have been the losers, though some of those operated on may indeed have benefited in some ways.
My contention is that where a cataract backlog remains, those qualified to carry out cataract surgery should maintain a flexible approach in those rural areas where so many patients with mature and hypermature cataracts still exist. Most of the older, mature cataract patients in those areas are illiterate. They do not particularly want to be able to read. All they require is vision to enable them to get about their own homes again, and their local market, without the need for someone to guide them. A simple, quick operation is enough for them. For the time being, I see a place for any 'quick' operation which, properly applied, will help to reduce cataract waiting lists. Once cataract waiting lists are coming down and show signs of being under control, then yes, by all means, settle on a regime to restore all patients' vision to as near 6/6 as you can get, cost problems being dealt with at the same time.
End piece: after their successes around Delhi I heard that there were so few cataracts left for the doctors to do, that they started on patients with 6/24 vision or better. It kept their hands in! Sadly, they did not consider going to those places where many mature cataracts are found.
