Eye Specialist Emphasizes the Importance of Scaling Up Cataract Surgeries in The Gambia to Clear Backlog of Cases

Dr. Abba Hydara

By Momodou Jarju

A renowned Gambian eye specialist has made a clarion call for the country to scale up its effort towards conducting cataract surgeries in a bid to clear the backlog, which is believed to be affecting hundreds of people.

Dr. Abba Hydara, who is the Chief Executive Officer for Sheikh Zayed Regional Eye Care Centre, revealed in an exclusive interview recently that cataract is currently the leading cause of blindness in the country and that for every 150, 000 to 200,000 people, there are about 200 operable cataracts.

The eye specialist, who is also a Senior Consultant Ophthalmic Surgeon and Coordinator for National Eye Health Programme, observed that because one of the causes of cataract is natural aging process, plus more Gambians are living longer, the prevalent of the eye disease is anticipated to be higher.

“So when you project that into the national population, you will see that we have several 100, 000 people in the population who will be developing cataract,” he said.

“Currently, The Gambia is doing over 3, 500 cataract surgeries per annum. We need to double that number. We need to be doing between 5000 to 6000 to be able to clear the backlog; to be able to clear all the people in the population who have cataract so that we can have a balance and so we will be only dealing with incidents, that is new cases.”

Dr. Hydara said cataract is extremely prevalent in The Gambia, while revealing that two National Eye surveys were done in the past.

The first one was done in 1986, whereby it was established that cataract was responsible for almost 55% of blindness cases in The Gambia.

After the first survey was done, Hydara said a National Eye Care programme was implemented to tackle the commonest causes of blindness (cataract).

The programme was implemented after 10 years- 1996.

A resurvey was done to assess the impact of the intervention and it was discovered that the prevalence of blindness had reduced, Hydara revealed.

“In 1986, it was found nationally that all the cases of blindness were found to be 0.7%. And after the programme was implemented in 1996, the evaluation found that the blindness prevalent had reduced by almost half, it reduced to 0.42% in 1996,” he said.

New Survey in the Offing…

Meanwhile, Hydara said the third national eye survey was conducted last year- in 2019 by the National Eye Health programme.

The survey was supported by the Queen Elizabeth Diamond Jubilee Trust under the London School of Hygiene and Tropical Medicine through the Commonwealth Eye Health Consortium.

Hydara said the results are currently been analysed. It would be shared to Government and the public when they are ready. The outcome is also expected to be higher.

“But I would say we have to be cautious, because the population has increased and then life expectancy of the Gambian has also increased. So when the population increases, the prevalence of blindness also increases. When life expectancy increases we also expect the prevalence of blindness to increase because the commonest causes of blindness tend to occur in the older age groups. So you remember I said cataract is commonest with increasing age. So blindness is also commonest in people who are older,” Dr. Hydara said.

Dealing With Avoidable Blindness

Eye specialist Hydara defined avoidable blindness as blindness that could either be prevented or blindness that could be treated.

For example, he said if someone has a cataract, the person can undergo operation for it to be treated and his/her sight restored. To Hydara, nobody should be blind due to cataract because it can be treated.

“You cannot prevent the cataract, but you can treat it. So it is an avoidable blindness,” he said.

However, unlike trachoma- also an eye infection, cataract can be reversed. And globally, Hydara said cataract is the leading cause of blindness.

Emerging Problem

Blindness due to diabetes is an emerging problem. Hydara revealed that currently in the world, there is an epidemic of diabetes mellitus.

He said the World Diabetes Federation estimated that there are 500 million people with aforesaid diabetes, of which 500 million people worldwide- which is one third of them and very close to 200 million people, will develop diabetic retinopathy.

Hydara said diabetic retinopathy is the damage inside the eye due to diabetes. And if the damage is not treated, he said it can lead to permanent blindness.

“Of this, it is one third who will develop diabetic retinopathy, a third of those people- that is very close to 70 million people, will develop blindness. So diabetes is extremely important in the world. And it is the leading cause of blindness in the working age group worldwide; that is people aged between 25 and 65,” Hydara said.

The Way Forward

So how do you deal with the incidents if every year in a population of two million people you have over 200, 000 people developing a cataract in their eyes, Hydara posed the fundamental question.

He proffered the implications first and then the solution.

Some of them will die naturally because they are advancing in age, while many of them will live with visual impairment, he said.

Deliberating on the implications further, Hydara said their socio-economic status and quality of life will deteriorate, adding some of them will feel depressed while others would not be employed.

“So how do we deal with the incidents, all the new cases that are happening every year, we need to scale up, do more surgeries so that we clear the backlog of the cataract blindness so that the new cases that come, we can deal with them,” he said.

But in order to balance the new cases of cataract and clear the backlog- that is the population that still has a cataract, they need to do more surgeries.

One strategy that could be employed to accomplish the scale up on surgeries is by equipping all the secondary centres in across the country, according to Hydara.

A British Non-Governmental Organisation (NGO) called Sight Savers used to support the National Eye Health Programme in The Gambia in this endeavour since 1986 up to around 2000 when they scaled down their involvement in the country.

Hydara recalled that the British NGO used to provide the eye programme with vehicles and fuel for the health workers who went to villages and screened people; identified those that were blind, brought them to the hospital or major health centres, operated them and took them back.

Sadly, the Gambia Government didn’t continue with the programme.

“But unfortunately Government did not take over fully {by} supporting the eye care programme. So it led to a lot of problems, so many nurses left. They left the ophthalmic services, they went and did midwifery and continued to do those midwifery related activities and stopped checking eyes,” he said.

The eye specialist believed that more people need to be trained and also rendered with support by proving them with vehicles, fuel and accommodation.

This Hydara hinted would entice the health workers to look for people who are blind and with visual impairment in the population and treat them so that they can eliminate “avoidable blindness.”

He also said people who have visual impairment suffer from depression.

“They are three times more likely to fall down and injure themselves. They are three times more likely to be depressed. They are more likely to be unemployed. They are more likely to be in isolation and develop illnesses and all those things. So is not just the eyes, is a very complex system and we all have eyes. Every human being has eyes and we need to be sensitive about the issues of blindness and visual impairment especially due to an unavoidable problem like cataract,” he explained.