South African eye care well below international standard World Sight day

WORLD Sight Day is celebrated on October 13 and its international theme is: ‘Eye Care For All’. But in South Africa, that should read: eye care for all who can afford it.

South Africa’s state eye care falls far below international standards. The Global Action Plan [GAP] for prevention of avoidable blindness and visual impairment, was unanimously adopted at the 66th World Health Assembly in May 2013. That replaced the Vision 20/20 initiative, which had hoped to eradicate treatable blindness by the year 2020. South Africa was a signatory to GAP, with a vision of “a world in which nobody is needlessly visually impaired; where those with unavoidable vision loss can achieve their full potential and where there is universal access to comprehensive eye care services,” said Claudette Medefindt, Head of Science for Retina South Africa.

The stated goal of GAP is to reduce visual impairment as a global public health problem and to secure access to rehabilitation, for the visually impaired. That should lead to a reduction in prevalence of avoidable visual impairment by 25% by 2019 [from 2010 estimates]. Key indicators to be monitored are: prevalence and causes of vision impairment, numbers of ophthalmologists (a doctor who’s an eye illness expert and can perform eye operations), optometrists and allied ophthalmic personnel; plus cataract surgical rate and cataract surgical coverage.

The two most common forms of avoidable blindness are refractive error – treated with spectacles and glaucoma – and raised pressure in the eye, that causes silent and irreversible retinal damage.

There are 64 State hospitals with eye clinics in South Africa – which means 1 clinic for every 800 000 people. A rural area as large as Limpopo has a scant five ophthalmologists, who work in five private or three state hospitals [and sometimes in both]; they provide eye care to 5,5 million people.

Compare that to Gauteng, with 142 ophthalmologists working in 12 state and 51 private eye clinics, who cater to 12,3 million people.

Services in the private sector for those who have medical aids or private means are excellent, but for those who need access to underfunded state eye care, the position is critical. A simple cataract operation can be done on an outpatient basis, but in the state hospitals patients can wait for up to twoyears for this sight saving operation. The ophthalmologist density in South Africa is 1 per 150 000 population; compare that to Australia with 1 ophthalmologist per 25 000 people – six times better than South Africa!.

The Government has committed to establishing a national health plan, but with only 342 registered ophthalmologists catering to over 51 million people, it could take 10 years to train enough skilled eye specialists to even come close to the desired density.

So with such abysmal eye care facilities, what can we do to protect our precious vision?

“We should never smoke, as this increases our risk for both cataract and age-related macular degeneration. That is a serious retinal condition which affects an estimated 130 000 South Africans – mostly in the Caucasian population. We need to follow a healthy diet full of leafy green and multi-coloured veggies, coupled with oily fish twice weekly.”

That diet has shown good retinal protective qualities. Protection against high levels of sunlight [UVa and UVb] will also protect your retinas. Never look directly into the sun, as it could cause permanent retinal damage. Gazing for hours uninterrupted at TV, computer and smart phone screens can cause eye strain. Follow the 20:20:20 rule – after 20 minutes change your focus and look as far away as possible [20 meters], for at least 20 seconds.

Have regular eye checks – increased ocular pressure which leads to Glaucoma is easily detected by an optometrist and responds well to early intervention. Children should have an eye test after the age of three and definitely before entering grade one. Most optometric groups offer subsidised or free testing for children under the age of 12. It is estimated that over 200 000 children may need spectacles to treat refractive error.

With obesity and diabetes on the rise worldwide, the risk of developing Diabetic Retinopathy is also increasing. The only way of preventing this serious loss of vision in later life, is to control blood/ insulin levels and excessive weight gain in your younger years. Late stage treatments are not always effective.

The untreatable genetic retinal conditions that affect thousands of South Africans, are the focus of the patient led advocacy group Retina South Africa. The first ever gene therapy to treat an eye condition will soon be registered in the USA. This therapy which replaces a faulty gene that causes one form of leber congenital amaurosis [LCA], has just completed rigorous clinical trials. LCA is a rare but severe early onset of genetic blindness, when two sighted carrier parents may both pass on a faulty copy of the gene to their offspring. When two carriers marry, the child may inherit a double copy of the gene mutation and thus the condition.

Retina South Africa estimates that there are around 10 million unsuspecting carriers in South Africa of a single gene mutation for various forms of retinal degeneration, such as retinitis pigmentosa, Stargardt Dystrophy or Usher Syndrome [deaf blindness].

“This gene therapy is merely the first. There are dozens of clinical trials effectively treating hundreds of patients internationally. With the help of caring South Africans we can bring these successful trials in the areas of Gene therapy and stem cells, to South Africa. If we treat the estimated 17 000 young people losing their vision to genetic retinal blindness, we can save 1 million blind years” Medefindt concluded.

South Africans can donate R10 and invest in this miracle by sending an SMS with the word ‘Dream’ to 38267. Larger donations are tax deductible. See www.retinasa.org.za.

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