The mystery of cataract operations

Dr. SYLVESTER IKHISEMOJIE FROM PUNCH

One of the most common operations offered to indigent communities across the country is free cataract surgery provided by a wide range of non-governmental organisations. In addition to free screening for hypertension, diabetes, obesity and various other ailments, it is one of the operations performed with basic requirements but with tangible results. In some communities, like one just a fifteen-minute drive from my native Ekpoma (in Edo State), the problem of cataracts is so widespread that the people have come to believe that it is a sign of old age.

As a result, they view it as something of a symbol to mark the coming of age. The only problem associated with that is that the vision in the affected eye is progressively lost as the opaque figure within the lens becomes increasingly dense. However, the annual pilgrimage engaged in by various volunteer organisations offering free surgical treatment for cataracts among other common ailments is slowly changing this perception, especially when they rub minds with other beneficiaries, and they begin to appreciate the fact that they were close to becoming blind.

However, what they mostly need their eyes for is to spot snakes lurking in the bushes as they go about their farming business. Others miss their ability to readily identify bush meat where they camouflage among the verdant green. Very few of them can read and write but this subset, in particular, comes to appreciate the gift of a second chance the most.

Although this is a condition we have discussed before on this page, it is useful to look at the important facts again.

Images enter the eye through the lens which is positioned in the middle of the iris— the black or brown round structure in the center of the eyeball. In some races, the iris may be grey, green, blue or hazel. It is a natural part of the ageing process, in some people, for this lens to acquire an opaque appearance, and it is more common in that capacity after the age of 60 years. Before that age, it is often due to some other conditions in the body such as diabetes, trauma to the eye and undue exposure to ultraviolet light. When it sustains an injury, it develops a certain cloudiness that progresses over time. As it does so, the vision becomes increasingly blurred, such that reading and driving become more difficult. Night vision, in particular, is affected very negatively and the person is often found stumbling over objects, even with the benefit of good lighting around the house.

For many of the patients who live in impoverished communities in all parts of the country, the only succour they can hope to get is when these NGOs come calling with their irresistible offers of free operations from which they derive immediate benefits. While the preparation for such an operation is very basic, requiring only the minimum of blood investigations, the affected eye is meticulously examined for the extent of involvement of the lens and its size.

Such preparations are very important to help choose the appropriate size of lens to insert in the diseased eye after the cataract must have been removed. For those village inhabitants who do not get this extra benefit, the removed lens is often replaced with prescription glasses of an adequate power to compensate for the loss of visual acuity. In the final analysis, though, the modern procedure is one of the safest kinds of operations with a huge success rate, similar in scope and scale to the benefits of repairing inguinal hernias in children. Within a couple of days, when the initial eye pack is removed, many beneficiaries of this operation report improved vision.

Many of our institutions— both public and private—often make use of manual tools, in spite of which most of the operations are conducted in about half an hour. However, many new institutions are investing in modern hardware, including laser equipment that greatly shortens the time frame of each operation and boosts the recovery time. Virtually all these modern equipment are associated with the insertion of an appropriate intraocular lens which has been made easier by the fact that the deployment of laser delivers such precise incisions that the lens, which is offered in various sizes, fits snugly.  While some of these lenses correct for distant vision, others correct for near vision, and yet others for astigmatism.

However, only in our highly specialised centres can such services be obtained, such as the Guinness eye clinics in Kaduna and Lagos; and the privately owned Eye Foundation Hospital at Ikeja in Lagos. On the day before the operation, the patients are carefully given their final checks, and blood test results are evaluated principally for the presence of any aberrations, such as derangements in blood clotting and high blood sugar. The patient is encouraged to arrive at the hospital with an empty stomach. They are instructed not to apply any make-up, sun screen or other common skincare products. The operation is performed under local anaesthesia, which means that the patient will not be made to sleep. It is only among persons who suffer from acute anxiety that a mild sedative may be administered principally to keep them calm, as that is also vital for the accuracy of the incisions made into the eye. After the operation, an eye dressing is placed over the operated eye, which would appear more like a little pad. It is removed the following day to let in some light, and that is when the patient begins to appreciate how beautiful the world is. Some redness will be evident in the operated eye and various eye drops are then started for pain control, and an antibiotic to ward off infections, as well as a steroid eye drop. Their use will be dictated by the surgeon, and the patient is advised to follow the instructions governing such use to the letter.

As part of the post-operative care, patients are often told not to look down or bend down for the first seven days after the operation. They are also instructed not to lie on the side of the operated eye, and they should not allow bath water to enter the said eye. Adherence to these instructions is crucial to obtaining the best results from the operation. After one week of the use of the relevant eye drops, there is another follow-up visit to determine, through proper examination, that the lens is in place. The final visit occurs a month afterwards when the eyes are examined by way of refraction to determine what fraction of their vision has to be corrected. Therefore, in some cases, while the operation lends clarity to the vision, more crisp vision is attained by determining the visual acuity, which helps to identify what sort of prescription glasses the beneficiary will have to wear. Over several years, the previously operated eye may develop some further blurring of the vision, not because the cataract has returned, but because there is scar formation over the operated site. Cataracts do not come back once the whitish, diseased lens is removed. It is the combination of all these factors that come together to determine which operation is successful, and which one ends in failure. In the contemporary world as we know it today, most of these operations usually succeed.

For the multitude of the ordinary men and women who are daily losing their vision as a result of this lens opacity, it is everybody’s business to adequately inform anyone we come across that it is a treatable condition that can be corrected through a simple operation that is mostly successful. That way, we can also contribute our quota to the improvement of our collective visual health in the communities we live in. This operation has also been linked to increased survivability of the beneficiaries as they are better able to navigate their environment with the reduced risk of falling and enhanced overall health after they have successfully undergone this operation. It is thus clear that the benefits to those individuals both in the immediate post-operative period and on a long-term basis are immeasurable.  It is this kind of actionable health outreach that can go far to improve the overall health of our respective communities.

Questions and answers

Good day, Sunday Doctor. I hope you doing great! My toddler is running a temperature. I have given him medicine for that but I noticed he’s holding his tummy like there’s a bug in it. He coughs intermittently. And he’s sleeping now and breathing fast, but I looked at his tummy and saw something…I will send a video now so you can advise. He isn’t eating much as well. He pooped little last night, and it was very dark brown and strong. What should we do?                                 090264XXXXX

Thank you very much for your kind inquiry about my health. I am doing just fine. As for your son, because you kept on referring to “he and him”, that video shows obvious intestinal movements, and such movements are usually seen when there is an attempt by the intestines to overcome an impediment. Judging by your description of the kind of stool he passed last night, he may have a hard, impacted stool which his intestines are working hard to force out.  On the other hand, he may have a more serious condition that will require hospitalisation, especially if a situation of intestinal obstruction has developed. This is also possible because there is a fever. In either situation, your son is likely to be experiencing significant abdominal pain each time those movements occur which may account for why he holds on to his abdomen. Please see a doctor urgently for an examination.

Hi doctor. I am a regular follower of your column in the Sunday Punch newspaper. I need your professional input on a personal dilemma. What could be the cause of a sensation one feels in the head when having goosebumps, except that this time, there are no goosebumps. It is sort of weird, but that is the best way I can explain it. There are no headaches though, and I sleep quite well.                           080648XXXXX

Thank you very much for your kind words, and for keeping a date with us every Sunday. Your question is also a weird one, as it is something we are unable to relate to any specific ailment. You have goose pimples but no fever or headache. We don’t know your gender or what you do for a living, and all of those would be helpful factors in seeking to determine what might be the case. However, strange feelings like these could occur if you smoke, particularly if it is something like marijuana, or if you take large quantities of alcohol, or if you have some developing ailment of some consequence.