It is morning – the sun has risen anew and birds chirp outside your window as they begin their daily hustle to catch food. You rise, eagerly greeting the new day as you shake the slumber from your still slightly lethargic body. What is one of the first things you do every single day? You open your eyes and take in your surroundings.
The simple, yet profound, gift of sight opens doors no other organ in the body is able to. It allows you to see your reflection in the mirror, navigate safely around objects, alert you to obvious danger and open a gateway to all the beauty the world has to offer.
Despite these marvellous wonders, many take sight for granted. Just for a moment, imagine only seeing the world through a hazy curtain as your eyes battle some chronic condition. Imagine the daily struggle of wiping tears from your cheeks as your eyes water, battling endless eye pain, constant eye strain or a life of inflamed, bloodshot eyes which no over-the-counter medication from your local pharmacy can cure. Or, perhaps worse, imagine living in complete darkness, having either been born blind or unfortunate enough to lose fractions of sight daily as blindness stealthily creeps up on you.
The large number of Africans with poor vision is worrisome. According to the World Health Organisation (WHO), visual impairment is a significant health problem in Africa as a whole. An estimated 26.3 million people have some form of visual impairment and of those, 20.4 million have low vision, while 5.9 million are estimated to be blind. A staggering 15.3% of the world’s blind population is said to live on the African continent alone.
Highlighted eye conditions affecting the masses include cataracts, glaucoma, age-related macular degeneration, corneal opacities, diabetic retinopathy and refractive errors. In their report, the WHO lamented the fact that almost 80% of the conditions which lead to visual impairment are either curable or preventable.
The key to remedying this problem lies in the provision of both effective and easily accessible eye care services. A 2011 study published in the South African Medical Journal titled “South Africa’s cataract surgery rates – why are we not meeting our targets?” took an in-depth look at possible causes of not performing sufficient numbers of surgeries to clear the backlog of cataracts- the number one cause of reversible blindness in the country. The main barriers reported were inadequate commitment by hospital or provincial managers to increase surgery numbers, insufficient access to theatre, theatre staff who were unfamiliar with high-volume cataract surgery, an erratic supply of surgery consumables plus a shortage of ophthalmic nurses. A shortage of ophthalmologists is perhaps the most important barrier.
According to a report by Orbis Africa, there are approximately six ophthalmologists for every million South Africans. This number is dismal when compared to international figures. Just look at Argentina, as an example. Figures provided by the International Council of Ophthalmology reveal that this country has 138 ophthalmologists for every one million people. This is followed closely by Bulgaria, with 120, and Austria, which has 92 ophthalmologists for every one million of its inhabitants.
The paucity of ophthalmologists has been ascribed to many factors, including too low an output (the inability of the medical schools to train enough specialists due to financial and human resource challenges), the brain-drain (largely hinted at by worrisome media reports – but often vehemently refuted by government officials) and the strategic move by government away from specialised medicine to primary health care.
Notwithstanding the actual causes, the issue remains the same: there is a dire shortage of suitably qualified ophthalmologists to adequately care for South Africans’ eyes. The Global Eye Health Action Plan 2014 – 2019, which aims to reduce avoidable visual impairment as a global public health problem and secure access to rehabilitation services for the visually impaired was drafted during the 2011 sitting of the 65th World Health Assembly, and is based on five principles which look at universal access to care and the general empowerment of people with visual impairment. Without the necessary eye health care workers this action plan cannot be implemented.
An unwavering commitment to the training of specialist eye healthcare providers, coupled with a workable plan to retain the country’s professionals, could be the answer to South Africa’s eye woes. Crucial to this is the drafting and implementation of a workable plan of action, with a clear vision to change the fortunes of those affected by poor eye health. As writer Helen Keller once said: “The only thing worse than being blind is having sight, but no vision.”
So yes, inheriting good genes, eating carrots and leafy green vegetables and protecting your eyes from harm may help you see well for longer, but for lifelong eye health, a handy ophthalmologist, or two, is the answer to the vision problems experienced by South Africans daily.
Dr Linda Visser is the president at the Ophthalmological Society of South Africa (OSSA). OSSA promotes general interest of ophthalmology and the specific interests of its members within the sector.