Eye Care in Nigeria: A sober reflection on the past and a rational look at the future

The year 2016, in a few hours’ time, will become history. To consign 2016 to the dust bin of history is not to learn any lesson from it. In order to deal meaningfully with the present, it is a worthwhile exercise to analyse the past and see how well we have fared. Unfortunately, while the rest of the world is moving forward in all aspects of eye care, Nigeria has been static in many areas and actually moving backwards in others.

Cataract remained the leading cause of blindness in 2016. We still have a backlog of over two million persons with blinding cataract in need of surgical intervention. Sadly, we haven’t even started to tackle this! Added to this, new cases are coming up at the rate our human resources and available facilities cannot cope with. The result is that couching (an ancient practice which is over 2000 years old) is still widely practised, converting reversible blindness into irreversible blindness!

Is anyone surprised? Why should we? If we are applying the solution of yesteryears to the challenges of today, what can we expect? What hope do we have in a country that cannot find a lasting solution to a road that is just 120km long? Rebuilding the expressway and adding more lanes is no solution to the recurring anguish, nightmares and several hundreds of deaths on that road for over 50 years without addressing, simultaneously, the issue of alternative means of mass transportation.

Similarly, a pragmatic, well coordinated approach must be taken to tackle the challenge of blinding cataract. With judicious use of the available human and financial resources, Nigeria can conquer cataract blindness. Special thanks and appreciation to several Nigerians and organisations who have contributed to our fight against cataract blindness in 2016.

Through them, several hundreds have had their sight restored. I must mention in particular BOVAS Charitable Foundation, Novartis, the staff of Zenith Bank, Bodija Branch and a 90-year-old ‘young man,’ who would not like his name mentioned. There are others, unknown to me, working with other institutions, who have also contributed in cash and kind to our repeated nationwide call for assistance to tackle the cataract challenge. To you all we are immensely grateful. May your sight never fail!

If the problem of cataract is receiving a little bit of attention, to my knowledge, many Nigerians are still largely unaware of the potential danger of irreversible blindness from glaucoma. Those that are aware are not responding to our call for pre-emptive measures to prevent blindness from this scourge. While cataract blindness is reversible, glaucoma blindness is irreversible.

While cataract calls attention to its presence from the onset by gradually increasing impairment of vision, glaucoma causes no visual impairment in the early stages and only announces its presence when blindness is knocking at the door. And what are these pre-emptive measures that can help prevent blindness from glaucoma? Yearly visit to an ophthalmologist who has the knowledge and instruments to recognise its early signs; compliance with treatment and follow up appointments once the diagnosis is made.

Two conditions, however cause me a lot of heartache. They remind me of the two occasions that I knew a fatal accident was going to happen and could not stop it. On each occasion, a young man was at the wheel driving. I was driving in the same direction at a speed of about 100km/hour. This young man overtook me at a speed of about 140km an hour.

Knowing that about half a kilometre ahead, there was a sharp bend to the left, I was certain an accident was inevitable. It happened and sadly, I was there only to play the role of an undertaker! The second happened in similar circumstances but this time the occupants of the vehicle were luckier this time. They escaped with varying degrees of injury but no life was lost.

Blindness from gonococcal conjunctivitis and Chloroquine are avoidable and caused by utter recklessness akin to what has been described above. Gonococcal conjunctivitis occurs when an infected, usually, own urine is used as eye drops for a simple eye irritation or infection. With every epidemic of Apollo, many cases of gonococcal infection of the eyes are coming up and quite a few end up with blindness. Blindness from Chloroquine arises from an excessive use of the medicine.

What do we expect in 2017? The omen is bad! More people will need cataract surgery and will not be able to afford the cost. Many will end up having couching and becoming irreversibly blind. Fewer Nigerians will visit the ophthalmologists because they have no money and their glaucoma will remain unrecognised until blindness sets in. Those who are on treatment will find it difficult to buy their medicines because of increasing costs and non-payment of salaries and pensions.

Consequently, blindness from all causes will increase in 2017. What can the government do? Rise up to the occasion and ensure availability of medicines and importation of needed items of equipment. What can you do? If you have been supporting eye care, kindly redouble your effort. If you have not, please do so now. The sight you save may save your life.