Why children can be born with cataract —Expert

Cataracts are the most common age-related eye condition. They are treated by replacing the eye’s cloudy natural lens with an artificial one. However, in this interview with Professor Charles Bekibele, head, department of Opthalmology, University College Hospital (UCH), Ibadan by SADE OGUNTOLA, he reveals that steps like wearing sunglasses and hats to shield the sun  a rare protective against early-onset cataract.  Excerpt:

DOES a particular diet improve eyesight and reduce chances of developing cataract?

Some diets are generally said to help with cataract prevention, especially those that are rich in vitamins, because of their antioxidant effect.

Antioxidants help to reduce lens hydration, which is cataract formation. Results of studies on this to compare communities that are given some vitamins against those not given vitamins are conflicting. However, we still advise people to eat foods that are rich in vitamins such as fruits and vegetables.

But there is no concrete evidence to show that you can really prevent cataract given all those things. Howbeit, there are things that can cause eye lens oxidation that, if avoided, may stop cataract forming. These include smoking.

Are there other things that can delay or prevent cataract?

Once the cataract has formed, its only definite treatment is surgery. In some cases, if we give corrective glasses, the patient can still manage to cope for some time until the cataract has become more problematic and will have to be removed.

The truth is, cataract is a natural ageing phenomenon. Virtually everybody develops cataract if they get old enough. But there is individual susceptibility. For some people, it is early and for others, it is later.

What are the things that predispose to cataract?

Aside from age, things that are known to predispose to cataract include eye exposure to excessive sunlight. Others are radiation, steroid, eye injury and infection.

The specific radiation from the sun that causes cataract is ultraviolet B. So, wearing sunglasses that cuts off that wavelength of the sunlight and hats can help to reduce the amount of sunlight that gets into the eyes are helpful. These have some effect in reducing chances of developing cataract. That is why individuals in tropical countries tend to develop cataract at an earlier age than those in temperate countries.

What are the basic things to know about cataract surgery?

Cataract surgery can restore sight by 100 per cent. We always explain the whole procedure so that the patient can understand what it all entails and sign to be allowed to undergo the surgery.

Basically we make a small incision to get to the cloudy natural eye lens to wash it out and then replace it with a clear artificial lens. Of course, they are told the possible risks.  Every surgery has some risks but in good hands, we try to reduce the risk as much as possible.

In some instances, people after the surgery still wear glasses, why is this so?

Before the surgery, a test is done to determine the power of the lense to use to replace the natural lens. Although there is a high degree of precision, there is a possibility that the patient may have a residual refractive error that needs to be corrected by glasses.

When we over correct sightly, the patient will be able to read without glasses. We do that for those who do a lot of   near work especially. The refractive error correction required will be with glasses to see far distances. But many of them are happy that they can now read without the glasses they were wearing before.

What are common myths about cataract and cataract surgery?

Myths on cataract and cataract surgery are more in rural areas. For example, they feel that cataract is part of ageing and so cannot be corrected. Some people say that it is due to witchcraft or funny things like the other wife syndrome. Howbeit, it is part of the ageing change. Through technology, it can be corrected and sight restored.

Do we have cataract in children?

Cataract can be present in children. Most children that have cataract have it because of problems that occurred when their mother was pregnant with them. These include such things as side effects of medication and rubella infection. When a pregnant woman has a rubella infection, it affects the lense in the eye of her unborn child.

Again, treatment for cataract in children is surgery. Treatment of cataract in children is particularly important. They need their sight for schooling.

 How easy is it accessing this surgery in Nigeria?

Access to cataract surgery in Nigeria is easy because there are ophthalmologists everywhere. However, one of the barriers to cataract surgery is its cost because materials required for the surgery, including intraocular lens and the expertise, is not cheap.

The microscope required to do cataract surgery is not cheap and is available only in very established or big hospitals.

If access to equipment and cost are barriers to cataract surgery, can individuals go for couching?

Couching eye is a traditional way of removing the lens of the eye. The practice, which started in India and then later in the Middle East as long been abandoned in developed countries. But it is still done in many rural areas in Nigeria.

During couching, they push the lens into the back of the eye and that prone the eye to a lot of reactions. Many patients have lost their eyes as a result of these reactions.

Pushing the lens in and not replacing with an artificial one does not correct the problem. So, the patient will still require glasses to see very well.

Couching is obsolete and it is no more recommended. Quite a number of our local people still do it but it is not an advised way of treating cataract.

 Are there other advantages of cataract surgery aside from better vision?

Of course, there is so much. It has been found that the risk of falls and the risk of dying early increase almost three folds when a patient is blind from cataract. Also, having the sight restored will allow the individual to be able to move around independently, provide for himself and the family.

What types of cataract surgery are available in Nigeria?

We have quite a number of techniques; currently, there are three basic techniques. The most expensive and the best technique is called the phacoemulsification (phaco), which use a machine to break down the lense and then aspirate it through a small incision.  It is the latest cataract surgery technique and recovery is faster than in the other methods.

Another type is called manual small incision cataract, which is cheaper than the phacoemulsification. Recovery is fast and by the following day after surgery, the patients’ vision should have improved significantly.

The third type is called extracapsular cataract extraction (ECCE); it requires a bigger incision. The incision needs to be closed with sutures. The cost of phacoemulsification varies from N250, 000 to N500, 000  while the manual small incision surgery cost between N50,000 and N150,000. The extracapsular cataract extraction is about N45,000.

In UCH, Ibadan the manual small incision cataract surgery costs N50,000  because it is subsidised, being a public hospital.

Current statistics on cataract?

Based on the last survey in Nigeria, blindness and visual impairment occurred in 0.8 per cent of the Nigerian population and cataract accounted for about 50 per cent of all these cases.

Visual impairment and blindness cut across all ages but what we observe is that females have more barriers to accessing cataract surgery. Most are not financially buoyant and for cultural reasons need the permission of their children or husbands before they can assess surgery.