The eyes have it

 Greater awareness of disease has resulted in most of us taking better care of our health and taking such preventive measures as improved nutrition, more exercise and regular check-ups. Yet most of us ignore our eye health, consulting an ophthalmologist only if we are suffering from a major vision problem. 

Exactly 100 years ago Luang Prajakvejasit, Thailand’s first ophthalmologist, started practising his chosen field of medicine, and to celebrate this, as well as the 20th anniversary of the Royal College of Ophthalmologists of Thailand (RCOPT), eye doctors all over the country are focusing on raising awareness of eye ailments, which have become all the more complicated now that technology has overtaken our lives.

While ophthalmology technology as well as treatment has greatly improved, the prevalence of blindness in Thailand still lags behind World Health Organisation recommendations to bring national blindness prevalence rates to less than 0.5 per cent.

Five surveys undertaken between 1983 and 2013 reveal that the prevalence of blindness among those aged 50 years and over in Thailand is gradually decreasing, going from 1.14 per cent to 0.6 per cent over the survey period. Most of the vision problems – a massive 69.7 per cent – can be blamed on cataract disease.

“We are not yet satisfied with the prevalence rate, especially as the major cause is treatable cataracts,” says Dr Paisan Ruamviboonsuk, president of the RCOPT, adding that the royal college is determined to bring the prevalence down to 0.5 per cent.

Cataracts, a clouding of the lens in the eye that affects vision, occur among the elderly and most treat it just as part of the ageing process thus failing to seek treatment even though surgery is easy and fast. 

The problem is compounded by the shortage of qualified ophthalmologist in Thailand: the country has just 1,200 doctors and half of them are in Bangkok.

Dr Paisan says that the royal college is working closely with the healthcare sector across the country to reach out to patients. They’ve teamed up with local hospitals and village healthcare volunteers to check patients in remote villages and encourage them to embrace the national cataract surgery programme.

Other causes of blindness include age-related macular degeneration, glaucoma, diabetic retinopathy and refractive errors including uncorrected aphakia, complications after cataract surgery and accidents.

 Screening is important because glaucoma has no early symptoms and most people don’t notice that anything is wrong. Glaucoma is caused by increased pressure within the eye, which damages the optic nerve – a bundle of nerve fibres that sends vision signals to the brain. Glaucoma damage is irreversible, but eyedrops and, possibly laser surgery, may halt progress of the disease.

The symptoms of macular degeneration are very different from those of glaucoma. Here the eyesight is impaired first in the centre of one's field of vision, rather than around the edges.

Associate Professor Naris, an ophthalmologist from Siriraj Hospital, says that Thais don’t think about their eyes and this is reflected in annual health check-ups, which usually exclude eye check-ups from the list.

“People aged over 45 should see the ophthalmologist annually because most eye diseases are treatable. In addition, many common eye diseases such as glaucoma, diabetic eye disease and age-related macular degeneration, often have no warning signs. A dilated eye exam is the only way to detect these diseases in their early stages,” says Dr Naris.

“We are increasingly finding that a common cause of eye disease comes from wearing contact lenses for cosmetic purposes. Overuse of mobile devices, including laptop or desktop computers in daily life may be harmful to the eyes as well,” says Dr Teeravee Hongyok, chairman of the Public Communications and News Subcommittee, the RCOPT.

Dr Teeravee adds that some patients fail to take out the contact lens while sleeping leading to infection. If they wait to consult doctor, they could well lose their vision.

Currently many patients in Thailand suffer from problems related to wearing contact lenses, particularly as recent fashion fads have dictated the wearing of “big eyes” lenses. That problem is made even worse through sales of second-hand lenses through the social networks and teenagers swapping their lens with friends.

The problem is compounded if one of the wearers is sero-positive for HIV and hepatitis.

“We don’t have proof of transmission of these infections through wearing contact lenses, but it is better to avoid the risk,” says Dr Naris.

“Over-exposure to digital screens – or ‘computer vision syndrome’ – is another modern eye ailment that’s likely to increase in the future due to current habits. However, there are simple steps we can follow to help identify and prevent these diseases,” he adds.

Another important eye disease, though thankfully reasonably rare, is retinopathy of prematurity (ROP), a potentially blinding eye disorder that primarily affects premature infants who are in incubators.

The more premature the baby, the greater the risk and work is now being undertaken to effectively screen infants, which should be done by an ophthalmologist six weeks after birth.

Dr Naris adds that young children should get eye check-ups before starting school to diagnose not just nearsightedness or farsightedness, but strabismus (misaligned eyes), tracking problems; and amblyopia or lazy eye, the leading cause of treatable blindness in children.

“Children don’t know what normal is, so tests are important because you can't rely on children to alert you to a vision problem,” says Dr Naris.

 Thailand’s first ophthalmologist, “Luang Prajakvejasit” (Louis Khongthavorn) finished his medical degree and started taking care of patients with Dr Campbell Highet at Chulalongkorn Memorial Hospital in 1915. Highet, who was also the ophthalmic surgeon for Chulalongkorn Red Cross Hospital, wrote about the treatment of trachoma with carbonic snow in the first edition of the Siamese Red Cross journal in 1928.

 On the Web:

www.rcopt.org/

www.facebook.com/AllAboutEyebyRCOPT