Fred Hollows

CATARACT-THE ULTRAVIOLET RISK FACTOR

Ophthalmic examination of 64 307 Aborigines and 41 254 non-Aborigines in remote rural Australia during the course of the National Trachoma and Eye Health Program revealed a positive correlation between the prevalence of senile cataract and levels of climatic ultraviolet (UV) radiation. Aborigines were more likely to be affected by senile cataract than non-Aborigines. It seems that Aborigines who live in areas of higher UV irradiation are more likely to acquire cataract; more likely to acquire the condition earlier in life; and more likely to be blind or visually disabled by it, than their counterparts living in areas of low UV irradiation. Provision of adequate shelter in areas of high insolation, where most cases of cataract occur, is likely to be an effective preventive measure.

Flash and pattern electroretinogram changes with optic atrophy and glaucoma

We investigated recent reports that, contrary to common belief, glaucoma can affect flash as well as pattern electroretinograms. An extensive flash and pattern electroretinogram test protocol was used in a large sample of glaucoma patients and age-matched controls who were either visually normal or had other optic nerve diseases. All electroretinogram parameters were reduced and delayed in normal people > 55 years of age. The effect did not increase in later decades. In patients aged < or = 55 years, flash electroretinograms showed mild reductions and delays from optic atrophy alone. Glaucomatous ERG changes were larger and increased with disease severity. Pattern electroretinograms and oscillatory potentials were almost equally reduced in optic atrophy and all degrees of glaucoma. Mildly affected patients > 55 years of age had similar electroretinogram change to age-matched normals in most conditions. Advanced glaucoma patients showed similar differences from normal irrespective of age. This suggests that direct diagnostic application of these results to older patients will be difficult, that the ERG changes in glaucoma cannot be attributed simply to optic atrophy and that additional widespread outer retinal damage occurs in glaucoma.

A "Development Aid" Approach to Third World Surgical Blindness

Establishing local production of intraocular lenses (IOLs) and sutures should be as much a part of surgical blindness prevention assistance to Third World countries as teaching extracapsular cataract extraction with IOL implantation, because it would increase financial independence and encourage economic growth.

On the practicalities of eye camp cataract extraction and intraocular lens implantation in Nepal

Based on our experience in Nepal, we discuss the practicalities of performing extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation in the context of the third-world eye camp. At slightly less than 30 minutes per case, while not as quick as an intracapsular cataract extraction (ICCE) with a Graefe section, the trade-off between vision result and operation time, according to patients, is very much in favor of the ECCE/IOL technique. Also, although IOLs remain expensive, by using donated lenses, the overall costs of providing ECCE/IOL surgery need not exceed those of providing ICCE.