By Samwel Doe Ouma@samweldoe
Lack of capacity in Ophthalmology specialists is to blame for the delays in diagnosis and treatment, putting the sight of thousands at risk.
According to Dr. Oscar Muwale Onyango, Consultant Ophthalmologist and Vitreoretinal Surgeon, there are only 11 Vitreoretinal specialists in Kenya.
Data from the Health ministry reveals Kenya has 115 ophthalmologists operating in major cities of Nairobi, Kisumu, Eldoret, Mombasa and Nakuru, leaving periphery counties exposed.
“Vitreoretinal specialists handle all aspects pertaining to structures behind the eye lens, such as vitreous, retina and choroid.”
He explains that despite fearing losing their sight, 90 percent of patients suffering from inflammatory conditions like uveitis, retinitis and choroiditis seek services of opticians, often falsely believing they are eye doctors.
Opticians and optometrists learn basic eye care and refraction as a basic course while Ophthalmologists are eye specialists who have a basic degree in medicine and surgery. Thereafter they undertake a 3 year postgraduate degree in Ophthalmology. They then undergo 2 years of supervised work at designated hospitals before being granted specialist recognition by the Kenya Medical Practitioners and Dentists Board. Vitreoretinal specialists do a fellowship study in treating their subspecialty complications. Other subspecialties available in Kenya include: glaucoma, oculoplasty/orbit, pediatric ophthalmology,cornea.
Vitreoretinal specialists handle infective conditions like endophthalmitis, retained intraocular foreign bodies post trauma, scleral abscesses and other conditions that affect retinal function like diabetes, hypertension, hypercholesterolemia, retinopathy of prematurity, very short sighted patients, sickle cell disease, tuberculosis, intraocular cancers, various retinal detachments.
“Patients who suffers from these retinal conditions risk going blind because of rarety of Vitreoretinal specialists in Kenya,” he explained.
Retina is a layer at the back of the eyeball that contains cells sensitive to light. These trigger nerve impulses that pass via the optic nerve to the brain, where a visual image is formed.
Access to specialist eye care in rural or remote areas is a major concern in many counties as Kenya is expanding its healthcare infrastructure in order to attain Universal Health Care (UHC).
“Eye care service provision is a hit or miss affair as it depends with your geographical location, you can lose or keep your sight depending simply on where you live.”
Geographic distribution and availability of human resources has been a challenge, with over 80 percent of the health work force working in urban and semi-urban areas.
“Devolution of healthcare was a good idea but it’s ahead of its time because of lack of personnel and equipment at the county level making timely access a challenge,” he said.
Even with more than 75 per cent of permanent blindness cases being avoidable, Kenyans are struggling with the burden of blindness, visual impairment and ocular morbidity.
With simple diagnostic tools like a standard slit lamp bio microscope, Optical coherence tomography machine, retina laser machine and electrophysiology machines, a specialist will be able to accurately diagnose, interpret the diagnosis and initiate treatment.
For surgery, one needs a vitrectomy or a phaco machine, cryotherapy machine, various tamponade agents and a retina laser.
“If one is diabetic, sickle cell disease patient or hypertensive, they need annual eye checkup to ensure the retina is not affected by these diseases. If one is very shortsighted (-5DS) and above, annual eye exam is needed. All preterm babies born less than 32 weeks gestation and/or less than 1500g birth weight must have an eye review by fourth week of life,” he emphasized.
Eye screening at a public health facility costs between Sh50 and Sh200, compared to between Sh2, 000 and Sh5, 000 in private hospitals.
WHO data shows 39 million people are living with blindness in the world, 224,000 are Kenyans.
The report further shows that 750,000 Kenyans are visually impaired while 28 million people worldwide have severe vision impairment.
Without sight, people are at risk of losing their employment and their ability to travel independently as well as having to rely on help to undertake day to day tasks. Blind people are also at higher risk of experiencing falls and accidents.
Dr. Oscar Muwale Onyango Profile
Dr. Oscar Muwale Onyango is a Consultant Ophthalmologist with subspecialist training in Vitreoretinal Surgery from the Ludwig Maximillian University and Herzog Carl Theodore Eye hospital, both in Munich, Germany.
He holds a Bachelor’s degree in Medicine and a Master’s degree in Ophthalmology from the University of Nairobi. He holds a certificate in Basic Sciences from the International Council of Ophthalmology (I.C.O) and is also a recipient of the ICO International Fellowship Award.
He is a Senior Medical Specialist in Ophthalmology Department at the Kenyatta National Hospital, Nairobi, Kenya.
Apart from treating numerous vitreoretinal conditions, he has got special interest in preterm babies who are suffering from Retinopathy of immaturity and is extremely active in its management.
He is a member of the Vitreoretinal Unit in the Ophthalmology department. He is also a fellow of the FCOECSA (E.A) (College for Ophthalmologists of Eastern, Central and Southern Africa) and an active member of the Kenya Medical Association (KMA). He’s also a member of the European Retina Society, African Vitreoretinal Society and American Academy of Ophthalmology.