January 25, 2009
3 min read

Volunteer project brings ocular services, training to Southeast Asia

Locally trained ophthalmic technicians provide preop and postop support to surgeons.

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She was a young woman of 18 and had been blinded by cataracts for most of her life when her parents brought her to a Myanmar eye care clinic in a monastery. She underwent cataract surgery there. Afterward, her bandages were removed, and she could see.

John A. Hovanesian MD, FACS
John A. Hovanesian

Her reaction to her restored vision was not what one might have expected, her surgeon, Geoff Cohn, MB, BCH, FRANZCO, FRACS, founder and consultant ophthalmologist of the See Again Myanmar project, said.

“She was profoundly depressed because she had no idea. She had never seen the world, and I suppose was thinking, ‘Where’s that 18 years of my life gone?’” Dr. Cohn said. “But on the third day, when I was racing through the ward, doing quick postops, she was looking at a silver thing that is sort of a mirror. She said … she’d like the second eye done. I knew then that we’d done something worthwhile.”

Dr. Cohn began the eye care project in Myanmar, formally known as Burma, more than 6 years ago. Since its inception, the program has helped set up several clinics in the country that treat and medically train the Myanmar people.

“The country is beautiful and the people even more so. They’re extraordinarily wonderful people,” he said. “It’s inspiring to work with people who really commit themselves with such love.”

Dr. Cohn examines a student with congenital glaucoma
Dr. Cohn examines a student with congenital glaucoma.
Two hours after cataract operation in Myanmar
Two hours after cataract operation in Myanmar.
Images: Cohn G

More needed

In addition to volunteering in Myanmar, Dr. Cohn is also involved in ophthalmic outreach projects in Cambodia and Indonesia. Outreach is imperative in many countries in Southeast Asia because there are often not enough trained medical personnel to treat people who have cataracts and ocular diseases. In fact, there is a backlog of visually impaired individuals waiting for help, he said.

In Myanmar, there are about 200 surgeons serving 55 million people with limited resources, Dr. Cohn said. An extraordinary number of young people in the country are blind from treatable causes, including cataracts and angle-closure glaucoma.

There are many in Myanmar whose vision could be restored easily and inexpensively, he said.

He knows of many lives changed and reshaped by restored vision throughout the world. Once, he operated on a young Myanmar mother who had never seen her child because of cataracts. After surgery, Dr. Cohn removed the young mother’s bandages. Her first reaction was to look at her child, and then she wept, he said.

“Fortunately, tears are good for the eye after the operation,” Dr. Cohn said.

Role of op techs

The cost of sight in Myanmar

To help meet the need for more medical personnel, Dr. Cohn and fellow Australian colleagues use ophthalmic technicians, or op techs, who combine the skills of a refractionist, clinical assessor, scrub nurse and postoperative monitor. Op techs can take a visual history, assess vision and IOP, examine the front and back of the eye, and prepare patients for surgery.

“Surgeons should be operating; they shouldn’t be wasting their time looking at itchy, burning eyes,” Dr. Cohn said. “They shouldn’t be doing glasses — our op techs prescribe the glasses.”

The See Again Myanmar program and outreach projects in Cambodia train op techs to assist with eye care, making ocular services available in a more sustainable way. He said the goal of the programs’ training is to render volunteer Australian physicians obsolete.

“We must support and edify our beleaguered local colleagues,” Dr. Cohn said, adding that the work is far from done, and many more volunteer hours are needed.

“We desperately need more ophthalmologists to come operate and teach,” he said. “Of course, they have to be able to do extracapsular surgery because phacoemulsification would bump the cost of an operation from $15 to $400, which wouldn’t be a constructive exercise. We would welcome all comers, and we’d welcome any equipment that anyone could donate.” – by Erin L. Boyle

  • Geoff Cohn, MB, BCH, FRANZCO, FRACS, is senior lecturer, University of New South Wales, and founder and consultant ophthalmologist of the See Again Myanmar project. He can be reached at 94-98 Chalmers St., Surry Hills, NSW 2010, Australia; 61-41-437-1423; e-mail: tshwaragano@gmail.com.