“Would you rather lose a limb, or an eye?”
It is the question that grabs the attention of someone who is about to close the door in your face — a reaction that ophthalmologist Dr. Debra Bartholomew has experienced during the National Eye Survey of Trinidad and Tobago (NESTT).
“We value our eyesight so much that many would much rather lose a limb — and yet, it is one of the senses that we take for granted,” she explains.
“Many persons in T&T over the age of 40 have never taken an eye test. Eye disease is something you hear about but never really think it will happen to you — until it does.”
Dr. Bartholomew works as the Registrar at Port-of-Spain General Hospital, and serves as a core part of the National Eye Survey team, conducting free eye tests in a Mobile Eye Clinic for a targeted population sample size of approximately 10,000 persons.
First survey of its kind and magnitude in the region for several decadesIt is the first survey of its kind and magnitude in the region for several decades, and its results will have far-reaching implications.
“From a national and international standpoint, we cannot effectively plan a programme for eye care without any data,” adds Dr. Bartholomew.
“The Caribbean on the whole has very little data on the subject, and this project is helping to fill that hole of knowledge so that we can treat the bigger issue: why are we afflicted with these diseases, and how can we avoid it?”
The Pathway to Ophthalmology
For those of us that often get confused between the various types of eye specialists, here is the breakdown:
- Opticians are technicians who design, verify and fit eyeglass lenses and frames, contact lenses, and other devices to correct eyesight. They use prescriptions supplied by ophthalmologists, but do not test vision or write prescriptions for visual correction. Opticians do not diagnose or treat eye diseases.
- Optometrists are healthcare professionals who provide primary vision care ranging from sight testing and correction to the diagnosis, treatment, and management of vision changes. Although one can be a Doctor of Optometry, an optometrist is not a medical doctor. They can, however, detect certain eye abnormalities, and refer to an ophthalmologist.
- Ophthalmologists are Eye M.D.s, i.e. medical doctors that specialise in eye and vision care. An ophthalmologist is licensed to practice medicine and surgery, and diagnoses and treats all eye diseases and performs eye surgery to correct vision problems.
Many ophthalmologists, such as Dr. Bartholomew, are also involved in scientific research on the causes and cures for eye diseases and vision disorders.
Dr. Bartholomew believes she was destined for a career in ophthalmology.
“Since I was a young child, I was always interested in the human body,” she says. “A family friend ran the HIV unit at PAHO (Pan American Health Organisation), and there were always all these medical books around. I knew that this was something I wanted to do.”
The eye — which would freak most people out — was what I really likedHowever, she struggled at first when she began to study medicine.
“All the blood, guts and gore was really not for me,” she says, laughing.
“I rotated through all of the disciplines, and didn’t like any of them. But when it came to the eye — I knew immediately: that was it. It was tailor-made for me, with minimal blood compared to other disciplines. The eye — which would freak most people out — was what I really liked.”
Moreover, what attracted her to this specialty field of medicine was the connection that the human eye has to the body in its entirety, which will soon be highlighted by the outcome of the NESTT survey.
The National Eye Survey
The National Eye Survey of Trinidad and Tobago is a research project being conducted by researchers from the University of the West Indies (UWI) and Anglia Ruskin University in the United Kingdom.
Funded by the Ministry of Health of Trinidad and Tobago, its aims to find out:
- How well people in Trinidad and Tobago can see
- How healthy their eyes are
- How many people are suffering with sight loss or eye disease
- Different risk factors for sight loss
- The impact that sight loss is having on people in their daily lives
- The barriers to obtaining eye care
- The existing and projected capacity (staff, equipment and infrastructure) to meet the demand for eye care and treatment
Other stakeholders involved in the project include the World Health Organisation (WHO), the International Agency for Prevention of Blindness, the Pan American Health Organisation (PAHO) Regional, the Ophthalmological Society for Trinidad and Tobago, the Trinidad and Tobago Blind Welfare Association; and physicians who deal with diabetes.
The survey, which is being conducted over a two-year period, hopes to test at least 70% of the 10,000 households that are randomly selected.
Part of the survey also involves genetic testing to determine the distribution, causes and risk factors for loss of vision in our population, thereby providing information that can be used to better align health care resources to the areas of greatest need and maximum impact.
There are so many ‘silent’ problems that can be seen by examining the eyeBeginning in 2012, the survey is still ongoing, but so far out of the approximately 4200 cases tested thus far (as at September 2014), the researchers have already found several cases of untreated cataract surgery, diabetic eye diseases and undiagnosed glaucoma.
“Just by looking at someone’s eye, we can tell so much,” says Dr. Bartholomew.
“There are so many ‘silent’ problems that can be seen by examining the eye. NESTT will provide real information that governments can use to improve eye health care.”
Beyond ophthalmology
One of the key aspects of a cohesive national plan for eye care would be to develop the human capital of staff trained in appropriate medical fields.
As Dr. Bartholomew notes, ophthalmology in particular is a specialist field that requires a significant level of technical skill and practice. Compared to other human organs, the eye is very small, and performing a surgery would require the surgeon to sit at a microscope while each hand and each foot moves a different machine.
Ophthalmologists also have to be ambidextrous“Ophthalmologists also have to be ambidextrous,” she adds. “One of the first things I teach my juniors is to brush your teeth with your non-dominant hand, to get those muscles used to being stimulated. Also, playing the keyboard helps.”
Even when she is not performing surgery, Dr. Bartholomew makes sure to keep her wrists and fingers active — she is quite the artist.
“I have found that painting helps with surgery as it requires maintaining so much control,” she notes. “But it also helps with much more — it is incredibly cathartic.”
Dr. Bartholomew’s family was among the Trinidadians in Libya during the Civil War in 2011 that left hundreds dead, and managed to survive following an emergency evacuation. It is an experience she can never forget, but she strives to find ways to process it through her art.
“I wanted to showcase that there was harmony in the smallest thing, and my art just flowed until it became an exhibition,” she says.
“It is so important for everyone to have an expressive hobby or outlet. Despite the fact that our lifestyles are beginning to mirror those of the more developed countries, our mindsets are slow to adapt when it comes to cultural acceptance and emphasis on psychiatric illness, depression and anxiety.”
Holistic care is needed when dealing with patientsParticularly for this reason, she is adamant that holistic care is needed when dealing with patients.
“I have seen so many sad cases, for example a young person in her 20’s came for a check-up only to find out that she has advanced glaucoma,” she notes.
“I need time to be able to develop a rapport with this person, to treat appropriately not just the eye but the entire person. I always encourage my patients to think about the impact their physical health will have on their mental health.”
She acknowledges that the work being done via NESTT now will not only help future generations, but will also immediately touch the lives of those who are tested.
It really is the window to the soul“When someone learns at an early stage that they are suffering from any kind of disease — whether an eye-specific disease or a lifestyle disease such as diabetes or high blood pressure — this empowers them because they can do something about it, on all aspects,” she says.
“It truly is fascinating, the amount of information we can learn from looking at the eye. It really is the window to the soul.”