The Need for Eye Care in Barbados
Barbados, though small, has a high prevalence and incidence rates of the major sight-threatening eye diseases: glaucoma, cataract and diabetic retinopathy.
We know this because the Barbados Eye Studies, one of the largest epidemiological studies on a population of mainly African descent, provided us with a wealth of information on the major eye diseases in Barbados. This study, which began its work in 1987 and ended in 2003, was funded by the National Eye Institute (NEI) in the United States of America, and was coordinated by the Chronic Disease Research Centre (CDRC) of the University of the West Indies Cave Hill. Over 4000 Barbadians participated.
It revealed that the major cause of blindness was glaucoma (accounting for 28.4% of persons blind), followed by cataract and retinal diseases, such as diabetic retinopathy, retinal vascular occlusion and retinal detachment. With the increase in cataract surgery being done since the study started in the 1980s, we would expect that blindness due to cataract has significantly decreased; however, as our population ages and we become more affected by the chronic non-communicable diseases, we expect that our prevalence rates of glaucoma and retinal diseases would remain high. A similar study in St. Lucia and one in Trinidad, suggest that the situation is likely similar across the Caribbean.
The Caribbean Lions Eye Care Centre at the Queen Elizabeth Hospital serves as the island’s only public secondary and tertiary eye care unit. The Centre has a critical role to play in preventing blindness in Barbados, and the wider Caribbean. All 3 of the major causes of visual impairment on the island require surgical intervention: if glaucoma cannot be controlled by eye drops, surgery is required to save the sight; cataract requires surgical removal; retinal diseases often require even more complex surgery.
At present the Department of Ophthalmology sees the greatest number of outpatients in the hospital annually: over 20,000 (data from QUEST 2016 Equipment Prospectus). Many of these require surgery, for which 10 highly trained consultant ophthalmologists are available. The Department also runs the University of the West Indies post-graduate training programme in Ophthalmology, which is Barbados Medical Council certified. However, the Ophthalmology Department’s surgical potential is (see over) constrained to one theatre within the main general theatre complex, for these 10 surgeons on a weekly basis; this means each doctor can only operate on one half day a week. This is clearly inadequate to service a department that sees over 20,000 patients a year. Even under its constraints, the department conducts over 1500 surgeries annually (data from QUEST 2016 Equipment Prospectus), but this is still not enough.
With the commissioning of the dedicated Eye Theatres on the 3rd floor of the Lions Eye Care Centre, assuming adequate support is provided in terms of the requisite supporting personnel (nursing, anaesthesia, etc) it would be possible for each surgeon to have a whole day operating list, thus potentially doubling the surgical throughput. In addition, increased operating means that we can offer training to our Caribbean neighbours to equip their ophthalmologists to return to their own countries to offer a higher level of surgical expertise there – thus having a major impact on blindness across the Caribbean. This is at the heart of the vision for the aptly named Caribbean Lions Eye Care Centre.