OSTT Cataract Project [abstract]

The ophthalmological society of Trinidad and Tobago entered into a contract with the Governament of Trinidad and Tobago to perform two thousand cataract surgeries during a three-month period. This was successfully completed. Fourteen ophthalmologists participated. The Society provided all supplies and the ophthalmologists provided the para-medical personnel. Strategies to increase productivity and efficiency and decrease cost will be discussed. Results of the project will be offered. This may serve as a blueprint for similar projects in developing countries. (AU)

Challenges of starting a refractive surgery centre [abstract]

The challeneges of starting a refractive surgery practice in Trinidad and Tobago will be discussed including the financial aspects such as obtaining finance, negotiating best deals and the various ways of saving start up cost. The attitudes of patients regarding local versus foreign expertise and the resultant impact will be addressed. The methods of dealing with various market forces including colleagues and patient financing will be debated. (AU)

Continous Curvilinear Capsulorrhexis

A good continous curvilinear capsulorrhexis (CCC) is a prerequisite to a successful phaco-emulsification. It presents a capsular edge that is very strong and which resists peripheral tearing. Understanding the various physical forces that come into play is important for increasing the success rate. There must be a posterior force that is greater than the naturally occurring anteriorly directed force. The anterior capsule should not be convex forward, but an attempt should be made to get this plane as flat as possible before proceeding with the manoeuvre. The above may be achieved by using compressive forces generated by viscoelastics, or balanced salt solution under hydrostatic pressure. Adoption of the above principle will decrease the incidence of "runaway rhexis". A CCC may be performed with a bent needle, or a pair of capsulorrhexis forceps, or by using a capsulorrhexis diathermy. It is a procedure that should be done slowly and deliberately.(AU)

The Itinerant Surgeon

This term has become tainted among the members of the Ophthalmologcal Society of the West Indies because of the practice of some surgeons who visit the region of not making adequate arrangements for post-operative care, visiting without informing local ophthalmologists and, in some instances, bringing inferior and unsuitable skills. By its nature the practice of ophthalmology requires the use of large amounts of disposable materials that the region cannot always afford. Several international organizations offer help in this regard, but this is often linked to the requirement that their staff should visit and do the surgery. We have to be vigilant that surgeons who are sent by these organizations are adequately trained and licensed and we have to be aware of the surgeon who is seeking further training in our islands. There are many ethical surgeons who visit from time to time to perform surgery and engage in the exchange of skills. They should be welcomed, providing that they are satisfying a need that has been identified by the local surgeons. The visiting surgeons should treat the local fraternity with respect and should leave the local doctors and their patients with their dignity intact. I would further suggest that the term "itinerant surgeon" be dropped from our vocabulary and the term "visiting surgeons" be substituted.(AU)

Challenges of practising ophthalmology in the West Indies

With increasing globalisation and better communications the world has shrunk to the point where information of any kind is easily acceptable but not necessarily understandable by the masses. Practising ophthalmology in the West Indies, we are not immune to the effects of this phenomenon. The expectation is that we should be producing a level of care that is at least equivalent to what obtains in the developed world. We are even expected to exist at the cutting edge of medicine. The level of ophthalmology that is offered in the West Indies bears testimony to the hard work, intelligence and sacrifice that is invested in the profession. Training for ophthalmologists from the West Indies is not widely available locally. When it is sought, it is done at considerable financial and social cost. Because we must access training in foreign lands we must be satisfied with less than the best. The best is reserved for the local doctors and it is very difficult for us to ascend the ladder of training to the point of good exposure. Therefore, although our doctors may be brilliant, they are usually deficient in surgical skills and have to come home to home their skills under the guidance of seniors who themselves would have gone through the same routine. What is the answer? Training of ophthalmologists in the West Indies is the obvious way to go. This, however, needs money, and determination by the authorities in the University of the West Indies to offer a wider syllabus. Unfortunately, we ophthalmologists are partly to blame since we have not until recently given ophthalmology the attention that it deserves as a speciality. We have to influence the other branches of the profession to accept ophthalmology as an important speciality. When the speciality gets the respect that it deserves and attains the status that ranks it with the other major specialities then we can push for increasing attention to academia. Ophthalmology in the West Indies suffers from a lack of money. On the one hand, there is inadequate funding by the various governments and, on the other hand, inability of patients to compensate doctors adequately for services rendered. In the former, it leads to chaos in the hospitals and loss of initiative in the public health workers. In the latter, it leads to inadequate funding for investment in private practice (AU)