Eyeworld

A mid- and long-term goal is creating sustainability. Haiti is the poorest country in the Western Hemisphere, with 80% of the popu- lation living under the poverty line, according to the Central Intelligence Agency's World Factbook, so its eye- care and health systems were in dire straits even before the earthquake hit. "The education system has never been able to produce a steady Haitian doctors so they're being taught skills directly rather than having things done for them. "It's still in the formative stage, but we hope by the end of 2011 to have six to 12 ophthalmic assistants trained and certified," Dr. Brennan said. PAAO is working on organizing mini-fellowships in partner coun- tries such as the U.S., Columbia, and India to support training in cataract surgery, pediatrics, and other sub- specialties. Progress overall, though, has been slow. Reconstruction of the buildings demolished by the quake has yet to begin and the country has recently been afflicted with a cholera epidemic. "We're looking at a country and it's not changing," Dr. Olivier said. "There are the same broken build- ings. Every day there's something to remind people what they went through. Every day they're reminded of this horrible thing that happened to them in a matter of seconds. It's like every time they take two steps forward, they take five steps back." Even with all of the challenges, Drs. Brennan and Olivier have hope and resilience. Dr. Olivier's office is stacked with supplies waiting to be sent over and donations are still coming in. Some items that remain in high demand are auto refractors and other portable devices. The country is also in need of physical structures to house all the donated equipment. "I work on Haiti every day," said Dr. Olivier. "My office is filled with supplies and I'm always looking for empty boxes. I think one person can make a difference and a team of peo- ple can make a huge difference. You have to try; otherwise there is no hope. You do what you can. If you help one person it's worth every frustration." EW Contact information Brennan: mbrennan43@gmail.com Olivier: molivier@midwestglaucoma.com Powell: 213-300-6109 Important Safety Information – Tecnis ® Multifocal IOL Caution: Federal law restricts this device to sale by or on the order of a physician. Indications: Tecnis ® Multifocal intraocular lenses are indicated for primary implantation for the visual correction of aphakia in adult patients with and without presbyopia in whom a cataractous lens has been removed by phacoemulsification and who desire near, intermediate, and distance vision with increased spectacle independence. The intraocular lenses are intended to be placed in the capsular bag. Warnings: Physicians considering lens implantation under any of the conditions described in the Directions for Use labeling should weigh the potential risk/benefit ratio prior to implanting a lens. Some visual effects associated with multifocal IOLs may be expected because of the superposition of focused and unfocused images. These may include a perception of halos/glare around lights under nighttime conditions. It is expected that, in a small percentage of patients, the observation of such phenomena will be annoying and may be perceived as a hindrance, particularly in low illumination conditions. On rare occasions these visual effects may be significant enough that the patient will request removal of the multifocal IOL. Under low-contrast conditions, contrast sensitivity is reduced with a multifocal lens compared to a monofocal lens. Therefore, patients with multifocal lenses should exercise caution when driving at night or in poor visibility conditions. Patients with a predicted postoperative astigmatism >1.0D may not be suitable candidates for multifocal IOL implantation since they may not fully benefit from a multifocal IOL in terms of potential spectacle independence. Precautions: The central one millimeter area of the lens creates a far image focus, therefore patients with abnormally small pupils (~1mm) should achieve, at a minimum, the prescribed distance vision under photopic conditions; however, because this multifocal design has not been tested in patients with abnormally small pupils, it is unclear whether such patients will derive any near vision benefit. Autorefractors may not provide optimal postoperative refraction of multifocal patients; manual refraction is strongly recommended. In contact lens wearers, surgeons should establish corneal stability without contact lenses prior to determining IOL power. Care should be taken when performing wavefront measurements as two different wavefronts are produced (one will be in focus (either far or near) and the other wavefront will be out of focus); therefore incorrect interpretation of the wavefront measurements is possible. The long-term effects of intraocular lens implantation have not been determined; therefore implant patients should be monitored postoperatively on a regular basis. Secondary glaucoma has been reported occasionally in patients with controlled glaucoma who received lens implants. The intraocular pressure of implant patients with glaucoma should be carefully monitored postoperatively. Do not resterilize or autoclave. Use only sterile irrigating solutions such as balanced salt solution or sterile normal saline. Do not store in direct sunlight or over 45°C. Emmetropia should be targeted as this lens is designed for optimum visual performance when emmetropia is achieved. Care should be taken to achieve centration. Adverse events: The most frequently reported adverse event that occurred during the clinical trial of the Tecnis ® Multifocal lens was macular edema, which occurred at a rate of 2.6%. Other reported reactions occurring in 0.3-1.2% of patients were hypopyon, endophthalmitis, and secondary surgical intervention (including biometry error, retinal repair, iris prolapse/wound repair, trabeculectomy, lens repositioning, and patient dissatisfaction). Attention: Reference the Directions for Use for a complete listing of indications, warnings, and precautions. 2011.02.08-CT2955 Ophthalmologists continued from page 169 stream of surgically trained ophthal- mologists," Dr. Brennan said. "I think many who do become sophis- ticated surgeons decide there are bet- ter places to go, so the residency program has struggled." "What can we do to educate?" Dr. Olivier said when asked about the remaining challenges. "We should set up residencies so we can send volunteers down to do skills transfers for future generations and for the current physicians' continu- ing education. How can we help Haitians set up a business plan?" Dr. Brennan went on a trip to Haiti in December 2010 to meet with the Minister of Health and dis- cuss how to build up its medical sys- tem and develop a stronger unit of doctors across all specialties. He also wants organizations to come to the country to provide aid to "check in at the door" and work directly with EW IN OTHER NEWS 170 March 2011

• Cover