JAN 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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January 2012 EW IN OTHER NEWS Fighting preventable blindness in the Dominican Republic by Faith A. Hayden EyeWorld Staff Writer Dr. Kosoko-Lasaki tackles glaucoma and vitamin A deficiency For the entirety of her career, Sade Kosoko-Lasaki, M.D., has centered her research around the prevention of blindness. Over the past decade, Dr. Kosoko-Lasaki, professor of oph- thalmology surgery and glaucoma specialist, Creighton University, Omaha, Neb., has traveled to the Dominican Republic (D.R.) to fur- ther that quest by addressing vita- min A deficiency (VAD) and glaucoma, two major areas of public health concern in the developing Caribbean country. Creighton University has a med- ical mission program based in both Omaha and the D.R. called ILAC, or the Institute for Latin American Concern, which began in 1973. "ILAC has a medical facility [in the D.R.] where we schedule surger- ies with various groups for poor peo- ple in the rural areas," said Radalme Pena, executive director, ILAC. Surgical services ILAC provides include hernia, orthopedic, ophthal- mologic, and ear, nose, and throat, among others. Doctors travel to the D.R. from around the world and do- nate their time as part of a volunteer health program. The medical facility has three ORs, each with two beds. ILAC trains volunteer public health work- ers called cooperadores who travel to 162 Dominican villages and exam- ine people for VAD and other dis- eases. If there's a problem, the cooperadores round up the patients and bring them to ILAC for treat- ment. Creighton medical students also travel to the D.R. ILAC facility as part of an exchange mission pro- gram. When one Creighton student came back from the country telling Dr. Kosoko-Lasaki of villagers with night blindness, an early sign of VAD, she knew she had to act. With the help of numerous organizations including ILAC, the World Health Organization, and a non-profit hu- manitarian association called Sight and Life, Dr. Kosoko-Lasaki traveled to the D.R. in the early 2000s for her first vitamin A intervention. VAD is the leading cause of pre- ventable blindness in children, mostly affecting lower income coun- tries like the Dominican where, ac- cording to the CIA World Factbook, 42.2% of the population lives below the poverty line. VAD also causes a host of additional health issues such as anemia, increased risk of infec- tion, and early mortality. WHO clas- sifies the D.R. as having a mild VAD public health crisis, affecting an estimated 2-10% of its population, according to a 2009 report. "Vitamin A is primarily found in animal products like eggs or milk," said Klaus Kraemer, Ph.D., executive director, Sight and Life, Basel, Switzerland. "In many countries, it's just a matter of affordability and knowledge. Animal foods are very difficult for the poor to buy." During VAD interventions, Dr. Kosoko-Lasaki administers vitamin A megadoses, donated by Sight and Life, to children between the ages of 3 and 10, as well as lactating moth- ers and pregnant women in the sec- ond and third trimester. In recent years, Dr. Kosoko- Lasaki expanded her charity work in the Dominican to encompass glau- coma screening and surgery as well. Sebastian Guzman, M.D., an oph- thalmologist based in the D.R, ap- proached her during one of her VAD trips and asked if she'd be interested in glaucoma collaboration. Dr. Kosoko-Lasaki would see glaucoma patients in addition to doing vita- min A dosing, and Dr. Guzman would follow-up with her patients for free if necessary. "I asked her if she would come next year to do some glaucoma work," said Dr. Guzman. "That's how it started. The next year she came and saw patients." "In order to go into any country and do glaucoma surgery, we need to have collaborators to follow-up on patients," Dr. Kosoko-Lasaki said. "It's not a one-time deal. Most oph- thalmologists shy away from glau- coma surgery because it's not gratify- ing. The patients don't see better; sometimes they see worse. Glau- coma blindness in the D.R. is pretty high. The patients I see have severe glaucoma with pressures in the 30s." Dr. Kosoko-Lasaki's last trip to the Dominican was in March 2011 for 6 days, four of which were dedi- cated to glaucoma surgery. She brought with her Rebecca Batt, a certified ophthalmic assistant, who took patient pressures and per- formed reading exams, and Brett Briggs, a Creighton student, who co- ordinated the glaucoma screening process, visual field, and visual acu- ity. "We saw upward of 250 people," said Mr. Briggs. "People hear there's an American doctor coming and they travel from far and wide. The D.R. is very underserved. People just don't have the money to see an oph- thalmologist. A lot of these patients are risking losing their jobs by tak- ing off work to see a doctor." Dr. Kosoko-Lasaki and her team were able to cover a tremendous amount of ground in under a week. She performed 120 adult eye exams and found 41 existing cases of glau- coma, seven new cases of glaucoma, and 13 instances of other ocular dis- eases. She administrated vitamin A megadoses to 117 children, educated continued on page 70 69 Doctors at Creighton University's ILAC medical facility perform surgeries on Dominican villagers from rural areas Dr. Kosoko-Lasaki screens a patient for glaucoma in the D.R. Source: Creighton University Source: Creighton University

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