Eyeworld

EW CATARACT 31 August 2017 other physicians who are practicing in a low-resource environment," said Dr. MacDonald, who has undertaken surgical missions in Egypt, Jamaica, El Salvador, Tanzania, Kenya, and Guatemala. Dr. Padmanabhan noted that academic physicians may find that combining clinical trips with research endeavors can eliminate the need to use vacation. Additionally, ophthalmologists could keep it in mind when negoti- ating their employment contracts. "The right employer will often allow you to tailor your contract to maximize your time available to work abroad," Dr. Padmanabhan said. Logistical requirements In order for such volunteer missions to work best for the surgeon and the patients, experienced surgeons suggested going under an umbrella organization knowledgeable about operating in that country. But they noted that every international volunteer group is different. Dr. Patterson said some organizations may allow surgeons to show up and they provide all the equipment and staff, while others have nothing. The organization Dr. Patterson has volunteered through, Health Talents International, has its own facility in rural Guatemala and a permanent staff of local workers. But when he travels there to per- form cataract surgery he also brings volunteers—usually college students studying medicine or nursing—as well as his own scrub technician and office staff members. "That way, the people who already understand ocular issues, both in an office setting and surgical setting, can be there," Dr. Patterson said. "It's important to have people who already know the basics of eye- care and eye surgery." Dr. Padmanabhan urged visiting surgeons to bring as much surgical material as possible with them and, if possible, train the local ophthal- mologists in their use and leave the equipment behind. Many compa- nies are willing to donate materials for the purpose of a service trip. Communication with the local staff several months ahead of time allows them to gather the appropri- ate patients, who may need to travel far distances, Dr. Padmanabhan said. Cross-specialty efforts can also help. "The most successful camps I've seen partner with their anesthesiol- ogy colleagues, either as part of the traveling team or in-country," Dr. Padmanabhan said. If a U.S. anesthesiologist is unavailable, it's important to try to identify one in-country ahead of time who can work with them. Dr. MacDonald urged first-time volunteer surgeons to accompany an experienced lead surgeon and be willing to perform critical preop and postop patient work as part of the team. "Having that attitude of easing yourself into the experience and pacing yourself is an important piece," Dr. MacDonald said. Needed skills The more advanced cataracts of patients in developing countries require surgeons to first acquire the skills to treat them. The ASCRS Foundation and AAO have resourc- es online and offer international volunteerism courses at their annual meetings. "Every surgeon who is vol- unteering should be capable of performing small incision cataract surgery, and there are courses to pre- pare for that," Dr. MacDonald said. "They need to understand that these are cases where they are going to be challenged and are much more diffi- cult than the ones that we routinely see in the United States." Specific equipment that may be helpful includes the miLOOP (Iantech), which is a small snare ac- tivated by a thumb deployment that chops the lens. Dr. MacDonald has found it useful for harder cataracts. "It may be a skillset that sur- geons want to obtain so that when they volunteer internationally they are able to use that technology," Dr. MacDonald said. EW Editors' note: Dr. MacDonald has financial interests with Iantech. Drs. Padmanabhan and Patterson have no financial interests related to their comments. Contact information Patterson: larryp@ecotn.com Padmanabhan: s.padmanabhan@ucsf.edu MacDonald: susan.m.macdonald@lahey.org

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