Refer this article as: Guballa, H., Cataract in the Philippine: Past, Present and Future, Points de Vue, International Review of Ophthalmic Optics, N61, Autumn 2009
Cataract in the Philippine: Past, Present and Future
Although the incidence of blindness in the Philippines has steadily declined over the years, cataract remains to be the single most significant cause of remediable visual impairment or blindness. From an overall incidence of blindness of 1.02% in the mid eighties (based on findings of the first national blindness survey), it has gone down to 0.57% in early two thousand ( based on findings of the third national blindness survey ). Yet cataract still ranks the number one cause of blindness, accounting for no less than 70% of blind individuals surveyed.
Addressing the cataract blindness problem however has grown by leaps and bounds. Aside from the dramatic increase in the number of ophthalmologists, access to and delivery of services has evolved as well. Surgical techniques and equipment have improved over the years and availability of intraocular lenses have ceased to be a problem. In the early eighties, a majority of cataract procedures being performed were intracapsular cataract surgeries and intraocular lens implantations were rare. By the mid eighties there was a large surge to shift to extracapsular cataract surgery and lens implantations dramatically increased. Then phacoemulsification was introduced in the late eighties. At present, routine cataract procedure for a great majority of cases are either phacoemulsification or extracapsular cataract surgery. Lens implantation is the norm. The choice of extracapsular surgery technique is fast shifting to small incision cataract surgery in the last few years. Outpatient cataract surgery is now being performed in a great many hospitals and ambulatory surgical facilities and inpatient surgery is fast dwindling.
Initially, in the late eighties, programs by the Department of Health (DOH) backed by non-governmental organizations made the initial organized effort in addressing the cataract blindness problem by launching a Primary Eye Care program (PEC). This basically increased awareness about eye problems including cataract by training community health workers (mostly of the Department of Health) in primary eye care and establishing referral networks for enhanced access to eye care services. Shortly after, to improve the access of these referrals to ophthalmologists the modified residency training program (MRTP) went full blast. Unfortunately with the devolution the DOH PEC program simply faded away.
An earnest effort in improving the distribution of practicing ophthalmologists occurred with the modified residency training program (MRTP). In the mid eighties, as many as 72 provinces still had no government eye doctor. In fact for a lot of these areas there was no single practicing ophthalmologist for the entire province. The MRTP recruited doctors serving with the Department of Health from areas identified to have no government eye doctor and trained them under an accredited ophthalmology residency program. The training hospitals of the program included the Philippine General Hospital and other base hospitals in Luzon, Visayas and Mindanao. Upon completion of their training, these doctors went back to their respective hospitals and served the province or region for an agreed term of no less than 6 years as a government eye doctor. Financial and logistical support for this program came largely from two non-governemntal organizations : Helen Keller International and Christoffel Blinden Mission. These doctors also became the initial trainors and resources persons for the DOH primary eye care program in the nineties.
Subsequently, in the mid nineties, with the launching of Vision 2020, more non-governmental organizations and civic organizations joined in the fight against blindness. The National Committee for the Prevention of Blindness ( NCSP ) was formed. It was composed of both government agencies and non-governmental organizations who were considered key players in the fight against blindness. Government agencies (like the Department of Health, Department of Education and Sports and the Philippine Information Agency) and nongovernmental organizations including allied health professionals (like Optometrists organizations), civic organizations (like Rotary and Lions) and other non-government organizations and foundations (like Helen Keller International, Christoffel Blinden Mission and its partner organizations, Tanggal Katarata Foundation, Foundation or Sight and Ophthalmologic Foundation of the Philippines to name a few) bonded together to initiate the organized effort to implement Vision 2020. Priority areas of Vision 2020 Philippines include cataract, refractive errors and childhood blindness.
Concepts in trying to address the cataract problem has also undergone quite a few paradigm shifts. While in the eighties services were concentrated in urban hospitals and the eye specialists simply waited for patients to come to them, the emergence of more nongovernmental organizations and civic organizations pushing for greater efforts to solve the cataract back log led to community based screening efforts, outreach surgical activities and surgical missions in the nineties. In early two thousand, the Philippine Academy of Ophthalmology initiated another paradigm shift among its members. It adapted the concept of : «my community, my responsibility» thereby shifting the primary role of attacking the cataract problem to the local ophthalmologists. Missions were encouraged only in areas where there were no eye doctors but coordination with local chapters of the academy and assurance of post-operative followups started to be closely monitored. To further institutionalize this concept, the NCSP started to help local groups to form local (provincial) sight preservation committees.
With cataract phacoemulsification procedure becoming more popular and available, there also emerged the need to re-define when a cataract can be deemed operable. In the early two thousand, the Philippine Academy of Ophthalmology embarked on formulating cataract guidelines. Thus emerged the Philippine cataract guidelines, not only based on consensus and mere recommendations but also applied principles of evidence based medicine. Hand in hand with this was the formulation of the Philippine Academy of Ophthalmology mission guidelines. These guidelines contain recommended parameters to ensure the quality of surgery that is performed even in primary or other smaller hospitals in rural areas. The attempt to solve the cataract blindness problem in the Philippines is now a concerted and organized effort. Sure the road has its bumps and potholes but so long as we are steadfast, we surely will get there.