Post on 12-Jul-2015
Manual Small Incision
Cataract Surgery :
The BEGINNINGNawat Watanachai
Chiangmai University Hospital
RCOPT 2014
Special Thanks to
Associate Prof. Anuchit Poonyathalung, MD
Aektet Chansue, MD
Nawaporn Techamaneesathit, MD
Prof. Sanduk
Ruit
2006 Ramon Maysaysay Award
2007 Prince Mahidol Award
2007 Honorary Officer of the Order of Australia for service to
humanity
Prof. Sanduk Ruit
2011 ‘Out of The Darkness’ Movies - Italian director Stefano Levi
2011 BBC documentary series Human Planet, episode 5
2014 Australian documentary dedicated to Fred Hollows
Nepal’s Eye
Problem
not enough eye docs
no eye doc in the remote
areas
poor transportation
system (esp in the
mountainous areas)
poor patients
suffers the pts/ burdens to
the family
170,000 blind people
70% cataract
+30,000 cataract blindness/ year
90% of blind population lives in
remote areas
150 eye docs (1/ 189,000)
90% works in urban areas
Nepal Ministry of Health
Vision 2020, WHO
Nepal’s Eye Problem
The Solution
lower the price
IOL
surgical technique
offer cataract Sx service
to the remote areas
surgical technique
camp surgery
eye doctors
The Solution
lower the price
IOL
surgical technique
offer cataract Sx service
to the remote areas
surgical technique
camp surgery
eye doctors
lower the price : IOL
Prof. Fred Hollows
problem : IOL from major manufacturers are too
pricey
solution : ask for special price from the leading
companies
lower the price : IOL
Prof. Fred Hollows
problem : IOL from major manufacturers are too
pricey
solution : ask for special price from the leading
companiesFAILED!!!!
lower the price : IOL
Prof. Fred Hollows
problem : IOL from major manufacturers are too
pricey
solution : build their own factory!!!!
lower the price : IOL
Prof. Fred Hollows
AUS
Prof. Ruit’s mentor
visited Nepal in 1985 as a
consultant to the WHO
together with Dr. Sanduk
Ruit
set the goal of their lives to
help the blinds
lower the price : IOL
Prof. Fred Hollows
Fred Hollows Foundation
1992
Fred Hollows IOL
Labolatory
Nepal
Eritrea
1990 Australian of the year
1991 Companion of the
order of AUS
lower the price : IOL
Fred Hollows
Foundation
Fred Hollows IOL
Laboratory
1994 opened
computer-ctrl IOL
prod.
got SGS certification
(UK)
1993 Prof. Hollows
passed away
lower the price : IOL
1994 started producing rigid IOL (4 USD/piece)
2005 started producing foldable IOL
>400,000 IOL/Yr
>3.5M IOL
approved supplier for IOL in WHO’s VISION2020 project
on the way
to produce hydrophobic IOL
have their own eye drops factory
lower the price : IOL
>70 Countries in which FHF
IOLs are distributed Bangladesh
Cambodia
China
Egypt
Indonesia
Iran
Malaysia
Mongolia
Myanmar
Pakistan
Philippines
Sri Lanka
South Africa
ThailandVietnam
The Solution
lower the price
IOL
surgical technique
offer cataract Sx service to the remote
areas
surgical technique
camp surgery
eye doctors
Prof. Sanduk Ruit
MSICS
Cataract Sx Technique
ECCE PE
instrument/ price less more
mobility more less
time of Sx more less
postop. pain/
astig.more less
skill needed less more
Cataract Sx Technique
ECCE PE MSICS
instrument/
priceless more less
mobility more less more
time of Sx more less less
postop. pain/
astig.more less less
skill needed less more less
Cataract Sx Technique
MSICS
instrument/ price less comparable to ECCE
mobility more comparable to ECCE
time of Sx less comparable to PE
postop. pain/ astig. lessin the middle between
ECCE/PE
skill needed lessneeds few adjustment from
ECCE
How MSICS work?
1. conj peritomy
2. curved scleral tunnel
3. V-shape capsulotomy
4. move nucleus into the AC
5. nucleus extraction
6. cortex clean up
7. IOL insertion, remove
capsule
8. close wound
How MSICS work?
1. conj peritomy
2. curved scleral tunnel
3. V-shape capsulotomy
4. move nucleus into the AC
5. nucleus extraction
6. cortex clean up
7. IOL insertion, remove capsule
8. close wound
How MSICS work?
1. conj peritomy
2. curved scleral tunnel
3. V-shape capsulotomy
4. move nucleus into the AC
5. nucleus extraction
6. cortex clean up
7. IOL insertion, remove capsule
8. close wound
How MSICS work?
1. conj peritomy
2. curved scleral tunnel
3. V-shape capsulotomy
4. move nucleus into the AC
5. nucleus extraction
6. cortex clean up
7. IOL insertion, remove capsule
8. close wound
How MSICS work?
1. conj peritomy
2. curved scleral tunnel
3. V-shape capsulotomy
4. move nucleus into the AC
5. nucleus extraction
6. cortex clean up
7. IOL insertion, remove capsule
8. close wound
How MSICS work?
1. conj peritomy
2. curved scleral tunnel
3. V-shape capsulotomy
4. move nucleus into the AC
5. nucleus extraction
6. cortex clean up
7. IOL insertion, remove capsule
8. close wound
How MSICS work?
1. conj peritomy
2. curved scleral tunnel
3. V-shape capsulotomy
4. move nucleus into the AC
5. nucleus extraction
6. cortex clean up
7. IOL insertion, remove capsule
8. close wound many need 0-1 stitch in most
cases
The Solution
lower the price
IOL
surgical technique
offer cataract Sx service to the
remote areas
surgical technique
camp surgery
eye doctors
The Solution
lower the price
IOL
surgical technique
offer cataract Sx service to the
remote areas
surgical technique
camp surgery
eye doctors
Eye Doctors
Tilganga Institute of
Ophthalmology
established in 1994
provide medical
training in over 18
countries
Eye Doctors
Tilganga Institute of Ophthalmology
facilities
Fred Hollows IOL lab
Research department
eye bank
18 outreach microsurgery eye
clinics
looking forward to built eye
medication factory
Eye Doctors
Nepal docs
foreign docs from US, EU, Asia, Aus,
Africa
Programs
Residency program 5X/yr, 3 yrs course
Modular training programs,
specific courses, 1-3 mths course
fellowship, 1 yr course (VR, cornea)
Exposure training programs
medical students
The Solution
lower the price
IOL
surgical technique
offer cataract Sx service
to the remote areas
surgical technique
camp surgery
eye doctors