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I read with interest the article by Pawiroredjo et al1 which described an intervention programme to increase the cataract surgical rate in Suriname. I commend the team at the Suriname Eye Centre (SEC) for their efforts towards eliminating avoidable cataract blindness and visual impairment. The Suriname Rapid Assessment of Avoidable Blindness (2013-2014) survey showed that the proportion of eyes with a postoperative visual acuity <6/60 (poor outcome) was lowest in eyes operated at the SEC (8.5%), higher for the Cuban Mission Milagros (18.8%) and highest in surgeries performed by foreign humanitarian ophthalmic missions (33.3%).
In neighbouring Trinidad and Tobago, Persad and Bhola reported higher complication rates following cataract surgery performed by a foreign visiting team over a 2-week period compared to those done by local surgeons2. Despite a similar case mix, the visiting team had a sixfold higher vitreous loss rate and a fourfold higher overall surgical complication rate. The authors recommended careful screening of visiting surgical teams by relevant authorities. This supports Pawiroredjo’s suggestion of lowering complication rates and improving outcomes by regulating and limiting access of less experienced foreign ophthalmic teams to eye camps, where 50% of poor outcome was caused by intraoperative complications.
Suriname has achieved cataract surgical coverage (for all VA levels) of 90% in bilaterally blind or visually impaired individuals age...
Suriname has achieved cataract surgical coverage (for all VA levels) of 90% in bilaterally blind or visually impaired individuals aged ≥50 years.3 This has been accomplished by training its local surgeons in phacoemulsification and strengthening ophthalmic services at the SEC, resulting in a self-sufficient and sustainable system. This is in line with WHO’s framework for strengthening health systems and use of cataract surgery as a proxy indicator for the provision of eye care services4. It could also explain the difference in surgical outcomes between visiting and local teams. Other Caribbean territories should follow the Suriname initiative to improve eye care services in the region.
1. Pawiroredjo JC, Minderhoud J, Mans DRA, et al. Br J Ophthalmol 2017;101:89–93.
2. Persad S, Bhola R West Indian Med J 2010;Vol 59 (suppl. 3)
3. Minderhoud J, Pawiroredjo JC, Themen HCI, et al. Blindness and visual impairment in the Republic of Suriname. Ophthalmology 2015;122:2147–9.
4. World Health Organization Universal eye health: a global action plan 2014-2019 available at http://www.who.int/blindness/actionplan/en/