Bringing specialty contact lenses to Vietnam
At the end of March 2014 I spent three days teaching and consulting in the Refractive Department of the Vietnam National Institute of Ophthalmology (VNIO), in Hanoi. The VNIO is a government ophthalmic hospital, seeing 1500 patients a day, separated over several departments to which a patient’s destination is determined at the reception windows each morning. I was working within the Refractive Department, although our program also involves the Corneal and Paediatric Departments. Minh Anh Tran, one of Vietnam’s two Optometrists (who trained at LV Prasad in India) works closely with Dr Huong, Ophthalmologist and Nurse Huong to manage their patients. Minh Anh tirelessly translated my lectures all morning long, and each afternoon we would see a handful of patients. In three days I saw multiple cases of post-LASIK ectasia, extremely high ametropia (-17.00’s and +12.00’s wearing glasses!) and advanced teenage keratoconus in the magnitude that I’m more likely to see once a week in my practice. No-one was older than their mid 20’s.
Our VNIO contact lens teaching program has been organized by my visionary colleague Gavin O’Callaghan, an Adelaide optometrist who sits on the board of a South Australian not-for-profit called Sight For All. (www.sightforall.org) Sight For All has traditionally focused on educating trainee ophthalmologists in developing countries, particularly in Asia. This is its first optometry program. Sight For All’s volunteer educators will donate 10,000 hours of time to projects in Asia this year alone, and this skills transfer means a lasting effect for tackling blindness and vision impairment in these countries.
Gavin put out the feelers to a group of us Aussie contact lens specialists and visited Hanoi to scope out the project in February. It was initially going to be focused on aphakic babies but Gavin quickly realized that Vietnamese people of all ages could benefit from a comprehensive contact lens program at VNIO. Despite world class knowledge and experience, the staff at VNIO do not have access to world class contact lens products. Until our program commenced, Minh Anh’s contact lens armament was wholly supplied by a Japanese company, and it’s pretty clear that Japanese eyeballs are a whole lot different to Vietnamese eyeballs. No plus powers beyond +3.00, no silicon hydrogels, flatter base curve RGP’s than what we needed in small diameters. My amazing colleague Jess Chi, a paediatric contact lens specialist from Melbourne, has recently returned from our second SFA teaching visit and worked ridiculously hard teaching while also managing to fit loads of aphakic babies – she discovered that a higher incidence of microphthalmia means we’ll need smaller diameter baby lenses.
Contact lenses can be life changing. They can save aphakic babies and keratoconics from visual impairment or blindness. But they don’t even have to be complicated RGP’s to do this – soft disposables can do just as much. I take it for granted that I can get almost anything my patients need, quickly, in my practice. We don’t realize how lucky we are! I was also struck at how supportive and collaboratively optometry and ophthalmology work together at the VNIO. Given, this is just one remarkable optometrist at present (the unstoppable Minh Anh Tran!), as optometry is in its infancy in Vietnam, but the hospital leaders and ophthalmologists on the ground alike could not have been more supportive of our teaching program and our goals. Also, Vietnamese people are probably among the nicest in the world! Think how much we could achieve for people at home, particularly those who are financially disadvantaged, if we could achieve stronger inter-professional collaboration in our public health system.
Optometry as a profession, and provision of optical products, are not yet a regulated in Vietnam, so Minh Anh cannot sign off on any prescriptions, but you can walk across the street from the VNIO and buy a pair of glasses from a number of optical shops after an auto-refraction. Contact lenses can be bought on the street, so of course the VNIO ophthalmologists are more used to seeing nasty coloured lens disasters than seeing the difference that specialty contact lenses can make to their patients. I got talking to a highly myopic musician one evening after watching her and her group perform traditional Ca Tru chamber music. In her early 20’s, she explained that her glasses gave her headaches and her vision felt funny. Oh how desperately I wanted to check her binocular vision! An autorefractor can never replace a proper refraction. I told her to go and see the only optometrist in Hanoi for a proper eye exam!
If you’d like to learn more about Sight For All, or even better, donate to its education initiatives, go to www.sightforall.org.