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Others    New eye surgery fails the poor (Dec 22, 2010)

Phacoemulsification surgical technology has failed to eradicate cataract-caused blindness in Viet Nam because not enough people have access to it.

The technique had unexpectedly impeded the blindness eradication process, complained leading ophthalmologists, given both cost and surgeons' bias against traditional eye surgery.

Phacoemulsification surgery, also known as phaco among surgeons, employs ultrasonic tips to break up clouded lenses which helps restore vision, while the traditional extracapsular extraction removes cataracts through incisions.

The new technique involved the use of a machine, whereas the traditional method could be performed manually, according to eye surgeons.

The smaller incisions used in the phaco technique allows for faster recovery time, while manually operated patients have to stay in hospitals with limited physical activities for weeks.

Phaco surgery costs VND6 million (US$300), eight times the amount of the manual technique.

On the other hand, surgeons can travel to outlying provinces to perform manual surgery on poor patients who cannot afford to go to eye clinics in big cities where phaco technology is available.

However, since phaco technology was introduced in the country five years ago, it has replaced the traditional surgery to the extent that the latter has become almost extinct.

"Provincial hospitals which are already equipped with phaco machines have stopped organising trips to remote districts to perform operations on poor patients," said Phi Duy Tien, deputy director of HCM City's Eye Hospital.

"This poses a big obstacle to the national objective of blindness relief," he added, noting that after five years, phaco technology had spread to eye clinics across the country like a ‘very appealing fashion'.

Up to 80 per cent of provincial hospitals are equipped with phaco machines.

In northern Nam Dinh and central Thanh Hoa Provinces, phaco technology accounts for up to 80 and almost 100 per cent of ocular surgery respectively.

"Patients who can afford the technology have already gone to provincial hospitals for surgery," said Nguyen The Luong, former director of northern Bac Ninh Province's Eye Clinic.

In the meantime, charity eye surgery trips to faraway districts had decreased in recent years, according to Dr Do Nhu Hon, director of Ha Noi-based Central Eye Hospital.

Lots of poor patients had their sight restored on such kinds of trips, he noted.

Benefactors are still committed to extracapsular cataract surgery given the low cost involved that enables them to help more visually impaired people.

However, surgeons are no longer interested in manual surgery due to poor payment and their craving for ‘advanced technology'.

Dr Hon said that at least 250,000 eye operations were needed on an annual basis to achieve the national target of full eradication of cataracts, which caused up to 60 per cent of blindness in the country, by 2020.

However, the nation's eye clinics could only handle from 120,000 to 150,00 a year at full capacity, he added.

As a result, untreated cases had been piling up, with tens of thousands of new cases each year.

Mechanical and manual techniques should go in tandem to prevent a phaco surgery monopoly, he remarked.

"Frankly speaking, once surgeons learn the phaco technique, they tend to try and improve on it and ignore the old method," said Dr Nguyen Xuan Hiep, deputy director of the Central Eye Hospital.

"Phacoemulsification has more strengths, and surgeons don't have to make stitches," he added, noting that each phaco machine costs from US$20,000 to $100,000.

However, he also noted that it was hard to popularise the advanced technique given the huge cost and lack of trained surgeons. — VNS

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