Dr. Shamshad Ali

Assistant Professor of Ophthalmology

at Services Institute of Medical Sciences, Lahore

Jahangir’s World Times (JWT): How do you see the state of affairs regarding the prevalence of eye diseases in flood-hit areas?
Dr Shamshad Ali: As you know that Pakistan has faced this year the most devastating flood in its history. A glimpse into the severity of the damage – unimaginable in the words of UN Secretary-General António Guterres – caused by this catastrophe can be had from the estimates being presented by the government and multiple international agencies. They suggest that almost one-third of the country has been badly affected by this flood of biblical proportions, causing gigantic losses in terms of life and property. People in these calamity-hit areas were left with no option but to leave their inundated houses and areas, and stay in shelters set up for them. Since many areas remained submerged in water many weeks; therefore, sanitation and hygiene conditions present a gloomy picture, and many diseases have broken out. Although ailments like diarrhoea, gastroenteritis and other stomach problems, as well as skin diseases, were very common in these areas, malaria is also rearing its ugly head as stagnant water provides mosquitoes an ideal breeding place. Besides, dermatological diseases and conjunctivitis (pink eye, a condition caused by infection or allergies) are becoming rampant. As people in these areas had left their homes, they hardly have spectacles, especially those who would use them while doing household chores or while reciting the Holy Quran. Numerous people come to medical camps we have set up there with request for glasses. But, as the rehabilitation work is very slow-paced, the number of patients is constantly increasing, which is likely to further grow.

JWT: Do you think some special medicine for eye care should be included in the first-aid kits being provided to the flood-affected people?
Dr Shamshad Ali: Yes, of course! While other diseases are being treated through medical camps and mobile teams, ophthalmology treatment should also be a part of these efforts. We need to provide the people with full diagnostic and treatment facilities, as well as with all required medicines. In particular, as I mentioned earlier, infection and allergy-related conjunctivitis is being reported more frequently, so antibiotics and other medication must be added to treat this. Administration of anti-cataract and anti- conjunctivitis medication under the care of an ophthalmologist (eye specialist) will go a long way in safeguarding the eyesight of many patients. Even if an ophthalmologist is not part of the team, these medications must be included.

JWT: How rescue workers can provide first aid for eye problems in areas where doctors haven’t reached yet?
Dr Shamshad Ali: In such areas, people associated with other fields of this profession can help patients in treating eye problems to a great extent as they can educate patients on better hygiene practices, prescribe antibiotics for them, and so on. Nowadays, with the advent of tele-medicine, people can use various social platforms to get instant consultation from an ophthalmologist by sending him/her pictures and making video calls. Elderly patients may be provided with glasses.

JWT: Do you see any upsurge in the number of patients if flood victims are not treated immediately for eye problems?
Dr Shamshad Ali: Yes, the number will rise and this is a very important aspect that needs immediate attention. Although treatment in some eye disorders can be delayed for a while, there are some that require early or immediate handling. Those falling in the latter category – as they pose a high risk of vision loss – include eye sores and ulcer that can spread the infection all through the eye, leading to the loss of vision. Many eyes can be saved by providing timely treatment. Other disorders that require early treatment include cataracts, conjunctivitis and retinal diseases. Recently, during the Covid-19 pandemic, many patients lost their sight as they could not get timely treatment for these diseases. Black cataract is a silent killer of vision and its continuous treatment is very important. But while the flood victims are suffering from many other problems, black cataract, as well as the continuous supply of its medicines to the patients, is also a big problem. In these circumstances, the number of patients is continuously rising and the patients may also face many more problems in the coming days.

JWT: What precautions should the flood victims observe to avoid eye disorders?
Dr Shamshad Ali: As far as precautionary measures are concerned, I would say that while many other diseases can be avoided by adopting hygiene and a proper sanitation system, eye diseases too can be prevented in the same way. If you think your eyesight is weakening, do consult a doctor and wear the glasses (s)he recommends for you as regular use of glasses can save you from headaches, eye pain and vision loss. As the recovery process progresses, people with eye disorders should get regular checkups and treatment so that they don’t lose the blessing of sight.

JWT: Given the current prevalence of eye disorders in Pakistan, what number of ophthalmologists is required in the country?
Dr Shamshad Ali: Currently, there are only, on average, 11 ophthalmologists per million population in both Pakistan and India — other South Asian countries like Bhutan, Nepal, Bangladesh and Sri Lanka have even fewer of them while that ratio is about 38.4 in developed countries. According to guidelines of the World Health Organization (WHO), Pakistan needs, at least, 15 ophthalmologists per a million population. Unfortunately, a good number of ophthalmologists are leaving the country for seeking better employment opportunities abroad. This trend is causing a further shortage of specialist doctors here.
On the contrary, in Pakistan, vices like a sheer disregard for merit, precarious law and order situation meagre salaries, lack of employment opportunities and favouritism are forcing skilled and capable people to migrate to foreign countries. The drain of smartest brains still continues but, perplexingly, the authorities here do not bother.

JWT: What are the initial symptoms which indicate that a person has caught an eye disease?
Dr Shamshad Ali: Since the primary function of eyes is to see, the earliest symptom of eye problems is weakening eyesight. Such a person should consult an eye specialist who would check if the reason behind this is only the number of the lenses or something else, and treat that in time. Another major cause of vision loss is cataract, which can be corrected with a few minutes of surgery and lens insertion, and the patient can see clearly again.
If a patient suddenly loses his eyesight or has severe eye pain or extreme redness, (s)he must immediately consult a qualified doctor, as these symptoms are more likely to result in permanent loss of vision or blindness. In fact, these symptoms are the signs of retinal detachment, blood-vessel blockage, bleeding in the eyes or acute attack of black cataract.

JWT: If there is an eye emergency, what the affected person must do immediately?
Dr Shamshad Ali: Actually, eye emergency can be of various types. If the eye is damaged in an accident, it should be immediately covered with a clean cloth or tissue paper and the patient must be taken to a nearby hospital as early as possible. If any chemicals or battery acid gets into the eye, one should go to the hospital immediately. If it is difficult to get to the hospital or if it may take some time, eyes should be immediately washed thoroughly with clean water and the person should reach a hospital as soon as possible for treatment. It is necessary to use glasses with large lenses while doing welding or any other mechanical work(s).

JWT: How frequently a person should have a complete eye check-up?
Dr Shamshad Ali: When a child is born, he must be checked up by an ophthalmologist so that if there is an eye problem, it can be diagnosed in time. Examination of a kid’s eyes is necessary second time before he starts going to school.
Aside from kids, there are two types of population: people who know the number of the lenses, and the other who do not know about the lenses they should be using. I recommend that you should have a complete eye check-up after every six months. This is in the case of people who do not have diseases like blood pressure and diabetes.
People having problems like diabetes and blood pressure should have a detailed eye examination once a year. If the effects of diabetes or high blood pressure begin to show, eye examinations are scheduled according to severity. For patients with less severe changes, a check-up is required after six months. And those with more severe changes may need monthly or weekly follow-ups as well.
In addition, there is a high possibility of catching cataract in people who are 40 years old or above. Such people, especially if they have a family history, must get themselves screened for black cataract.

JWT: There are some superstitions prevalent among the masses regarding eye treatment, e.g. eye drops can dissolve cataract, cataract must mature before it can be removed, cataracts can be removed with lasers, eyes can be transplanted, and so on. How much truth is there in these?
Dr Shamshad Ali: Yes, there are still many such notions found in our society. I know an aged person who has been evading surgery for cataract since long because he believes that he will die soon after having that. People don’t go for surgery in summer and rainy season because the wound, they believe, doesn’t heal soon, and there is a lot of sweating as well. There are also drops available in the market that claim to dissolve cataracts. But, believe me, there is still no medically approved product that can do this. So, you should avoid these so-called medications. The only universally accepted treatment for cataracts at present is surgery; there is a false notion even about it that this operation is done by laser. The fact is that the technology is so advanced today that no sutures are used in white cataract surgery. The lens is also foldable which is inserted into the eye with the help of an injector and it opens after entering the eye. If there is no need to apply any stitches, the patient thinks that maybe my operation was done with laser. Although the actual technique is ultrasound, which is called Phacoemulsification, in which it is melted and removed by ultrasound waves. Cataract is not operated by laser. In addition, there is no need to let the cataract ripen before getting it removed. The eye cannot be transplanted; it is connected to the brain through the optic nerve which cannot be reconnected once disconnected. Only the cornea can be transplanted.

JWT: What would you say about the hindrances in the way of better eye treatment in our country?
Dr Shamshad Ali: Despite the presence of free, proper eye treatment in our country, a very small proportion of the population is able to benefit from it. If we study carefully, the problems that are major obstacles to providing better treatment include a lot of rush in hospitals, financial constraints, people preferring home remedies, traditional treatment, wearing unsuitable glasses, etc. The Sehat Sahulat Program by the state is a very welcome initiative; however, there is still much room for improvement.

The writer can be contacted at: misteratif@yahoo.com