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

An opthalmologist uses ultrasound to treat cataracts at Ha Noi Eyes Clinic. The new technology is said to be beyond the financial reach of the visually impaired poor. (Photo: VNS)

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.

VietNamNet/Viet
Nam News