The medics on the FBR relief teams are a brave and honorable group that I would love to help and encourage.
I am a pediatric ophthalmologist in Anchorage with extensive experience in remote children's vision screening and amblyopia (lazy eye) treatment in Alaska. Over the last four years and six trips with FBR, I have observed 1) common farsighted astigmatism and 2) a desperate lack of spectacles in the Karen and other ethnic groups in Burma. I estimate that at least 100,000 people in the Karen state alone are functionally vision impaired simply due to lack of glasses.
Over the last five trips to the Thai-Burma border with FBR, we have developed a 3-stage plan to screen and examine eyes, then provide on-site spectacles. We have trained 15 medics in northern Karen state and 12 in southern Karen state to do this.
The simplest stage is just reading glasses. About 30% of Karen benefit from these. Especially those between 40-50 years old. Our favorite type is a thin, sturdy reader than fits in a cigar-case rendering it practical in a back-pack.
The next, and intermediately simple stage, is what we call "Burma Bifocals." Many adult Karen (and Shan and Wa) have farsightedness combined with an astigmatism perpendicular to the typical American astigmatism (Americans have football shaped corneas lying down whereas Karen have football shaped corneas upright- ready to be place-kicked). About 30-40% of Karen, especially those over age 50 benefit from "Burma Bifocals."
The third, and most complex stage is a technique to allow FBR medics, or doctors, to manufacture custom spectacles in the field. Kind-of a Lenscrafters-in-a-backpack providing glasses-in-about-10-minutes. A set of 140 custom nearsighted, farsighted and astigmatism lenses are carried in a zippered notebook. Also included are two fitting racks of lenses and a retinoscope exam light. Medics learn how to select the 38 mm round lenses, and then fit them in custom "Burma-spectacle" 38 mm round glasses for children and adults. About 30% of Karen benefit from these custom glasses.
An additional 10-20% have cataracts or other conditions about which Mitch Ryan and others are devoting tremendous effort.
My intent is to encourage FBR. To strengthen the medics and not make their task more complicated.
The FBR medics often are faced with discouraging and "hopeless" medical conditions. I believe that delivering immediate vision improvement will have a multiplied benefit. 1) adults and children will see better, 2) adults will be able to read to the children, 3) a few might not step on land mines and 4) the medics will be encouraged knowing that a simple addition to their back-pack load was able to immediately help many of their people. Please view this VIDEO.
Robert W. Arnold, MD
