November 2014




Ophthalmologist leads knowledge, outreach trip

by Michelle Dalton EyeWorld Contributing Writer


Dr. Asbell discusses surgical techniques with Prof. Win and other faculty members.

Cornea consultation at Myanmar with Prof. Win. The traditional male dress, a longyi, is very comfortable in the warm, humid weather.

Patient with descemetocele. Corneal tissue is scarce and often amniotic membrane is used to seal the eye and protect the globe.

Examining cornea consult patient and exchanging approaches for addressing dense corneal scar. About 100150 transplants are done each year, but the waiting list is more than 3,000.

Source (all): Penny A. Asbell, MD, FACS, MBA

Some surgeons not only embrace teaching others, but choose to do so outside their comfort zone and outside the U.S. For decades, Myanmar (also known as Burma) had closed borders that prevented foreigners from entering the countryand that included medical personnel on training missions. When Penny Asbell, MD, heard about a medical mission to Myanmar for the purpose of training residents and surgeons on various corneal surgical techniques, she quickly volunteered her time and expertise.

The teaching exchange was organized by John M. Corboy, MD, Hawaiian Eye Foundation (HEF), Mililani, Hawaii, which is well known for its philanthropic work in the South Pacific and Southeast Asian region. Dr. Asbell has regularly participated in HEF-organized teaching missions in Vietnam. Myanmar has roughly 60 million inhabitantsand only 350 ophthalmologists; 70 practice in the countrys largest city, Yangon. There is only one cornea-trained specialist, Dr. Asbell said. In Myanmar, it takes 6.5 years to become a doctor, before any specialty training, she added.

After getting their medical degree, they do a year of internship, then 2 years of government service. Then they have to pass an exam to see if they can get into ophthalmology, she said. There are about 1220 residents a year specializing in ophthalmology, but only 4 programs country-wide. Although previously a wealthy country when it was under British rule, the Human Development Index ranks the country as having one of the lowest levels of human development in the world, likely a result of decades-long civil wars and ethnic cleansing after the British withdrew. Currently, estimates of per capita income are about $230 (although data is unreliable).

Were certainly indebted to HEF for having organized this course, Dr. Asbell said. It was a wonderful experience. Prof. Tin Win, department head of the Yangon Eye Hospital, served as the surgeons host during their time in Myanmar. Dr. Asbell said the country started an eye bank in 1993, and receives between 100150 corneas a year, but Prof. Win shared with me that he has a waiting list of 3,000 patients who need corneal transplant surgery. And the government is of little help, spending anywhere from 0.5% to 3% of its GDP on healthcare, leaving patients to pay for medicine and treatment even in public clinics. According to the RANZCO Eye Foundation, Surrey Hills, Australia, the country has a backlog of more than 600,000 cataract surgeries, and less than half the ophthalmologists in the country are trained to perform surgery. RANZCO notes that Myanmar has an 8.1% blindness prevalence rate, caused by cataracts (64%), glaucoma (17%), trachoma (4%), and other causes (15%). Low vision is rampant40.4% in rural areas, 70% of which is attributed to cataract.

Covering the bases

The HEF-organized course covered a range of topics from cataract and corneal external disease to glaucoma and retina issues.

We even managed to squeeze in some instruction on pediatric ophthalmology and refractive laser surgery, Dr. Asbell said. Throughout the 4-day Myanmar Eye Meeting course, if the surgeons were not lecturing, they were invited to share their expertise in clinic. We wanted to share our knowledge and invited the clinic personnel to bring back any patient they wanted an additional consultation on, she said. As almost everyone is bilingual, language barriers were not an issue.

In addition to HEFs donating equipment, the Singapore division of Carl Zeiss Meditec donated equipment as well, Dr. Asbell said. Myanmar has some pretty modern equipment theyre beginning to accumulate, including optical coherence tomography, she said. Clinics were run at Prof. Wins site, and the surgeons also visited the American Vision Center in Yangon, a privately run vision center. Lectures were attended by students, residents, and current faculty, and the question and answer period was totally pertinent and quite well thought out, Dr. Asbell said. The course was designed to be typical of fellowship-level topics, Dr. Asbell said. For example, in Myanmar it is common to use amniotic membrane to fill the hole after treating a corneal melt, which impressed Dr. Asbell. It might not be how I would treat a patient, but theyre pretty experienced with it. There is an abundance of ocular surface disease, a fair amount of Stevens-Johnson disease, she said. There are chemical burns. In the United States, chemical burns are typically industrial, but in Myanmar its more likely a result of an argument where someone throws a chemical in somebodys face. Dr. Asbell illustrated how to perform a patch graft and the advantages of using that treatment; other topics included treating ocular herpes and preventing recurrence.

It was definitely not a one-way street. We shared how we handle difficult cases, and we learned about some of their innovative approaches, like the use of amniotic membrane when fresh cornea tissue is not available, she said. Partnering with a non-profit like the HEF fits my goals, Dr. Asbell said. I dont want to go and just do surgeryI want to teach skills that can be of continuing benefit to the physicians and their patients. HEF is planning another teaching course and has been invited to return in the fall of 2015, Dr. Asbell said. This was a great meeting. I do sense that it was a shared experience, she said. I had a very warm feeling about the interactions and thought that the attendees wanted to learn as much as they could from us. We can use some of their techniques, too. Im looking forward to the next opportunity.

Editors note: The Myanmar Eye Meeting was conducted by HEF in partnership with the Yangon Eye Hospital, Carl Zeiss Meditec Southeast Asia (Singapore), and the Myanmar American Vision Company. HEF is a non-profit organization, and volunteers fund their own travel and lodging. Dr. Asbell has no financial interests related to her comments.

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