Category: Case Studies

1. Why did you choose to study optometry? Could you tell us about your journey into this course?

Having grown up in a mainly low income neighborhood in one of Kampala’s suburbs in Uganda with a Type 1 Diabetic sister, who I frequently had to escort for her medical visits and checkups, I was early on introduced to some of the complications of the disease. One of the many clinics my sister was advised to regularly visit was the eye clinic at Mengo hospital in Kampala. Being one of the very few eye care facilities in the country, the waiting line was always long and we normally had to wait for days before ever getting attended to. So many people, particularly those who had to travel long distances from the far corners of Uganda to get these eye care services, usually ended up giving up. They were condemned to lives of reduced vision and blindness. I was never able to comprehend why the doctors constantly emphasized the need for my sister to visit the eye department, having grown up in a community where many eye-related conditions are either ignored or blamed on wizardry, witchcraft or superstition, and where most of the local health centers and clinics mainly focus on what are considered to be more fatal diseases like Malaria, HIV/AIDS, tuberculosis and other infectious diseases. 

It was not until one of our career guidance sessions in my final year of secondary school when one of my teachers talked about the newly introduced optometry course at Makerere University. It was then that I formerly got introduced to the optometry profession. In a country which barely has any primary eye care service providers, it is not surprising that it took me that long. Fascinated by how fondly my teacher spoke about the course, I was attracted to do a little research of my own through the Makerere University website and a number of online optometry journals. With all this information I had acquired, I decided to pursue optometry given that it was a virgin and unmapped field where both my impact and skills could be best felt. Through optometry, I realized that I could have the power to improve the lives of so many individuals, with conditions ranging from refractive errors to more fatal conditions like diabetes and hypertension, which are on the rise in the country. Given my real life testimony of how optometry could impact almost every other field of medicine, I grew passionate about the profession and decided to apply for optometry at Makerere University where I got admitted and have literally learned new and exciting things every day.

2. You are one of the very few student optometrists in Uganda-how does it feel to be part of the movement to improve eye health in Uganda?

To be one of the very few student optometrists in Uganda feels exciting and special at the same time. To have this largely unexplored field with vast amounts of unrealized potential and opportunities and so many unfilled gaps in the eye care sector of Uganda literally challenges me to think bigger, to learn and better myself every day of my life.

3. What would you say to anyone thinking of studying optometry?

I would tell anyone thinking of studying optometry to buckle up for a very exciting and interesting journey in their lives where they will have to be motivated, committed and focused as a lifelong readers, where they would constantly appreciate the satisfaction of restoring vision and improving or even saving lives.

4. What do you want to do once you finish your degree?

After I finish my degree, I would like to further my studies and get qualifications that would make me eligible to teach and train more optometrists in Uganda so that we can quickly build up our numbers. This will give us a stronger voice and a bigger impact in the eye care sector of Uganda. I would also like to actively participate and streamline nation-wide research in the optometry field in Uganda. This will help us uncover and expose the numerous deficits in the eye care sector and challenge us to think of rational solutions to solve them.

5. What are your wishes for the future of eye care in Uganda?

I wish to see a future in which optometry as a profession is well recognized, regulated and integrated in both the private and public sectors of Uganda. A future where eye care services are made available to every last corner of the country. A future where no person should be condemned to a life of low-quality vision and preventable blindness. A future where no student has to drop out of school just because of a simple refractive error, and a future where effective and widespread eye care provision eliminates preventable blindness and increases the quality of lives and productivity of every last Ugandan.

Emmanuel goes to school for the first time

Emmanuel is a 12 year old boy who didn’t attend school. He wished every day he could go with the other children in the village but he had been nearly blind since birth. He spent his days in his village which he knew well enough to get around. His local community tried to look out for him to help him stay safe.

His mother was very unhappy about Emmanuel not being able to go to school. She also wished he could help out with the daily chores as she worked every day in the fields on the family farm. His grandparents used to mind Emmanuel during the day so his mother could work, but his grandmother was becoming more concerned as her eye sight was beginning to dim.

Emmanuel had a cousin, Yusuf, who was very kind to him and used to take time to tell him stories about school and other villages that Emmanuel could not visit. It was Yusuf who helped save Emmanuel from lifelong blindness.

Yusuf had good eyes and was very interested in school. He learnt one day that his teacher had been trained in screening the school children’s eyesight. Yusuf had his eyes tested like all the other children, and all the while he thought of his cousin Emmanuel. He told his teacher about Emmanuel and sadly described his blindness.

Some weeks later the teacher asked again about Emmanuel and gave him a note to take home to his Aunty, Emmanuel’s mother. A few days later the teacher came home with Yusuf to meet Emmanuel. Yusuf was so happy he smiled the whole time. In the village he found Emmanuel’s mother so the teacher could talk to her.

“Compromised in every which way”.

Albinism is a congenital disorder that is characterised by the partial or complete absence of pigment in the skin, eyes and hair. The disorder has a very high prevalence in Tanzania with 1 in every 1,200 people suffering from it. In contrast, the usual occurrence in the rest of the world is around 1 per 14,000. Tragically, many Tanzanian families with an albino child believe they have been cursed and must dispose of the child far from home or abandon them to an orphanage.

Unfortunately, albinos in Tanzania have another deadlier threat to deal with, as Dr. Moes Nasser from Vision Source in Houston discovered on a recent visit to Mitindo orphanage, which is in the same region where he grew up.

Watch the interview with Dr. Nasser here.

“There is a myth in Tanzania that if you own a body part of an albino, you’ll become rich and famous,” said Dr. Nasser. “I’m told that sometimes these albinos are kidnapped and their arms and legs are chopped off, even their organs are removed and they get sold for US$10,000 for each body part. So these albinos are compromised in every which way.”

Compounding these serious threats to life, people with albinism are sensitive to light and are almost universally near-sighted with stigmatism.

“They need to wear sunglasses and a hat.”

At the orphanage, Dr. Nasser observed an albino girl playing with a piece of string that she had found on the floor. When she dropped that string she could not see enough to pick it up. She was struggling to clasp it multiple times.

“So can you imagine what a pair of glasses will do to them? It will transform their quality of life.”

Dr. Nasser examined 70 children and of these 68 needed glasses.

“Some of the patients were very high near-sighted, up to minus 15. Hopefully we’ll get the glasses there very soon.”

The glasses were in fact delivered in October with the help of Dr. Nasser’s brother, Azim, who lives in Kenya. He arranged to have the prescriptions filled and delivered to the children.

“We are so blessed that we have been able to do our little part,” said Dr. Nasser.

Optometry Giving Sight and CooperVision funded the One Bright Vision program in Tanzania which screened close to 100,000 people in 2013 and 2014. That project was managed and implemented by Brien Holden Vision Institute. Dr. Nasser is a regular visitor to the region and always takes time out to provide vision correction to people in need, and training and mentoring support to the local eye care professionals in partnership with the Institute.

Every day, my eyes were so sore

Aged 16, Seakthy wanted to excel at school but she couldn’t see things clearly. Without professional eye care she also wrongly believed that her condition was a normal vision development.

“I started having problems with my eyes when I was studying in grade five. I had headaches and my eyes started getting sore and I didn’t want to study anymore,” said Seakthy. “I was unhappy as my performance at school wasn’t good.”

As her conditioned worsened, Seakthy finally confided in her parents.

Fortunately, a School Eye Health Cambodian project was undertaken recently in Phnom Penh. Its aim was to contribute to the elimination of visual impairment due to uncorrected refractive error in school children and teachers in Cambodia through the development and implementation of a comprehensive school eye health screening program.

The School Screening Project is funded by Optometry Giving Sight and BHVI. Implementing partners include BHVI, Royal Government of Cambodia Ministry of Education, Youth and Sport (MoEYS), Department of School Health (DSH) and the Phnom Penh Municipal Department of Education.

“My school principal and teachers announced that the Brien Holden Vision Institute, supported by Optometry Giving Sight, would be performing school screenings here,” said Seakthy. “I thought it is a good opportunity to get my eye tested. After the screening I received a pair of spectacles”.

Seakthy now wears her spectacles every day. “I cannot do anything without wearing them. I feel very fortunate that I got a free eye exam and spectacles. I can fully focus on my studying and now longer have headaches reading books.”

Seakthy’s studies have improved as well as her confidence to engage in life. “Because of my spectacles I am an outstanding student. I am good at Khmer and English literature and I am a Red Cross Youth representative for my high school. I am happy that I can participate in every activity I want as a result of having good vision. I give thanks to Optometry Giving Sight for supporting this screening activity in Cambodia through which I received a pair of spectacles.”

Overall, the project had 2 School Vision Screening trainings conducted with 30 participants, of whom 10 are MoEYS staff and 20 are teachers. 19,764 students and teachers received eye health screening and 2,225 spectacles were prescribed at 10 schools.

At these schools an awareness of eye health conditions and services presentations were conducted targeting MoEYS staff, school teachers, students and their families.

Since going through this experience Seakthy shares information with her friends, relatives and community about the importance of professional eye checks.

Photos courtesy: Brien Holden Vision Institute

Optometry Giving Sight has provided substantial financial support over the past 7 years to help enhance access to eye care for people in Sri Lanka. 3 Vision Centres have been established and 7 Sri Lankans have obtained their degrees or diplomas in Optometry.

Over the past year, we have contributed to the efforts of the Brien Holden Vision Institute and the University of Colombo in Sri Lanka to establish the country’s first optometry degree program. As a result, eye care in Sri Lanka is gradually becoming recognised by the government as a priority for the country’s health care sector, and as an important profession in the Sri Lankan health system.

There is much enthusiasm for the optometry program in both the government and private sector, with the first intake of 20 students anticipated in January 2015. Around 40 to 50 students will be enrolled in subsequent years to meet the targets of the National Eye Care Plan.

Once they graduate, the students will join the eye care work force, supporting existing structures, creating new infrastructure and sustaining service delivery across the country, making comprehensive eye health services accessible at primary, secondary and tertiary levels.

Niroshan, who took part in a one-year vision technician course in India with the LV Prasad Eye Institute in 2008, now has more than five years of work experience in the Warakapola Vision Centre. He has provided eye examinations to over 12,000 patients. Over the past three years he has also been working in the National Vision 2020 program eye clinics where he has assisted community eye screening projects on a monthly basis, and in 2011, he undertook a diploma course in optometry at the Sri Lanka Foundation.

He is excited about the introduction of the optometry degree program in Sri Lanka as he knows it will strengthen the overall quality of eye care that will be available to local people.

“Most of the people in local communities lack eye health awareness or basic vision care education, so when they hear about our clinic they come to us with life-long, untreated eye conditions including refractive error,” he said.

“It is very common for young children to have eye conditions which are avoidable with earlier treatment, and unfortunately they lead to a stifled or incomplete education and divergent career paths. A sad fact is that many parents do not even know their children are having problems with their vision”.

Niroshan said he recently treated a young girl who was suffering from eyestrain and frontal lobe headaches.

“I examined her and found she was suffering from severe myopia and keratoconus,’ he said. “I prescribed her a pair of spectacles and gave her a referral for the keratoconus to be investigated. Several months later I heard that she had passed her exams, and the following year she managed to get into the University of her choice. She had previously given up on her goal of tertiary education because of her difficulties in seeing.”

Abrehet is an ambitious woman with a love for helping people. These two traits have resulted in her pursuing a profession in the health services – Abrehet works as a maternity nurse in a general hospital.

In order to correctly dispense medicine, Abrehet relies heavily on her sight. Without it, she cannot read the labelling on the bottles and cannot precisely give the women she attends to what they need.

Therefore it was a huge problem when, two years ago, Abrehet’s vision started to fail. “In the last six months in particular, it’s been almost impossible for me to do my work. I cannot read patient records and I cannot read medicine labels. I also can’t see the patients’ veins – so it is difficult for me to give intravenous injections.”

“At home, I really struggle to do any household chores. My life is not going well since my vision started to fade,” she added.

A mother of four, Abrehet also used to help her children with their school-work. “Now, this has stopped,” she said. “I can’t see what is written down, so how can I help my children?” she asked.

After visiting the optometry department at the Asmara School of Health Sciences, Abrehet was examined by a student in the department and diagnosed with refractive error. She was given a pair of glasses from the optical workshop lab that had already been processed by the students as part of their cut and fit training.

“I am so happy and so excited,” said Abrehet. “Now, I will be able to work again – to do the job that I love! I will be able to dispense medicine and read the patient records! I’ll be able to do all the things that a nurse is required to do! Thank you so much!”

Abrehet was so impressed with the service and the treatment she received that she is now going to encourage all her colleagues to visit the optometry department to get their eyes tested. “For us, our vision is vital for our jobs and for our patients. Regular check-ups are therefore necessary. I will make sure to tell my co-workers to come here to get those tests done,” she said.

“Thank you so much for the help! You have changed my life,” said Abrehet.

The Developing Optometry Services program in Eritrea is a partnership between the Brien Holden Vision Institute, Asmara College of Health Sciences and the Eritrean Ministry of Health with funding support from Optometry Giving Sight.

To date 38 students have graduated as Optometry Technicians and are being deployed in Vision Centres across the country to provide refractive error services to the Eritrean population. Each year around 20 new students enrol in the program.

The EyeTeach© workshops continue to prove a success since launching in Latin America in 2013. The workshops, implemented by Brien Holden Vision Institute and sponsored by Optometry Giving Sight, focus on the development of local optometry in the region and strengthening the professional development of existing eye health practitioners and educators.

17 participants from Bolivia, Colombia and Argentina took part in a recent workshop at the Instituto de Salud, Seguridad Ocupacional y Medio Ambiente (ISSEM), a lead training institute in Bolivia. The curriculum focused on providing professional educators with new teaching methods for the development of optometry in the region, and providing further development for eye health practitioners and educators.

“I was surprised by my own lack of knowledge regarding certain teaching methods, even more so because I was confident with my way of teaching,” said Edson, a new optometry lecturer at ISSEM. “I feel it has allowed me to identify some of my weaknesses and apply new methods in which to motivate and engage with students more effectively”.

Aleida (pictured) , a microbiology lecturer at ISSEM and an epidemiology medical doctor for government health services in Santa Cruz de la Sierra, said that she found the workshop to be challenging and motivating as it identified new teaching techniques she can use.

“I am looking forward to applying these methods in my lectures,” she said. “I would be more than happy to participate in another Institute and Optometry Giving Sight workshop.”

The EyeTeach© workshops contribute to the development of leaders, so in the future they will be able to mentor other faculty and drive the development of optometry standards, both for optometric education and patient care. Optometry Giving Sight will fund more workshops in 2015.

Sheila is one of the first female optometrists who graduated from the School of Optometry in Makerere University, Uganda. She graduated in January 2019 and completed her 6-month internship.

Sheila started wearing glasses when she was only 8 years old. She could not see the blackboard in her class and her teacher noticed her struggling. Sheila and her brother both were myopic, and after eye exams at the Hospital they were diagnosed as needing glasses.

“As an optometrist, I need to be able to see my patients properly.” Sheila knows the importance of having glasses, without which she would not have been able to become an optometrist today.

Optometry was not something she knew a lot about as a child or even in high school. As she started learning more about optometry, she realized how blessed she is to become an optometrist and appreciated her learnings even more.

As the first optometry students, Sheila and her friends have fought many battles, but she is thankful and proud that the profession is now recognized in Uganda. “I am among the first female optometrists in Uganda, so it gives me a lot of pride!” She wants to encourage young girls to study optometry because she believes it is a prestigious profession.

She wants to thank all the funders, including Optometry Giving Sight, for providing excellent equipment and lecturers, without which they would not have been able to get through the course and become the first optometrists in Uganda.

Alejandra has been on a journey of discovery and one that resulted in a beautiful transformation of her young life.

For an active, intelligent and successful student who always liked to perform well in school, it was a matter of concern when, at the age of ten, Alejandra’s class performance started declining.

She said she couldn’t understand why she had problems reading words from the school board and had to depend on other students for help. Recognizing people and signs from a distance was another problem she started having.

“Fear,” she said, is the only word that comes to her mind when Alejandra was asked how she felt. Over time the fear started to turn into distress, and she began to develop the habit of putting her head in her hands and resting like that for a long time – it all seemed to be too much.

Her concerned parents looked for a solution to the difficulty their daughter was experiencing. After having a long discussion with Alejandra’s teachers, they all agreed she was having great trouble seeing well. Unfortunately, eye care services are expensive and not close to Alejandra’s town community.

Together they looked for ways to help Alejandra feel better and be able to continue to join in regular school classes. She sat close to the school board which seemed to help some, but by the afternoon she would resort to holding her head in her hands. Her teacher was sad to see her stop playing school yard games.

Luckily, the following year Alejandra’s school was invited to participate in a school screening program implemented by Ver Bien, supported by funding partner Optometry Giving Sight.

Having a comprehensive eye examination and the correctly prescribed glasses has helped Alejandra greatly improve the quality of her life and allowed her youthful ambitions to open up again. She mentioned her dreams returning.

“My life is easy now,” Alejandra said happily. “I can see all my friends walking to school, so I feel part of life again. And I can see the school board and play catch again, my favorite lunch recess game.”

Nimesha, like many young teenage girls, loves school, chatting with her friends and spending time with her family. She has many ideas for what she wants to do when she graduates High School – on the top of the list: Medical School. Unfortunately, unlike other children her age, Nimesha noticed her eyesight deteriorating two years ago and her quality of life also quickly began to deteriorate.

“Although I noticed my eye problem two years ago, there was no one who could come with me to the eye clinic. My mother works full-time and my father passed away four years ago,” she said. Not only that, but Nimesha is part of a large percent of low-income families in Sri Lanka who don’t have access to regular health care and lack substantial employment opportunities.

Nimesha said that when she goes to school, she cannot see the blackboard clearly from where she sits. She added, “I have to hold my textbooks very close to my face in order to read the small font.It is not fair because all I want is to be able to see, work and play like the other girls in my class.”

Nimesha was very excited about being seen by the eye care nurses and optometrists who came to her school. After being screened and further examined by the Brien Holden Foundation team through a program funded by Optometry Giving Sight, she was provided with high prescription glasses. Nimesha now enjoys playing with her friends and studying more effectively, and is no longer alienated by her classmates. She now has equal opportunity to reach her goal of becoming a doctor when she graduates.