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Wednesday, 09/13/06 - The Tennessean.com
Vanderbilt to give gift of sight to poor in Third World nations
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| By CLAUDIA PINTO Staff Writer |
Larry Merin, Vanderbilt assistant professor of ophthalmology, looks out from behind digital retina imaging equipment in his office at the Vanderbilt Ophthalmic Imaging Center, located in the BellSouth Building downtown. (JAE S. LEE / THE TENNESSEAN) |
Larry Merin will soon begin screening the poor in Peru and Bolivia for a potentially blinding eye disease caused by diabetes, but he will have to travel only as far as his Nashville office.
The long-distance exams are made possible when medical workers in the South American countries take pictures of diabetic patients' eyes with a special camera and e-mail the images to specialists at the Vanderbilt Ophthalmic Imaging Center for evaluation. Vanderbilt is providing the equipment and services at no charge.
Merin, a Vanderbilt assistant professor of ophthalmology, expects the program to be launched within two months. He said the services are desperately needed in those Third World countries because of a shortage of eye specialists and an exploding rate of diabetes.
"There's an area of Peru where there are 1 million people but not one ophthalmologist," Merin said. "Without this, more and more people will go blind. It will allow people to continue to be productive members of society."
Merin said about 10 percent of those who receive the screening are likely to need laser surgery to treat the eye disease. He said there are doctors in urban areas who are able to conduct the procedure, which won't cure the disease but will halt its progression.
"They don't have enough ophthalmologists to screen all the people who need screening, but they do have enough to treat the 10 percent who need treatment," Merin said.
Dr. Alberto Barcelo, acting chief of noncommunicable diseases for the Pan American Health Organization, warned that everyone with diabetes is at risk for diabetic retinopathy — a disease that causes progressive damage to the blood vessels in the eye's retina and can cause loss of vision and blindness. In America, there are 21 million people with diabetes, and nearly 45 percent of them have some stage of diabetic retinopathy, according to the National Eye Institute.
No one knows how many people have diabetes in Bolivia and Peru, but Barcelo estimates that 7 percent of the population is afflicted. He said that rate is slightly lower than in the United States, but it is becoming worse.
"Diabetic retinopathy is growing at a rate that will bankrupt countries," Merin said. "If we can use technology that provides high-quality care inexpensively, everybody wins."
Barcelo said diabetes rates are being spurred worldwide by obesity. America shifted from an agrarian society to a nation of office workers decades ago, but people in Third World countries are just beginning to make the transition to a more sedentary lifestyle.
"A large part of it is that people don't have to work as physically hard as they used to. They aren't out tilling the land," Merin said. "Peasants are moving to big cities. There's no work. And they don't exercise. The food they eat is not nutritious. The problem is the same everywhere. It's cheaper eating badly than buying fresh fruits and vegetables."
The Vanderbilt program will attempt to combat the problem by providing fundus cameras — which take pictures of the inside of the eye — to two health clinics: one in Lima, Peru, and the other in Cochabamba, Bolivia. However, health workers there will frequently take those cameras to more rural areas to screen additional people.
Medical workers at the clinics will be trained to take pictures of diabetics' eyes with the fundus cameras; those images will be e-mailed to Vanderbilt specialists for evaluation. If problems are found, the specialists will contact doctors at the foreign clinics to arrange treatment.
"You don't have to have that face-to-face to identify lesions that show there is something wrong with that person," Merin said.
Vanderbilt, along with many other health facilities, has been conducting long-distance medical exams via the Internet for years, but this is the first time Vanderbilt has offered the service outside the United States.
The program is being funded for the first year by a $150,000 grant from the Vanderbilt Center for the Americas, which concentrates on building relationships with South American countries. Officials with the Vanderbilt University School of Nursing will be training the medical workers in Bolivia and Peru. The Washington-based Pan American Health Organization, an international agency that works to improve health in the Western Hemisphere, made government contacts and provided technical assistance.
Officials are hoping to expand the program in the future, so that specialists can evaluate other health conditions, as well.
"It's very easy to take a picture of a freckle and send it to a dermatologist to find out if it's cancerous," Merin said. "You could potentially do this for any condition that presents itself physically." •