Intraocular lens implantation in developing countries: an ophthalmic surgical dilemma

Rapid and remarkable development of intraocular lens technology during the past 10 years has made intraocular lens (IOL) implantation the standard of practice with cataract surgery in wealthy industrialized nations. However, although visual results of IOL implantation are vastly superior to aphakic spectacle correction after cataract surgery, several factors mitigate against the widespread implantation of IOLs in most developing nations: the high cost of surgical equipment, ancillary drugs, and intraocular lenses; difficulty in postoperative follow-up of cataract surgical patients; and a dearth of surgical personnel properly trained in IOL technology in developing nations. While many of these problems could be addressed through national initiatives, a major area of concern remains that of manpower, since the number of unoperated cataract patients is immense. One strategy for alternative surgical manpower development is the training of medical assistants to perform cataract surgery, as is presently being carried out in several African nations. The question arises, however, as to whether medical assistants, as opposed to ophthalmologists, are qualified to select patients and implant IOLs.