Perfect Vision

Eyes are our window on the world, but do we take enough care of them in Oman? Along with other health issues, are eyes neglected until too late in Oman? Talking to a Muscat-based ophthalmologist about such questions was quite an eye-opener!
Dr Fuad al Hussein studied General Medicine, followed by Ophthalmic training for four years at Damascus University. He is now the Medical Director at Finland Eye Center in Qurm.
In conversation with Dr Fuad, he outlined areas of concern with patients from the interior of Oman. Some may have advanced cataract eye disease and experience problems with their vision, yet do not seek specialist advice and treatment early on. They delay seeking medical help until their vision has deteriorated considerably and intervention becomes more challenging.
Another issue he encountered was patients who do not take their prescribed oral medication in a rigorous regime, according to their doctor’s instructions, but stop after a week or two. Diabetic retinopathy and Glaucoma are serious, chronic diseases (long-term or life-long) so should be taken seriously by patients themselves. The reason people develop cataracts is mostly a simple matter of aging. For those above the age of sixty, 80 per cent will develop cataracts, increasing as one ages.
Other factors could be a trauma to the eye, taking steroids or cortisone medication over a period of time, radiation, eczema, atopic dermatitis and having diabetes – all may induce early cataracts. The decision of when to operate then depends on someone’s quality of life and ability to function normally, such as driving, if they keep falling over because of poor vision or cannot read and so their ability to work is affected.
“In Oman we see glaucoma in many cases. It is known as the ‘silent thief’ as eye pressure will not affect sufferers’ vision at first, only in their greater field. It is revealed through a test.” The familiar air-puff test, or using a Goldmann applanation tonometer which gives more accurate results, can diagnose people with an eye pressure outside the ‘normal’ range of 9 – 21 mmhg who may have glaucoma. Early intervention is of prime importance in preserving sight. Glaucoma is indicated through hereditary factors, but may also be induced through prolonged use of steroids/cortisone medication or an advanced cataract itself. Treatment may include anti-glaucoma medication, topical beta-blockers or Prostaglandin.
Diabetes and eye conditions are linked in health care, and one may lead to the diagnosis of the other. For example, someone experiencing blurred vision may seek ophthalmic advice, and a retinal check, using ‘Ocular Coherence Tomography’ or OCT to discover a swelling of the macula, may reveal underlying undiagnosed diabetes.
Dr Fuad estimated 30-40 per cent of such patients may be unaware that they have (Type 2) diabetes – they may think their blurred vision is because of a developing cataract. Out of twenty diabetic patients he sees, six to eight may have mild or more severe retinopathy – macular swelling resulting from poorly controlled diabetes. If the retinopathy is mild, tighter diabetes control (of blood sugar) is ALWAYS required, as well as monitoring blood pressure which in turn affects the arteries, blood vessels and the heart. Cholesterol level checks, along with increased exercise and diet control might be advised by the diabetic specialist, who may prescribe oral medication or insulin to help maintain stricter blood sugar control.
If there is more advanced retinopathy, affecting the macular oedema, an injection may reduce or minimise macular deterioration, but if there is a haemorrhage or vascularisation of the tiny blood vessels in the back of the eye, then Pan Retinal Photocoagulation, commonly known as ‘laser treatment’, will be needed to prevent further deterioration of vision. As a further complication in the ocular equation Dr. Fuad explained, “if I need to observe the optic nerve in a case of diabetes or glaucoma, a cataract will obscure my view, so that needs to be removed first.”
There are several speciality eye clinics in Muscat, such as the German Eye Centre, Magrabi Hospital and Muscat Eye Laser Centre, along with Finland Eye Centre, one of the prestigious and recognised private facilities in the Sultanate for ophthalmological consultations and procedures. There are clinics in al Khod, Salalah, Suhar and Nizwa making them accessible to most of the population. For Omani Nationals, the Al Nahdha Public Hospital in Wattaya has specialised in treating ocular conditions since 1974.
Dr Fuad estimates he operates on eight to twelve patients in cataract-related surgery on two mornings per week. Old lenses are replaced with modern trifocal lenses which correct vision so that younger and healthy patients do not need to use glasses any more. Other recipients with underlying conditions will be given mono-focal lenses and use glasses for reading.
There is no reason for increasing poor vision leading to blindness in the 21st century in a country which prides itself on excellent health care. Early intervention, however, is crucial in maintaining good eyesight, with a commitment to following medical advice and treatment as appropriate.