The five basic human senses are the means by which we perceive everything in life. Blindness is not an isolated condition because sight heightens one’s ability to establish the purpose of living.
Working with patients who struggle with low-vision lifestyles, I have been astonished by the mental health troubles they confide in their ophthalmologist. The anxiety they express, the tears they shed, some having contemplated suicide since their vision loss, is enough for me to acknowledge that vision is more than a luxury.
In a place where health professionals are abundant, patients have access to discuss their mental health concerns with an ophthalmologist. However, developing countries lack these resources and provide few options to individuals who experience similar feelings from visual impairment conditions. Mental illness is complicated and difficult to treat. Blindness, on the other hand, is not always so; with increased promotion of innovative public health projects, surgery could not only be the solution to blindness due to cataracts but also an improvement to the quality of life for millions of people globally.
Cataract surgery cannot cure all forms of mental illness, but reversing blindness due to cataracts and, in turn, dependency and depression issues is a valid starting point in reducing the suffering of many people worldwide. However, public health professionals commonly misconceive surgery as an overly expensive intervention that addresses only a limited portion of the global burden of disease.
While 20 million people being bilaterally blind from cataracts is itself a significant public health problem, the estimated 350 million people affected by depression worldwide is substantially greater. With the genesis of innovative surgical projects occurring internationally, the support and influence from the World Health Organization (WHO) on improving access to high quality and affordable surgical care is the key to make an impact on this issue.
One surgery at a time, cost effective surgical projects could begin to alleviate these health conditions affecting the disability-adjusted life years for so many.
The lack of support of surgery as a public health endeavor limits the expansion of organizations that are making an impact on providing cataract surgery in low resource areas. The Himalayan Cataract Project has designed teaching programs with simplified surgical techniques and established locally-run lens factories to allow cataract surgery to be performed in remote areas of Nepal for as little as $20. This project is gradually expanding with academic and private partnerships to help several other communities in low- and middle-income countries. The cost effectiveness and sustainability of this project to other parts of developing world gives hope that regained sight and decreased mental illness is possible for millions of people worldwide.
Providing surgery as a public health intervention for the people who struggle with mental illness due to visual impairment will impact several WHO initiatives. I have seen the detriment to one’s mental state when they struggle with vision loss, and I have witnessed the euphoria that follows the recovery of vision.
When the emotions of patients are extreme opposites, it is difficult to understand why we continue to leave so many in their state of suffering.
The WHO currently has several initiatives to support conventional means of treating mental illness. However, additional support and awareness of the WHO Initiative for Emergency and Essential Surgical Care including cataract surgery would be another pivotal movement to improve mental health globally, while returning the priceless gift of sight to millions.
Maryana Boulos is a public health student at the University of Utah and an ophthalmic assistant at Clarus Vision Clinic in Murray.
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