“Editor’s Note: The two articles in this issue by Professor Johnson and Paul Courtright provide a short report and recommendations from an international Workshop on Practical Eye Care Guidelines for Leprosy Patients, which took place in summer 2001. This workshop was run by LEPRA (British Leprosy Relief Association) and sponsored by members of the International Federation of Anti-Leprosy Associations, Christian Blind Mission and the International Centre for Eye Health.”
- It is critical that leprosy patients (during their anti-leprosy treatment and after release from treatment) are integrated into general health and eye care programmes.
- Integration will require close collaboration between leprosy control and prevention of blindness programmes. At the national, regional and local level, strong political commitment (including professional organisations) is needed. Integration will reinforce and complement Vision 2020 initiatives and support leprosy control activities.
- Cataract is the leading cause of blindness in leprosy affected persons and many do not have access to general eye care services. All persons affected by leprosy should have equal access to eye care services. Education of health workers (including eye care staff) is required to ensure that leprosy patients gain access to eye care facilities.
- At the time of disease diagnosis all patients should be examined for lagophthalmos (any gap), visual acuity, the red eye, and presence of a facial skin patch. All patients with lagophthalmos, decreased vision, persistent red eye, and/or a facial skin patch in reaction should be referred by the general health worker to a higher level.
- We recommend that visual acuity and lagophthalmos become the major indicators for monitoring disability and that corneal hypoaesthesia, corneal opacities, and uveitis (which will be recognised as one cause of a red eye) are removed from the leprosy disability grading scheme.
- At the end of treatment patients must be educated regarding the risk of eye disease and informed that they should return for examination if they develop lagophthalmos, diminished vision, red eye, or a facial skin patch in reaction. Explicit instructions need to be given to each discharged patient as to where to go. Patients with lagophthalmos should continue to be followed up.
- A training component that addresses the skills and activities of health workers in relation to care of eyes in leprosy should be introduced into national plans. Plans should address the needs at different levels and should include the needs of existing health workers through supplementary courses. Health workers currently in training should receive appropriate teaching through medical, nursing and paramedical curricula. In every setting with a leprosy control programme, a practical referral system needs to be clearly defined. All referral points (staff) need to be educated regarding the eye care needs of leprosy patients.
- In settings where there are leprosy colonies/villages it is recommended that at least annual screening eye examinations and treatment are conducted. Furthermore, patients in ‘care after cure’ programmes should have, as a minimum, annual eye care examinations and management.
- Lagophthalmos surgery should be provided to patients who need it. Evaluation of the need for lagophthalmos surgery should be based on one or more of the following conditions:
– size of lid gap
– corneal exposure
– corneal hypoaesthesia
– visual acuity
– cosmetic appearance
There are a number of surgical procedures being used for lagophthalmos surgery. Research is needed to determine the best possible surgical procedures to correct the lagophthalmos and to improve functional and cosmetic outcomes of the surgery. Standardised routine monitoring of outcomes of lagophthalmos surgery is recommended. There are many barriers that prevent patients from accepting lagophthalmos surgery which need to be clearly identified; programmes need to be developed to increase uptake of lagophthalmos surgery. Finally, ophthalmologists and other relevant surgeons need to be trained in good quality lagophthalmos surgery.
- Research shows that cataract surgery with IOL implantation, even in patients with evidence of chronic uveitis, can provide a good quality outcome. IOL implantation, where available, should be promoted among leprosy patients who need cataract surgery. The outcomes of cataract surgical services need to be routinely monitored.