October 8, 2015 is World Sight Day (WSD), an annual day of awareness held on the second Thursday of October, to focus global attention on blindness and vision impairment. This year, the ‘Call to Action’ for WSD is: Eye care for all. This is apt, given the very dismal statistics on blindness, especially in Nigeria.
According to the International Agency for the Prevention of Blindness (IAPB), 39 million people are blind worldwide, including 19 million blind children. Ninety percent (90%) of blind people live in low-income countries. Four (4) out of 5 blind people are needlessly so because 80% of visual impairment is readily preventable/treatable.
In Nigeria, it is estimated that over one million individuals aged 40 years and above are currently blind. The major causes of visual impairment in Nigeria are cataract, glaucoma, refractive error or damage to the cornea (the transparent front part of the eye) usually caused by measles, use of traditional eye medicines, vitamin A deficiency, trachoma and trauma.
It is instructive to note that blindness from any cause results in reduction in the quality of life and the life expectancy of the individual. The life expectancy of blind persons is one-third less than that of their sighted counterparts, and most of them die within 10 years of becoming blind. The data is even more disheartening for blind children with 50 to 60 per cent of children dying within one to two years of becoming blind. Blindness also exacerbates poverty by limiting employment and social opportunities. The good news is that restoration of sight and blindness prevention strategies are among the most cost-effective interventions in health care.
The goal of the new WHO Global Action Plan for the Prevention of Avoidable Blindness and Visual Impairment 2014-2019 is to reduce avoidable visual impairment as a global public health problem by improving access to eye care services that are integrated into health systems. In line with this goal, preventive eye care is incorporated into the Mobile Cancer Centre (MCC) system which is being championed by the Committee Encouraging Corporate Philanthropy (CECP-Nigeria).
The integration of eye care into the MCC is also necessary because cancer can affect the eye in several ways; eye cancer also contributes to the burden of blindness. The rest of this article will thus focus on the relevance of eye evaluation in cancer detection.
The eye is a very important organ of the body. The eye does not just enable an individual to see objects in his surrounding; it also serves as a channel through which the doctor could detect abnormalities in the person’s internal organs. Indeed, several systemic diseases in humans including hypertension, diabetes mellitus, hepatitis, HIV/AIDS, renal disease and cancers in other parts of the body, could be detected by examining the eye. Eye examination by an ophthalmic surgeon (a medical doctor specialized in medical and surgical eye diseases) is often the most important step in diagnosing cancer of the eye.
Eye cancers can be primary cancer (starts within the eye) or metastatic (secondary) cancer (spread to the eye from another part of the body). However, secondary cancers are more common than primary cancers. The most common cancers that spread to the eye are breast and lung cancer in women and lung and gastrointestinal cancers (e.g. stomach and colon cancers) in men. Other less common sites of origin include the prostate, kidney, thyroid, skin, brain and blood or bone marrow. The branch of medicine that deals with cancers relating to the eye and its adnexa (adjoining tissues) is known as ocular oncology.
Primary and secondary cancers of the eye as well as cancers of other parts of the body that have not spread to the eye can manifest with eye symptoms. As a result in some of these cancers, the ophthalmic surgeon / ocular oncologist could be the first doctor to diagnose the primary cancer. This is evident from the case of Mr. William (not his real name) who presented to the eye department of a teaching hospital in Lagos with complaints of protrusion of the eye. However, on further evaluation, it was discovered that the problem was not from the eye but that he actually had prostate cancer that had spread to the eye. Although, he had been having other worrisome symptoms of prostate cancer, he never thought it was necessary to go to the hospital for evaluation until it involved his eye.
The eye symptoms of cancer include: paleness (a sign of anaemia); blindness and blurring of vision; high pressure in the eye; a growing dark spot on any part of the eye; change in the size or shape of the pupil (the dark spot in the center of the eye) and protrusion of the eyeball. Pain in or around the eye, although rare is a symptom of eye cancer.
Strabismus (‘cross-eye’) and whitish spot in the eye could be a sign of eye cancer in children. Jaundice (yellowness of the eye) can occur in liver, gall bladder and pancreatic cancer. Double vision, loss of part of the field of sight, paleness and swelling of the optic nerve could be due to brain tumor.
Many of these symptoms are common to other eye conditions, and their presence does not necessarily mean that the individual has cancer of the eye. Nevertheless, it is very important that these eye symptoms are checked by a doctor as soon as possible to rule out cancer, thereby improving the outcome of treatment. Conversely, we must note that most of the eye signs of cancer may not be apparent in the early stages. Thus, the need for routine and regular screening cannot be overemphasized.
Mr. William’s case shows why the eye should not be treated in isolation from the other parts of the body. If that was done in his case, his prostate cancer, which was the primary cause of his problem won’t have been diagnosed. It is therefore expedient that people with eye complaints should see an ophthalmologist or ophthalmic surgeon for accurate diagnosis and appropriate treatment rather than an optometrist or optician who although are an important part of the eye care team, are not medical doctors. An optometrist is a graduate whose primary role is related to the correction of eyesight by prescribing and dispensing eyeglasses and contact lenses whilst the optician is a technician trained to design, verify and fit eyeglass lenses and frames, contact lenses, and other devices to correct eyesight.
Although, primary eye cancers are not very common, the fact that the common cancers of the body could manifest with eye symptoms make eye evaluation a valuable, inexpensive and non-invasive tool for cancer diagnosis. For this reason, eye examination is an integral part of comprehensive cancer screening at the National Cancer Prevention Programme (NCPP), a non-governmental initiative of mass medical mission. The field experience of NCPP indicates that integrating eye care into cancer prevention increases the uptake of both eye and cancer screening. The NCPP is the operational partner of CECP for the BIG War Against Cancer.
CECP is co-promoted by the core bodies of the Organized Private Sector (OPS-Nigeria). The aim of CECP is to mobilize Nigerians to unite for societal development. The flagship focal cause of CECP is the “BIG WAR Against Cancer” aimed at “Taking wholistic health care to the Grassroots” using Mobile Cancer Centres (MCC) and Comprehensive Cancer Centres (CCC). The first phase involves raising funds to acquire/deploy 37 MCC, one for each state and Abuja.
An MCC is much more than a Mobile Mammogram. Rather, it is a clinic on wheels, in which screening, follow-up and treatment (including surgeries), can take place. It includes facilities for mammography, sonology, colonoscopy, colposcopy and cryotherapy, as well as a surgical theatre. It is also equipped with facilities for screening against most common diseases, including the Ten Major Cancer-related killer diseases (Diabetes, Renal Disease, Obesity, Malaria, Schistosomiasis, Helicobacter pylori, Hepatitis, HIV/AIDS, Human Papillomavirus (HPV) and Hypertension). As mentioned earlier, most of these cancer risk factors also manifest with eye signs.
The Mobile Cancer Centres (MCC) is thus an excellent means of achieving the goal of this year’s World Sight Day – Eye care for all. A single MCC in a state of Nigeria could make a huge positive difference. That state would be divided into smaller units such that every community would be reached by the MCC at least once a year. The cost of one MCC is $600,000 only.
We cannot achieve this goal unless we ACT! (Attack Cancer Together!!). The first Tuesday in December every year is marked as Global ↑↓GoodTuesday. ↑↓GoodTuesday is a global movement, aimed at celebrating and encouraging generosity. CECP enjoins every Nigerian whether at home or in diaspora to join in the ↑↓GoodTuesday movement. In this regard, it is important to note that CECP is an approved body listed under the 5th schedule of the companies income tax act (CITA). Therefore all donors to CECP are entitled to take tax deductions for their donations. Further information on the ↑↓GoodTuesday could be obtained at www.givingtide.org.
“By moving forward together we have the potential to show Cancer: It is not beyond us.”- UICC 2015
Published by the Guardian Newspaper on Sunday, October 11, 2015