2014 Chinandega, Nicaragua

Doctors of VOSH had the pleasure of partnering with BASIC Nicaragua to provide vision care for the people of Chinandega, Nicaragua. 8 optometrists across Canada and USA volunteered their time to serve the community of Santa Patricia. Families living in the barrio of Santa Patricia live in makeshift houses built out of materials that could be scavenged from local junk, boards, rusted tin, and black plastic. With a population that is constantly expanding, there is a high demand for eye care and need for new homes. The doctors had a unique opportunity to not only provide eye examinations, but also to get involved with construction alongside BASIC Nicaragua to build 4 new homes for nominated families of Santa Patricia.
We were able to serve a total of 1,366 patients over 4 days during our February mission to the villages of Santa Patricia and Camillo Ortega. We had one optometrist working in the optical dispensary, another training our optician in the optical lab, and the rest performing comprehensive eye examinations. Each doctor performed retinoscopy to determine a patient’s refractive error, loose lens refraction to fine tune the spectacle prescription, examined the anterior and posterior segment with hand-held slit lamp biomicroscopy, undilated 90D or direct ophthalmoscopy, and a dilated fundus examination with BIO when necessary.
The vast majority of visual needs in the Chinandega area are high, against-the-rule, compound hyperopic astigmats. Many cases of accommodative disorders were also diagnosed in our clinics; these patients were given either a bifocal prescription or a combination of single vision distance/readers. There were very few myopic patients seen in our clinic; however, there were a handful of children with prescriptions greater than -10.00 diopters. With the help from Dr. Abraham Delgado’s office, Foniprece, for only $13 we were able to make special order prescription glasses for any patient with high myopia or astigmatism. All other prescriptions were readily available to dispense thanks to our hardworking optical lab.
BASIC Nicaragua started an optical lab in Chinandega, Nicaragua on February 1, 2014. Jorge Garcia is Santa Patricia’s resident full-time optician who created an inventory of glasses for us to dispense to the patients. The doctors noted a high quality of craftsmanship and were impressed with the organization of labeled boxes with corresponding spectacle prescriptions. The patients were given a large variety of frames to choose from, many leaving the dispensary with a modern, contemporary, or high fashion looks that were welcomed by the community. With the help of local bilingual volunteers providing translations for those who could not speak Spanish, this mission provided over 1,800 pairs of prescription glasses to those that needed them.
The doctors were able to provide treatment for most of the ocular disease seen in the clinic. Thanks to support and product donations from Alcon, Allergan, and Bausch & Lomb, we were able to dispense topical medications for patients suffering from chronic ocular surface disease, infections, and primary open angle glaucoma. Because of the dry, dusty, dirty conditions in which all of these patients live, dry eye syndrome is quite pervasive. The patients were very grateful since more than 2/3 of the patients seen in clinic were given artificial tears, gel tears, and/or lid scrubs. Dense nuclear sclerosis and corneal pterygiums were visually devastating for many of our patients. Thanks to our partnership with Foniprece, 45 of our patients seen on this mission trip will receive cataract or pterygium surgery in the next 2 months. Unfortunately, we did not have enough funds to schedule surgery for every patient requiring surgery; thus patients with bilateral 20/200 or worse vision were prioritized. For patients diagnosed with glaucoma, we dispensed a one-year supply of topical eye drops to lower the intraocular pressure, some requiring a combination of two or three different eye drops depending on the severity of the glaucoma. These patients were made aware of their chronic disease that requires frequent follow-up and continued treatment with an eye care professional. Unfortunately, most of these patients are unable to make arrangements for the 2-½ hour drive to Managua to see Dr. Delgado to monitor their glaucoma, so at the very least they were encouraged to return in 6 months when VOSH and BASIC Nicaragua return to ascertain the efficacy of treatment.
Other notable cases include toxoplasmosis, optic atrophy secondary to ocular trauma, displaced IOL, dense PCO after cataract surgery, ocular albinism, aphakia, nasolacrimal duct obstruction, congenital nystagmus, age-related macular degeneration, vitreous hemorrhage, non-proliferative diabetic retinopathy, strabismic amblyopia, meridional and refractive amblyopia, hypertensive retinopathy, band keratopathy, trichiasis, blepharitis, meibomian gland dysfunction, hordeola, chalazion, and retinal detachments.
There was one case of choroidal melanoma in a 12-year old girl. This young girl is emmetropic and was complaining of a floater in her right eye. Each doctor had on average 6-8 minutes to provide care for each patient; I could have very easily told her mother that her daughter didn’t need a spectacle prescription, provided education about the signs and symptoms of a retinal detachment, and moved on to the next patient. With an undilated posterior pole examination, I did not find the floater she was complaining about so I decided to dilate her eyes. The choroidal melanoma and serous (exudative) retinal detachment in the inferior nasal periphery could have very easily gone unnoticed without a dilated fundus exam especially since she was not requiring any spectacle prescription. Serous detachments are caused by a number of inflammatory, or exudative retinal disease processes such as Sarcoidosis or choroidal neoplasms. This was one of many unique examples of the extraordinary care our doctors were able to provide during this mission. What an impact we made on the people of Chinandega, Nicaragua!
Paul Lovero, OD
Therapeutic Optometrist
Optometric Glaucoma Specialist

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