My Experience In Tuvalu: Blind Prevention, Focusing On Refraction & Pterygium, Cataract And Diabetic Retinopathy.

Provide basic ophthalmic care in Tuvalu and surveyed epidemiology of refraction error, pterygium, cataract, diabetic retinopathy.

Tuvalu is an island country in the Polynesian subregion of  Oceania in the Pacific Ocean. Tuvalu is composed of three reef islands and six atolls. It has a population of 11,204. The total land area of the islands of Tuvalu is 26 square kilometres. We recognized the lack of eye care in Tuvalu and high risk of blindness. After COVID pandemic, there’s no ophthalmic assistance nor surveillance for almost 3 years. We are the first Asian ophthalmologist group assembled from Taiwan.

Basic eye care and epidemiology of refraction error, pterygium, cataract, diabetic retinopathy was surveyed. All the patient’s initial visual acuity, refraction error status, intraocular pressure, lens and retina situation was record. The total pterygium size, corneal invasion area size and direction was estimated under slit lamp. Pterygium excision with/ without amniotic membrane transplant (one group from our Eye Bank tissue; one group from AMNIOAID, amniotic tissue Allograft, HCT Rgenerative Ltd.). and Intravitreal injection of anti-VEGF (Eylea^® aflibercept, Bayer; Avastin®,bevacizumab, Roche) for diabetic macula edema was done in early 2023. Post-operative visual acuity and refraction error was monitored around 2 weeks. 

Total 562 patient was collected. The epidemiology showed pterygium 106 patients, pterygium covered pupil or with high astigmatism 32 patients, dense cataract 201 patients, ocular trauma history 10 patients, diabetic macula edema 23 patients. All patient received Pterygium excision with/ without amniotic membrane transplant gained visual acuity and decreased spherical equivalent value. There’s infection event nor major complications during post-op 2 weeks. No significant differences was found between eye bank group and commercial product group. The patients recieving Intravitreal injection of anti-VEGF gained their visual acuity around post-op 2 weeks. The macula situation became flatter and dryer. 

We surveyed the epidemiology of Tuvalu nearly innately. Pterygium excision with/without amniotic membrane transplant and Intravitreal injection of anti-VEGF is a promising operation under very difficult condition. Blind prevention can be done with the help of cold chain transportation.