Preventing Corneal Blindness: Proctor Team Engages Volunteers

Dr. Jeremy Keenan confers with volunteer health workers in Nepal

A stem of rice, a chicken feather, threshing debris lifted by the wind. Such elements can easily scratch the front of the eye, inviting infections that lead to corneal ulcers, opaque scars, and vision loss. People who perform manual agricultural labor are far more likely to suffer corneal abrasions, and they are the least likely to receive sight-saving treatment.

Promising Strategy, NIH Funding

With extremely high rates of corneal ulcers and related blindness, Nepal seeks solutions for its people. “In rural areas, eye hospitals are few and far between,” says Kieran O’Brien, MPH, study coordinator at UC San Francisco’s Francis I. Proctor Foundation for Research in Ophthalmology. “Poor roads make traveling for treatment more difficult,” she adds. To overcome these challenges, the Proctor Foundation developed an intervention that relies on diagnosis and treatment by local volunteers.

Initial studies, seed funded by private investors, showed promise. The National Institutes of Health then awarded the Proctor Foundation $2.25 million over five years to plan, implement, and analyze a rigorous community-randomized trial, which has the potential to reshape blindness prevention efforts worldwide.

The $2.25 million study has the potential to reshape blindness prevention efforts worldwide.

More than 200,000 people living in Nepal’s Bharatpur Valley are study subjects. A Proctor Foundation team – Kieran O’Brien, Jeremy Keenan, MD, MPH; Nisha Acharya, MD, MA; Travis Porco, PhD; Jack Whitcher, MD, MPH; and senior investigator Tom Lietman, MD – works closely with the Bharatpur Eye Hospital, the Seva Foundation, and local volunteers.

Nepal recruits women to provide basic health services in their villages and to rally participation in public health campaigns. More than 100 of these volunteers are learning techniques for diagnosis and treatment of corneal abrasions, guided by Dr. Keenan, Kieran O’Brien, and nine Bharatpur Eye Hospital health workers. Back in their home villages, these women will be on the front lines of blindness prevention.

Embracing Low and High Tech

A magnifying loupe and a special flashlight substitute for the ophthalmologist’s slit lamp in the field. Volunteers diagnose abrasions by gently pressing a fluorescein-coated paper strip inside the lower eyelid and then examining the eye. If the fluorescein shows green staining, the corneal surface has been compromised. The volunteers then apply ointments to prevent bacterial and fungal infections and teach their patients to use the medications at home. Follow-up exams and referrals of unhealed cases to the eye hospital promote effective care.

This volunteer health worker will provide diagnosis and
treatment in her home village during the trial.

A smartphone application, customized at UCSF,speeds and improves data collection. Census takers upload demographics and images of each person’s eyes to establish baselines for corneal health, enabling the team to most accurately determine the rate of corneal ulcers.

Advancing Global Health

To determine the extent to which the Proctor Foundation’s innovative strategy has, in fact, reduced the rate of corneal ulcers and resulting blindness, researchers will meticulously analyze the huge data set produced by the trial. According to Dr. Lietman, “The outcomes could impact the development of a worldwide program to eliminate blinding corneal ulcers, including in California’s Central Valley, where manual harvesting increases risk.”

Seed funds for initial investigations were provided by Laurence and Sue Spitters through That Man May See, Harper-Inglis Trust, Peierls Foundation, Mort and Marilyn Leiter, Chuck and Sue Leiter, the World Health Organization, and Research to Prevent Blindness.
To learn more about ways to support corneal research at UCSF, contact Kathleen Rydar at That Man May See (415.476.4016 or rydark@vision.ucsf.edu).