By Beatrice Nakibuuka
Gladys Atto, ophthalmologist, Moroto Regional Referral Hospital is the only ophthalmologist, covering all the nine districts of Karamoja with a population of 1.5 million. It is also one of the subregions in Uganda that is still endemic for trachoma.
The distances are long, the roads unforgiving, and for many, blindness has been a slow, creeping shadow that felt inevitable.
A region once without a specialist
When Dr Atto came to Karamoja in 2018, there was no resident ophthalmologist. Eye surgery was rare, only possible when a visiting specialist happened to pass through. The backlog of untreated cataracts, glaucoma, and other preventable conditions was overwhelming.
In 2020, determined to understand the barriers, she reviewed patient referrals from the eight other districts. The numbers startled her—12 in 2018, 16 in 2019, and 18 in 2020. For a regional referral eye unit, these were alarmingly low.
She moved to all eye care facilities observing and asking questions. She later made recommendations that made huge improvements over the years, including opening a WhatsApp group for all the eye care workers in Karamoja.
She says: “This group has worked magic for us. We discuss difficult cases before referrals, share advice, and identify facilities that are struggling. Now, we receive hundreds of referrals each year, and patients are seen earlier.”
She partners with Sightsavers, an organization which sponsors monthly surgical outreach missions to the people living in the nine districts of the subregion. Cataract surgery is the main surgery performed on these trips.
Common eye problems in Uganda
Trachoma
Trachoma, one of the neglected tropical diseases is endemic in 50 districts of Uganda and is more prevalent in dry places where there is scarcity of water like the Karamoja region where it is hard for people to wash their eyes regularly.
The disease has not been fully eliminated in Uganda, but significant progress has been made. While the disease has been eliminated in 46 out of 50 districts, it persists in the remaining four, all located in the Karamoja sub-region, which has a nomadic population that is difficult to reach.
According to Dr Tomson Lakwo, an entomologist at Ministry of Health, trachoma mostly affects children and if not treated, it can lead to total blindness.
He says: “Washing eyes regularly and going for early treatment can reverse the diverse effects of trachoma.”
Uganda has an established trachoma elimination program using the SAFE strategy (Surgery, Antibiotics, Facial cleanliness, and Environmental improvement).
According to four Rapid Assessments of Avoidable Blindness (RAAB) surveys conducted in Uganda, the prevalence of blindness is 0.4 per cent which is equivalent to 160,000 people while moderate and severely impaired sight is 7 per cent, nearly 2.8million people. The leading causes are cataracts and refractive errors like near or far sightedness, astigmatism and presbyopia.
A cataract is a clouding of the eye’s natural lens, which can cause blurred vision and impaired color perception. It typically develops gradually with age, as proteins in the lens clump together and cloud the lens. While cataracts can affect individuals of all ages, they are most common in older adults.
Nearsightedness/shortsightedness/myopia
According to Dr Franklin Wasswa, an oculist at Entebbe Grade B Hospital, the soaring rates of near-sightedness in children are alarming parents and doctors around the world. The problem seems to be spreading at a faster rate than ever and if there is no change in the current trends, about 50 per cent of the world’s population will be short-sighted by 2050.
When a person is nearsighted, they struggle to see things that are at a distance. The challenge is that not even glasses can permanently fix this problem. Myopia is one of the leading causes of vision impairment and blindness globally.
“The eyeball should be more spherical (like a rugby ball) and not oval (like a basketball) but as we grow, the eyeball grows longer when the length growth is not controlled then you start having a problem with casting image on the retina. The image is usually cast before the retina hence becoming short sighted,” Dr Wasswa says.
In children, this problem does not only affect their ability to learn and enjoy their daily life, it also sets them up for future eye health problems.
“While the typical age for a child to develop myopia is between eight and 12 years, children are becoming myopic at a much younger age. When children develop myopia at such an early age, it increases their risk of severe myopia in their adulthood and other eye problems such as cataracts, glaucoma and retinal detachment,” he says.
The factors at play
While a family history of myopia raises the risk of a child developing it, a small fraction of the cases are genetic. Dr Wasswa remarks that the biggest contributors of childhood myopia are lifestyle factors especially a lack of time outdoors.
He says: “Having very little light entering the eye reduces the growth in length of the eye lens into the shape of the rugby ball and instead becomes more as round as a basketball. Daylight is important.”
The way children obtain education in the modern world is questionable because they spend long hours in classrooms which is hurting their eye health.
“The other theory is having to read or look at something so close always during the age of eyeball development which is from birth to adolescent age,” he says.
Like education, a higher income is generally associated with greater wellbeing in children – but this is the opposite when it comes to eye health. Instead, myopia is associated with higher socioeconomic status.
According to Dr Wasswa, children, especially those whose parents are in the middle-income class are even suffering more because they are always indoors in an apartment on the third floor, watching television, using the tablet or playing video games.
He says: “They do not have a play area save for the parking lot and they go to schools that prioritise education and trash play time as part of a healthy lifestyle so they do not get enough play time in the sunlight.”
Impact
Although some children and adults with myopia can leave a normal life with glasses as a treatment option, myopia causes a lot of stress on the anatomical structures of the eye which puts them at risk of other eye conditions like retinal detachment, cataracts and glaucoma. It is important that they need to have a regular check up on their eye health.
For Dr Atto, the fight against blindness in Karamoja is not just about treating eyes—it is about bridging worlds, breaking myths, and delivering care where it is needed most.
Facts about your eyes
1. The normal eye cleanses itself. No need for any ‘cleansing’.
2. You do not need any specific herbal supplement to see better. The vitamin A in regular diet is mostly enough.
4. Wearing glasses does not make your eyes worse or increase your dependency in a biological sense. They correct your existing refractive error but they don’t cause it to worsen.
5. Children of any age can wear glasses if they need it. Don’t deny them the chance to see
6. Herbs in the eye will kill it faster than putting nothing.
7. Eye whitening is a myth.
8. Glaucoma will kill your vision slowly without any pain until you’re totally blind.
9. There’s no other treatment for cataract except surgery. Don’t be deceived.
10. The most common cause of cataract is old age. If you can prevent that you can prevent cataract.
11. A deviated or squinted eye must be checked as soon as yesterday.
12. Double vision is not normal.
13. You can have dry eyes while tearing.
14. It is possible for the eye to pop out, but it clearly spells a warning.
16. Surgery for treating Glaucoma does not improve vision. The aim is to maintain the vision left.
17. Every eye surgery carries a risk for complications. That’s why you sign a consent form.
18. Borrowing your neighbor’s eye drop is a recipe for disaster.
20. As an adult, using a phone or computer for longer periods will not spoil your eyes but it can lead to temporary discomfort and vision problems, commonly referred to as digital eye strain or computer vision syndrome.
21. Giving phones to children will definitely affect their vision because their eyes are still growing.
23. If anything has entered your eyes and it persists for more than one day, it is most likely not getting out on its own.
24. Yes, eye tattooing can be done for specific reasons.
26. Sheep eyes to replace your lost eyes is a myth.
27. During surgery, the eye is not removed and then put back.
28. Not every vision loss can be restored. Some are permanent.
29. Gonorrhea can cause vision loss faster than any other disease.
30. Almost everyone will require reading glasses from 40 years. Not true.
32. Any blunt trauma to the eye should be checked to avoid preventable injuries.
33. Sunglasses are perfectly okay especially during outdoor activities
34. Do not ride a bike without eye protection.
35. Do not swim without eye protection.
36. If anything splashes into your eyes, wash it thoroughly with clean water before going to the hospital.
37. Buying eye drops over the counter without prescription is a recipe for disaster.
38. Use urine in your eyes at your own risk.
39. Do not leave your doctor before knowing the name of your eye problem.
40. Because it worked for your neighbor, is not a scientific evidence!
