Durban, South Africa, is a city situated on the eastern seaboard of the country, known for its beautiful coastline and its subtropical climate. It has one of the busiest ports in Africa, it’s a top surfing and diving destination and it was where Nelson Mandela chose to cast his first vote as a free man in the first Democratic General Election in 1994. Now Durban is the site for a new training program for optometrists that will significantly improve the quality of vision care for South Africans.
The course is offered by the SUNY College of Optometry. Dr. Scott Morrison, OD, who has maintained a private practice in New Paltz while also serving as an assistant clinical professor at the college for 30 years now, went to South Africa in June to participate in the ground-breaking medical education program, teaching alongside SUNY College of Optometry department chair Dr. Richard Madonna, MA, OD (who is also Morrison’s former partner in private practice before he chose to teach full-time).
The course was developed to train optometrists in South Africa in therapeutic treatment for eye diseases that don’t require surgery. While optometrists in the U.S. have been treating conjunctivitis, glaucoma, foreign bodies in the eye and abrasions since 1986, that hasn’t been the case in South Africa, where optometrists have only been permitted to do basic eye exams for eyeglasses and contact lenses. With everything else falling under the purview of ophthalmology, that meant an imbalance in a system where, according to Dr. Morrison, too many people have been left visually impaired for long periods of time, with more than 50 million people served by only about 3,000 optometrists and 400 ophthalmologists.
In the U.S., a person in need of cataract surgery can be diagnosed and have the operation within a week. In South Africa, a person is put on a waiting list for surgery, and they can’t even make it that far until their vision has deteriorated to at least 20/60, says Dr. Morrison. (And to put that in perspective, we can’t drive here if our vision is worse than 20/40.) “And once on the list, it can be two to two-and-a-half years before they get to you, because there are only 400 MDs.” Training optometrists in South Africa to treat simple eye diseases should free up the ophthalmologists — currently overloaded with patients suffering minor eye afflictions — to conduct more surgeries.
The training course was enacted because of the advocacy of optometrists in South Africa, led by Dr. Vanessa Moodley, affiliated with the University of KwaZulu-Natal (formerly the University of Durban Westville). “You have to give her the credit for this,” says Dr. Morrison. “She fought really hard for this to happen. She took ‘ophthalmology’ on and said, ‘We have to come together as two professions that have the same interests at heart. These patients need help and they’re waiting years for treatment. We have to find a way to come together and come up with a plan.'”
It took years of negotiation and back-and-forth before there was some type of agreement between optometry and ophthalmology in South Africa — “ophthalmology was reluctant to give another profession the right to do the work they do,” says Dr. Morrison — but the end result is a program in which South African optometrists can become certified to treat eye disease by going through a 72-hour course and doing 600 clinical hours in a hospital-type setting.
The SUNY College of Optometry course is divided into three parts. The introductory segment was conducted in Durban for the first time in April, followed in May by the second part of the course covering the anterior, or front of the eye. The posterior, or back of the eye, where diseases take place, was addressed in the third and final part of the course in June, taught by doctors Morrison and Madonna. Their section of the course involved six hours of instruction per day for four days, with the two professors “tag-teaming” the curriculum so that each doctor was responsible for 12 hours each.
The course was open to any licensed optometrist who could pay the fee to take the class and pass an exam beforehand. The criteria of 600 hours of clinical experience is a stringent one, says Dr. Morrison, difficult to achieve while also working full-time as an optometrist, but if the doctors enrolled in the course are able to come to New York for several weeks, the SUNY College of Optometry is welcoming them to fulfill any part of the requirements in the clinics here.
Doctors Morrison and Madonna may make a repeat visit to South Africa to teach the course again next year, with it anticipated that another 150 optometrists will want to take the training. “We taught five student doctors in our course to be mentors, so that they can take over and teach others to do this. But I don’t know if they feel prepared to do that quite yet,” says Dr. Morrison.
The long-term goal, he adds, is that “Once people there realize that optometrists can do more than just glasses and contacts and are able to bring disease treatment to the population, more people will sign up to go through school and become an OD.”
Knowing what the situation in South Africa has been, “It makes you realize how fortunate we are in this country to have the eye care that we have,” he says, “and be able to receive care so quickly. And there, they just haven’t had that.”
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