Report: Diabetic retinopathy laser program, St. Jude Hospital (St. Lucia), by Jeevak Lal, MD

July 3-14, 2017 - St. Jude Hospital, St. Lucia - The effort to offer laser treatment to patients afflicted with diabetic retinopathy started in 2002.  This was the 27th session. 

Patients were screened during the mornings and early afternoons.  The screening involved a brief but focused history, visual acuity determination (but no refractions because of time constraints and lack of a refracting lane), applanation tonometry, gonioscopy, slit-lamp check, followed by dilation if the angles were deemed safe.  Patients would return for fundus exams with a 78 diopter lens at the slit-lamp.   Indirect ophthalmoscopy was performed only if there was a clinical suspicion requiring the procedure.

Patients identified with significant retinopathy were apprised of their situation.  Laser treatment was offered if it was felt to be a viable option.   Often, laser procedures were performed on the day of diagnosis.  Dr. Darra Burt, St. Jude’s ophthalmologist, provides post-laser care and follow-up.

The questioning reader should ask, “why aren’t we using Anti-VEGFs?”  Two answers. 1) They’re too expensive and 2) they’re yet to be approved for use on the island. 

The patient volume was heavy.  The clinic and administrative staff worked gallantly from early morning till after 9PM on several days.  They were heroic.  Thank you.

There were 190 clinic visits and 50 laser procedures were performed.   While St. Jude does charge fees, no patient is ever turned away because of an inability to pay.

The cumulative totals for the program since 2002 are now 4144 clinic visits and 735 laser procedures.   Given the magnitude of the problem and the grief caused by diabetic retinopathy, these numbers are severely inadequate.  Much more has to be done.  What little we can do, we will try to do.

Patrick Commiskey