August 14, 2000
Volume XXXIII, No. 31


HSC Profiles

In Memoriam



Border residents benefit from UTHSC, community and state cataract expertise 



Health Science Center ophthalmologists improved the sight of 14 Ciudad Acuña residents during a recent visit to the Mexican border city. Ciudad Acuña, population 113,000, is across the Rio Grande from Del Rio. The operations, to remove advanced cataracts, took place July 13-15 at the Amistad Eye Clinic.

"We want to be useful for patients who can’t afford to pay anything, and we want to expand and support the already excellent care provided by local Mexican doctors," said Dr. William E. Sponsel, associate professor and director of clinical research in the Department of Ophthalmology. Dr. Sponsel performed the cataract removals and lens implants with two other experienced ophthalmologists, Dr. Gianmarco R. Paris, an international fellow at the Health Science Center, and Dr. Donald Keith Sanford, clinical instructor. Dr. Gustavo Vela Delgado, a Ciudad Acuña ophthalmologist, supervised the operations and patient follow-up.

Lions Clubs chapters in Texas and Mexico funded the construction of the Amistad Clinic, which has helped 4,000 people in the past year, Dr. Sponsel said. Services include a dispensary of more than 40,000 pairs of recycled eyeglasses donated through the Lions Clubs, classified by prescription and stored at the clinic for distribution to patients.

The clinic’s operating room is air-conditioned and includes a state-of-the-art microscope. "It’s a very nice facility considering the financial constraints of the people it serves," Dr. Sponsel said. "The Lions built it on faith that groups like ours would come to see patients there. We have made two trips so far, and teams from other institutions also are providing care. This literally is a case of ‘build it and they will come.’"

Doctor examining patient's eyes.

Dr. Gustavo Vela Delgado, an ophthalmologist in Ciudad Acuña, Coahuila, Mexico, examines a patient at the Amistad Eye Clinic. Dr. Vela is the principal surgeon at the Acuña clinic.

The physicians used lenses and other supplies donated by Alcon Laboratories Inc. of Fort Worth. The local Lions leadership verified that the candidates for surgery were uninsured individuals unable to afford surgical care elsewhere.

Families with loved ones seeking the surgery were evaluated daily from 8 a.m. to 6 p.m. both inside and outside the clinic. "We work in an ideal surgical environment in San Antonio, but when you have the opportunity to share in the care of patients in a setting like Acuña, you want to do more because there is such a need," Dr. Sponsel said.

A cataract is a clouding of the lens, the spherical structure that focuses light upon the back of the eye, the retina. In healthy eyes, the lens is crystal clear. In eyes with cataracts, the lens is opaque, affecting vision. When vision cannot be corrected to better than 20/50 and visual function is compromised to the point where someone is unable to perform tasks at work or home, surgeons remove the clouded lens and implant an artificial lens. "We’re using an acrylic lens that can be folded like a taco and placed into the eye," Dr. Sponsel said. "We pop it into the pupil and let it open inside the bag where the original lens used to be. It’s like wearing a contact lens inside the eye rather than on the surface of the eye."

This procedure is called "Clear-Cornea Extracapsular Cataract Extraction with Intraocular Lens Implant." It is safer and less invasive than previous methods of cataract removal.

"At its best, this procedure affords a significant improvement over older methods of cataract surgery," Dr. Sponsel said. "The classical technique featured removal of the lens—and the bag around the lens—through a large incision. This method could cause glaucoma. A later variant called for removing the entire lens through a large incision while leaving the bag intact. However, in modern cataract surgery, we remove the diseased lens through a tiny incision and avoid taking out the bag. We can correct the problem with a minimum chance of complication in many patients."

An instrument shaped like an ice cream scoop is used to extract the cataract and old lens. Surgeons bombard the eye with sound waves to break up the cataract. A tiny incision is made in the cornea, the surface of the eye. The surgeons break the lens into small pieces and, using the extraction instrument, carefully remove the pieces.

The incision is only large enough to permit passage of the instrument. The lens implant is inserted through the incision and pops into place.

Cataracts occur with advancing age. According to the National Eye Institute, cataracts affect more than half of all Americans age 65 and older, and about 1.5 million cataract removals are performed annually in the United States.

The UTHSC team performed eight Extracapsular Cataract Extractions during a May visit to Ciudad Acuña. "Most of the patients were legally blind by physician standards (vision of 20/100 or worse)," Dr. Sponsel said. "On our July trip we worked more efficiently, seeing more patients and making more pre-operative evaluations of people in the community." A third visit is planned for the fall.

Robert Hobson, Department of Ophthalmology, is the project coordinator. Supporters include Dr. Richard Evans, a private practice ophthalmologist in San Antonio and a graduate of the UTHSC ophthalmology residency training program; Christus Santa Rosa Northwest; other community and state ophthalmologists and optometrists; and Dan and Pat Tappmeyer of University United Methodist Church in San Antonio.

The Department of Ophthalmology, under the leadership of Professor and Chairman Dr. Wichard A.J. van Heuven, is providing clinical support for the ongoing program in Ciudad Acuña. Anyone interested in making a donation to the program is invited to call Dr. van Heuven’s office at (210) 567-8402. The department is raising money to expand Pan-American research and education programs in ophthalmology.