• Written By: Martine J. Jager, MD, PhD
    Cataract/Anterior Segment

    This study reports on the cases of 50 patients with cataract (55 eyes) treated by traditional couching who presented to an eye clinic in Yemen between one month and 35 years after undergoing the procedure. Couching is a traditional treatment for cataract that is still used in areas of Africa and Asia. The authors conclude that the couching method used where the study was conducted is relatively ineffective and dangerous and that most patients are dissatisfied with the results.

    The patients in the study underwent testing for BCVA and IOP, slit-lamp biomicroscopy and fundus examination. They were also asked about the cost of the surgery and their clinical history and satisfaction with the procedure immediately following the operation and presently.

    The authors report that traditional healers who performed the procedure were often paid partially in kind, with the price varying according to the patient's ability to pay. Healers were paid on average $62 plus accommodations and meals in the village they visited. After aphakic correction, 1.8 percent of eyes (1/55) had good vision (≥ 6/18), 21.8 percent (12/55) had low vision (≥3/60) and 76.4 percent (42/55) were still blind (<3/60). Complications noted were glaucoma in 21 eyes, corneal opacity in 14, uveitis in six, posterior capsule opacity in eight, retinal detachment in seven and severe pain in 14.

    The authors conclude that the traditional couching procedure studied is associated with ocular morbidity and disastrous late complications leading to blindness. They say that health policy-makers and medical authorities in Yemen should discourage performance of the procedure, as well as inform the population about the existence of a more effective and safer alternative. They add that it is important to improve the quality of ophthalmic services in order to provide cataract patients with the best, most accessible and least expensive services possible. They say it is also important to understand the barriers to accessing eye care services and formulate effective strategies for their removal. They recommend integration of traditional healers at the community level into the modern health care system.