By Albert T. Vitale, MD
In resource-poor countries such as Myanmar, which has the second-highest number of people living with HIV in Southeast Asia, the rates of cytomegalovirus (CMV) retinitis and associated vision-threatening complications remain unacceptably high. Patients present late with advanced ocular pathology due to delay in diagnosis and limited access to care.
David Heiden, MD, of California Pacific Medical Center, pioneered comprehensive workshops for non-ophthalmologist HIV/AIDS physicians to address this problem. The training includes the use of indirect ophthalmoscopy to diagnose CMV retinitis and other ocular opportunistic infectious diseases. Training workshops, including the safe administration of intravitreal antiviral therapy, have been conducted in Yangon since 2007.
Along with past uveitis fellows, I have participated in six such workshops and will have submitted for publication a study to assess the utility of prophylactic argon laser photocoagulation to prevent retinal detachment in patients with CMV retinitis. The methodology and details of CMV screening in these workshops, as described in the peer-reviewed literature, have been highly successful and sustainable, allowing trainees from all over the country to provide appropriate and timely care for their patients with ocular complications from HIV/AIDS.
Until recently, a variety of non-governmental organizations supported this work; however, over the past several years, there has been a shift in the care of patients with HIV/AIDS to governmental institutions.
Our most recent workshops were conducted at Yangon Eye Hospital (YEH) with Dr. May Zun Aung Win, director of the Uveitis Service, her colleagues, and residents. The workshops have provided the impetus for an ongoing, sustained institutional relationship between YEH and the Moran Eye Center, initially in the arena of uveitis, with the eventual goal to include other subspecialties in ophthalmology.
Moran’s uveitis outreach care also extends to Pakistan.
Akbar Shakoor, MD, has been a lecturer at the Aga Khan University Medical College and the Layton Rahmatullah Benevolent Trust in Karachi. This work has included an annual Uveitis Lectureship to residents and staff and the development of uveitis curriculum.
Of our three superb international uveitis fellows thus far, two have hailed from Pakistan and one from Myanmar.
Dr. Vitale directs Moran’s Uveitis Division and specializes in diagnosing and treating uveitis and other infections and inflammatory diseases of the eye. He is co-author of the definitive text on the subject with Dr. C. Stephen Foster, titled "Diagnosis and Treatment of Uveitis."