Restoring Vision for Ebola Survivors

Doctors take steps to bring eye surgeries to those in need

After undergoing anterior chamber paracentisis to test for the presence of Ebola in his eye, a survivor is led by Emmanuel with Samaritan’s Purse from the Emergency ‘Smart’ Pod (ESP) at ELWA Hospital in Monrovia, Liberia. / Joshua Yospyn, JSI

The 2014–15 Ebola virus disease outbreak in West Africa killed over 11,000 people and left behind more than 7,000 survivors. In Guinea, Liberia and Sierra Leone, at least 65 survivors developed cataracts in one or both eyes and faced vision loss.

In early 2017, a collaboration of health-oriented organizations came together in Liberia to provide cataract surgery to Ebola survivors and support research on this discovery in Ebola survivors many months after their recovery.

Robert Dolo, a non-physician cataract surgeon and executive director of New Sight Eye Center in Liberia, chats with patients while Karen Daniels, a registered nurse and program manager of cleft and cataract teams for Samaritan’s Purse, helps a patient with an eye bandage at ELWA Hospital in Monrovia, Liberia. / Joshua Yospyn, JSI

Ebola’s effects on survivor health

People who survive Ebola frequently suffer multiple complex health problems. The Ebola virus can persist in the eyes of survivors, causing inflammation and potentially transmitting the disease to health workers during exams or procedures of the eye.

“All along, we have been very afraid to operate on Ebola survivors, because we are thinking that, well, is there a piece of virus in their eye that might cause a recurrence of this Ebola disease,” says Robert Dolo, a Liberian ophthalmic nurse trained in cataract surgery. Doctors and nurses needed to confidently know if eye procedures on survivors were safe.

Left: A nurse examines a patient’s eyes before surgery. Right: Levi Vambram, a farmer, Ebola survivor and participant in the cataract program, stands at Camp Luwana, an overnight facility for ELWA Hospital patients. He underwent anterior chamber paracentisis, where ophthalmologists in personal protective equipment extract an extremely small amount of fluid with a needle to test for any presence of the virus. He said after spending two months in an Ebola Treatment Unit, his vision started deteriorating. The world started to “look like a dew.” He lost his wife, mother, brother and nephew to the virus, and now he’s caring for his brother’s orphaned children. / Joshua Yospyn, JSI

A unique eye surgery program

Creating an eye surgery program with an Ebola research component in a low-resource setting was complex, requiring partners with diverse capabilities and a specialized surgical environment. The National Institute of Allergy and Infectious Diseases (NIAID), part of the U.S. National Institutes of Health (NIH), and the USAID-funded Advancing Partners & Communities project coordinated this effort for survivors in Guinea, Liberia and Sierra Leone. PREVAIL, a separate partnership between NIAID/NIH and Liberia’s Ministry of Health, helped locate survivors with cataracts.

“This particular project has more partners than most and we’re very lucky because we didn’t have a funding source to provide cataract surgery… . Samaritan’s Purse and JSI were able to provide this infrastructure along with organizational support and the surgeons,” says Dr. Rachel Bishop, chief of the National Eye Institute’s Consult Services Section. JSI stands for John Snow Inc.

Dr. Ben Roberts, an ophthalmologist at Tenwek Mission Hospital in western Kenya who was asked by Samaritan’s Purse to help with cataract surgery for Ebola survivors in Liberia, preps William Pewee for cataract surgery in the ELWA Hospital operating room in Monrovia in 2017. / Joshua Yospyn, JSI

Testing for Ebola virus

After more than six months of planning, 24 Liberian Ebola survivors and a control group of 10 close contacts received cataract surgery in September 2017 at ELWA Hospital in Monrovia.

Not knowing if Ebola virus would be present, doctors from Emory University Eye Center, one of the program’s three academic partners, extracted a small amount of fluid from the anterior chamber of each survivor’s eye — “anterior chamber taps” — a few days before surgery. Fluid extraction required a surgical isolation unit to protect doctors and patients in case active Ebola virus was present.

Doctors draw fluid from survivors’ eyes to test for Ebola. / Joshua Yospyn, JSI

With USAID’s support through the Fighting Ebola Grand Challenge, Baylor College of Medicine developed the Emergency Smart Pod, a rapidly deployable care setting that can be set up in less than an hour with just four people as a field hospital, laboratory or isolation unit. Baylor sent the pod to ELWA Hospital, and the staff decided that it was a perfect place to perform the taps.

The laboratory at the Liberian Institute for Biomedical Research tested each fluid sample; thankfully, all were negative.

“To date, we have not found evidence of the virus in our Ebola survivors… so that’s really great news,” says Bishop. “What that means is we can hopefully make the recommendation that, in general, Ebola survivors can get regular standard eye surgery, whether for cataracts or anything else.”

Researchers are currently analyzing the cataract surgery samples. Based on this analysis, a team of eye experts from West Africa and the United States will create consensus guidelines for surgical management of ocular needs in Ebola survivors, giving health workers valuable information on how to approach eye surgery for Ebola survivors.

A nurse accompanies a patient after her procedure. / Joshua Yospyn, JSI

About the Author

Anne Marie Hvid is the KM Adviser on the Advancing Partners & Communities project, which provides support for USAID’s post-Ebola work in Liberia, Sierra Leone and Guinea.