Sesona Mehlala has dealt with poor eyesight for most of her life. The 27-year-old started wearing glasses at nine. But even with the spectacles she struggled to see. In 2015 she buckled under the financial and mental strain of frequent changes to her prescription spectacles. She just stopped wearing glasses and contact lenses.
For the next four years Mehlala was “highly dependent on other people”. She couldn’t drive and needed help with everyday tasks such as withdrawing money from an ATM and sending text messages.
In 2019, when she moved to Cape Town to study, Mehlala resumed the journey to restore her eyesight. In 2020 the cause of her ailing sight was diagnosed: an advanced stage of keratoconus.
Keratoconus, a disease that affects the shape of the cornea and the way the light enters the eye. It’s one of the most common causes of corneal blindness. At this stage Mehlala was partially blind and needed scleral contact lenses to restore her sight.
“Groote Schuur Hospital got me in contact with the NGO Eyes2Eyes and I eventually got the lenses in April 2022 with their help,” she tells Health-e News.
“The cornea is the transparent front window of the eye. It helps to focus an image or light into the back of the eye which then sends the image to the brain. Corneal blindness is anything that causes this ‘front window’ to not remain clear. If light cannot get through to the eye, you don’t see very well,” explains Dr Roland Höllhumer, head of the Corneal Unit at Charlotte Maxeke Johannesburg Academic Hospital.
Specialised scleral contact lenses can be fitted to restore sight. These are highly technical lenses offering a life changing solution to patients who cannot see due to conditions like keratoconus.
“These patients will usually have a gradual reduction in their vision and become more short-sighted. They usually go to the optometrist for glasses, who notice if their vision or glasses are changing too frequently.
“They are then referred to an ophthalmologist who does special scans that look at the shape of the eye or different layers of the cornea, which help diagnose the condition.”
Höllhumer says if patients are diagnosed early a lot of corneal conditions are treatable and people can still recover a lot of their vision.
In 2018 Amanda Seccombe lost her sight rather suddenly. Through surgeries and the addition of a specialised scleral lens imported from New Zealand, she was able to see again. But many South Africans don’t have access to the level of care she received.
This pushed her to start a non-profit the Eyes2Eyes foundation with two friends in 2020 to help disadvantaged patients in the Western Cape get world class corneal care.
“One of the biggest challenges is that there are no confocal microscopes in the public health sector to help facilitate early diagnosis,” Seccombe says.
“It is a useful, though not essential, piece of equipment for the diagnosis of certain types of corneal infections. Even in the first world setting, this is not a piece of equipment that many have access to,” explains Höllhumer.
According to Seccombe, Dr Leonard Heydenrych, an ophthalmologist, has just obtained a confocal microscope for his private practice in Durbanville, Cape Town.
Eyes2Eyes aims to purchase a confocal microscope, which does high resolution imaging of
all the layers of the cornea. This means corneal diseases can be diagnosed far more quickly and accurately.
“Our goal is to install one at the Groote Schuur Hospital Eye Clinic, which screens more than 38 000 patients per year,” she says.
There are also no customised scleral lenses in the public sector.
“Patients are mostly assisted by academic institutions, but still need to buy the lenses. As far as I am aware, there is work to make this available,” says Höllhumer.
Seccombe says the foundation also wants to fund highly customised scleral lenses for patients with advanced keratoconus.
“There is an urgent need for a more integrated approach to all categories of blindness in South Africa. Current data on the prevalence and incidence of blindness is outdated. A national eye care plan with clear objectives and adequate budgets should be a serious priority in healthcare services,” says Seccombe. – Health-e News