Serious eye problems are affecting tens of thousands across the half-island Pacific nation of Papua New Guinea (PNG) and exacerbating suffering in rural areas, say health workers.
"The need for treatment must be prioritized in this country as the number of people suffering from blindness or low vision is high and the problem is growing," the country's chief ophthalmologist, Simon Melenges, told IRIN.
Almost 200,000 people nationwide have poor eye-sight or no vision; many go without treatment due to inadequate eye-care facilities, specialists, surgical supplies and drugs.
The state estimates it will cost nearly US$8 million to provide eye care to those in need in 2012, with the cost expected to double by 2016 - this in a country where almost nine out of 10 people live in rural areas and are dependent on erratic farming income.
For children unable to get into one of the country's seven special education programmes for blind children, in which 6,000 are enrolled, blindness consigns them to a life of begging to survive when they are unable to support their family in the fields or find other income sources, said Arnold Koima, a local special education expert.
"People with vision problems or who are blind and living in rural areas do not get all the support they need. Many adult[s] are left to suffer in silence and wait to die."
Widowed and living alone, Kuragl Ambu, over 60 years old, was doing fine in her village in the Highlands Province of Chimbu, 450km from the capital, Port Moresby.
Until she lost her vision.
"I could make my own garden, collect my own firewood and look after my pigs but because I could not see, I stayed at home. I could not go anywhere."
The mountainous topography and population concentration in rural areas make eye care all the more critical in a country where rural healthcare and income are already precarious, noted recent research by the NGO CARE Australia conducted in a community 50km from Ambu's.
In Obura-Wonenara District of Eastern Highlands Province, of the 262 surveyed families, more than 60 percent earned less than $100 the previous month through coffee sales, comprising most of their income and 75 percent of those surveyed reported problems obtaining enough food.
"This is exacerbated by isolation, the lack of alternative income sources, and the lack of options afforded to them through their low levels of education," wrote the authors of CARE's report.
"We have a very sad situation here. In most of the cases, it's just the need for a pair of glasses. People in this country live with blindness not only because they can't access [medical care] but because they can't afford it," said Eileen Tagum of the local NGO, PNG Eye Care.
One-third of surveyed patients over the age of 50 in a study published in 2006 were visually impaired and 8.9 percent were completely blind.
A pair of prescription eyeglasses can cost from $150 to $250. There is no health insurance or sliding-scale payment plan for the country's poor. Cataract surgery costs up to $40 plus the cost of the hospital stay.
Uncorrected refractive error and cataracts are the leading causes of vision impairment, followed by corneal infections, pterygium (growth of scar tissue and blood), uveitis (eye inflammation), trauma and eye disease complications from diabetes, said Melenges.
Nationwide, there are seven functioning eye clinics partially funded by the Australian government; almost all lack sufficient stocks of drugs to treat eye infections, surgery supplies or prescription glasses, PNG Eye Care says.
The country needs 60 eye specialists to treat the 6.9 million population, but there are only 18 ophthalmologists practising, according to the government.
"The government needs to do more for eye-care services in the country," said Melenges.
Working with the National Department of Health to address poor eye care are local NGOs such as Callan Services and PNG Eye Care; Fred Hollows Foundation New Zealand; Australia-based International Centre for Eye Care Education; St. John Association for the Blind; and Royal Australian and New Zealand College of Ophthalmologists.
"Eye-care NGOs are coordinating more to spread our services. We are increasing our presence in the community. The need is there," Tagum said.
Practitioners wrote and submitted the country's first National Eye Plan - covering 2011-2015 - to the National Department of Health in April 2011.
"It is now up to the department to take it up with government for funding," Melenges said.