Megan Webber, the co-Founder of KnowTheGlow, was excited to speak with Dr. Jairo Mercado, a young optometrist, and teacher at the School of Optometry at Universidad Nacional Autónoma de Nicaragua (UNAN) who was also honored as an IAPB Eye Health Hero. It was Dr. Mercado, however, who turned the tables and shared with Megan that he had been following KTG’s work and was impressed, in particular with a presentation he had seen at a VOSH International event. He told Megan that he was very excited about the opportunity to work with KTG. Dr. Mercado shared with Megan that he is currently in a development campaign with VOSH International for a project specifically targeting children’s vision in Nicaragua. He explained that in Nicaragua, it is necessary to develop a national visual health plan and standardized protocols. Dr. Mercado believes it is imperative to have a global view and to work in collaboration with ophthalmologists to focus not only on refractive error treatment but also focus on preventable blindness. Dr. Mercado sees common ground with KTG regarding bringing awareness and early detection to help find eye conditions like trachoma, diabetic ROP, retinoblastoma, and cataracts.
Megan asked Dr. Mercado about his work at the College of Optometry to better understand how their program works. At the College of Optometry, with the support of VOSH-International, there is a three-pronged approach to reaching out to communities with vision care. First, they conduct clinics outside of the college with students in their fifth year (about 20) accompanied by 6 professionals. Secondly, these campaigns are run in conjunction with Dr. Mercado’s foundation, Funcaciōn Para el Cuido de Ojo (https://fconicaragua.com) which tasks itself with finding children in the rural areas of Nicaragua and bringing vision care to them. Since 2016, FCO has been able to conduct 22,000 visual assessments of children ages 6-14. The third part of the program is his strong partnership and collaboration with the Fundaciōn Ojo Sano, which helps with any ophthalmological needs or surgery (i.e. free cataract surgeries) that may arise as a result of the screening done by Dr. Mercado’s clinics. As Megan has always said, we can not be in a position where we are looking for children but then have no path to treatment or care. Both of these foundations are vital and key partners in helping Dr. Mercado focus on children’s eye health. Dr. Mercado also shared with Megan that Nicaragua has a wonderful Ministry of Health. Nicaragua has 17 “departments” or “states” and Dr. Mercado’s goal is to work initially with six to begin implementing the larger goal of a national plan for vision care. His plan this year is to serve 7,500 children in three departments of the country where access to visual health is difficult. He will go to these six states and hope to achieve the following: provide visual health care, give lenses/glasses, collect data on the patients they are seeing, and then finally, correctly compile the data and turn it over to the Ministry of Health and promote a national vision plan. It is imperative that they not just have data, but that the data be accurate and specific, so that the government can properly assess the vision needs of the people. As Megan pointed out, if governments could see the cost of carrying a blind child through adulthood, they could more easily quantify the value of finding these cases early when the conditions can be more effectively treated or even prevented.
Megan was curious if there were any cultural barriers or hesitancy to wear glasses in Nicaragua. Dr. Mercado said there is not, but there is a concern in schools that there is bullying. In order to deter these behaviors, he wants to give teachers the tools to talk to the children about visual acuity and the importance of wearing glasses. Dr. Mercado said their real problem is that it is hard to get access to vision care, especially in rural areas.
It is very easy to see how Dr. Mercado is fully invested in helping children and adults get proper vision care. His passion and drive is clear when you speak with him. He shared one experience with Megan. Last May, at one of his many clinics in the rural areas of Nicaragua, he found himself in San Juan del Rio Coco. He saw 1 person right away that was missing one eye. When he sat down with these patients to do the clinical history, he was heartbroken to see that if that person had been able to get to a doctor in time, there would have been no need to lose an eye. He also saw cases of strabismus and amblyopia in people aged 30-36 who for the first time attended a visual assessment . When he asked them why they had not gone to see a doctor they explained that they did have the money nor the time to travel 4 hours to seek help. Time is money and taking time off from work was not an option for these and countless other patients Dr. Mercado would see. Furthermore, the prevalence of vision disorders is radically different in these remote areas. In general, Dr. Mercado explained, the prevalence of some eye conditions is usually between 4-10% of the population. In San Juan del Rio Coco, however, the prevalence of eye conditions was 40%– well over the normal 10% at most seen in urban settings. Why is this? With no access to vision care the prevalence numbers are alarmingly high.
Megan shared what she had heard the head of the Peek Vision Foundation say at this year’s IAPB International Conference in Dubai. Megan told Dr. Mercado how the PVF CEO stressed the importance of bringing vision care to people rather than waiting for people to come to vision care. The communities need to be mapped out with a plan to reach the people in these outlying areas. Even using the models created during the COVID -19 pandemic to deliver much-needed vaccines to these areas can be utilized.
Megan wanted to understand how they publicize the clinics in these rural areas to ensure that they have patients. Before COVID-19, Dr. Mercado told Megan that they were given permission by the Ministry of Health and provided a patient list but they also utilized TV and radio to invite people to come to the clinics. They have resumed clinics again since the pandemic, but they operate them a little differently. Dr. Mercado talks with local partners before going to the area. This pre-selection helps them to know exactly who their patients will be ahead of time. For example, in one town, he spoke with a church that knows the community and made him a list of people that they felt needed to be seen.
Dr. Mercado expressed to Megan his desire to build bridges among all the players in the vision community– optometrists, ophthalmologists, ocularists, etc. Additionally, he wants to engage optometry students to create teams with their professors, who are so vital to furthering the proliferation of vision care throughout the country as they work closely with these young professionals of the future. “We can help these children if we work together by building bridges between all the eye health providers.” We applaud Dr. Jairo Mecardo and his boundless drive to help put an end to needless blindness for the children in Nicaragua and around the world.
