Between 2014 and 2016, an epidemic of Ebola swept across West Africa, infecting over 28,600 people and leaving over 10,000 dead. In Guinea, Liberia and Sierra Leone, where the epidemic was primarily located, the disease left behind around 17,000 survivors. Many of them are now dealing with an unexpected complication: cataracts.
Ebola, properly known as Ebola virus disease, is a severe viral hemorrhagic fever that was first observed in central Africa in 1976. Since then, it has appeared in intermittent outbreaks, with mortality rates ranging from 25 percent to 90 percent.
The 2014-2016 epidemic was unique not only because it was the largest one to date, but also because its death rate hovered around 50 percent, lower than that of many prior outbreaks. The combination of these two factors has meant that researchers have observed an unprecedented number and variety of post-infection complications, with cataracts being one of the most dreaded.
Cataracts involves the clouding of the eye’s lens, which can lead to eventual blindness, and although they are normally seen in older individuals, cataracts have been observed in Ebola survivors as young as five years old. In the case of Ebola survivors, the direct cause of the cataracts was often a type of inflammation inside the eye, called uveitis.
Cataract surgery can be useful in repairing sight, by removing the damaged lens and inserting an artificial one. However, surgeons were often wary of operating, concerned that the Ebola virus might still be present in the eye.
A team of researchers from Emory University made several visits to West Africa, to determine if the virus was still present in survivors’ eyes. They discovered that although the live virus could be detected at first, after a certain period of time, tests began to come back negative.
This does not necessarily prove that the pathogen had actually been eliminated by the immune system, but it is considered an indication that the eye is safe to operate on.
One of the researchers was Dr. Ian Crozier, an Ebola survivor who had suffered from uveitis and cataracts himself after contracting the disease while treating patients in Sierra Leone during the epidemic.
“The same things you go through today, I went through for the past two years, even with the same doctors,” he told a group of Sierra Leonean patients preparing for treatment, according to The New York Times.
Crozier received cataract surgery in March of 2017, after tests for the Ebola virus in his eye finally came back negative.
By the summer of 2017, he and several fellow doctors examined around 50 West African Ebola survivors with cataracts.
The surgeons would begin by “tapping” the eye. This involves drawing fluid out through a thin needle inserted into the eye, and then the surgeon would test to see if the virus was present.
If not, the patient could then undergo surgery.
For some, the outcome of the surgery has improved vision.
Others have faced complications from inflammation of the optic nerve or dangerously low eye pressure, which could cause the organ to collapse during surgery.
The goal for now is to ensure as many survivors with cataracts as possible receive the treatment they need.
