Dr Nkumbe specializes in the management of the following eye conditions:
Retinal Detachment
The retina is the thin, transparent membrane that lines the inside of the eye. It is on the retina that images are formed in the eye. A detached retina simply means that the retina is separated from the inner lining of the eye. A retinal detachment is an emergency and must be treated surgically as soon as possible. The chances of vision recovery reduce with the duration of the detachment. The approaches we use to manage retinal detachment include:
- Careful examination of the other eye to rule out lesions, such as retinal tears, which could result in a retinal detachment. In Cameroon, we have observed that up to 30% of persons presenting with a detached retina either have detachment in the other eye already, or have a lesion in the other eye that puts them at a very high risk of having a detached retina. Should we find a lesion during this exam, we can reduce the risk of retinal detachment by performing laser or cryotherapy preventive treatment.
- Pars plana vitrectomy surgery to reattach the retina or
- Scleral buckling surgery to reattach the retina.
- Pars plana vitrectomy surgery to reattach the retina or
- Scleral buckling surgery to reattach the retina.
Diabetic Retinopathy
This is a complication of diabetes, which affects about 25% of persons with diabetes mellitus. To prevent vision loss from diabetes, it is important to ensure proper control of blood sugar as well as other risk factors such as high blood pressure and high blood lipids (cholesterol etc.). It is also important to stop smoking, reduce excessive weight and engage in more physical activities especially after meals.
In addition, we recommend yearly comprehensive eye exams, which include a dilated examination of the retina, to screen for diabetic retinopathy. Early detection and management of diabetic retinopathy can prevent irreversible loss of vision.
The management of diabetic retinopathy, depending on the type and stage includes: good systemic control of diabetes and other risk factors, laser treatment of the retina, injections inside the eye to reduce bleeding or swelling of the macula, retinal surgery (vitrectomy) in advanced cases to clear vitreous haemorrhage, perform laser photocoagulation and reduce traction on the retina.
Persons with diabetes have an increased risk of developing cataract, dry eyes, glaucoma and infections of the eye.
The burden of blindness from diabetic retinopathy is highest in the age group between 18 and 65 years, the economically active population.
Cataract surgery
Cataract is a progressive whitening or yellowing of the naturally clear and transparent crystalline lens. It is the first cause of blindness in the world.
Cataract results from the natural ageing of the eye. In Central and West Africa, the age range of the majority of persons undergoing cataract surgery is 60 - 70 years. However, other causes of cataract include medical conditions such as diabetes, eye trauma, use of certain pharmaceuticals and cosmetic products that lighten the skin colour (bleaching, Njangsang). We also have a few cases of children who are either born with or develop cataract after birth. Cataract, especially in very young children is considered an emergency and needs to be treated as soon as possible.
The only known treatment for cataract is surgery. We can offer two forms of cataract surgery:
- Manual small incision cataract surgery (MSICS), through an incision between 8 and 12mm.
- Phacoemulsification surgery, through an incision averaging 1.5 – 3mm
- Manual small incision cataract surgery (MSICS), through an incision between 8 and 12mm.
- Phacoemulsification surgery, through an incision averaging 1.5 – 3mm
Computer Vision Syndrome
This is a condition caused by prolonged use of digital devices such as computer monitors, smartphones etc. Symptoms and signs include blurred vision, eye discomfort (sandy sensation, burning sensation, itchy eyes, red eyes, headaches, back pain etc.
To diagnose and manage computer vision syndrome, it’s important to take a detailed history and perform a good clinical examination of the eyes. Additional tests may be required.
Glaucoma
Glaucoma is an eye condition in which the pressure inside the eye is too high for the eye. When the pressure is too high, it damages the optic nerve, which is the cable carrying images the eye sees to the brain. Any damage to the optic nerve is irreversible. Therefore, early diagnosis of glaucoma is important, so as to start treatment early enough and prevent irreversible blindness from glaucomatous optic nerve damage.
Management of glaucoma includes:
- Screening of first degree relatives of glaucoma patients, since glaucoma can run in families (hereditary)
- Use of eye drops to reduce eye pressure
- Laser treatment to open up the drainage channels of the fluid produced inside the eye, to reduce the eye pressure.
- Minimally Invasive Glaucoma Surgery (MIGS)
- Trabeculectomy
- Glaucoma drainage devises
- Screening of first degree relatives of glaucoma patients, since glaucoma can run in families (hereditary)
- Use of eye drops to reduce eye pressure
- Laser treatment to open up the drainage channels of the fluid produced inside the eye, to reduce the eye pressure.
- Minimally Invasive Glaucoma Surgery (MIGS)
- Trabeculectomy
- Glaucoma drainage devises
Occlusion of the blood vessels inside the retina (vein or artery
An occlusion of one of the blood vessels inside the eye is, simply put, a form of stroke of the eye. The risk factors for occlusion of blood vessels in the retina are very similar to those of stroke: high blood pressure, high blood lipids etc. The most important step in the management of retinal artery or vein occlusions is therefore the management of the underlying medical condition.
Ophthalmic imaging, such as coloured fundus photography, Optical Coherence Tomography and Fluorescence Angiography may be requested to determine the severity and propose a management plan. Management may include:
- Observing the eye to see in mild cases
- Injection of certain pharmaceuticals inside the eye to reduce swelling of the retina and retinal bleeding
- Laser treatment of the retina to reduce bleeding in the retinal
- Pars plana vitrectomy surgery, to restore vision, when there is massive bleeding inside the eye.
- Observing the eye to see in mild cases
- Injection of certain pharmaceuticals inside the eye to reduce swelling of the retina and retinal bleeding
- Laser treatment of the retina to reduce bleeding in the retinal
- Pars plana vitrectomy surgery, to restore vision, when there is massive bleeding inside the eye.
Sickle Cell Retinopathy
Sickle Cell Retinopathy is a common condition among persons with sickle cell disease. In SS and SC, about 14% and 43% of patients have sickle cell retinopathy respectively. Advanced sickle cell retinopathy can cause blindness from bleeding inside the eye or retinal detachment.
It is therefore important for persons with sickle cell disease to have comprehensive examination of the eye, including a dilated examination of the retina to identify early stages of sickle cell retinopathy every 1 to 2 years. This should start from the age of 10 years.