VOSO: Eyecare in good hands in Tonga

Dr Duke Mataka is the sole ophthalmologist employed in Tonga. Since January 2019, he has been working full-time across the country's 108,000 population, having recently completed his surgical ophthalmic training at the Pacific Eye Institute (PEI) in Fiji.

Dr Duke, as he is known, is an accomplished and skilled surgeon who runs a theatre list most weeks at the Vaiola hospital, dealing mainly with pterygiae and cataracts. Trips from the Surgical Outreach teams from the PEI, and VOSO’s Dr Andrew Riley, have managed to reduce the number of cataract-blind patients over a 10-year period to the stage where Dr Duke is now keeping up with the incidence of cataracts across the entire population.

The vision requirement for surgery in Tonga is now about 6/18, a marked improvement from when VOSO first started running aid trips to the Pacific island 12 years ago.

As a result, when VOSO contacted Dr Duke about this year’s trip, he said the most useful thing we could do this year was to help with surgical supplies and in the clinic with several difficult cases the team have been dealing with.

We took over 60kgs of supplies, including a large number of medications such as topical antibiotics, glaucoma drugs and oral antibiotics. Some Avastin was given to the hospital as well as operating consumables.

Dr Riley and I worked in the morning at the OPD, seeing patients that Dr Duke’s team had booked for us, including several children with keratoconus who had undergone corneal cross-linking in New Zealand (funded by the Tonga MoH). I found the corneas were all clear and refractively stable, indicating what an important treatment this has become, especially in the islands, where hard contact lenses are not well-tolerated and corneal transplantation is not a good long-term option.

Other conditions included a recurrent squamous cell carcinoma needing exenteration, a young boy with a sixth nerve palsy and a patient with a retinal detachment.

We also taught the nurses how to fully use their Zeiss OCT and reviewed a list of medical retinal cases, discussing management.

VOSO chairman Dr Riley said, “The medical retinal service at Vaiola Hospital is now well-organised and they are certainly getting on top of the diabetic retinopathy problems that were prolific when we started visiting Tonga a number of years ago.

“The eye department has a Zeiss OCT and retinal camera, a YAG and Argon laser and the nurses (Mele, Meleane, Savelena and Blessie) are very competent and capable. They did appreciate the reassurance from us though, that their diagnoses and management plans were appropriate.