Lessons From Abroad

Discovering the value of international outreach during glaucoma fellowship.

By Matthew Miller, MD

Midway through my glaucoma fellowship, I traveled to Cap-Haïtien, Haiti, with a small team to provide surgical and medical eye care. This was my first experience with global outreach as an ophthalmologist, and it gave me a glimpse into the burden of unnecessary blindness around the world. Like many other poor nations, Haiti has a high rate of treatable and preventable vision loss due to cataract and glaucoma. But within this problem lies a tremendous opportunity to improve both the lives of those debilitated by poor vision and the country as a whole. Proper eye care can help reduce the economic impact of individuals leaving the workforce due to poor vision or the need to care for a visually impaired relative.


Within hours of arriving in Cap-Haïtien, we joined forces with Haitian ophthalmologist Pierre Dupuy, MD, and his team at the Vision Plus Clinic. We began to examine patients, all hoping to receive the gift of sight and return to normal life. After several hours, I had seen more white and black cataracts than I had come across in nearly 5 years of residency and fellowship training. We also encountered a tremendous burden of severe glaucoma in desperate need of treatment. Many of the patients with glaucoma were young and middle-aged adults with very high IOP due to juvenile or early-onset primary open-angle glaucoma. Fortunately, a majority had not yet developed significant optic nerve damage, giving us an incredible opportunity to provide timely interventions and hopefully prevent permanent loss of vision.

Figure 1. Matthew Miller, MD, performs small-incision cataract surgery, assisted by Dan Bettis, MD, and a Haitian scrub tech.

As I operated late into the evening each day, performing glaucoma tube shunt surgeries, angle-based glaucoma procedures, and manual small-incision cataract surgeries, the cases I encountered were some of the most challenging I had ever experienced (Figures 1 and 2). The complexity of the surgeries was compounded by the need to manage problems intraoperatively without the instruments and devices I was accustomed to having readily accessible in the States. Moreover, operating in this setting requires a constant minimalist mentality to maximize the limited resources available in order to benefit as many patients as possible. Collectively, these factors challenged my surgical assumptions and created a breeding ground for ingenuity in a way that undoubtedly made me a better surgeon and led me to ask critical questions about the procedures we perform as glaucoma specialists.

Figure 2. A view of the OR, which includes two operating microscopes with simultaneous surgeries being performed—a standard approach. On the left, Matthew Miller, MD, operates with scrub tech Amber Bettis, RN. On the right, Pierre Dupuy, MD, operates, while Dan Bettis, MD, looks through assistant oculars and provides feedback.

Figure 3. From left to right, Dan Bettis, MD; Matthew Miller, MD; Pierre Dupuy, MD; and Shane Havens, MD.


The primary goals of international outreach are to educate and train local providers to advance the specialized care they can provide and ensure that sustainable eye care is in place for underserved populations after the outreach teams depart. The Vision Plus Clinic in Cap-Haïtien is a perfect success story in achieving these missions. Our small team was able to perform a high number of sight-restoring and sight-preserving surgeries in a single week, but the true benefit to the people of Haiti was the transfer of knowledge and skills to local surgeons such as Dr. Dupuy (Figure 3). The training has enabled him to perform a high volume of surgeries throughout the year with knowledge and skills equivalent to what patients would experience from a competent surgeon in the United States. Our team is just one of many from multiple institutions that have been involved in outreach efforts in Cap-Haïtien in recent years; collectively, we are making it possible for Haiti to tackle the problem of treatable and preventable blindness.


It was an absolute joy for me to work with the Haitian physicians and staff at the Vision Plus Clinic. My experience in Haiti as a glaucoma fellow made me a better surgeon, a better doctor, and, hopefully, a better person. Thanks to this visit, I feel tremendous gratitude for my life at home and for the health care system I practice within, which, despite its problems, allows me to consistently provide patients with exceptional eye care.

Albert S. Khouri, MD | Section Editor
• Associate Professor, Program Director of Ophthalmology Residency, and Director of the Glaucoma Division at Rutgers New Jersey Medical School in Newark
• Member, Glaucoma Today Editorial Advisory Board
• Financial disclosure: None

Matthew Miller, MD
• Glaucoma Fellow, Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa
• Financial disclosure: None


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Glaucoma Today is mailed bimonthly (six times a year) to 11,519 glaucoma specialists, general ophthalmologists, and clinical optometrists who treat patients with glaucoma. Glaucoma Today delivers important information on recent research, surgical techniques, clinical strategies, and technology.