Training surgeons to meet the surgical needs of Africa.

SIR,-In the light of the article by Messrs D A K Watters and A C Bayley (26 September, p 761) I am concerned at the increasing irrelevance ofsome modern ophthalmic techniques for doctors training in Britain who intend to return to Africa and other countries. Now, even the ancient art of cataract extraction has become high tech. In 1949 at St Thomas's Harold Ridley was the first to replace the cataractous human lens with an artificial one. He used an extracapsular technique and a posterior chamber acrylic lens implant, but over the next 30 years it was the intracapsular technique that was gradually perfected, combined latterly when desired with an anterior chamber implant. This could be performed with a relatively simple microscope, or even a good pair ofoperating spectacles, and was suitable for use world wide. Likeany operation it had to be properly performed; it produced excellent visual results and a low rate of operative and long term complications. Over the past 10 years the extracapsular technique has been revived and now popularised here and in the United States because it may have an even lower rate of complications; it is combined with a posterior chamber implant. However, it requires expensive equipment and optimal operating conditions-both major drawbacks in developing countries, particularly in rural areas, where most of the blindness due to cataracts is to be found. Yet it is this expensive extracapsular technique which most overseas doctors training in Britain are now having to learn, to the virtual exclusion of the intracapsular method. Indeed, the intracapsular method is even frowned on in some quarters, despite its good record and despite the fact that in the foreseeable future it is the only method by which millions of the world's blind can have their sight restored. For this reason the training of overseas doctors here must include the mastering of intracapsular cataract surgery. A few years ago Professor Barrie Jones had the vision to establish a department of preventive ophthalmology, which is closely linked with Moorfields and the Institute of Ophthalmology, which teaches the scientific and medical principle of tropical ophthalmology. Our contribution in the National Health Service, which is largely staffed at junior levels by overseas doctors, must be to include practical surgical techniques for use at home-in particular intracapsular cataract surgery-to dilute the diet of lasers, vitrectomies, scans, extracapsular surgery, etc, many of which will not be available in their own countries in their lifetimes. M S DAVIES