Restoring Sight in Patients at Home and Abroad

Lloyd Williams, M08, GBS08, developed a passion for providing care abroad while studying medicine at Tufts, and now travels regularly to developing nations to provide cataract and corneal surgeries

Lloyd Williams, M08, GBS08, is the director of Global Ophthalmology at Duke University because it paired his passion for education with providing care, both in North Carolina, and abroad.

An expert in corneal disease, corneal transplant, and cataract surgery, Williams travels to developing nations an average of 50 days per year to provide life-changing eye care to people who do not have access to a physician or surgeon.

Williams was introduced to ophthalmology as a student at Tufts University School of Medicine, in part, due to his parents’ lifelong dedication to service.  

“I was inspired by my parents, who were missionaries while I was growing up,” Williams said. “When I decided to go into medicine, what I really wanted to do was mission work.”

Williams’ father knew of his son’s aspirations and put him in touch with a physician who was working at a hospital in Zambia. Williams spent the summer of his first year of medical school providing care at Macha Mission Hospital, where he was inspired to change his area of focus from general surgery to ophthalmology.

“When I was working in Zambia, a doctor came and did cataract surgery on about 30 people. He was a surgeon from Ghana and my job was to go and take the bandages off the next day,” Williams said. “People who had been blind for a decade, who had to be led walking 20 miles to get to the eye center, could all see after the surgery. And I thought, well this is the coolest thing I've ever seen in my life.”

A patient in Aweil, Sudan receives an eye exam.

A patient in Aweil, Sudan receives an eye exam during Lloyd Williams' recent trip. Photo: Chris Hildreth / RoosterMedia

Continuing the Work in the U.S.

With a refreshed perspective, Williams returned to Boston and focused on one specific patient he cared for at the mission hospital: a child named Mercy. She was not an ophthalmologic patient, but she was the first patient that Williams treated on the trip and her injuries were severe. While having a seizure, Mercy fell into a fire and suffered third-degree burns across much of her body.

Mercy required reconstructive surgery on the most severely burned areas, specifically her hands. The scarring was so severe that over time, her hands contracted into a nonfunctional position.

During his third year at Tufts, Williams launched HelpMercy International, Inc. in 2004, and successfully raised money for Mercy’s surgical care.

In the 19 years since HelpMercy was established, the nonprofit has grown to offer aid through the purchase of equipment for Macha Mission Hospital, through educating surgeons in Sierra Leone on how to cure blindness, and through agricultural training on growing and cultivating nutritious foods, particularly in the care of patients with HIV/AIDS.

Eight times a year, Williams travels to developing nations to provide cataract and corneal surgeries, the latter of which have been sponsored by Duke Global Ophthalmology with corneal tissue donated by CorneaGen. He partners with other organizations to plan the trips, including the Moran Eye Center and Himalayan Cataract Project.

He recently completed a 10-day trip to South Sudan, where he and a team of South Sudanese physicians, led by Dr. Aja Paul, performed 1,023 cataract surgeries, and Sierra Leone, where 15 corneal transplants were performed.

In the summer of 2021, Williams was particularly moved while treating a woman who had lost an eye completely and was only able to perceive light in the other eye.

“We picked her as the first corneal transplant of that trip because we felt like she had the potential to gain a lot,” Williams said. “She'd been completely blind for 29 years. She had never seen her children. She had five kids who were all teenagers. She'd never seen her husband. So the next day, when I took her patch off and she walked out into the waiting room and saw her kids for the first time, that was a really beautiful moment.”

He was invited back to Sierra Leone by Dr. Jalikatu Mustapha, the head of the National Eye Programme. During his return trip, Williams saw the patient again, who joked that she was particularly glad to see now because she knows when her children aren’t cleaning their room.

A patient is given an A-scan to determine the length of the eye and diagnose any sight disorders.

A patient is given an A-scan to determine the length of the eye and diagnose any sight disorders. Photo: Chris Hildreth / RoosterMedia

Ophthalmologic Treatment Across the Globe

Blindness is prevalent in many areas of the world where residents lack access to ophthalmologists who can do simple things like prescribe glasses. "The most common causes of blindness worldwide is cataracts, which often go untreated when care is nonexistent or hard to come by,” Williams said.

“Worldwide, everyone will eventually need cataract surgery because of old age,” Williams said. “In many locations, it may happen sooner because of poor nutrition or excessive sunlight exposure. In Africa, the cataracts become a significant cause of blindness because there aren’t nearly enough eye surgeons to treat them all.”

In South Sudan alone, Williams shared, there are only four ophthalmologists for a country of 11 million, which means one physician per 2.75 million people. Comparatively, in the United States, there is one ophthalmologist per 25,000 people.

“You can see how that disparity would create a big difference in care,” Williams added.

A lack of resources means relatively minor injuries, like getting dirt in an eye while working outdoors, can cause a serious infection that when left untreated becomes a corneal scar resulting in blindness.

“In that situation, the only treatment is a cornea transplant,” Williams said. “There are two eye banks in the process of being started, one in Ghana and one in Mali, but there are few, if any, operating eye banks in sub-Saharan Africa right now. And there are no working eye banks that I'm aware of in West Africa.”

Williams travels with human donor corneas that are stored for a maximum of two weeks and require transplantation soon after he arrives at his destination. The corneas, which are valued at about $4,000 each, are donated before Williams leaves for a trip, delivered by courier, and Williams carries them personally while he travels.

After providing a corneal transplant, which requires 16 nearly invisible sutures, patients are required to attend postoperative appointments and use eye drops to ensure the cornea isn’t rejected. Williams notes that the success rate for the corneal surgery has been around 90 percent thus far.

A cataract surgery is less invasive and heals on its own, and can be done in about five minutes, for as little as $20.

Both cataract and corneal surgeries themselves are relatively quick. In most cases, when bandages are removed in 24 hours, patients can see with further improvement developing in the following two weeks.

When he is home, Williams can’t leave his job at the office. He often works nights and weekends to support his nonprofit work, which he balances with his full-time role at Duke, a partner in his efforts to help cure blindness here and abroad.

“The connections I’ve made with patients, like a young woman who lost hope after being blind from age 10 to 20, and the boy who said he doesn’t deserve to have any friends because he is blind, drive me to remember that there are millions of people in need of ophthalmologic care.”

As a father of three teenagers, the youngest of which hopes to be an ophthalmologist himself, Williams finds it important to help them understand that the sacrifices he makes in terms of his time and skills are worth the time and effort.

“I've taken my kids to surgery camps to see what I do and what it's like,” Williams said. “Seeing somebody who's been blind for a long time gain their vision, it's beautiful. I want my kids to experience that, and I want them to know why I'm not always around.”

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