Traditional Arabic Technique of Couching for Cataract Treatment in Yemen

Abstract

Purpose. In Yemen, a number of cataract patients still receive sight-restoring surgery using a traditional Arabic couching procedure. In order to evaluate the relative effectiveness and outcomes of the traditional couching procedure, patients attending a teaching center in Sana'a who had the procedure were studied. Methods. Fifty-five eyes of 50 patients treated by traditional couching were evaluated. All individuals were checked for best-corrected visual acuity, intraocular pressure, slit-lamp biomicroscopy and fundal examination. All were questioned regarding their clinical history, cost of the surgery, and their satisfaction with the procedure immediately following the operation and presently. Results. There were 55 eyes of 50 patients treated by a traditional couching procedure by a local healer. A total of 32 (64%) were men and 18 (36%) were women. The traditional healer was often paid partially in kind and the price paid varied according to patient?s ability and was on average $62 USD plus accommodation and meals in the village the healer visited. After aphakic correction of eyes, 1.8% (1/55) had good vision (VA ? 6/18), 21.8% (12/55) had low vision (?3/60), and 76.4% (42/55) were still blind (<3/60). Complications noted were glaucoma (21), corneal opacity (14), uveitis (6), posterior capsule opacity (8), retinal detachment (7), and severe pain (14). Conclusions. In Yemen, cataract-blind persons are still treated by traditional healers. This study suggests that the couching method used is relatively expensive, ineffective, and dangerous, and most patients are not satisfied with the results.