PHOTO BY ROBERT MAASS

Cover Story
Jimmy Carter Crusades for Improved Vision Care

The former president and Nobel Prize winner discusses his role in fighting blindness in developing nations and in bringing better eye care to children at home.

Jimmy Carter, the 39th president of the United States, is known internationally for his dedication to freedom, democracy and world peace. In 1982, he founded the Carter Center, which is committed to human rights and the alleviation of human suffering. In recognition of this work, Mr. Carter was awarded the 2002 Nobel Peace Prize.

A distinguished professor at Emory University in Atlanta, Mr. Carter is the author of 16 books. He and his wife, Rosalynn, are regular volunteers for the Habitat for Humanity, a nonprofit organization that helps needy people in the United States and other countries build homes for themselves.

Earlier this year, Mr. Carter addressed the opening session of the American Optometric Association annual Congress. Recently, Dr. Neil Gailmard, OM's chief optometric editor, had the opportunity to ask Mr. Carter about his remarks at the AOA meeting and about other issues of importance to optometrists.

Neil Gailmard: Thank you for giving us this opportunity to share your experience and ideas with our readers. Could you give us some background on your present activities, especially the Carter Center and the work it does in eradicating disease in third world countries? Our readers would be particularly interested in diseases that affect the eye, such as trachoma and river blindness, even though we rarely see these problems in the United States.

Jimmy Carter: Onchocerciasis is transmitted by small black flies that breed in rapidly flowing streams, leading to the common name "river blindness." The adult parasitic worms are long-lived (8 to 15 years), and the prelarval forms (microfilaria) released by adult females permeate the skin and eyes and cause inflammation and disease. An annual dose of Merck's Mectizan (ivermectin), while not curative, can arrest progress of the disease in those already infected and prevent the disease in others.

In 1987, Merck approached the Carter Center and offered to donate the medicine in developing nations if we could develop a proper delivery system. Working with many others, we did so, and later assumed responsibility for its distribution. The Carter Center now assists these activities in Cameroon, Ethiopia, Nigeria, Sudan, and Uganda, and coordinates activities that we believe will completely eliminate the infection in all six endemic countries in the Americas (Brazil, Colombia, Ecuador, Guatemala, Mexico, and Venezuela). Last year, we delivered Mectizan to more than eight million people, bringing our total treatments to over 40 million.

Trachoma is the number-one cause of preventable blindness (second only to cataracts). It comes from flies and filthy eyes, the resulting infection causing the eyelids to turn inward. With each blink, the eyelashes slash the cornea. My mother was a registered nurse, and treated patients in South Georgia for trachoma when I was a child, but now people are afflicted mostly in Third World communities that lack sanitation and insect control.

Assisted by the Conrad Hilton Foundation, Pfizer Co., and Lions International, the Carter Center provided treatment in 2001 to 487,000 patients in 4,400 villages in Mali, Ghana, Niger, Nigeria, and Yemen. To promote our program, we use the acronym SAFE, referring to surgery (removal of eyelashes), antibiotic (Zithromax), facial cleanliness, and environment.

Dr. Gailmard: In your address at the opening session of the American Optometric Association (AOA) Congress in New Orleans, you indicated that you have a strong interest in the eye care of children in the United States. How did you come to develop an interest in pediatric vision care?

Mr. Carter: Rosalynn and I know from personal experience how important it can be to detect amblyopia at an early age.

Our granddaughter Margaret suffered from lazy eye, and her parents noticed that by the time she was three years old she often tilted her head to the side, attempting to favor one good eye. But her problem was not understood until she injured her eyeball by accidentally sticking a butter knife in it, obviously not able to see it when it approached her eye. When she was taken to a doctor, a thorough test revealed that she had little reaction to a source of light. Early treatment, which included a combination of eye therapy and patching, corrected her amblyopia.

A more serious case was with our grandson Jamie, who, at 8-1/2 years old, had no noticeable symptoms and had passed several eye tests administered in school. When he finally failed one of the school eye exams, his parents took him to an optometrist, who diagnosed a serious and advanced case of amblyopia. The doctor advised that it might be too late to correct Jamie's eyesight completely, but prescribed therapy and a rigid discipline of a patch over the good eye for several hours each day.

	Dr. Carlton Hicks with former President Jimmy Carter.

Our grandson is following this advice meticulously, and his eyesight has now improved from 20/80 to 20/60 and, with glasses, he can read increasingly fine print. We are hopeful that his problem will be corrected. Jamie's parents feel strongly about the importance of children being tested in an optometrist's office long before they start school in order to expose lazy eye.

Because of our commitment to improving the health of our nation's children and our experience in our own family with undiscovered amblyopia, Rosalynn and I are delighted to participate as national co-chair- persons of Operation Bright Start. It is our hope that this program will grow and quickly become a nationwide effort to detect and correct vision and eye disorders in very young children.

Dr. Gailmard: You challenged eyecare professionals at the AOA Congress to develop a program that would provide eye exams for children who could not afford care, at no government cost. Could you elaborate on that concept?

Mr. Carter: I would like to see the AOA take the lead in developing a program where all children can receive a comprehensive eye exam at no cost to the family. This should be at a very early age, while they are young enough to have problems like amblyopia corrected.

Dr. Gailmard: It seems that one of the challenges in delivering free eye care to the needy is in developing a system that fairly identifies people who are truly in need. Any suggestions?

Mr. Carter: I don't really see any alternative to having local optometrists reach each child at a very early age. These are trusted eyecare specialists who can identify children in need of some kind of treatment, by offering a free eye examination (to those not covered by Medicaid or existing insurance).

There should not be any restriction on the income level of the parents. For poor families, this might be their only chance, and even for wealthier ones (like mine) the early evaluation can avoid serious problems that might otherwise be unknown.

This is an act of altruism that can be rewarding in many ways, both in benefits to children and also in cementing good relationships between the care provider and families who might not otherwise ever know of the fine services available.

	President Carter with Dr. Roy Vargelos (white cap), former CEO of Merck & Co., while on a river blindness mission. Photo credit: William Vander Decker

Dr. Gailmard: The AOA and its affiliated state associations have a very successful program called Vision USA, which delivers eye care and eyeglasses to uninsured, low-income people of all ages. While Vision USA has helped hundreds of thousands of people receive care, there are millions more who could qualify but don't apply. If a program existed for no-cost eye care for children, how do we get people to use it?

Mr. Carter: Such a program could be made known through public announcements, government agencies, parent-teacher organizations, and other civic organizations. I have been a top leader in Lions International, and would be glad to encourage every Lions Club in America to promote and endorse such a nationwide campaign.

Dr. Gailmard: The state of Kentucky passed groundbreaking legislation requiring all children to have a comprehensive eye exam (not a screening), before entering public school. There is some state funding available for children who cannot afford this care. Other states are currently working on similar legislation. What is your view of such legislation?

Mr. Carter: I favor legislation in all states, using Kentucky as a fine example. As a former governor, I know how difficult it is to have even good opportunities become one of the top priorities for busy governors. A specific offering by optometrists would be welcomed by any governor, all of whom want to help their people, score political points, and associate with admirable professionals. However, the services advocated here should not wait for states to pass legislation.

Dr. Gailmard: It seems that most U.S. presidents appear on television without eyeglasses, yet they are at an age when glasses are generally needed. Are bifocal contact lenses a common presidential aid?

Mr. Carter: As an active politician I was always able to get along without lenses when making speeches, either by using large print, teleprompters, or just by speaking extemporaneously from a few notes. However, I don't have any feeling of embarrassment now when I speak while wearing well-designed eyeglasses. Recently, following a text closely while addressing the people of Cuba in Spanish, I wore them, with comfort and pride. Rosalynn sometimes uses contact lenses when referring to a written text.

Dr. Gailmard: Thank you, President Carter.