The doctor is in

If a very long line of patients waiting to see a medical doctor for one health reason or another is an indication of the doctor’s famed professional performance, Dr. Manuel B. Agulto tops the list of most sought-after ophthalmologists.

Let me quote from an article, titled “Hindsight,” by the late Josefina T. Lichauco that appeared in the Nov. 26, 2007 issue of The Philippine STAR, regarding the competence of Dr. Agulto: “(Dr. Agulto) is a true medical leader in the highest sense of the word, who has created a gigantic impact on the endeavor to provide the best care and treatment in our country for the eyes – for me, one of the most important organs of man. Pursuing his lifetime goals with a dedicated ruggedness not too many can equal, his name has become synonymous with the excellent practice of ophthalmology, with emphasis on the treatment of glaucoma, a medical condition that causes blindness.”

Manny Agulto, 72, was kind-hearted, even as a kid growing up in San Jose, Nueva Ecija, then as a medical student at the University of the Philippines Manila (BS MD Class of 1973). He set up his clinic with the mission “To heal the blind through a nurturing, ethical ophthalmological practice.” He then went on a glaucoma fellowship at the Philippine Eye Research Institute, then to Harvard Medical School for post graduate ophthalmology, then to the New England Glaucoma Research Foundation for glaucoma and anterior segment disease fellowship, and the Institute of Clinical Ophthalmology for anterior segment surgery in Japan.

The highlights of his accomplishments are his active involvement in the preparation of the SEAGIG Asia Pacific Glaucoma Guidelines, which became the resource book of the Asia Pacific in updating the diagnosis and treatment of glaucoma in the region, which has the highest global glaucoma blindness incidents; as concurrent chair of the Department of Ophthalmology, he was influential in putting up the Sentro Oftalmologico Jose Rizal, the National Eye Center donated by the Kingdom of Spain; as director of the Institute of Ophthalmology, National Institutes of Health, University of the Philippines Manila, then as professor and chair of the Department of Ophthalmology and Visual Sciences, then from 2011-2014, as chancellor of the University of the Philippines Manila.

I consulted the doctor for blurring eyesight, thank God not for glaucoma, and, spending some time ( sorry, at the expense of many patients waiting at the corridor outside his clinic at the Manila Doctors Hospital), he gladly acceded to my request for an interview.

First, on glaucoma, he said that “despite the decreasing prevalence of blindness and visual impairment in general, more Filipinos become blind and/or visually impaired due to our country’s high population growth rate. Some of the reasons for the increase include lifestyle related diseases (e.g. increase in the prevalence of diabetes mellitus, thereby DM retinopathy), myopia among children due to genetics and other environmental factors, and eye strain in the workplace especially among office workers.’

Glaucoma, the doctor said, is the third cause of visual impairment among Filipinos (283,287 persons), following cataract (1.112 million persons), and uncorrected EOR (398,688 persons). Glaucoma, when diagnosed and managed early, has a better prognosis and reduce blindness.

Glaucoma is more likely seen among people with the following risk factors: family history, nearsightedness, use of steroids, and ocular inflammatory disease.

What age group is mostly going through visual impairment? Dr. Agulto said, “Eye problems can be encountered by all sexes and ages, but significantly more visual impairment is seen in late adulthood and the elderly than in the young. Certain eye conditions may be brought about by aging (like in senile cataract), or DM retinopathy (a complication of diabetes), and pinguecula (repeated long exposure in the sun. There are also certain sight-threatening factors among children, like inherited cataract, ROP and retinoblastoma, although these are rare.

Obviously the cyber age has resulted in the increasing deterioration of children’s eyesight. The doctor said computer games or screens in general, may cause children to experience same symptoms seen in computer vision syndrome in adults (eye discomfort, fatigue, blurry of vision and headaches). Prolonged gameplay may cause eye strain.

“Parents should be mindful of the screen time of their children. They should be encouraged to have frequent breaks to relax the eye.” Also recommended are computer/anti-glare glasses to be used even by children. Studies on blue light and its harmful effects on the retina, can be addressed by using one’s phone night mode, Dr. Agulto added.

Asked if cataract change (by surgery) has become very popular, the surgeon said, “Surgery remains the most cost-effective solution for cataract management. More than a million of Filipinos have cataract (deficiency) and a third of them (300,000), need surgery.” But, he gave the assurance of there being enough institutions with complete surgical facilities. “Recognizing the burden of blindness brought about by cataract, the government has established a program for complete surgical facility development. Aside from primary to tertiary hospitals in the country, there are at last 97 ophthalmologic ambulatory surgery centers.”

With the passage of Universal Health Care, the doctor said, medical services like most common corrective eye surgeries can be availed of even by the poor and marginalized Filipinos. Philhealth covers most of the eye surgeries.

Eyeglasses will never be passe, but many people favor using contact lenses. Dr. Agulto said, “Contact lenses or preference of using contact lenses can be attributed to aesthetics (like colored lenses). Some people with a high degree of refractive error opt to use contact lenses to avoid using very thick spectacles. With the innovative technologies on the production of safe and effective contact lenses, and development of one-day use types (to minimize potential eye infection), contact lenses are recommended as 2nd in line of management for errors of refraction.”

“Taking care of one’s eyes is not just an ophthalmologist’s duties; it is everyone’s. Caring for your eyes can be done even in our own home or workplace. A good eye care practice is the 20-20-20, that is, looking at the distance of 20 feet for every 20 minutes near one’s work. This will minimize the occurrence of eye strain. Another important advice is to use protective glasses/shades,/ hat/umbrella when going outside. This will prevent cataract and/or pinguecula/pterygium.”

High points of Dr. Agulto’s career include his being an administrative manager, beyond his actual practice as eye surgeon. While he is proud of “being one of the best glaucoma specialists in the Philippines and a part of the Board of Ophthalmology,” he also relishes his program of action during his term as the UP Manila chancellor, such as major infrastructures being started, operational efficiency program of the university system developed, restoration of the Museum of the History of Ideas, supporting free tuition, and other academic programs and faculty recruitment that helped increase the international ranking of the university.

As chancellor, he accepted the challenge to set up the Sentro Oftamologica Jose Rizal (SOJR). “Being the largest eye national institution we promoted training among the graduate students of the university, thus providing the country with well-trained subspecialists in ophthalmology born of the researches and studies in the Philippine Eye Research Institute and the Department of Ophthalmology and Visual sciences.”

Of great import to him is the UP Manila’s collaboration with the Asia Pacific Academy of Ophthalmology and the subspecialty regional societies like the Asia Pacific Glaucoma Society and the others in cornea, retina, pediatric ophthalmology, and refractive error, among others. “Together with other specialty societies we have faced the eye health problem of the Asia Pacific region squarely.”

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