In West Africa, Duke eye surgeon is helping local doctors restore sight to the blind, a mission that is both easier and harder than you’d think.
Balu Sesay had been blind for 29 years when Lloyd Williams, MD, PhD first met her. It was a sweltering day in July 2021, in a small hospital exam room in Freetown, the bustling port capital of Sierra Leone. Williams saw immediately that both of Sesay’s eyes were badly damaged, the right one completely ruined and a milky haze covering the left, both the result of injuries she sustained as a teenager.
Now 46 and the mother of five, Sesay had never seen her husband or her children. What brought her to Freetown, nearly three hours from her home, was a promise she still couldn’t quite believe: that her left eye could be fixed and that her years in the dark might end.
The next day, Williams worked with a team of Sierra Leonean ophthalmologists to replace the opaque cornea in her left eye with one from a donor. It was one of eight corneal transplants that week, the first ever performed in the West African country. Twenty-four hours later, when doctors removed the patch protecting her repaired eye, she walked into the waiting room and toward a teenage child whose eyes were flooding with tears. “Girl, why are you crying?” she asked in Krio, the local language. “Mom, it’s me,” the girl cried, reaching out to embrace her mother. “I am your daughter.”
Even for Williams, who has performed hundreds of vision-restoring surgeries in the United States and other countries, those moments are soul-stirring. It’s why he’s back in Freetown nine months later, having traveled 7,000 miles, taking three planes and a boat, clutching a Styrofoam cooler packed with human eyeballs.
“It’s the closest we can come to performing miracles on Earth,” he says.
“Miracle” is a word that Williams, a devout Christian and the son of Lutheran missionaries, invokes with a good deal of reverence. He notes that healing the blind is among the most frequently described miracles attributed to Jesus. But as a scientist, he knows what he and others are doing to restore sight in places like Sierra Leone is not divine intervention. It’s actually pretty straightforward ophthalmology.
Consider cataracts — the most common cause of blindness globally, leaving more than 17 million people with no functional vision — can usually be fixed with a simple, one-time surgery that costs as little as $12 to perform. Millions more, like Balu Sesay, could have their vision restored with a corneal transplant.
In fact, according to the International Agency for the Prevention of Blindness, more than three-quarters of the estimated 43 million people around the world who are blind could regain sight through medical intervention.
That so many remain in darkness is primarily a function of the massive inequities in global health care. Ninety percent of people with preventable blindness live in low-income countries, which often lack the resources to offer anything like comprehensive eye care. In sub-Saharan Africa, there are just 2.5 trained eye specialists for every million people, akin to a city the size of Durham having only one eye doctor. Problems like cataracts or glaucoma, which are typically painless and progress slowly, often go untreated for years, eroding vision until a person is left completely blind.
“There are no campaigns in West Africa to tell people to go get their eyes checked,” says Leon Herndon, MD, Professor of Ophthalmology and glaucoma division chief who has done clinical research and training in Ghana and Nigeria.
“There’s very little education about eye diseases, and many people believe that once you lose
vision, it’s just hopeless.”
After finishing medical school and joining a private practice in Utah, Williams threw himself into that mission with characteristic, high-motor zeal. A competitive cyclist who builds guitars to unwind, he crammed his calendar with trips abroad, usually funded by himself or with small donations. He estimates he has done some 700 cataract surgeries in countries including Nepal, Guatemala and South Sudan.
But such drop-in visits are a Band-Aid solution at best. Williams came to Duke in 2019 to work on something more sustainable. He now leads Duke’s Global Ophthalmology Program, adroitly rebranded as Duke GO, which is aiming to provide more structure to the international efforts of several Duke eye doctors across Africa, Asia, and Central America. The point is not just to help eye doctors in those places, but to empower them, he notes.
“No one person is going to end preventable blindness alone,” he says. “We need an army of people.”