To promote peace and offer a second chance

A Decade of Retinal Surgery in The Dominican Republic


We started retina surgery at ILAC (The Institute for Latin American Concern) in January of 2007. WE are now starting our 11th year and have performed close to 1500 major retinal surgeries. In addition, we have assisted other patients by bringing them to the US for more complicated care including neurosurgery and cancer care. The video on the left shows a pictorial story of the people, the surgery and the facilities.


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None of this would be possible without the assistance of others. First and foremost, our hosts, Dr. Sebastian Guzman and ILAC, define what we do and how we do it. There are many books written about the damage that can be wrought by well-intended "vacationaries" and medical tourist, who come trying to help not knowing the landscape of needs of the existing infrastructure. This usually wastes money and does little or no good. People in the third world, by and large, are not hapless, as depicted in Christmas-time fundraising commercials. They are smart, resourceful, creative, and well aware of their needs. The principle thing they lack is a chance. A chance denied by the irrelevant mindset of those in better circumstances. What they need is resources. To be successful, we must be a resource to be directed and used by our hosts, not knights in shining armour coming to lead the battle. We don't know the battle field. We only know what we do, and we ONLY succeed if we have the humility to serve at the direction of our hosts.


On our first trip in January of 2007, we operated for 7 straight days, working from 8 AM until 1 or 2:00 in the morning. We used contact lenses with an old refurbished microscope and still did buckles. I spoke no Spanish and Dr. Guzman, while very talented, did no retinal surgery. As a result, every single patient had massive retinal trouble: total diabetic detachments, non diabetic detachment with massive PVR, trauma, infections, and tumors. To accommodate the need, I came 3 to 4 times a year.

Now, a decade later, Sebastian and other local doctors have learned how to do sophisticated retinal surgery, and my cases have changed. We still reserve the most severe cases for my trips, which are now 2 to 3 times a year. In the interim, Sebastian and others are able to treat some patients totally on their own, and for worse cases at least stabilize them for second stage repair when I come. To the right is a video of a severe detachment repaired by Dr. Guzman, for which I only needed to remove silicone and address remaining membranes.

2017 Video Gallery

In January of 2017, we did a 4 surgical day trip working from 3 PM to 10 on Friday, 8 to 8 on Saturday and Sunday, and did only one case on Monday morning. We had to cancel another case on Monday of a young one-eyed girl whose blood sugar was over 800! We did a total of 32 cases, including 26 vitrectomies and cataract surgeries combined with those cases. We did as many surgeries over a weekend as we did in 7 days working from 8 AM to Midnight on our first trip. We have designed this program so that First World surgeons can do more trips simply as long weekends. We are now still doing the severe, "worst US case of the year" cases, but now, more and more, we are supporting the surgeons who have learned from previous trips and started their own retinal practices. This not only helps patients but also rewards vendors, particularly Alcon, who have been open-minded enough to provide assistance to us along the way. Also, over the last decade, organizations like SEE International and Retina Global have grown. Unlike earlier organizations, these groups are doing great work within the context of host leadership and are realizing the potential for a new generation of eye care collaboration throughout the world.

Tabletop Traction Detachment

We see a set of problems with a broader range and greater complexity than the usual patient seen in the US. In a typical day, we will see diabetic detachments, giant tears, PVR, and other problems that might qualify as a "worst case of the year" in a US practice. And we might see 6 or day in a day.

This patient has shallow but total tabletop traction retinal detachment. Perfluoro-octane is used to hydrodissect and support the macula allowing the necessary delimitation of scar tissue.

Recent Trauma

This patient had severe sclspeteria from a gunshot wound. He had initial repair in Santiago with silicone oil. This allowed the eye to stabilize and begin healing. This allowed us to simply remove the oil and the moderate surface fibrosis that remained.

Diabetic Traction Detachment

Complex diabetic traction retinal detachments are very common in the third wold. In many areas, populations that had been starving are now receiving more calories. When that happens, diabetes incidence rises, as do diabetic complications. These patients often have little access to basic diabetic and hypertension care, much less access to treatment for complications. This is becoming a crisis in many parts of the third world, particularly in Latin America. Retinal care is critically necessary but also critically absent throughout the third world, which is why the efforts of organizations such as SEE International are so important.

Old Trauma

Sympathetic Ophthalmia is rare in the developed world. It is more common in the Third World, where eye trauma is more common and it management is often late or never happens at all. This patient lost one eye to trauma. The remaining eye is badly damaged but still has some visual potential. Even poor vision could return him to some kind of employment and a useful level of independence. We removed the cataract with vitrectomy, scissors, and phacofragmentation. He will be treated with anti-inflammatories and hopefully receive a lens implant later.