a critical challenge for ophthalmology: enhancing training to meet the need for eye care...

A Critical Challenge for Ophthalmology:A Critical Challenge for Ophthalmology:

Enhancing TrainingEnhancing TrainingTo Meet theTo Meet the

Need for Eye CareNeed for Eye Care

International Council of Ophthalmology/International Council of Ophthalmology/International Federation of Ophthalmological International Federation of Ophthalmological SocietiesSocieties

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International Council of Ophthalmology/International Council of Ophthalmology/International Federation of Ophthalmological SocietiesInternational Federation of Ophthalmological Societies

Training To Meet Public NeedsTraining To Meet Public NeedsWhat I will cover:What I will cover:• The unmet public need for eye careThe unmet public need for eye care• Key issues related to trainingKey issues related to training• The challenge for ophthalmologyThe challenge for ophthalmology• VISION 2020 and WHA Resolution 59-25VISION 2020 and WHA Resolution 59-25• Resources:Resources:

– VISION 2020 Human Resources Working GroupVISION 2020 Human Resources Working Group– Corporate and private supportCorporate and private support– ICO/IFOS curricula, programs, guidelines and moreICO/IFOS curricula, programs, guidelines and more

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Unmet Public Need for Eye Unmet Public Need for Eye CareCare• Worldwide at least 161 million people are severely Worldwide at least 161 million people are severely

visually impaired:visually impaired:– 37 million blind37 million blind– 124 million with low vision124 million with low vision

• Burden of blindness greatest in the least Burden of blindness greatest in the least developed regions of the globe.developed regions of the globe.

• Global vision loss is certain to increase, particularly Global vision loss is certain to increase, particularly in developing countries, due to population growth in developing countries, due to population growth and aging, and aging, unlessunless concerted action is taken. concerted action is taken.

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Unmet Public Need for Eye Unmet Public Need for Eye CareCareNew WHO Estimates (October 2006):New WHO Estimates (October 2006):• 153 million people around the world have 153 million people around the world have

uncorrected refractive errorsuncorrected refractive errors• Including at least 13 million children (age 5 to 15) Including at least 13 million children (age 5 to 15)

and 45 million working age adults (age 16 to 49)and 45 million working age adults (age 16 to 49)• 90 percent of those with uncorrected refractive 90 percent of those with uncorrected refractive

errors live in low- and middle-income countrieserrors live in low- and middle-income countries• A total of 314 million are visually impairedA total of 314 million are visually impaired

“ “We must re-double our efforts to ensure that We must re-double our efforts to ensure that every person who needs help is able to every person who needs help is able to receive it,” receive it,” – Serge Resnikoff, MD, WHO Serge Resnikoff, MD, WHO

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Number of Visually ImpairedNumber of Visually Impaired((Per Million Population, WHO data from 2002)Per Million Population, WHO data from 2002)

-

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

Afr Emr Sear Wpr Amr Eur

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Global Distribution of Global Distribution of BlindnessBlindness (by Cause, 2002 WHO Data)(by Cause, 2002 WHO Data)

CataractCataract47 %47 %

TrachomaTrachoma4 %4 %

GlaucomaGlaucoma12%12%

Onchocerciasis -1 %Onchocerciasis -1 %

OtherOther13 %13 %

Age Related Age Related Macular Degeneration 9%Macular Degeneration 9%

Childhood blindness 4%Childhood blindness 4%

Diabetic Retinopathy 5%Diabetic Retinopathy 5%

Corneal scar 5%Corneal scar 5%

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World Health Report 2006World Health Report 2006

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World Health Report 2006World Health Report 2006

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International AssistanceInternational Assistance

• A 50:50 guideline, whereby half of all A 50:50 guideline, whereby half of all international assistance funds go to international assistance funds go to health systems and half to national health systems and half to national health workforce strengthening health workforce strengthening strategiesstrategies

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Key Issues Related to TrainingKey Issues Related to TrainingParticularly in developing countries:Particularly in developing countries:• Not enough ophthalmologists and other eye care Not enough ophthalmologists and other eye care

providers to provide the care neededproviders to provide the care needed• Mal-distribution: Lack of providers where most Mal-distribution: Lack of providers where most

neededneeded• Not enough training programsNot enough training programs• Existing training programs not focused on public Existing training programs not focused on public

needs, e.g., for community eye healthneeds, e.g., for community eye health• Lack of infrastructure and professional Lack of infrastructure and professional

development for those who are traineddevelopment for those who are trained

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Challenge for OphthalmologyChallenge for Ophthalmology• To provide LEADERSHIP for training the To provide LEADERSHIP for training the

ophthalmologists and other personnel needed ophthalmologists and other personnel needed to meet the public need for eye careto meet the public need for eye care

• Long-term goals:Long-term goals:

– Increase access to quality eye care Increase access to quality eye care worldwideworldwide

– Prevent avoidable blindness and visual lossPrevent avoidable blindness and visual loss

– Preserve and restore visionPreserve and restore vision

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What the ICO Asks Societies To What the ICO Asks Societies To DoDo• Work with national VISION 2020 programs and Work with national VISION 2020 programs and

others involved with eye careothers involved with eye care

• Assess the needs for ophthalmologists and Assess the needs for ophthalmologists and other providers in your countryother providers in your country

• Evaluate existing training programsEvaluate existing training programs

• Define what needs to be done to improve and Define what needs to be done to improve and expand trainingexpand training

• Advocate for funding and other support to do itAdvocate for funding and other support to do it

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Eye Care Personnel NeededEye Care Personnel NeededTeams of:Teams of:• Ophthalmologists (surgeons and “eye Ophthalmologists (surgeons and “eye

doctors”)doctors”)• Subspecialists (pediatric, retina, etc.)Subspecialists (pediatric, retina, etc.)• Primary physicians trained in eye carePrimary physicians trained in eye care• Mid level eye personnel (MLEP) and nursesMid level eye personnel (MLEP) and nurses• Optometrists or refractionists and opticiansOptometrists or refractionists and opticians• Managers and community eye health Managers and community eye health

workersworkers

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Training PrinciplesTraining Principles• Training in ophthalmology should focus Training in ophthalmology should focus

on meeting needs of communities and on meeting needs of communities and populations, not just individualspopulations, not just individuals

• Needs are best met by eye care teams, Needs are best met by eye care teams, trained together to work as teamstrained together to work as teams

• Comprehensive eye care should be an Comprehensive eye care should be an integral part of the health care systemintegral part of the health care system

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Training Principles (2)Training Principles (2)• Community-level primary eye care should Community-level primary eye care should

be integrated into primary health carebe integrated into primary health care• Eye care training should be integrated Eye care training should be integrated

with training for the rest of the health with training for the rest of the health care systemcare system

• Those who are trained need Those who are trained need infrastructure and continuing professional infrastructure and continuing professional developmentdevelopment

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VISION 2020: The Right To VISION 2020: The Right To SightSight• Global initiative to eliminate avoidable blindness by the Global initiative to eliminate avoidable blindness by the

year 2020year 2020• Partnership launched in 1999, led by International Partnership launched in 1999, led by International

Agency for the Prevention of Blindness (IAPB) and WHO Agency for the Prevention of Blindness (IAPB) and WHO • VISION 2020 implementation plans being defined at VISION 2020 implementation plans being defined at

regional, national and provincial/district levelsregional, national and provincial/district levels• Three core strategies:Three core strategies:

– Disease controlDisease control– Infrastructure developmentInfrastructure development– Human resources developmentHuman resources development

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WHA Resolution 59-25WHA Resolution 59-25• Adopted by World Health Association in May Adopted by World Health Association in May

20062006• Calls on countries to:Calls on countries to:

– reinforce efforts to define national VISION 2020 reinforce efforts to define national VISION 2020 plansplans

– mobilize domestic funding to support VISION 2020mobilize domestic funding to support VISION 2020– include prevention of blindness in national include prevention of blindness in national

development plans and goalsdevelopment plans and goals– integrate prevention of blindness into primary integrate prevention of blindness into primary

health carehealth care

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WHA Resolution 59-25WHA Resolution 59-25• Adopted by World Health Association in May 2006Adopted by World Health Association in May 2006• Calls on countries to:Calls on countries to:

– develop and strengthen eye care services and integrate develop and strengthen eye care services and integrate them in the existing health care system, them in the existing health care system, including including training and re-training of health workers in training and re-training of health workers in visual healthvisual health

• Calls on WHO to:Calls on WHO to:– provide support to collaboration among countries for the provide support to collaboration among countries for the

prevention of avoidable blindness and visual impairment prevention of avoidable blindness and visual impairment in particular in the area of training of all in particular in the area of training of all categories of relevant staffcategories of relevant staff

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WHA Resolution 59-25WHA Resolution 59-25Offers an unprecedented opportunity to:Offers an unprecedented opportunity to:• Convince national governments to Convince national governments to

assign higher priority to prevention of assign higher priority to prevention of blindness and visual loss, andblindness and visual loss, and

• Advocate for increased supportAdvocate for increased support for for training of ophthalmologists and other training of ophthalmologists and other eye care providers to meet public eye care providers to meet public needsneeds

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Resources for Enhancing Resources for Enhancing TrainingTraining• VISION 2020 Human Resources Working GroupVISION 2020 Human Resources Working Group• Corporate and private supportCorporate and private support• ICO/IFOS:ICO/IFOS:

– Curricula for training of residents, medical students Curricula for training of residents, medical students and allied personneland allied personnel

– Pilot project to enhance residency training in Pilot project to enhance residency training in NigeriaNigeria

– ICO Courses for Residency Program DirectorsICO Courses for Residency Program Directors– ICO Basic and Clinical AssessmentsICO Basic and Clinical Assessments– IFOS/ICO International FellowshipIFOS/ICO International Fellowship– ICO International Clinical GuidelinesICO International Clinical Guidelines

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Resources: VISION 2020 Resources: VISION 2020 HRWGHRWG• VISION 2020 Human Resources Working Group VISION 2020 Human Resources Working Group

(HRWG) dedicated to optimizing and expanding (HRWG) dedicated to optimizing and expanding training of eye care personnel around the worldtraining of eye care personnel around the world

• Co-chaired by WHO’s Para Pararajasegaram, Co-chaired by WHO’s Para Pararajasegaram,

FRCS, FRCP, FRCOphth, FRCS, FRCP, FRCOphth, and ICO President and ICO President Bruce Spivey, MD, with Suzanne Gilbert as Bruce Spivey, MD, with Suzanne Gilbert as coordinatorcoordinator

• Will encourage and support planning and Will encourage and support planning and implementation of efforts to enhance trainingimplementation of efforts to enhance training

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Resources: Corporate and Resources: Corporate and PrivatePrivate• Carl Zeiss has donated $200,000 per year for five Carl Zeiss has donated $200,000 per year for five

years to support development of five years to support development of five IAPB – Carl IAPB – Carl Zeiss Training CentersZeiss Training Centers in different areas of need in different areas of need– Indonesia (2005), Nigeria (2006), Eastern Africa Indonesia (2005), Nigeria (2006), Eastern Africa

(2007), with 2008 and 2009 to be determined(2007), with 2008 and 2009 to be determined• Eli Lilly and Company Foundation award of Eli Lilly and Company Foundation award of

$150,000 to ICOFoundation for ICO to establish $150,000 to ICOFoundation for ICO to establish model Diabetic Eye Disease Centermodel Diabetic Eye Disease Center

• More to comeMore to come

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Background: ICO/IFOSBackground: ICO/IFOS• In 1857 in Brussels, 150 ophthalmologists from 24 In 1857 in Brussels, 150 ophthalmologists from 24

countries met in the first International Congress of countries met in the first International Congress of OphthalmologyOphthalmology

• International Council of Ophthalmology (ICO) International Council of Ophthalmology (ICO) founded in 1927 in Scheveningen, Holland founded in 1927 in Scheveningen, Holland

• International Federation of Ophthalmological International Federation of Ophthalmological Societies (IFOS) founded in 1933 in Madrid, SpainSocieties (IFOS) founded in 1933 in Madrid, Spain

• IFOS represents and serves associations of IFOS represents and serves associations of ophthalmologists around the worldophthalmologists around the world

• ICO is the executive body of IFOSICO is the executive body of IFOS

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Background: ICO/IFOSBackground: ICO/IFOSMission:Mission: The mission of the ICO/IFOS is to The mission of the ICO/IFOS is to collaborate with ophthalmologic societies and collaborate with ophthalmologic societies and related organizations to enhance ophthalmic related organizations to enhance ophthalmic education and improve access to quality eye care education and improve access to quality eye care in order to preserve and restore vision for the in order to preserve and restore vision for the people of the world.people of the world.

Primary Focus:Primary Focus: Elevating the level of eye care Elevating the level of eye care worldwide with special emphasis on developing worldwide with special emphasis on developing countries.countries.

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Background: ICO/IFOSBackground: ICO/IFOSICO Primary Commitments:ICO Primary Commitments:

1. Enhance ophthalmic education1. Enhance ophthalmic education

2. Support communication and collaboration among 2. Support communication and collaboration among ophthalmologic societies and ophthalmologistsophthalmologic societies and ophthalmologists

3. Advocate for preservation of vision3. Advocate for preservation of vision

4. Define proposed clinical guidelines and standards4. Define proposed clinical guidelines and standards

5. Stimulate research to eradicate preventable 5. Stimulate research to eradicate preventable vision lossvision loss

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Resources: ICO Ophthalmic Resources: ICO Ophthalmic EducationEducation• Curricula for residents, medical students, allied health Curricula for residents, medical students, allied health

and CMEand CME• Pilot project to enhance residency training in NigeriaPilot project to enhance residency training in Nigeria• Courses for residency program directorsCourses for residency program directors• ICO Basic and Clinical AssessmentsICO Basic and Clinical Assessments• IFOS/ICO International FellowshipIFOS/ICO International Fellowship• ICO International Clinical GuidelinesICO International Clinical Guidelines• World Ophthalmology CongressWorld Ophthalmology Congress• Atlas of Ophthalmology - Atlas of Ophthalmology - atlasofophthalmologyatlasofophthalmology.com.com

(endorsed by the ICO)(endorsed by the ICO)

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Resources: ICO CurriculaResources: ICO Curricula• ICO international task forces have defined ICO international task forces have defined

principles and guidelines for curricula for :principles and guidelines for curricula for :– Ophthalmology residency educationOphthalmology residency education– Medical student education in Medical student education in

ophthalmologyophthalmology– Allied ophthalmic personnel trainingAllied ophthalmic personnel training– Ophthalmology continuing educationOphthalmology continuing education

• Intended to be adapted by ophthalmologic Intended to be adapted by ophthalmologic societies and training programssocieties and training programs

• Can be downloaded from Can be downloaded from www.icoph.org/edwww.icoph.org/ed

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Resources: Pilot Project in Resources: Pilot Project in NigeriaNigeriaInitiative of ICO and Ophthalmological Society ofInitiative of ICO and Ophthalmological Society ofNigeria (OSN) to improve residency training:Nigeria (OSN) to improve residency training:• Six regional residency resource centers with Six regional residency resource centers with

Internet accessInternet access• OSN has defined aOSN has defined a Vision for the Future – Nigeria Vision for the Future – Nigeria

and established an OSN Foundationand established an OSN Foundation• ““Twinning” with All India Ophthalmologic Society Twinning” with All India Ophthalmologic Society

and work with Aravind Eye Care Systemand work with Aravind Eye Care System• Creating high-quality training center in IbadanCreating high-quality training center in Ibadan• Evaluation of impact on patient careEvaluation of impact on patient care

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Resources: Residency TrainingResources: Residency Training• Two-day ICO Course for Residency Program Two-day ICO Course for Residency Program

Directors offered in Mexico, Peru, Egypt, etc.Directors offered in Mexico, Peru, Egypt, etc.• New ICO committee to focus on enhancing New ICO committee to focus on enhancing

residency trainingresidency training• Translation of ICO Curriculum for Residency Translation of ICO Curriculum for Residency

Training into SpanishTraining into Spanish• Minimum Standards for Residency Training Minimum Standards for Residency Training

in Latin Americain Latin America defined by Pan-American defined by Pan-American Association of Ophthalmology and Pan-American Association of Ophthalmology and Pan-American Council of University Professors in OphthalmologyCouncil of University Professors in Ophthalmology

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ICO International Assessments ICO International Assessments for Ophthalmologistsfor Ophthalmologists• ICO Basic Science AssessmentICO Basic Science Assessment and and Clinical Clinical

Sciences Assessment Sciences Assessment offered each year throughout offered each year throughout the worldthe world

• In 2006, about 1540 candidates enrolled for In 2006, about 1540 candidates enrolled for Assessments at 92 test centers in 61 countriesAssessments at 92 test centers in 61 countries

• Assessments offered early in April each year, in 2007 Assessments offered early in April each year, in 2007 on April 12on April 12

• Deadline to apply is January 31 each yearDeadline to apply is January 31 each year• Used in some countries to evaluate residentsUsed in some countries to evaluate residents

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IFOS/ICO International IFOS/ICO International FellowshipFellowship• 198 IFOS/ICO Fellowships awarded since 2001198 IFOS/ICO Fellowships awarded since 2001• Purpose: help young ophthalmologists, especially Purpose: help young ophthalmologists, especially

from developing nations, improve practical skillsfrom developing nations, improve practical skills• Fellowships generally last three monthsFellowships generally last three months• Fellows expected to bring knowledge and skills Fellows expected to bring knowledge and skills

back to their countryback to their country• Available from more than 60 ophthalmology Available from more than 60 ophthalmology

departments and institutions in 27 countriesdepartments and institutions in 27 countries• Application deadline: each March 31 and Application deadline: each March 31 and

September 30September 30

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ICO Clinical GuidelinesICO Clinical Guidelines• 20 ICO International Clinical Guidelines available 20 ICO International Clinical Guidelines available

at at www.icoph.org/guidewww.icoph.org/guide• Purpose: define appropriate eye care, Purpose: define appropriate eye care,

recognizing differing cultures and capabilitiesrecognizing differing cultures and capabilities• Designed to be translated and adaptedDesigned to be translated and adapted• Can be integrated into trainingCan be integrated into training• Basis for Clinical Practice Guidelines initiative in Basis for Clinical Practice Guidelines initiative in

ChinaChina• Most recent Guidelines: trachoma and leprosyMost recent Guidelines: trachoma and leprosy

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World Ophthalmology World Ophthalmology CongressCongress• Started in 1857 as International Congress of Started in 1857 as International Congress of

OphthalmologyOphthalmology• 2007 is 150th anniversary of first Congress2007 is 150th anniversary of first Congress• Longest continuing international meeting in medicineLongest continuing international meeting in medicine• Scientific program defined in cooperation with Scientific program defined in cooperation with

international subspecialty societiesinternational subspecialty societies• Next: June 28 - July 2, 2008 in Hong Kong Next: June 28 - July 2, 2008 in Hong Kong • Future Congresses:Future Congresses:

– 2010: June 29 - July 3 in Berlin2010: June 29 - July 3 in Berlin– 2012: 2012: November 10 - 13November 10 - 13 in Chicago in Chicago

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ICO Programs: Standards, ICO Programs: Standards, Advocacy, Advocacy, Research, and Research, and ICOFoundationICOFoundation• 2002 resolution on "Visual Standards - Aspects and 2002 resolution on "Visual Standards - Aspects and

Ranges of Vision Loss” incorporated into WHO’s ICD-Ranges of Vision Loss” incorporated into WHO’s ICD-1010

• 2006 report on “Vision Requirements for Driving 2006 report on “Vision Requirements for Driving Safety”Safety”

• Member of coordinating Task Force for VISION 2020: Member of coordinating Task Force for VISION 2020: The Right To SightThe Right To Sight

• Research Committee’s “Research Agenda for Global Research Committee’s “Research Agenda for Global Blindness Prevention” endorsed by WHOBlindness Prevention” endorsed by WHO

• ICOFoundation raises funds for ICO programsICOFoundation raises funds for ICO programs

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ICO CommunicationsICO Communications• The Eye SiteThe Eye Site ( (www.www.icophicoph.org.org))• The The ICO Leader LetterICO Leader Letter, monthly, monthly e-mail e-mail

newsletter for international leadersnewsletter for international leaders• IFOS NotesIFOS Notes, e-mail newsletter for IFOS , e-mail newsletter for IFOS

membersmembers• IFOS/ICO NewsletterIFOS/ICO Newsletter (printed once a year) (printed once a year)• Database of ophthalmologic societies and Database of ophthalmologic societies and

residenciesresidencies• Directory of International OphthalmologyDirectory of International Ophthalmology

(printed once a year)(printed once a year)

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ConclusionConclusion• There are critical public needs for eye care not being met, There are critical public needs for eye care not being met,

resulting in avoidable blindness and loss of visionresulting in avoidable blindness and loss of vision• Not enough ophthalmologists or other eye care providers Not enough ophthalmologists or other eye care providers

being trained and insufficient training programsbeing trained and insufficient training programs• The ICO asks ophthalmologic societies to take the lead in The ICO asks ophthalmologic societies to take the lead in

defining how to enhance training to meet public needsdefining how to enhance training to meet public needs• Lots resources available to help you do that, particularly Lots resources available to help you do that, particularly

from the ICOfrom the ICO• Thank you for considering this opportunity and challengeThank you for considering this opportunity and challenge• We look forward to working with you to improve trainingWe look forward to working with you to improve training

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To Contact the ICO:To Contact the ICO:Bruce E. Spivey, MD, PresidentBruce E. Spivey, MD, PresidentInternational Council of OphthalmologyInternational Council of Ophthalmology945 Green Street945 Green StreetSan Francisco, California, USA 94133San Francisco, California, USA 94133

Fax: (+1) 415 409-8403Fax: (+1) 415 409-8403

E-mail: E-mail: [email protected]@icoph.org

Web: Web: www.icoph.orgwww.icoph.org

a critical challenge for ophthalmology: enhancing training to meet the need for eye care...

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