what should international ophthalmology’s top priorities be for the next 10 years? serge resnikoff...
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What Should International Ophthalmology’s Top Priorities Be
for the Next 10 Years?
Serge Resnikoff MD PhDICO Director for AdvocacyAAO, Chicago, 16 Oct 2010
What Should International Ophthalmology’s Top Priorities Be
for the Next 10 Years?
Serge Resnikoff MD PhDICO Director for AdvocacyAAO, Chicago, 16 Oct 2010
Priority Setting
• In an ideal world, distribution of health care services aims at two goals:– efficiency – equity
• However, citizens, patients, and health care professionals have preferences over what kind of health outcomes they value most, and how they like them to be distributed
Priority Setting
• Traditionally, priority setting methodology focuses on cost-effectiveness
• However, in low and middle income countries, additional factors need to be considered, e.g.:– poverty-impact,– financial protection against the cost of
illness,– labour market productivity, and other
welfare benefits beyond improved health.
• According to:1. Magnitude2. Severity (personal, economic and social impact)3. Existence of a cost-effective intervention4. Feasibility in terms of:
• willingness• and acceptability
• Based on needs assessment
Priority Setting
Number of Blind people in the world(Best Corrected VA < 3/60)
VISION 2020
37 Million33 Million
+ 8 MURE
+ 7 MURE
?
Global Distribution of Blindness by Cause (2007)
Cataract5%
Glaucoma18%
Other4%
ARMDARMD50%50%
Ch Bl3%
DR17%
CO3%
CataractCataract50 %50 %
Trachoma4 %
Glaucoma12%
Oncho 0.8 %
Other14 %
ARMD6%
Ch Bl 4%
DR 4%
CO 5%
More Developed Countries
Less DevelopedCountries
Prevention of Blindness Global Challenges
• Ongoing Challenges– Cataract– Trachoma– Onchocerciasis– Childhood blindness
• “New” Challenges– Refractive Errors– Diabetic Retinopathy– Glaucoma– AMD– Low Vision services
0
500
1000
1500
2000
2500
3000
3500
4000
4500CSR
ArmeniaBangladeshCambodiaChinaDjiboutiDominicaDominican Rep.EthiopiaFijiGuatemalaGuyanaIndiaIndonesiaJamaicaMadagascarMaliMoldovaMoroccoMozambiqueNigeriaPakistanPeruPhilippinesRussiaTanzaniaYemen0
500
1000
1500
2000
2500
3000
3500
4000
4500CSR
ArmeniaBangladeshCambodiaChinaDjiboutiDominicaDominican Rep.EthiopiaFijiGuatemalaGuyanaIndiaIndonesiaJamaicaMadagascarMaliMoldovaMoroccoMozambiqueNigeriaPakistanPeruPhilippinesRussiaTanzaniaYemen
MoroccoMoroccoDominica
India
Fiji
Cataract Surgical Rate (1990 – 2006)
Pakistan
0
200
400
600
800
1000
1200
1400
CSR
Bangladesh
Cambodia
China
Dominican Rep.
Ethiopia
Guatemala
Indonesia
Jamaica
Madagascar
Mali
Moldova
Mozambique
Nigeria
Peru
Philippines
Tanzania
Yemen
Philippines
Peru
Bangladesh
Cambodia
Mali
Guatemala
Dominican Rep.Dominican Rep.
Tanzania
IndonesiaMoldova
MadagascarMadagascarMadagascarMadagascarChinaChinaChinaChinaEthiopiaNigeriaNigeriaNigeriaNigeria
Mozambique
Prevention of Blindness Global Challenges
• Ongoing Challenges– Cataract– Trachoma– Onchocerciasis– Childhood blindness
• “New” Challenges– Refractive Errors– Diabetic Retinopathy– Glaucoma– AMD– Low Vision services
Annual Shipments and Reported Distributed Zithromax Donated Treatments
D. Haddad, June 2010
Prevention of Blindness Global Challenges
• Ongoing Challenges– Cataract– Trachoma– Onchocerciasis– Childhood blindness
• “New” Challenges– Refractive Errors– Diabetic Retinopathy– Glaucoma– AMD– Low Vision services
Trichiasis Surgery ++++
Prevention of Blindness Global Challenges
• Ongoing Challenges– Cataract– Trachoma– Onchocerciasis– Childhood blindness
• “New” Challenges– Refractive Errors– Diabetic Retinopathy– Glaucoma– AMD– Low Vision services
Congenital CataractRoP
Prevention of Blindness Global Challenges
• Ongoing Challenges– Cataract– Trachoma– Onchocerciasis– Childhood blindness
• “New” Challenges– Refractive Errors– Diabetic Retinopathy– Glaucoma– AMD– Low Vision services
Eye Care Team approachEntails availability of affordable glasses
Prevention of Blindness Global Challenges
• Ongoing Challenges– Cataract– Trachoma– Onchocerciasis– Childhood blindness
• “New” Challenges– Refractive Errors– Diabetic Retinopathy– Glaucoma– AMD– Low Vision services
0
10
20
30
40
50
60
70
80
90
Est marketec
Formersoc.ec Eur
India China LatinAmer&Car
Middle East OtherAsia&Isl
Sub-Saharan
Afr
2000
2030
WHO, Wild & Roglic, 2004
Number of persons with diabetes (millions)Number of persons with diabetes (millions)
Diabetes
• Implications:– Projection for 2030: 366 million people with
diabetes• 68 million in High Income Countries• 298 million in Low and Middle Income Countries
– Workload for ophthalmologists (one eye exam per year):
• 1,000 diabetic patients/O'gist/year in 2000• 2,300 diabetic patients/O'gist/year in 2030 (10 per day)
Prevention of Blindness Global Challenges
• Ongoing Challenges– Cataract– Trachoma– Onchocerciasis– Childhood blindness
• “New” Challenges– Refractive Errors– Diabetic Retinopathy– Glaucoma– AMD– Low Vision services
Eye Care Team approachTechnology and drugs development
Vitreo-retinal surgery training
Prevention of Blindness Global Challenges
• Ongoing Challenges– Cataract– Trachoma– Onchocerciasis– Childhood blindness
• “New” Challenges– Refractive Errors– Diabetic Retinopathy– Glaucoma– AMD– Low Vision services
Glaucoma
• No validated C/E public health intervention• Individual case detection and management• Huge number of undiagnosed/untreated casesPreliminary estimate:
30 to 65 million cases not adequately managed
Prevention of Blindness Global Challenges
• Ongoing Challenges– Cataract– Trachoma– Onchocerciasis– Childhood blindness
• “New” Challenges– Refractive Errors– Diabetic Retinopathy– Glaucoma– AMD– Low Vision services
Case Detection and ManagementAvailability of affordable drugs
Prevention of Blindness Global Challenges
• Ongoing Challenges– Cataract– Trachoma– Onchocerciasis– Childhood blindness
• “New” Challenges– Refractive Errors– Diabetic Retinopathy– Glaucoma– AMD– Low Vision services
AMD increases in Low and Middle Income countriesGenerates demand of expensive treatments
Prevention could have significant impact (nutrition, tobacco)Eye Care Team approach
Prevention of Blindness Global Challenges
• Ongoing Challenges– Cataract– Trachoma– Onchocerciasis– Childhood blindness
• “New” Challenges– Refractive Errors– Diabetic Retinopathy– Glaucoma– AMD– Low Vision services
What Should International Ophthalmology’s Top Priorities
Be for the Next 10 Years?