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

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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International Council of Ophthalmology/International Council of Ophthalmology/International Federation of Ophthalmological SocietiesInternational Federation of Ophthalmological SocietiesUnmet 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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International Council of Ophthalmology/International Council of Ophthalmology/International Federation of Ophthalmological SocietiesInternational Federation of Ophthalmological SocietiesGlobal 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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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 development Lack of infrastructure and professional development

for those who are trainedfor 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 doctors”)Ophthalmologists (surgeons and “eye 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 workersManagers and community eye health workers

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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 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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International Council of Ophthalmology/International Council of Ophthalmology/International Federation of Ophthalmological SocietiesInternational Federation of Ophthalmological SocietiesResources 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 NigeriaPilot project to enhance residency training in Nigeria– 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 Bruce and ICO President Bruce Spivey, MD, with Suzanne Gilbert as coordinatorSpivey, MD, with Suzanne Gilbert as coordinator

• 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 $150,000 Eli Lilly and Company Foundation award of $150,000

to ICOFoundation for ICO to establish model Diabetic to ICOFoundation for ICO to establish model Diabetic Eye Disease CenterEye 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/IFOSICO Primary Commitments:ICO Primary Commitments:1. Enhance ophthalmic education1. Enhance ophthalmic education2. Support communication and collaboration among 2. Support communication and collaboration among

ophthalmologic societies and ophthalmologistsophthalmologic societies and ophthalmologists3. Advocate for preservation of vision3. Advocate for preservation of vision4. Define proposed clinical guidelines and standards4. Define proposed clinical guidelines and standards5. Stimulate research to eradicate preventable 5. Stimulate research to eradicate preventable

vision lossvision loss

2020


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

CMECME• 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)

http://www.atlasofophthalmology.com/

http://www.atlasofophthalmology.com/

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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 ophthalmologyMedical student education in ophthalmology– 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

http://www.icoph.org/ed

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International Council of Ophthalmology/International Council of Ophthalmology/International Federation of Ophthalmological SocietiesInternational Federation of Ophthalmological SocietiesResources: 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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International Council of Ophthalmology/International Council of Ophthalmology/International Federation of Ophthalmological SocietiesInternational Federation of Ophthalmological SocietiesIFOS/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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ConclusionConclusion• There are critical public needs for eye care not being There are critical public needs for eye care not being

met, resulting in avoidable blindness and loss of visionmet, resulting 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 94133Fax: (+1) 415 409-8403Fax: (+1) 415 409-8403E-mail: E-mail: [email protected]@icoph.orgWeb: Web: www.icoph.orgwww.icoph.org

mailto:[email protected]

http://www.icoph.org/apply

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

Documents

eye careworldwide

population growth

developed regions

concerted action

global vision loss

developing countries

critical challenge