A Critical Challenge for Ophthalmology: Enhancing Training To Meet the Need for Eye Care

1. International Council of Ophthalmology/ International Federation of Ophthalmological Societies A Critical Challenge for Ophthalmology:Enhancing TrainingTo Meet theNeed for Eye Care

2. Training To Meet Public Needs What I will cover: • The unmet public need for eye care • Key issues related to training • The challenge for ophthalmology • VISION 2020 and WHA Resolution 59-25 • Resources: • VISION 2020 Human Resources Working Group • Corporate and private support • ICO/IFOS curricula, programs, guidelines and more

3. Unmet Public Need for Eye Care • Worldwide at least 161 million people are severely visually impaired: • 37 million blind • 124 million with low vision • Burden of blindness greatest in the least developed regions of the globe. • Global vision loss is certain to increase, particularly in developing countries, due to population growth and aging, unless concerted action is taken.

4. Unmet Public Need for Eye Care New WHO Estimates (October 2006): • 153 million people around the world have uncorrected refractive errors • Including at least 13 million children (age 5 to 15) and 45 million working age adults (age 16 to 49) • 90 percent of those with uncorrected refractive errors live in low- and middle-income countries • A total of 314 million are visually impaired “We must re-double our efforts to ensure that every person who needs help is able to receive it,” – Serge Resnikoff, MD, WHO

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

6. Global Distribution of Blindness(by Cause, 2002 WHO Data) Other 13 % Age Related Macular Degeneration 9% Cataract 47 % Childhood blindness 4% Diabetic Retinopathy 5% Corneal scar 5% Onchocerciasis -1 % Glaucoma 12% Trachoma 4 %

7. World Health Report 2006

8. World Health Report 2006

9. International Assistance • A 50:50 guideline, whereby half of all international assistance funds go to health systems and half to national health workforce strengthening strategies

10. Key Issues Related to Training Particularly in developing countries: • Not enough ophthalmologists and other eye care providers to provide the care needed • Mal-distribution: Lack of providers where most needed • Not enough training programs • Existing training programs not focused on public needs, e.g., for community eye health • Lack of infrastructure and professional development for those who are trained

11. Challenge for Ophthalmology • To provide LEADERSHIP for training the ophthalmologists and other personnel needed to meet the public need for eye care • Long-term goals: • Increase access to quality eye care worldwide • Prevent avoidable blindness and visual loss • Preserve and restore vision

12. What the ICO Asks Societies To Do • Work with national VISION 2020 programs and others involved with eye care • Assess the needs for ophthalmologists and other providers in your country • Evaluate existing training programs • Define what needs to be done to improve and expand training • Advocate for funding and other support to do it

13. Eye Care Personnel Needed Teams of: • Ophthalmologists (surgeons and “eye doctors”) • Subspecialists (pediatric, retina, etc.) • Primary physicians trained in eye care • Mid level eye personnel (MLEP) and nurses • Optometrists or refractionists and opticians • Managers and community eye health workers

14. Training Principles • Training in ophthalmology should focus on meeting needs of communities and populations, not just individuals • Needs are best met by eye care teams, trained together to work as teams • Comprehensive eye care should be an integral part of the health care system

15. Training Principles (2) • Community-level primary eye care should be integrated into primary health care • Eye care training should be integrated with training for the rest of the health care system • Those who are trained need infrastructure and continuing professional development

16. VISION 2020: The Right To Sight • Global initiative to eliminate avoidable blindness by the year 2020 • Partnership launched in 1999, led by International Agency for the Prevention of Blindness (IAPB) and WHO • VISION 2020 implementation plans being defined at regional, national and provincial/district levels • Three core strategies: • Disease control • Infrastructure development • Human resources development

17. WHA Resolution 59-25 • Adopted by World Health Association in May 2006 • Calls on countries to: • reinforce efforts to define national VISION 2020 plans • mobilize domestic funding to support VISION 2020 • include prevention of blindness in national development plans and goals • integrate prevention of blindness into primary health care

18. WHA Resolution 59-25 • Adopted by World Health Association in May 2006 • Calls on countries to: • develop and strengthen eye care services and integrate them in the existing health care system, including training and re-training of health workers in visual health • Calls on WHO to: • provide support to collaboration among countries for the prevention of avoidable blindness and visual impairment in particular in the area of training of all categories of relevant staff

19. WHA Resolution 59-25 Offers an unprecedented opportunity to: • Convince national governments to assign higher priority to prevention of blindness and visual loss, and • Advocate for increased supportfor training of ophthalmologists and other eye care providers to meet public needs

20. Resources for Enhancing Training • VISION 2020 Human Resources Working Group • Corporate and private support • ICO/IFOS: • Curricula for training of residents, medical students and allied personnel • Pilot project to enhance residency training in Nigeria • ICO Courses for Residency Program Directors • ICO Basic and Clinical Assessments • IFOS/ICO International Fellowship • ICO International Clinical Guidelines

21. Resources: VISION 2020 HRWG • VISION 2020 Human Resources Working Group (HRWG) dedicated to optimizing and expanding training of eye care personnel around the world • Co-chaired by WHO’s Para Pararajasegaram, FRCS, FRCP, FRCOphth, and ICO President Bruce Spivey, MD, with Suzanne Gilbert as coordinator • Will encourage and support planning and implementation of efforts to enhance training

22. Resources: Corporate and Private • Carl Zeiss has donated $200,000 per year for five years to support development of five IAPB – Carl Zeiss Training Centers in different areas of need • Indonesia (2005), Nigeria (2006), Eastern Africa (2007), with 2008 and 2009 to be determined • Eli Lilly and Company Foundation award of $150,000 to ICOFoundation for ICO to establish model Diabetic Eye Disease Center • More to come

23. Background: ICO/IFOS • In 1857 in Brussels, 150 ophthalmologists from 24 countries met in the first International Congress of Ophthalmology • International Council of Ophthalmology (ICO) founded in 1927 in Scheveningen, Holland • International Federation of Ophthalmological Societies (IFOS) founded in 1933 in Madrid, Spain • IFOS represents and serves associations of ophthalmologists around the world • ICO is the executive body of IFOS

24. Background: ICO/IFOS Mission: The mission of the ICO/IFOS is to collaborate with ophthalmologic societies and related organizations to enhance ophthalmic education and improve access to quality eye care in order to preserve and restore vision for the people of the world. Primary Focus: Elevating the level of eye care worldwide with special emphasis on developing countries.

25. Background: ICO/IFOS ICO Primary Commitments: 1. Enhance ophthalmic education 2. Support communication and collaboration among ophthalmologic societies and ophthalmologists 3. Advocate for preservation of vision 4. Define proposed clinical guidelines and standards 5. Stimulate research to eradicate preventable vision loss

26. Resources: ICO Ophthalmic Education • Curricula for residents, medical students, allied health and CME • Pilot project to enhance residency training in Nigeria • Courses for residency program directors • ICO Basic and Clinical Assessments • IFOS/ICO International Fellowship • ICO International Clinical Guidelines • World Ophthalmology Congress • Atlas of Ophthalmology - atlasofophthalmology.com (endorsed by the ICO)

27. Resources: ICO Curricula • ICO international task forces have defined principles and guidelines for curricula for : • Ophthalmology residency education • Medical student education in ophthalmology • Allied ophthalmic personnel training • Ophthalmology continuing education • Intended to be adapted by ophthalmologic societies and training programs • Can be downloaded from www.icoph.org/ed

28. Resources: Pilot Project in Nigeria Initiative of ICO and Ophthalmological Society of Nigeria (OSN) to improve residency training: • Six regional residency resource centers with Internet access • OSN has defined a Vision for the Future – Nigeria and established an OSN Foundation • “Twinning” with All India Ophthalmologic Society and work with Aravind Eye Care System • Creating high-quality training center in Ibadan • Evaluation of impact on patient care

29. Resources: Residency Training • Two-day ICO Course for Residency Program Directors offered in Mexico, Peru, Egypt, etc. • New ICO committee to focus on enhancing residency training • Translation of ICO Curriculum for Residency Training into Spanish • Minimum Standards for Residency Training in Latin America defined by Pan-American Association of Ophthalmology and Pan-American Council of University Professors in Ophthalmology

30. ICO International Assessments for Ophthalmologists • ICO Basic Science Assessment and Clinical Sciences Assessment offered each year throughout the world • In 2006, about 1540 candidates enrolled for Assessments at 92 test centers in 61 countries • Assessments offered early in April each year, in 2007 on April 12 • Deadline to apply is January 31 each year • Used in some countries to evaluate residents

31. IFOS/ICO International Fellowship • 198 IFOS/ICO Fellowships awarded since 2001 • Purpose: help young ophthalmologists, especially from developing nations, improve practical skills • Fellowships generally last three months • Fellows expected to bring knowledge and skills back to their country • Available from more than 60 ophthalmology departments and institutions in 27 countries • Application deadline: each March 31 and September 30

32. ICO Clinical Guidelines • 20 ICO International Clinical Guidelines available at www.icoph.org/guide • Purpose: define appropriate eye care, recognizing differing cultures and capabilities • Designed to be translated and adapted • Can be integrated into training • Basis for Clinical Practice Guidelines initiative in China • Most recent Guidelines: trachoma and leprosy

33. World Ophthalmology Congress • Started in 1857 as International Congress of Ophthalmology • 2007 is 150th anniversary of first Congress • Longest continuing international meeting in medicine • Scientific program defined in cooperation with international subspecialty societies • Next: June 28 - July 2, 2008 in Hong Kong • Future Congresses: • 2010: June 29 - July 3 in Berlin • 2012: November 10 - 13 in Chicago

34. ICO Programs: Standards, Advocacy, Research, and ICOFoundation • 2002 resolution on "Visual Standards - Aspects and Ranges of Vision Loss” incorporated into WHO’s ICD-10 • 2006 report on “Vision Requirements for Driving Safety” • Member of coordinating Task Force for VISION 2020: The Right To Sight • Research Committee’s “Research Agenda for Global Blindness Prevention” endorsed by WHO • ICOFoundation raises funds for ICO programs

35. ICO Communications • The Eye Site (www.icoph.org) • The ICO Leader Letter, monthlye-mail newsletter for international leaders • IFOS Notes, e-mail newsletter for IFOS members • IFOS/ICO Newsletter (printed once a year) • Database of ophthalmologic societies and residencies • Directory of International Ophthalmology (printed once a year)

36. Conclusion • There are critical public needs for eye care not being met, resulting in avoidable blindness and loss of vision • Not enough ophthalmologists or other eye care providers being trained and insufficient training programs • The ICO asks ophthalmologic societies to take the lead in defining how to enhance training to meet public needs • Lots resources available to help you do that, particularly from the ICO • Thank you for considering this opportunity and challenge • We look forward to working with you to improve training

37. To Contact the ICO: Bruce E. Spivey, MD, President International Council of Ophthalmology 945 Green Street San Francisco, California, USA 94133 Fax: (+1) 415 409-8403 E-mail: info@icoph.org Web: www.icoph.org