What Should International Ophthalmology’s Top Priorities Be for the Next 10 Years?

1. What Should International Ophthalmology’s Top Priorities Be for the Next 10 Years? Serge Resnikoff MD PhD ICO Director for Advocacy AAO, Chicago, 16 Oct 2010

2. What Should International Ophthalmology’s Top Priorities Be for the Next 10 Years? Serge Resnikoff MD PhD ICO Director for Advocacy AAO, Chicago, 16 Oct 2010

3. 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

4. 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.

5. Priority Setting • According to: • Magnitude • Severity (personal, economic and social impact) • Existence of a cost-effective intervention • Feasibility in terms of: • willingness • and acceptability • Based on needs assessment

6. Number of Blind people in the world(Best Corrected VA < 3/60) VISION 2020 37 Million 33 Million ? + 8 M URE + 7 M URE

7. Other 4% Cataract 5% Glaucoma 18% Other 14 % CO 3% ARMD 6% ARMD 50% Ch Bl 4% Cataract 50 % DR 17% DR 4% CO 5% Ch Bl 3% Oncho 0.8 % Glaucoma 12% Trachoma 4 % Global Distribution of Blindness by Cause (2007) Less Developed Countries More Developed Countries

8. Ongoing Challenges Cataract Trachoma Onchocerciasis Childhood blindness “New” Challenges Refractive Errors Diabetic Retinopathy Glaucoma AMD Low Vision services Prevention of Blindness Global Challenges

9. Cataract Surgical Rate (1990 – 2006) India Pakistan Dominica Morocco Fiji

10. Philippines Bangladesh Peru Guatemala Cambodia Dominican Rep. Mali Tanzania Indonesia Moldova Madagascar China Ethiopia Nigeria Mozambique

11. Ongoing Challenges Cataract Trachoma Onchocerciasis Childhood blindness “New” Challenges Refractive Errors Diabetic Retinopathy Glaucoma AMD Low Vision services Prevention of Blindness Global Challenges

12. Annual Shipments and Reported Distributed Zithromax Donated Treatments D. Haddad, June 2010

13. Ongoing Challenges Cataract Trachoma Onchocerciasis Childhood blindness “New” Challenges Refractive Errors Diabetic Retinopathy Glaucoma AMD Low Vision services Prevention of Blindness Global Challenges Trichiasis Surgery ++++

14. Ongoing Challenges Cataract Trachoma Onchocerciasis Childhood blindness “New” Challenges Refractive Errors Diabetic Retinopathy Glaucoma AMD Low Vision services Prevention of Blindness Global Challenges Congenital Cataract RoP

15. Ongoing Challenges Cataract Trachoma Onchocerciasis Childhood blindness “New” Challenges Refractive Errors Diabetic Retinopathy Glaucoma AMD Low Vision services Prevention of Blindness Global Challenges Eye Care Team approach Entails availability of affordable glasses

16. Ongoing Challenges Cataract Trachoma Onchocerciasis Childhood blindness “New” Challenges Refractive Errors Diabetic Retinopathy Glaucoma AMD Low Vision services Prevention of Blindness Global Challenges

17. Number of persons with diabetes (millions) WHO, Wild & Roglic, 2004

18. 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)

19. Ongoing Challenges Cataract Trachoma Onchocerciasis Childhood blindness “New” Challenges Refractive Errors Diabetic Retinopathy Glaucoma AMD Low Vision services Prevention of Blindness Global Challenges Eye Care Team approach Technology and drugs development Vitreo-retinal surgery training

20. Ongoing Challenges Cataract Trachoma Onchocerciasis Childhood blindness “New” Challenges Refractive Errors Diabetic Retinopathy Glaucoma AMD Low Vision services Prevention of Blindness Global Challenges

21. Glaucoma • No validated C/E public health intervention • Individual case detection and management • Huge number of undiagnosed/untreated cases Preliminary estimate: 30 to 65 million cases not adequately managed

22. Ongoing Challenges Cataract Trachoma Onchocerciasis Childhood blindness “New” Challenges Refractive Errors Diabetic Retinopathy Glaucoma AMD Low Vision services Prevention of Blindness Global Challenges Case Detection and Management Availability of affordable drugs

23. Ongoing Challenges Cataract Trachoma Onchocerciasis Childhood blindness “New” Challenges Refractive Errors Diabetic Retinopathy Glaucoma AMD Low Vision services Prevention of Blindness Global Challenges • AMD increases in Low and Middle Income countries • Generates demand of expensive treatments • Prevention could have significant impact (nutrition, tobacco) • Eye Care Team approach

24. Ongoing Challenges Cataract Trachoma Onchocerciasis Childhood blindness “New” Challenges Refractive Errors Diabetic Retinopathy Glaucoma AMD Low Vision services Prevention of Blindness Global Challenges What Should International Ophthalmology’s Top Priorities Be for the Next 10 Years?