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. 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.

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

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. 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 %

6. World Health Report 2006

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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)

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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