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


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

A Critical Challenge for OphthalmologyEnhancing
TrainingTo Meet theNeed for Eye Care
International Council of Ophthalmology/ Internatio
nal Federation of Ophthalmological Societies
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.

Number of Visually Impaired(Per Million
Population, WHO data from 2002)
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
  • 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
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
World Health Report 2006
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
  • 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

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

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

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

Training Principles
  • Training in ophthalmology should focus on meeting
    needs of communities and populations, not just
  • 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

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

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

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

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

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 WHOs 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

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

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

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
  • 5. Stimulate research to eradicate preventable
    vision loss

Resources ICO Ophthalmic Education
  • Curricula for residents, medical students, allied
    health and CME
  • Pilot project to enhance residency training in
  • 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)

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

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

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
  • 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

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

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

  • 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
  • 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
  • We look forward to working with you to improve

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_at_icoph.org
  • Web www.icoph.org
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