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Myths and Misconceptions About Research and Clinical Ophthalmology in India

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5 MYTHS AND MISCONCEPTIONS Comprehensive eye health facility in Hyderabad, India Offers access to all ophthalmologic subspecialties Glaucoma Retina Cornea and ... – PowerPoint PPT presentation

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Title: Myths and Misconceptions About Research and Clinical Ophthalmology in India


1
Myths and Misconceptions About Research and
Clinical Ophthalmology in India
  • Sonia Yeung
  • PGY-5 Ophthalmology

2
5 MYTHS AND MISCONCEPTIONS
FACILITIES
PROCEDURES AND INSTRUMENTATION
RESEARCH ETHICS
PATIENTS AND SOCIOECONOMIC STATUS
EYE BANK
3
Myth 1 The Ophthalmologic Facilities and
Services are better in North America.
4
L.V. Prasad Eye Institute
  • Comprehensive eye health facility in Hyderabad,
    India
  • Offers access to all ophthalmologic
    subspecialties
  • Glaucoma
  • Retina
  • Cornea and external disease
  • Neuro-ophthalmology
  • Pediatric Ophthalmology
  • Orbital disease
  • Oculoplastics
  • Refractive
  • Ocular Oncology
  • Non-profit organization governed by
  • Hyderabad Eye Institute
  • Hyderabad Eye Research Foundation

5
  • inpatient wards
  • 8 operating rooms
  • research floor
  • subspecialty clinics
  • lodging for fellows and trainees
  • lecture theatre
  • library and study areas
  • cafeteria
  • medical records
  • optical dispensary
  • pharmacy
  • administrative offices

6
Associated primary and secondary eye care centers
  • Tertiary Centers
  • L.V. Prasad
  • Bhabneswar
  • Visakhapatnam
  • Also 76 associated primary and secondary eye care
    centers
  • Within Andhra Pradesh, these centers have
    provided eye care of over 1.5 million outpatients
  • Over 50 of these have received treatment free of
    cost
  • 2/3 of over 150,000 surgeries have been performed
    without charging the patients

7
LVP Pyramid of Eye Care
  • Foundation of community involvement
  • Trained young people who go door-to-door and
    organize visits to rural areas
  • Vision Centers which serve the primary eye health
    needs of the community
  • Cater to a cluster of villages
  • Vision Centers are networked with larger
    Secondary Eye Care Centers
  • Subspecialty physicians and surgeries
  • Linked to Tertiary Care Hospitals (Training
    Centers) in cities that provide all ophthalmic
    services, surgeries, and training
  • Does not depend on external funding or expertise
    in the long term
  • Cost of providing care is US1 per person served

8
ICARE Community Outreach
  • Forms the base of the Eye Care Pyramid
  • Health Care workers travel to remote villages
  • Patients are moved up the pyramid as necessary
  • Goal is to provide high quality self-sustaining
    eye care services in neglected areas

9
Referrals up the Pyramid
Door-to-door surveys
Community Screening Programs
Public Awareness Campaigns
School Screening Programs
Community Based Rehabilitation
10
It is estimated that there is over 18 million
blind in India alone
  • Most of these are in rural areas
  • Majority of the population lives in rural areas
  • Rural areas have the least access to eye care
    services
  • ICARE is servicing Andhra Pradesh
  • Model of other states and developing countries
  • In 2008-2009, almost 2 million people were served
    through this network

11
The regular work week
  • Daily academic rounds at 700-800
  • Clinic 0800 to 2000
  • Operating room
  • 0800 to 1800 Staff Fellow/Resident
  • 1800 to 2300 Fellow/Resident
  • 6.5 days a week!

12
6 MYTHS AND MISCONCEPTIONS
FACILITIES
PROCEDURES AND INSTRUMENTATION
RESEARCH ETHICS
PATIENTS AND SOCIOECONOMIC STATUS
EYE BANK
13
Myth 2 Only those who can pay for ophthalmic
care receive access to the full range of
services.
14
On admission, every patient pays the amount they
can afford
  • Some patients pay nothing
  • Some patients pay full price
  • Charts are coded differently but not treated
    differently
  • Paying patients have the option to buy packages
  • Wards
  • Type of Cataract Surgery

15
6 MYTHS AND MISCONCEPTIONS
FACILITIES
PROCEDURES AND INSTRUMENTATION
RESEARCH ETHICS
PATIENTS AND SOCIOECONOMIC STATUS
EYE BANK
16
Myth 3 Not all advanced services or surgical
procedures are performed in India.
17
All surgical procedures are offered in India, but
not all procedures in India are offered in Canada
  • Cataract surgery (phaco, SICS)
  • Retinal surgery
  • Refractive surgery
  • Oculoplastic surgery
  • Glaucoma surgery
  • Corneal transplantation
  • Stem cell transplantation

18
LVP has pioneered ex-vivo corneal stem cell
transplantation
  • First corneal stem cell transplant in 2002
  • Since then, over 750 procedures have been
    performed
  • Last year, the University of Toronto has received
    funding for the establishment of corneal stem
    cell transplantation and research

19
6 MYTHS AND MISCONCEPTIONS
FACILITIES
PROCEDURES AND INSTRUMENTATION
RESEARCH ETHICS
PATIENTS AND SOCIOECONOMIC STATUS
EYE BANK
20
Myth 4 Eye Donation is more widely accepted
and better implemented in North America.
21
Hospital Cornea Retrieval Program
  • Ramayamma International Eye Bank was started in
    1989
  • Focus is on active procurement from hospitals
    (started in 1990)
  • Medical history available
  • Tissue from younger donors available
  • Reduction in time between death and eye retrieval
  • More cost effective
  • Eye donation counselors combine grief counseling,
    education, and motivation

22
Statistics 2008-2009
  • Corneas Harvested
  • Hyderabad 2959
  • Bhubaneswar 83
  • Visakhapatnam 250
  • TOTAL 3292
  • No Waiting List for Corneal Transplantation
  • (In 2007 in BC, 527 donors)

23
6 MYTHS AND MISCONCEPTIONS
FACILITIES
PROCEDURES AND INSTRUMENTATION
RESEARCH ETHICS
PATIENTS AND SOCIOECONOMIC STATUS
EYE BANK
24
Myth 5 Research is not as big of a priority in
India as clinical care.
25
Hyderabad Eye Research Foundation
  • Basic, clinical, and public health research at
    LVP
  • Translational eye research centre
  • Jhaveri microbiology centre
  • Saroja A Rao immunology laboratory
  • Kallam Anji Reddy molecular genetics laboratory
  • Ophthalmic Pathology Laboratory
  • Sudhakar and Sreekanth Ravi Stem Cell Biology
    Laboratory
  • Clinical research department
  • Research is an integral part of improving the
    services in the eye health pyramid
  • All studies approved by the Institutional Review
    Board

26
Ophthalmologists at LVP are avid researchers
  • Over 80 publications per year in peer-reviewed
    journals
  • Many clinical trials
  • Often publish the largest series of ocular
    conditions that are seen rarely in North America
  • Atypical mycobacterial infections
  • Fungal infections

27
My Research
  • High rate of corneal transplantation secondary to
    trauma and infection
  • High rate of graft failures
  • Infectious etiologic agents are different in
    India
  • Goal to study poorly treated atypical
    mycobacterial, microsporidial, and fungal
    infections
  • Early identification of infection
  • Determining antibiotic resistance and treatment
    outcomes
  • What interventions are needed to improve outcomes
    following infection?

28
Take-Home Message
  • Initiatives should be directed to assist their
    existing program
  • Skills transfer
  • Research with goals that will benefit their
    population
  • MANY THANKS TO
  • UBC BRANCH FOR INTERNATIONAL SURGERY
  • DR. PAUL DUBORD
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