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

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

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

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.

According to: 1.Magnitude 2.Severity (personal, economic and social impact) 3.Existence of a cost-effective intervention 4.Feasibility in terms of: willingness and acceptability Based on needs assessment Priority Setting

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

Global Distribution of Blindness by Cause (2007) Cataract 5% Glaucoma 18% Other 4%ARMD50% Ch Bl 3% DR 17% CO 3% Cataract 50 % Trachoma 4 % Glaucoma 12% Oncho 0.8 % Other 14 % ARMD 6% Ch Bl 4% DR 4% CO 5% More Developed Countries Less Developed Countries

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

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

Philippines Peru Bangladesh Cambodia Mali Guatemala Dominican Rep. Tanzania Indonesia Moldova MadagascarMadagascar ChinaChina Ethiopia NigeriaNigeria Mozambique

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

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

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

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

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

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

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

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 ,300 diabetic patients/O'gist/year in 2030 (10 per day)

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

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

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

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

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

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

International Ophthalmology’s Top Priorities for the Next 10 Years Training – including subspecialists Getting connected to other international initiatives (e.g. NTDs, NCDs…) Developing Team Work approaches Advocating for “Eye care policies in All health cares policies” Advocating for inclusion of essential eye care in health insurance schemes