A Critical Challenge for Ophthalmology: Enhancing Training To Meet the Need for Eye Care International Council of Ophthalmology/ International Federation of Ophthalmological Societies

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 2 Training To Meet Public Needs What I will cover: The unmet public need for eye careThe unmet public need for eye care Key issues related to trainingKey issues related to training The challenge for ophthalmologyThe challenge for ophthalmology VISION 2020 and WHA Resolution 59-25VISION 2020 and WHA Resolution Resources:Resources: –VISION 2020 Human Resources Working Group –Corporate and private support –ICO/IFOS curricula, programs, guidelines and more

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 3 Unmet Public Need for Eye Care Worldwide at least 161 million people are severely visually impaired: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.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.Global vision loss is certain to increase, particularly in developing countries, due to population growth and aging, unless concerted action is taken.

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 4 Unmet Public Need for Eye Care New WHO Estimates (October 2006): 153 million people around the world have uncorrected refractive errors153 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)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 countries90 percent of those with uncorrected refractive errors live in low- and middle-income countries A total of 314 million are visually impairedA 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 “We must re-double our efforts to ensure that every person who needs help is able to receive it,” – Serge Resnikoff, MD, WHO

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 5 Number of Visually Impaired (Per Million Population, WHO data from 2002)

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 6 Global Distribution of Blindness (by Cause, 2002 WHO Data) Cataract 47 % Trachoma 4 % Glaucoma12% Onchocerciasis -1 % Other 13 % Age Related Macular Degeneration 9% Childhood blindness 4% Diabetic Retinopathy 5% Corneal scar 5%

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 7 World Health Report 2006

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 8 World Health Report 2006

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 9 International Assistance A 50:50 guideline, whereby half of all international assistance funds go to health systems and half to national health workforce strengthening strategiesA 50:50 guideline, whereby half of all international assistance funds go to health systems and half to national health workforce strengthening strategies

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 10 Key Issues Related to Training Particularly in developing countries: Not enough ophthalmologists and other eye care providers to provide the care neededNot enough ophthalmologists and other eye care providers to provide the care needed Mal-distribution: Lack of providers where most neededMal-distribution: Lack of providers where most needed Not enough training programsNot enough training programs Existing training programs not focused on public needs, e.g., for community eye healthExisting training programs not focused on public needs, e.g., for community eye health Lack of infrastructure and professional development for those who are trainedLack of infrastructure and professional development for those who are trained

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 11 Challenge for Ophthalmology To provide LEADERSHIP for training the ophthalmologists and other personnel needed to meet the public need for eye careTo provide LEADERSHIP for training the ophthalmologists and other personnel needed to meet the public need for eye care Long-term goals:Long-term goals: –Increase access to quality eye care worldwide –Prevent avoidable blindness and visual loss –Preserve and restore vision

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 12 What the ICO Asks Societies To Do Work with national VISION 2020 programs and others involved with eye careWork with national VISION 2020 programs and others involved with eye care Assess the needs for ophthalmologists and other providers in your countryAssess the needs for ophthalmologists and other providers in your country Evaluate existing training programsEvaluate existing training programs Define what needs to be done to improve and expand trainingDefine what needs to be done to improve and expand training Advocate for funding and other support to do itAdvocate for funding and other support to do it

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 13 Eye Care Personnel Needed Teams of: Ophthalmologists (surgeons and “eye doctors”)Ophthalmologists (surgeons and “eye doctors”) Subspecialists (pediatric, retina, etc.)Subspecialists (pediatric, retina, etc.) Primary physicians trained in eye carePrimary physicians trained in eye care Mid level eye personnel (MLEP) and nursesMid level eye personnel (MLEP) and nurses Optometrists or refractionists and opticiansOptometrists or refractionists and opticians Managers and community eye health workersManagers and community eye health workers

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 14 Training Principles Training in ophthalmology should focus on meeting needs of communities and populations, not just individualsTraining 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 teamsNeeds 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 systemComprehensive eye care should be an integral part of the health care system

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 15 Training Principles (2) Community-level primary eye care should be integrated into primary health careCommunity-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 systemEye care training should be integrated with training for the rest of the health care system Those who are trained need infrastructure and continuing professional developmentThose who are trained need infrastructure and continuing professional development

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 16 VISION 2020: The Right To Sight Global initiative to eliminate avoidable blindness by the year 2020Global initiative to eliminate avoidable blindness by the year 2020 Partnership launched in 1999, led by International Agency for the Prevention of Blindness (IAPB) and WHOPartnership 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 levelsVISION 2020 implementation plans being defined at regional, national and provincial/district levels Three core strategies:Three core strategies: –Disease control –Infrastructure development –Human resources development

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 17 WHA Resolution Adopted by World Health Association in May 2006Adopted by World Health Association in May 2006 Calls on countries to:Calls on countries to: –reinforce efforts to define national VISION 2020 plans –mobilize domestic funding to support VISION 2020 –include prevention of blindness in national development plans and goals –integrate prevention of blindness into primary health care

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 18 WHA Resolution Adopted by World Health Association in May 2006Adopted by World Health Association in May 2006 Calls on countries to: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: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

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 19 WHA Resolution Offers an unprecedented opportunity to: Convince national governments to assign higher priority to prevention of blindness and visual loss, andConvince national governments to assign higher priority to prevention of blindness and visual loss, and Advocate for increased support for training of ophthalmologists and other eye care providers to meet public needsAdvocate for increased support for training of ophthalmologists and other eye care providers to meet public needs

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 20 Resources for Enhancing Training VISION 2020 Human Resources Working GroupVISION 2020 Human Resources Working Group Corporate and private supportCorporate and private support ICO/IFOS: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

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 21 Resources: VISION 2020 HRWG VISION 2020 Human Resources Working Group (HRWG) dedicated to optimizing and expanding training of eye care personnel around the worldVISION 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 coordinatorCo-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 trainingWill encourage and support planning and implementation of efforts to enhance training

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 22 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 needCarl 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 CenterEli Lilly and Company Foundation award of $150,000 to ICOFoundation for ICO to establish model Diabetic Eye Disease Center More to comeMore to come

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 23 Background: ICO/IFOS In 1857 in Brussels, 150 ophthalmologists from 24 countries met in the first International Congress of OphthalmologyIn 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, HollandInternational Council of Ophthalmology (ICO) founded in 1927 in Scheveningen, Holland International Federation of Ophthalmological Societies (IFOS) founded in 1933 in Madrid, SpainInternational Federation of Ophthalmological Societies (IFOS) founded in 1933 in Madrid, Spain IFOS represents and serves associations of ophthalmologists around the worldIFOS represents and serves associations of ophthalmologists around the world ICO is the executive body of IFOSICO is the executive body of IFOS

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 24 Background: ICO/IFOS Mission: The mission of the ICO/IFOS is to collaborate with ophthalmologic societies and related organizations to enhance ophthalmic education and improve access to quality eye care in order to preserve and restore vision for the people of the world. Primary Focus: Elevating the level of eye care worldwide with special emphasis on developing countries.

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 25 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

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 26 Resources: ICO Ophthalmic Education Curricula for residents, medical students, allied health and CMECurricula for residents, medical students, allied health and CME Pilot project to enhance residency training in NigeriaPilot project to enhance residency training in Nigeria Courses for residency program directorsCourses for residency program directors ICO Basic and Clinical AssessmentsICO Basic and Clinical Assessments IFOS/ICO International FellowshipIFOS/ICO International Fellowship ICO International Clinical GuidelinesICO International Clinical Guidelines World Ophthalmology CongressWorld Ophthalmology Congress Atlas of Ophthalmology - atlasofophthalmology.com (endorsed by the ICO)Atlas of Ophthalmology - atlasofophthalmology.com (endorsed by the ICO)atlasofophthalmology.com

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 27 Resources: ICO Curricula ICO international task forces have defined principles and guidelines for curricula for :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 programsIntended to be adapted by ophthalmologic societies and training programs Can be downloaded from be downloaded from

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 28 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 accessSix regional residency resource centers with Internet access OSN has defined a Vision for the Future – Nigeria and established an OSN FoundationOSN 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“Twinning” with All India Ophthalmologic Society and work with Aravind Eye Care System Creating high-quality training center in IbadanCreating high-quality training center in Ibadan Evaluation of impact on patient careEvaluation of impact on patient care

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 29 Resources: Residency Training Two-day ICO Course for Residency Program Directors offered in Mexico, Peru, Egypt, etc.Two-day ICO Course for Residency Program Directors offered in Mexico, Peru, Egypt, etc. New ICO committee to focus on enhancing residency trainingNew ICO committee to focus on enhancing residency training Translation of ICO Curriculum for Residency Training into SpanishTranslation 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 OphthalmologyMinimum Standards for Residency Training in Latin America defined by Pan-American Association of Ophthalmology and Pan-American Council of University Professors in Ophthalmology

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 30 ICO International Assessments for Ophthalmologists ICO Basic Science Assessment and Clinical Sciences Assessment offered each year throughout the worldICO 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 countriesIn 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 12Assessments offered early in April each year, in 2007 on April 12 Deadline to apply is January 31 each yearDeadline to apply is January 31 each year Used in some countries to evaluate residentsUsed in some countries to evaluate residents

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 31 IFOS/ICO International Fellowship 198 IFOS/ICO Fellowships awarded since IFOS/ICO Fellowships awarded since 2001 Purpose: help young ophthalmologists, especially from developing nations, improve practical skillsPurpose: help young ophthalmologists, especially from developing nations, improve practical skills Fellowships generally last three monthsFellowships generally last three months Fellows expected to bring knowledge and skills back to their countryFellows expected to bring knowledge and skills back to their country Available from more than 60 ophthalmology departments and institutions in 27 countriesAvailable from more than 60 ophthalmology departments and institutions in 27 countries Application deadline: each March 31 and September 30Application deadline: each March 31 and September 30

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 32 ICO Clinical Guidelines 20 ICO International Clinical Guidelines available at ICO International Clinical Guidelines available at Purpose: define appropriate eye care, recognizing differing cultures and capabilitiesPurpose: define appropriate eye care, recognizing differing cultures and capabilities Designed to be translated and adaptedDesigned to be translated and adapted Can be integrated into trainingCan be integrated into training Basis for Clinical Practice Guidelines initiative in ChinaBasis for Clinical Practice Guidelines initiative in China Most recent Guidelines: trachoma and leprosyMost recent Guidelines: trachoma and leprosy

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 33 World Ophthalmology Congress Started in 1857 as International Congress of OphthalmologyStarted in 1857 as International Congress of Ophthalmology 2007 is 150th anniversary of first Congress2007 is 150th anniversary of first Congress Longest continuing international meeting in medicineLongest continuing international meeting in medicine Scientific program defined in cooperation with international subspecialty societiesScientific program defined in cooperation with international subspecialty societies Next: June 28 - July 2, 2008 in Hong KongNext: June 28 - July 2, 2008 in Hong Kong Future Congresses:Future Congresses: –2010: June 29 - July 3 in Berlin –2012: November in Chicago

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 34 ICO Programs: Standards, Advocacy, Research, and ICOFoundation 2002 resolution on "Visual Standards - Aspects and Ranges of Vision Loss” incorporated into WHO’s ICD resolution on "Visual Standards - Aspects and Ranges of Vision Loss” incorporated into WHO’s ICD report on “Vision Requirements for Driving Safety”2006 report on “Vision Requirements for Driving Safety” Member of coordinating Task Force for VISION 2020: The Right To SightMember of coordinating Task Force for VISION 2020: The Right To Sight Research Committee’s “Research Agenda for Global Blindness Prevention” endorsed by WHOResearch Committee’s “Research Agenda for Global Blindness Prevention” endorsed by WHO ICOFoundation raises funds for ICO programsICOFoundation raises funds for ICO programs

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 35 ICO Communications The Eye Site ( Eye Site ( The ICO Leader Letter, monthly newsletter for international leadersThe ICO Leader Letter, monthly newsletter for international leaders IFOS Notes, newsletter for IFOS membersIFOS Notes, newsletter for IFOS members IFOS/ICO Newsletter (printed once a year)IFOS/ICO Newsletter (printed once a year) Database of ophthalmologic societies and residenciesDatabase of ophthalmologic societies and residencies Directory of International Ophthalmology (printed once a year)Directory of International Ophthalmology (printed once a year)

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 36 Conclusion There are critical public needs for eye care not being met, resulting in avoidable blindness and loss of visionThere 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 programsNot 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 needsThe 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 ICOLots resources available to help you do that, particularly from the ICO Thank you for considering this opportunity and challengeThank you for considering this opportunity and challenge We look forward to working with you to improve trainingWe look forward to working with you to improve training

International Council of Ophthalmology/ International Federation of Ophthalmological Societies 37 To Contact the ICO: Bruce E. Spivey, MD, President International Council of Ophthalmology 945 Green Street San Francisco, California, USA Fax: (+1) Web: