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.
 Priority Setting

• 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
Number of Blind people in the world
(Best Corrected VA < 3/60)

VISION 2020

37 Million
33 Million

+8M
URE
?
+7M
URE
Global Distribution of Blindness by Cause (2007)

More Developed Less Developed

Countries Countries

Other Cataract
Other
4% 5%
14 %
Glaucoma
18% ARMD
6%

CO Ch Bl 4%
ARMD Cataract
3%
50% 50 %
DR 4%
CO 5%
DR Oncho 0.8 %
17%
Glaucoma
Ch Bl 12% Trachoma
3% 4%
 Prevention of Blindness Global Challenges

• Ongoing Challenges • “New” Challenges

– Cataract – Refractive Errors
– Trachoma – Diabetic Retinopathy
– Onchocerciasis – Glaucoma
– Childhood blindness – AMD
– Low Vision services
 4500
Cataract Surgical Rate (1990 – 2006)
4000 Armenia
India Bangladesh
Cambodia
3500 China
Djibouti
Dominica
3000 Dominican Rep.
Ethiopia
Pakistan Fiji
2500 Guatemala
Guyana
CSR

India
2000 Indonesia
Dominica Jamaica
Morocco
Madagascar
Mali
1500 Moldova
Fiji
Morocco
Mozambique
1000 Nigeria
Pakistan
Peru
500 Philippines
Russia
Tanzania
0 Yemen
1400

Philippines
1200 Bangladesh
Cambodia
China
Bangladesh
1000 Dominican Rep.
Ethiopia
Peru Guatemala
Guatemala
800 Indonesia
Cambodia Jamaica
..Dominican
Dominican Rep
Madagascar
Mali Mali
600
Moldova
Tanzania
Mozambique
Indonesia
Moldova Nigeria
400 Madagascar
Madagascar Peru
China
China
Ethiopia Philippines
Nigeria
Nigeria
Tanzania
200 Yemen
Mozambique

CSR
 Prevention of Blindness Global Challenges

• Ongoing Challenges • “New” Challenges

– Cataract – Refractive Errors
– Trachoma – Diabetic Retinopathy
– Onchocerciasis – Glaucoma
– Childhood blindness – AMD
– Low Vision services
Annual Shipments and Reported Distributed
Zithromax Donated Treatments

D. Haddad, June 2010

 Prevention of Blindness Global Challenges

• Ongoing Challenges • “New” Challenges

– Cataract – Refractive Errors
– Trachoma – Diabetic Retinopathy
– Onchocerciasis – Glaucoma
– Childhood blindness – AMD
– Low Vision services

Trichiasis Surgery ++++

 Prevention of Blindness Global Challenges

• Ongoing Challenges • “New” Challenges

– Cataract – Refractive Errors
– Trachoma – Diabetic Retinopathy
– Onchocerciasis – Glaucoma
– Childhood blindness – AMD
– Low Vision services

Congenital Cataract
RoP
 Prevention of Blindness Global Challenges

• Ongoing Challenges • “New” Challenges

– Cataract – Refractive Errors
– Trachoma – Diabetic Retinopathy
– Onchocerciasis – Glaucoma
– Childhood blindness – AMD
– Low Vision services

Eye Care Team approach

Entails availability of affordable glasses
 Prevention of Blindness Global Challenges

• Ongoing Challenges • “New” Challenges

– Cataract – Refractive Errors
– Trachoma – Diabetic Retinopathy
– Onchocerciasis – Glaucoma
– Childhood blindness – AMD
– Low Vision services
 Number of persons with diabetes (millions)

90
80 2000
70 2030
60
50
40
30
20
10
0
Est market Former India China Latin Middle East Other Sub-
ec soc.ec Eur Amer&Car Asia&Isl Saharan
Afr

WHO, Wild & Roglic, 2004

 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 2000
• 2,300 diabetic patients/O'gist/year in 2030 (10 per day)
 Prevention of Blindness Global Challenges

• Ongoing Challenges • “New” Challenges

– Cataract – Refractive Errors
– Trachoma – Diabetic Retinopathy
– Onchocerciasis – Glaucoma
– Childhood blindness – AMD
– Low Vision services

Eye Care Team approach

Technology and drugs development
Vitreo-retinal surgery training
 Prevention of Blindness Global Challenges

• Ongoing Challenges • “New” Challenges

– Cataract – Refractive Errors
– Trachoma – Diabetic Retinopathy
– Onchocerciasis – Glaucoma
– Childhood blindness – 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 • “New” Challenges

– Cataract – Refractive Errors
– Trachoma – Diabetic Retinopathy
– Onchocerciasis – Glaucoma
– Childhood blindness – AMD
– Low Vision services

Case Detection and Management

Availability of affordable drugs
 Prevention of Blindness Global Challenges

• Ongoing Challenges • “New” Challenges

– Cataract – Refractive Errors
– Trachoma – Diabetic Retinopathy
– Onchocerciasis – Glaucoma
– Childhood blindness – 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 • “New” Challenges

– Cataract – Refractive Errors
– Trachoma – Diabetic Retinopathy
– Onchocerciasis – Glaucoma
– Childhood blindness – AMD
– Low Vision services

What Should International

Ophthalmology’s Top Priorities
Be for the Next 10 Years?