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ICO and Capacity Building for
Human Resources for Eye Health
William C. Felch, Jr.
Chief Executive Officer, International Council of Ophthalmology
“Human Resources for Eye Health (HReH): Bridging the Gap”
International Agency for the Prevention of Blindness, Council of Members
16 September 2013 | Brighton, United Kingdom
ICO and Capacity Building for HReH (Africa)
Public Need for Eye Care and What
Ophthalmologists Can Do
ICO Approach to HReH and Evolution of ICO
Commitments
Eye Care Delivery and Leadership Development
ICO Educational Programs and Resources 3
International: The Public Need for Eye Care
Cataract, 33%
Glaucoma, 2%
Age-Related Macular Degeneration, 1%
Corneal Opacities, 1%
Childhood Blindness, 1%
Trachoma, 1%
Uncorrected Refractive Error, 42%
Diabetic Retinopathy, 1%
Undetermined, 18%
Cat + URE = 75%
Global Causes of Visual Impairment—2010
BCVA<6/18
Pascolini D, Mariotti SP. Br J Ophthalmol 2011; Epub Dec 1. Slide from Serge Resnikoff.
International: The Public Need for Eye Care
The Distribution of Blind and Visually Impaired
of All Ages in the Six WHO Regions (in Millions)
WHO
Regions
Visual Impairment
(Millions)
Blind
(Millions)
AFR 26.3 5.9
AMR 26.6 3.2
EMR 23.5 4.9
EUR 28.2 2
SEAR 90.5 12
WPR 90.2 10.6
The distribution of Visual Impairment by age group: 0-14 years 7%, 15-49 years 28%, 50 years and older 65%
2010 WHO Data, Source: http://www.who.int/blindness/table/en/index.html. Slide from Hugh Taylor.
Nigeria: The Public Need for Eye Care
National Causes of Blindness—2012
BCVA<3/60
Cataract, 43%
Glaucoma, 17%
Uncorrected Aphakia, 9%
Other Corneal Scars, 8%
Trachoma, 4%
Optic Atrophy, 4%
Others, 3%
Phthisis/Absent Globe, 2%
Macular Degeneration, 2% Refractive Error, 1%
Onchocerciasis, 1%
Abdull, M. M., S. Sivasubramaniam, G. V. S. Murthy, C. Gilbert, T. Abubakar, C. Ezelum, and M. M. Rabiu. "Causes of Blindness and Visual Impairment in Nigeria: The Nigeria National Blindness and Visual Impairment Survey." Investigative Ophthalmology & Visual Science 50.9 (2009): 4116. Print.
What Can Ophthalmologists Do?
Study designed and conducted by ICO
Aim: To capture the dynamics of the global
ophthalmic population, including residents
Standardized survey e-mailed to 213 global
ophthalmic societies or individuals (March 2010)
Missing data gathered from direct correspondence
with ophthalmologist contacts (August 2010)
Number of Ophthalmologists in
Practice and Training Worldwide
What Can Ophthalmologists Do?
Number of ophthalmologists in practice and training worldwide
• Of the 193 countries surveyed, 192 responded
(represents 99.99% of the global population)
Total number of ophthalmologists in the world
Ranging from 28,338 in China to 0 in some Small Pacific Islands, with 131
countries representing less than 5% of the total
204,909
Slide from Serge Resnikoff.
Number of Ophthalmologists in
Practice and Training Worldwide
What Can Ophthalmologists Do?
China
United States of America
Russian Federation
Japan
Brazil India France Germany
Argentina
Poland Italy
Mexico
Spain
Other
Two-Thirds of
Ophthalmologists in 15 Countries
Slide from Serge Resnikoff.
What Can Ophthalmologists Do?
0 to 0.99
1 to 3.99
4 to 24.9
25 to 99.9
100+
Ophthalmologists
per Million Population
Slide from Serge Resnikoff.
Africa: What Can Ophthalmologists Do?
0 to 0.99
1 to 3.99
4 to 24.9
25 to 99.9
100+
Ophthalmologists
per Million Population
Slide from Serge Resnikoff.
Ophthalmic Growth Rate vs.
60+ Population Growth Rate
All Ages 60+
Ophthalmologists growth rate + 1.2% + 1.2%
Population growth rate + 0.77% + 2.9%
Actual growth rate + 0.43% - 1.7%
On average, the population aged 60+ is growing more than
twice as fast as the number of ophthalmologists
Ophthalmic population is declining 1.7%
per year compared to the population aged 60+
Slide from Serge Resnikoff.
What Can Ophthalmologists Do?
Very broad picture
System being set up to improve data collection
The gap between need and supply is widening in
both developing and developed countries
Needs to be urgently addressed in
training eye care teams now focused on
meeting community needs
Slide from Serge Resnikoff.
Conclusions
Need for Training: Eye Care Teams
Particularly in Low Resource Countries:
• Not enough ophthalmologists and other eye
care providers to provide the care needed
• Mal-distribution: Lack of providers where
most needed
• 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
Hugh Taylor, February 2012
Need for Training: Principles
• Training in ophthalmology should focus on meeting needs of
communities and populations, not just individuals
• Dr. Para: “If ophthalmology is your profession, prevention of
blindness is your business”
• 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
• Eye care training should be integrated with training for the rest of the
health care system
• Those who are trained need infrastructure, support and continuing
professional development
Hugh Taylor, February 2012
Eye Health Personnel Needed
Teams of:
• Ophthalmologists (surgeons and “eye doctors”)
• Subspecialists (pediatric, retina, etc.)
• Primary physicians trained in eye care
• Optometrists or refractionists and opticians
• Ophthalmic nurses
• Allied eye health professionals/Mid-level eye personnel (MLEP)
• Eye health managers
• Community eye health workers
Hugh Taylor, February 2012
Mission of the ICO
The International Council of Ophthalmology
works with ophthalmologic societies and others
to enhance ophthalmic education and improve
access to the highest quality eye care in order to
preserve, restore and enhance vision for the
people of the world.
Collaborating Organizations
WHO
IAPB
AOI
INGOs
Supranational Organizations
APAO
MEACO
PAAO
SOE
Commitments
Education
Eye Care Delivery
Leadership and Society Development
Membership: The Global Ophthalmic
Community
~80 National Ophthalmic Societies
~30 International Subspecialty Societies
International Council of Ophthalmology
Programs Supported by the ICO Foundation,
Member Organizations, and the income from WOCs
Slide from Bruce Spivey.
Evolution of ICO Commitments
Improve Access to Quality Eye Care
Prevent Avoidable Blindness and Vision Loss
Education
International Council
of Ophthalmology
Evolution of ICO Commitments
Improve Access to Quality Eye Care
Prevent Avoidable Blindness and Vision Loss
Education Eye Care Delivery
International Council
of Ophthalmology
Evolution of ICO Commitments
Improve Access to Quality Eye Care
Prevent Avoidable Blindness and Vision Loss
Education Eye Care Delivery
International Council
of Ophthalmology Society and Leadership
Development
Evolution of ICO Commitments
Improve Access to Quality Eye Care
Prevent Avoidable Blindness and Vision Loss
Education Eye Care Delivery
International Council
of Ophthalmology Society and Leadership
Development Teaching the Teachers
ICO Programs
Eye Care Delivery/Capacity Building
Clinical Guidelines and Standards
Workshops and Materials for Advocacy/VISION 2020
Task Force on Uncorrected Refractive Error
School Eye Health Program
Task Force on Diabetic Eye Care
Ethics Committee
School Eye Health Program
CHEF International
International Council of Ophthalmology Foundation
Light For The World, Austria
Light For The World, Netherlands
Lions Aravind Institute of Community Ophthalmology (LAICO), India
JOS University Teaching Hospital, Nigeria
Partners:
ICO Programs: Eye Care Delivery
Task Force on Diabetic Eye Care:
1. Define and disseminate technical guidelines for screening,
patient evaluation and treatment of diabetic retinopathy
2. Evaluate how education needs to change to assure that
ophthalmologists and others have required skills and
knowledge
3. Define key indicators to evaluate the effectiveness of
diabetic retinopathy programs
Evolution of ICO Commitments
Improve Access to Quality Eye Care
Prevent Avoidable Blindness and Vision Loss
Education Eye Care Delivery
International Council
of Ophthalmology Society and Leadership
Development
National Societies and ICO Members by Country
0 to 0.99
1 to 3.99
4 to 24.9
25 to 99.9
100+
Ophthalmologists
per Million Population
National Societies Only
ICO Member
National and
ICO Members by Country
Sub-Saharan Africa has a
small population of
ophthalmologists…
And there are a number of
countries with
no professional
ophthalmological
society
Evolution of Regional Societies
National Societies Only
ICO Member
National and
ICO Members by Country
Regional Societies
Regional Society
Members by Country
There are a growing
number of regional
ophthalmological
Societies,
now including the Africa
Ophthalmology Forum
ICO Leadership Development
• Fifth Advisory Leadership Group meeting:
Bahrain, March 24–24, 2009,
at MEACO Congress
• Evolved into Africa Ophthalmology Forum
• ICO World Ophthalmology Roundtable on
Leadership Development (WORLD) at
AAO in 2009–2013
• Future: WORLD Online?
Evolution of ICO Commitments
Improve Access to Quality Eye Care
Prevent Avoidable Blindness and Vision Loss
Education
International Council
of Ophthalmology
ICO Programs
Education
World Ophthalmology Congress (Tokyo, April 2-6)
Examinations • Basic Science
• Clinical Sciences
• Advanced Exam
• New Foundation Assessment (2013 – online)
Fellowships (from developing countries) • ICO Three-Month International Fellowships: > 600 since
2000)
• ICO/Helmerich Fellowships
• ICO/Fred Hollows 12-Month Fellowships
(2012)
• Experimenting with Sandwich Fellowships
CME/CPD • Guidelines and Support for Societies
• Visiting Professors
ICO Programs
Education
Support for Regional Training Centers
• Slovenia (Retina and Oculoplastics)
• Beijing (Diabetic Retinopathy)
• Nigeria (Catholic Hospitals)
• Cameroon (Magrabi ICO Eye Institute, Yaounde)
- Subregional Center of Excellence
- Training in French and English
- Ophthalmologists, nurses, optometrists,
orthoptists, low vision, etc.
- Comprehensive eye care services regardless of
ability to pay
- Operational research
- Center for telemedicine and tele-education
- Collaboration with CBM, ORBIS and many
partners
Country Stats - Afghanistan
Ophthalmologists 128
Subspecialists(L1-L3) 16
Subspecialists(L3) 3
Ophthalmologytrainingcentres 7
Centresprovidingsubspecialtyservices 0
Centresprovidingsubspecialtytraining 0
100%government,100%residency
L2residency–3to4years
Faculty 28
Studentsinprogramme 37
ToplineStats
Ophthalmologists1:234,375pop
Ophthalmologists0.32/75,000pop
Subspecialists(L3)1:10millionpop
AlliedEyeHealthProfs1:256,410 Optometrists 6
Orthop sts 0
OphthalmicAssistants 46
OphthalmicNurses 65
Na onalsubspecialtytrainingcurriculum-None
ICO Programs
Education: Teaching the Teachers
• Courses for residency program directors
(22 since 2004) • Ethiopia 2008
• Ghana September 2013,
• Paris May 2014 for Francophone Africa
• World Ophthalmic Education Colloquium
at WOC
• Conferences for ophthalmic educators
• EyeExcel (with Aravind and Seva)
• Training Trainers of Eye Health Personnel
ICO Programs
Education: Teaching the Teachers
• International Curricula:
• For residents, allied providers and medical
students (2006)
• For ophthalmic assistants (2009) and
refractionists (2011)
• New curriculum for residents (2011–2012)
• For subspecialty training (2012–14)
• OSCARs and other assessment tools
• Online courses & tools for teachers
• Web based teaching (2012)
• Webinars (2013)
• Center for Ophthalmic Educators
(educators.icoph.org)
2012 Strategic Plan for ICO Education
Training Teams to Meet Public Needs
Curricula and Expectations for Training
Programs
Continuing Professional Development
Accreditation and Certification
Teaching the Teachers
Technologies for Teaching and Learning
1
2
3
4
5
6
The Future of Ophthalmic Education
What’s Next?
• Evaluating real outcomes of
educational programs
• Re-focus on community needs,
teams, critical competencies and
supporting change
• Blended learning: in person and
online
• More collaboration