What Should International Ophthalmology’s Top Priorities Be

for the Next 10 Years?

Serge Resnikoff MD PhDICO Director for AdvocacyAAO, Chicago, 16 Oct 2010

What Should International Ophthalmology’s Top Priorities Be

for the Next 10 Years?

Serge Resnikoff MD PhDICO Director for AdvocacyAAO, 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. Magnitude2. Severity (personal, economic and social impact)3. Existence of a cost-effective intervention4. 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 2020

37 Million33 Million

+ 8 MURE

+ 7 MURE

?

Global Distribution of Blindness by Cause (2007)

Cataract5%

Glaucoma18%

Other4%

ARMDARMD50%50%

Ch Bl3%

DR17%

CO3%

CataractCataract50 %50 %

Trachoma4 %

Glaucoma12%

Oncho 0.8 %

Other14 %

ARMD6%

Ch Bl 4%

DR 4%

CO 5%

More Developed Countries

Less DevelopedCountries

Prevention of Blindness Global Challenges

• Ongoing Challenges– Cataract– Trachoma– Onchocerciasis– Childhood blindness

• “New” Challenges– Refractive Errors– Diabetic Retinopathy– Glaucoma– AMD– Low Vision services

0

500

1000

1500

2000

2500

3000

3500

4000

4500CSR

ArmeniaBangladeshCambodiaChinaDjiboutiDominicaDominican Rep.EthiopiaFijiGuatemalaGuyanaIndiaIndonesiaJamaicaMadagascarMaliMoldovaMoroccoMozambiqueNigeriaPakistanPeruPhilippinesRussiaTanzaniaYemen0

500

1000

1500

2000

2500

3000

3500

4000

4500CSR

ArmeniaBangladeshCambodiaChinaDjiboutiDominicaDominican Rep.EthiopiaFijiGuatemalaGuyanaIndiaIndonesiaJamaicaMadagascarMaliMoldovaMoroccoMozambiqueNigeriaPakistanPeruPhilippinesRussiaTanzaniaYemen

MoroccoMoroccoDominica

India

Fiji

Cataract Surgical Rate (1990 – 2006)

Pakistan

0

200

400

600

800

1000

1200

1400

CSR

Bangladesh

Cambodia

China

Dominican Rep.

Ethiopia

Guatemala

Indonesia

Jamaica

Madagascar

Mali

Moldova

Mozambique

Nigeria

Peru

Philippines

Tanzania

Yemen

Philippines

Peru

Bangladesh

Cambodia

Mali

Guatemala

Dominican Rep.Dominican Rep.

Tanzania

IndonesiaMoldova

MadagascarMadagascarMadagascarMadagascarChinaChinaChinaChinaEthiopiaNigeriaNigeriaNigeriaNigeria

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 CataractRoP

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 approachEntails 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

0

10

20

30

40

50

60

70

80

90

Est marketec

Formersoc.ec Eur

India China LatinAmer&Car

Middle East OtherAsia&Isl

Sub-Saharan

Afr

2000

2030

WHO, Wild & Roglic, 2004

Number of persons with diabetes (millions)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 2000• 2,300 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 approachTechnology 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 casesPreliminary 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 ManagementAvailability 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 countriesGenerates 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?