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.
2.
3.
4.
Magnitude
Severity (personal, economic and social impact)
Existence of a cost-effective intervention
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)
Less Developed
Countries
More Developed
Countries
Other
4%
Cataract
5%
Other
14 %
Glaucoma
18%
CO
3%
ARMD
50%
ARMD
6%
Ch Bl 4%
Cataract
50 %
DR 4%
DR
17%
Ch Bl
3%
CO 5%
Oncho 0.8 %
Glaucoma
12%
Trachoma
4%
Prevention of Blindness Global Challenges
• Ongoing Challenges
– Cataract
– Trachoma
– Onchocerciasis
– Childhood blindness
• “New” Challenges
– Refractive Errors
– Diabetic Retinopathy
– Glaucoma
– AMD
– Low Vision services
4500
Cataract Surgical Rate (1990 – 2006)
4000
India
3500
3000
Pakistan
CSR
2500
2000
Dominica
Morocco
1500
Fiji
1000
500
19
83
19
85
19
87
19
89
19
91
19
93
19
95
19
97
19
99
20
01
20
03
20
05
20
07
20
09
20
11
20
13
20
15
20
17
20
19
0
Armenia
Bangladesh
Cambodia
China
Djibouti
Dominica
Dominican Rep.
Ethiopia
Fiji
Guatemala
Guyana
India
Indonesia
Jamaica
Madagascar
Mali
Moldova
Morocco
Mozambique
Nigeria
Pakistan
Peru
Philippines
Russia
Tanzania
Yemen
1400
Philippines
1200
Bangladesh
1000
Peru
Guatemala
800
Cambodia
Dominican Rep.
Mali
600
Tanzania
400
Indonesia
Moldova
Madagascar
China
Ethiopia
Nigeria
200
Mozambique
CSR
20
09
20
07
20
05
20
03
20
01
19
99
19
97
19
95
19
93
19
91
19
89
19
87
19
85
19
83
0
Bangladesh
Cambodia
China
Dominican Rep.
Ethiopia
Guatemala
Indonesia
Jamaica
Madagascar
Mali
Moldova
Mozambique
Nigeria
Peru
Philippines
Tanzania
Yemen
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
200,000,000
180,000,000
160,000,000
140,000,000
120,000,000
100,000,000
80,000,000
60,000,000
40,000,000
20,000,000
1999
2000
2001
2002
2003
shipments
2004
2005
2006
2007
2008
2009
treatments Distributed
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
Number of persons with diabetes (millions)
90
80
2000
2030
70
60
50
40
30
20
10
0
Est market Former
ec
soc.ec Eur
India
China
Latin
Middle East
Other
Amer&Car
Asia&Isl
SubSaharan
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
– 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?