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Individual potential may be key to addressing worldwide glaucoma epidemic
Training, continuing education, eye care guidelines, advocacy and research are imperative in the fight against glaucoma.
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CHICAGO — Recognizing individual potential is the key to addressing the worldwide epidemic of untreated glaucoma, a speaker said here.
Mildred M.G. Olivier, MD, FACS, who has been previously recognized for her extensive work in Haiti and for her work on the management of glaucoma in developing countries, gave the American Glaucoma Society Subspecialty Day Lecture preceding the joint meeting of the American Academy of Ophthalmology and Asia-Pacific Academy of Ophthalmology.
“We have to dare to think differently,” she said. “I really believe opportunity is the intersection of innovation and science. I ask you to take a look at yourself in the mirror and see if you can make a change.”
Five goals for glaucoma
By 2020, as many as 80 million people worldwide may be blind from glaucoma, Olivier said.
“Disparities of access to health care are really significant in some areas,” she said. “I have people who travel for 3 or 4 days just to get to the area where I’m located, only to hopefully receive some type of eye care.”
Olivier shared some of the goals of Vision 2020, which is the global initiative for the elimination of avoidable blindness.
During the initial stages of Vision 2020, Olivier said five goals were developed: training and education, continuing education, eye care guidelines, advocacy, and research.
Physicians need to develop curricula for allied health professionals, medical students and residents, she said, as well as provide individual assessments of the performance of residents
“[Training and education] are not just for residents because often when [a physician] goes international, even local ophthalmologists also need to be educated under these important guidelines,” Olivier said. “In rural areas in Haiti, people were using flash lights instead of slit lamps in order to see if someone had a problem.”
Olivier said residents may not be properly trained during their fellowships, noting that an early investment in an individual resident can lead to better opportunities in the future.
Physicians should continue education by ensuring that residents are capable of teaching their skills to others, she said.
Guidelines must be developed to help identify the appropriate care that a clinic is capable of providing, and international eye care standards must be established, Olivier said.
Advocacy includes facilitating global initiatives for the elimination of avoidable blindness and the mobilization of ophthalmologists and governments by creating an interest in blinding disorders, she said.
“Sometimes this is very difficult,” Olivier said. “For example, people in Haiti are just trying to get basic electricity, water and a place to live, so the government is dealing with all of those things, as well as sanitation; blindness or blinding disease is not something that is high on the priority list, but we have to make them understand that if somebody can’t see, then they can’t really work either.”
Basic and clinical research must be focused on global needs, as well as provide an emphasis on the acquisition of epidemiological research skills, Olivier said.
Strength in numbers
The current international emphasis in eye care has been on the management of cataracts, Olivier said.
“We really have had a challenge in being able to have some of these government organizations understand that we really need to find something glaucoma-wise internationally,” she said. “It’s not always just about the cataract, and it’s not always about seeing 100 cases. It’s much better to make sure that when we train the individual that they really have increased their quality of being able to do an exam.”
Olivier said the shortage of ophthalmologists in developing countries also presents a problem. She said the U.S. has approximately one physician per 10,000 people, a ratio that is dramatically worse in developing countries.
Most importantly, physicians must be able to teach skills to another person and ensure a constant transfer of those skills, thus creating strength in numbers, she said.
“Glaucoma is rampant and is unaddressed for millions of the most vulnerable people in the world,” she said. “We are aware of the myriad of logistical, tactical and medical impediments that stand in the way of delivering treatment to those who so desperately need it.”
Olivier asked if physicians would be willing to increase their efforts as either training volunteers or consultants on cases from all over the world.
“We must realize that finding solutions to these problems rest on our own shoulders, yours and mine, the shoulders of people here in this room today,” Olivier said. “There is no other army of heroes, pathfinders or caregivers better equipped or better motivated to discover how to break through the stalemate of the status quo.” –by Ashley Biro