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International Council of Ophthalmology Draft Meeting Minutes, July 20 - 21, 2001, Buenos Aires, Argentina

APPENDIX VFTF - 1: THE OPPORTUNITY FOR INTERNATIONAL OPHTHALMOLOGY IN TREATING BLINDNESS

By Bruce Spivey, MD

Abstract

As our worldview has become more pervasive, there has been a maturation of various international ophthalmological organizations. They have created several new initiatives that have the potential to dramatically affect preventable and treatable blindness, worldwide.

The first international ophthalmological organization (the International Council of Ophthalmology established in 1927) evolved from the longest continuously held medical meeting in the world (the World Ophthalmology Congress , first held in 1857).

Subsequently, a number of supranational and international organizations have been created which are beginning to communicate with each other and with national ophthalmological societies in joint planning.

The International Non-Governmental Organizations, lay/ophthalmic international organizations (e.g. IAPB) and the WHO have recently joined to create a proposal called VISION 2020: The Right to Sight.

The International Council in partnership with Academia Ophthalmolgica Internationalis has created a parallel and complementary plan –Vision for the Future.

The potential to alleviate or prevent blindness in over 150 million people requires our attention.

Understanding the seemingly complex interrelationships of these many organizations—often unfamiliar to American ophthalmology—is important for our country's uniquely strong ophthalmic organizations. American involvement can make a difference.

This presentation will describe the background, the relationships and present plans, which, if implemented, will have a tremendous impact on the world's treatable and preventable blind and on the level and quality of ophthalmic services throughout the world.

Over two million people a year are going blind with treatable or preventable ocular disorders (Figure 1).

The history and causation of blindness is well known. The magnitude of its incidence and prevalence is less so. Of the nearly one hundred and sixty million cases of blindness or serious visual impairment, two-thirds are avoidable. Three-fourths of these cases are cataract.

This paper describes the one hundred and fifty year process of maturation of international ophthalmology; its recent efforts and organizations; and two parallel and compatible efforts for confronting blindness worldwide.

Only since the latter half of the last century, has it been possible to treat most forms of blinding conditions with consistently positive outcomes and to prevent blinding conditions such as vitamin A deficiencies, trachoma and onchocerciasis.

There have, for decades, been individuals and entities dedicated to the alleviation of blindness in local, regional and international purview. Coordination, however, has been sporadic.

Given the maturity of international organizational structures and relationships, there are now several worldwide coordinated efforts, separate but parallel, distinct but intertwined, which focus on dramatically reducing worldwide blindness.

The prevention and treatment of blindness may be partitioned into public health, i.e. (prevention) and ophthalmologic (treatment) solutions (Figure 2).

Governments and International Non Governmental Organizations (INGOs) with the assistance of the World Health Organization (WHO), International Agency for the Prevention of Blindness (IAPB), World Bank, etc., are dedicated to prevention efforts.

These same groups along with ophthalmologists are involved in treatment programs.

Substantial impact is now possible due to a combination of advances in pharmacology and technology, with organizational cooperation and commitments.

First, medications for onchocerciasis, trachoma and vitamin A deficiency are now widely available.

Second, new technologies, sutures and intraocular lenses in cost affordable components are available in developing countries.

Third, a combination of organizational maturity and focus coupled with a cooperative commitment on the part of a variety, even competing entities, have been linked in sufficient degree to create the momentum necessary to launch the worldwide challenge of alleviating blindness.

There are many international ophthalmic organizations. The International Council of Ophthalmology (ICO), established in 1927 evolved from the International Congresses of Ophthalmology which date from 1857 (Figure 3).

National ophthalmology societies, many in existence for over one hundred years, are linked by a federation: the International Federation of Ophthalmological Societies (IFOS), established in 1933.

The International Agency for the Prevention of Blindness (IAPB), was established in 1975 by the ICO and the World Blind Union.

Academia Ophthalmologica Internationalis (AOI) was also established in 1975.

International non-governmental organizations (INGOs) have evolved in the past seventy or more years.

Also over more than the past fifty years, supra-national organizations have developed, playing regional roles in education and relationship building. These are the Pan-American Association of Ophthalmology (PAAO) established in 1939, the European Ophthalmological Society (SOE) established in 1956, the Asia-Pacific Academy of Ophthalmology (APAO) established in 1958, the Afro-Asian Council of Ophthalmology (AACO) established also in 1958 and the Pan-Arab African Council of Ophthalmology (PAACO) established in 1989.

A large number of international sub-specialty organizations are becoming more prominent.

Several years ago the INGOs, IAPB and the WHO began to plan for an effort called VISION 20/20: THE RIGHT TO SIGHT. This effort was focused on eradicating most preventable and treatable blindness by the year 2020. This effort is now in an early implementation stage after having been publicly announced in early 1999.

Earlier in the same year (1999) international ophthalmology through the ICO and the AOI, with a variety of consultants, began a planning effort concluded in early 2001. This effort, parallel and supportive to VISION 20/20 is called VISION FOR THE FUTURE is to be implemented under the aegis of The International Council of Ophthalmology. It focuses on the knowledge and skills particularly unique to or in the province of ophthalmology and ophthalmologists. The program is beginning to gain momentum.

The commitment and focus of ophthalmology's international efforts are designed for developing countries but the products and outcome of these efforts are applicable and useful in developed nations as well.

VISION FOR THE FUTURE has five major goals.

1. Ophthalmic education and training
   
   
   1. Provide curricula for allied health, medical student and residency education
      
      
   2. Provide an individual Examination of resident performance (basic and clinical science Examination programs)
      
      
2. Ophthalmology continuing education
   
   
   1. Identify and disseminate of appropriate curricular content
      
      
   2. Disseminate educational materials
      
      
3. Eye care guidelines
   
   
   1. Develop clinical guidelines that define appropriate care for existing capabilities
      
      
   2. Disseminate and continue to evolve guidelines for all ophthalmologists to ensure a basic international standard
      
      
4. Advocacy for the preservation and restoration of vision
   
   
   1. Facilitate global initiatives for elimination of avoidable blindness-Vision 20/20: The Right to Sight
      
      
   2. Mobilize ophthalmologist and government understanding and interest in blinding disorders worldwide.
      
      
5. Research in Ophthalmology and Vision
   
   
   1. Facilitate basic and clinical science focused on global needs
      
      
   2. Provide particular emphasis on the acquisition of clinical population and epidemiological research skills

Substantial progress has already been made in developing curricula and clinical guidelines. Continuing medical education surveys are complete. Advocacy and research are never-ending challenges, which require substantial augmentation.

Educational curricula and clinical guidelines are being made available through the International Council of Ophthalmology website (www.icoph.org) and then through the various supra-national and national ophthalmological organizations.

VISION FOR THE FUTURE includes commitments to the conditions of glaucoma and diabetic retinopathy not part of VISION 20/20.

VISION 20/20 has three major areas of focus.

1. Control of major causes of blindness
   
   
   1. Cataract
      
      
   2. Trachoma
      
      
   3. Onchocerciasis
      
      
   4. Childhood blindness. Vitamin A deficiency and surgically treatable disorders.
      
      
   5. Refractive errors and low vision
      
      
2. Human research development
   
   
   1. Community level workers
      
      
   2. Secondary and tertiary level professionals with emphasis toward Africa
      
      
3. Infrastructure and appropriate technology development
   
   
   1. Infrastructure including the structure itself, finances to support and motivation to continue.
      
      
   2. Technology

VISION 20/20 is to be developed and implemented by plans created in each country. Such efforts are underway and represent a challenge for multiple organizations to come together for the funding and functionality required.

The various INGOs are continuing their plans and priorities which are being considered as part of the overall VISION 20/20 plan.

The immediate task is to link closely the two major efforts by building on the strengths of the parties involved.

Ophthalmologists alone can create curricula, basic and continuing education materials, basic and clinic ophthalmic Examination examinations, clinical guidelines and ophthalmic research. Once accomplished, especially in developing countries, this will markedly facilitate eye care and, thus, VISION 20/20.

Together with the WHO, IAPB and INGOs, the international ophthalmic community can advocate for support to prevent and treat world blindness. It will, however, require a combination of individual ophthalmologists, their diabetes, diabetic retinopathy, glaucoma, surgically treatable childhood blindness and refractive errors.

The INGOs and IAPB with support and curricula from ophthalmologists can and must create the primary care human resources capability and infrastructure necessary to support the final implementation of blindness prevention and treatment.

The common good is obvious and the tasks are clear but daunting.

Close coordination as well as sublimation of ego and the natural desire to control will be required. Good will, thoughtful coordination, consistent communication and persistence of commitment will be necessary for success.

Ophthalmologists in developed countries have a particular role and responsibility in the implementation of both plans.

REFERENCES:

VISION 20/20: The Right to Sight, (Global Initiative for the Elimination of Avoidable Blindness) WHO/PBL/ 97.61 Rev. 1, Geneva.

VISION FOR THE FUTURE, (International Ophthalmology Strategic Plan), ICO/AOI, Los Angeles, May, 2001.

* From the Department of Ophthalmology, Weill Medical College of Cornell University and Columbia University College of Physicians and Surgeons

Next: APPENDIX VFTF - 2: PROPOSAL OF A MEDICAL STUDENT CURRICULUM IN OPHTHALMOLOGY TO THE INTERNATIONAL COUNCIL OF OPHTHALMOLOGY (ICO)

Also see:

• Report of July 20, 2001 Meeting on Vision for the Future

• ICO Minutes, July 20 - 21, 2001