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

APPENDIX 20: VISION FOR THE FUTURE, A DRAFT REPORT BUENOS AIRES, ARGENTINA

On this page:

• Draft Report
  
  
• I. Welcome from the Co-Hosts
  
  
• II. Content of Discussion
  
  
• III. Brief Review of Vision for the Future
  
  
• IV. Challenges in Implementation and the Relationship to VISION 2020
  
  
• V. Discussion of Actions to Date
  
  
• VI. Participant Comments
  
  
• VII. Conclusion

APPENDIX 20: VISION FOR THE FUTURE, A DRAFT REPORT BUENOS AIRES, ARGENTINA

This report summarizes a series of reports presented during a special session of the meetings of the International Council of Ophthalmology (ICO) and the Academia Ophthalmologica Internationalis (AOI) held in Buenos Aires, Argentina, July 20, 2001.

The participants included the members and representatives of the ICO, AOI, International Agency for the Prevention of Blindness (IAPB), The World Health Organization (WHO), Non-Governmental Organizations (NGO's) and independent researchers, scientists and caregivers concerned with the elimination of avoidable blindness in the world.

A partial attendee list includes:

Co-chairman, Gottfried O. H. Naumann, MD, President, ICO
Co-chairman, Bradley R. Straatsma, MD, President, AOI
Richard Abbott, MD
Adenike Abiose, MD
Frank Billson, MD
Michael Blumenthal, MD
Benjamin Boyd, MD
Rosario Brancato, MD
August Colenbrander, MD
Francisco Contreras, MD
Gabriel Coscas, MD
Jean-Jacques DeLaey, MD
Akef El-Maghraby, MD
Hanna Faal, MD
William Felch
Suzanne Gilbert
Balder Gloor, MD
David Green
Peter Hardy Smith, MD
H. Dunbar Hoskins Jr., MD
Mohammad Daud Khan, MD
Ino Kocur, MD
Paul Lichter, MD
Maurice Luntz, MD
Frank Martin, MD
Irene Maumanee, MD
Marilyn Miller, MD
Tony Murray, MD
Pran Nagpal, MD
Akira Nakajima, MD
David Noonan
Odel, MD
John Palmer
R. Pararajasegaram, MD
Bo Phillipson, MD
Yves Pouliquen, MD
Lou Pizzarello, MD
Alvaro Rodriguez, MD
Gullapolli Rao, MD
S. Selvarajah, MD
Koichi Shimazu, MD
Randolph Simpson, MD
Al Sommer, MD
Ronald Smith, MD
Yasuo Tano, MD
William Tasman, MD
Hugh Taylor, MD
Mark Tso, MD
Peter Watson, MD
Georges Yaya, MD
Zbigniew Zagorski, MD
Adam Zaid, MD

I. Welcome from the Co-Hosts

Drs. Naumann and Straatsma began the meeting by welcoming all the members and guests. Each outlined the importance of the joint efforts of those gathered and that of the organizations they represent as the driving forces to help realize the dream of the elimination of avoidable blindness in the world during our lifetime.

They noted that with all the forces gathered together, each utilizing the skills and experience for which they have the greatest expertise, there is a real chance to effect substantive change on a global basis.

II. Content of Discussion

Dr. Spivey outlined the hope of the meeting organizers that the discussion would serve as a clearing-house of ideas and initiatives currently underway among the multiple agencies represented at the meeting. Noting the enormity of the task, he stressed the need for ongoing communication to prevent confusion, duplication of effort or turf disputes.

The goal of the meeting was to bring understanding between two parallel and intertwined plans for dealing with the prevention of blindness and the treatment of vision loss worldwide.

VISION 2020: The Right to Sight, and Vision for the Future are similar but not identical. VISION 2020 was created with a public health orientation and speaks to implementation and infrastructure; Vision for the Future was created with an ophthalmic orientation and speaks to education, guidelines, advocacy and research.

VISION 2020 calls for the inclusion of ophthalmologists in critical roles that may well be best implemented through the existing international structures of NGO and local existing or new academic or clinical structures. Vision for the Future will greatly benefit from the traditions and experience in healthcare programming and implementation particularly in underserved and developing countries.

Dr. Spivey noted, it is from these priorities of need and partnership that call for exploration of options that will meld both efforts into a coordinated and functional reality.

III. Brief Review of Vision for the Future

Dr. Straatsma provided the attendees with a brief history of the creation of the Vision for the Future and noted that the plan was developed through a series of highly focused deliberations by members of the ophthalmic community representing the International Federation of Ophthalmological Societies and Academia Ophthalmologica Internationalis.

He outlined the major goals of Vision for the Future:

1. 1. Ophthalmic Education and Training
   
   
2. Ophthalmic Continuing Education
   
   
3. EyeCare Guidelines
   
   
4. Advocacy for the preservation and restoration of vision
   
   
5. Research in Ophthalmology and Vision

The principle elements of Education and Training include the provision of curricula for allied health, medical students, Residency education and the individual Examination of Resident performance.

Ophthalmic Continuing Education efforts require the identification and dissemination of curricula content and the dissemination of education materials.

Recognition of the needs for political and social support of the plan calls for advocacy of VISION 2020: The Right to Sight effort to mobilize ophthalmic and government understanding and interest in blinding disorders worldwide.

Research is required to facilitate basic and clinical science focused on global needs and the acquisition of population and epidemiological research skills.

IV. Challenges in Implementation and the Relationship to VISION 2020

(see appendix VFTF-1)

Dr. Faal presented her views on issues that need further deliberation to provide a clearer orientation between the parallel efforts of VISION 2020 and Vision for the Future.

She noted the overlap in blindness guidelines that will require clear differentiation or synthesis to avoid confusion.

She emphasized that curricula development is critical but getting the training where it is needed will be a continuing challenge. She also emphasized the need for the curricula to include a public health orientation that view's populations not just an individual patient.

She recognized the challenge to bring Vision for the Future to the national Ophthalmic Societies in order to make the goals and aspirations a reality. She further suggested that the emphasis on quality and shared standards require specific national and regional action plans.

Dr. Hugh Taylor noted the projection of world blindness from 45 million in 2001 to over 90 million in 2020 as the essential driving force requiring a combined effort among the organizations represented at the meeting.

He called for coalitions of organizations to form teams that will bring Head-Hands-Hearts to solve the problems of preventable blindness.

V. Discussion of Actions to Date

A. Education
Drs. Tso and Straatsma reported on the progress of the three Task Forces focusing on education.

1. Medical Student Education (see appendix VFTF-2)
   
   
2. Resident – under development
   
   
3. Allied Medical Practitioners – the key questions here revolve around placement of ophthalmology in the core curriculum
   
   
4. Medical Schools – can the curriculum be developed to be specific enough to provide clinical application skills?
   
   
5. Resident Education – this effort has the greatest chance of success since many curricula are developed but recognition of the differences created based on regional practice patterns is required.

B. Continuing Medical Education (see VFTF, appendix 3)
Dr. Hoskins presented the results of a survey of national Ophthalmological Societies Continuing Medical Education efforts and resources. His report includes specific projects to be undertaken to facilitate project completion.

He suggests that the major challenge in bringing ophthalmologists skills to the site of greatest need will be the discovery of rewarding mechanisms to take ophthalmologists from the population training centers to locales of high need.

Dr. Hoskins noted that some of the CME curriculum needs to be shifted to a public health orientation that improves health at lower total costs.

He advocates that a merger of some VISION 2020 efforts and Vision for the Future will be productive.

C. Clinical Guidelines
Dr. Richard Abbott presented the group with a series of suggested guidelines for clinical care based on the Preferred Practice Patterns of the American Academy of Ophthalmology.

Fully recognizing the need for regional variance in practice, the guidelines are intended to serve as a benchmark for evaluation of regional and national practice patterns and are presented to offer a framework for evaluation and deliberation at a local level.

The challenge, as always, will be to bring the guidelines into daily clinical application by the professionals involved in care- giving.

One participant comment suggested that guidelines on public health programs may be required as the effort proceeds.

D. Advocacy (see appendix VFTF-4)
Dr. Hugh Taylor presented his report as appended. He expressed his concern that organized ophthalmology worldwide will be required to contribute funds to support the efforts projected by VISION 2020 and Vision for the Future.

He strongly endorsed formal action by the Sydney Congress participants to sign a declaration of support for VISION 2020.

E. Research (see appendix VFTF-5)
Al Sommer, MD presented the aspirational goals for the research component of Vision for the Future.

He suggested three categories of research as desirable:

1. Evaluative Research
   
   
2. Operational Research
   
   
3. Discovery Research

The Evaluative Research focuses on "how we are doing" at a public health level. This area of research demands increased funding to support the effort.

Operational Research involves the practitioner directly in refining existing approaches to delivery and treatment.

Discovery Research focuses on etiology, prevention and treatment. This effort will yield the "new", the "improved", and the "preventable" approaches to the elimination of preventable blindness.

VI. Participant Comments

The following comments were offered by participants in response to their views of Vision for the Future:

Dr. Rao

• Focus on abilities.
  
  
• Guidelines are valuable to VISION 2020.
  
  
• Ophthalmologists must provide service and training.
  
  
• Focus on Training allied health personnel.
  
  
• Envision career ladders for allied health personnel.

John Palmer

• Practitioner re-credentialing is critical to improve quality.
  
  
• The opportunity for all segments of the equator to "win".

Daud Khan, MD

• There is a role to play for everyone under the WHO – what is needed is the WILL to work together.

Michael Blumenthal, MD

• VISION 2020 needs a structure to coordinate their programming efforts.
  
  
• He estimates that by 2020 there will be billions of dollars available to spend wisely in a coordinated effort.

Akef El-Maghraby, MD

• Suggests the need for one (1) joint committee between VISION 2020 and Vision for the Future.
  
  
• Leaders to push for clear joint actions to yield a self-sustained delivery system.

Hugh Taylor, MD

• Notes that ICO is a supporter of 2020.
  
  
• He suggests that ICO needs to provide contributions in the full amount to support IAPB.

Gullapalli Rao, MD

• Concerned that a self-sustaining model can be developed.
  
  
• Agrees that a joint committee would be beneficial.
  
  
• Suggests that ICO could promote $ support to the effort by asking every ophthalmologist to donate one consultant fee to the effort.
  
  
• Help ophthalmologists recognize their moral obligation to be part of the solution.

VII. Conclusion

Drs. Naumann and Straatsma concluded the special section of the ICO meeting by thanking each of the participants for their contributions to the meeting and the discussion.

Dr. Naumann noted the results desired could be achieved if "we all do what we do best". Dr. Straatsma suggests that we will all succeed if we focus on three (3) C's:

COMMUNICATION

COOPERATION

COLLABORATION

Next: APPENDIX VFTF 1 - VISION FOR THE FUTURE AND VISION 2020 THE RIGHT TO SIGHT

Also see: ICO Minutes, July 20 - 21, 2001