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ICO Leader Letter

August 2011, Volume 8, Number 8

1. Cataract – A Persistent Challenge

In spite of the best efforts of many NGOs and ophthalmologic institutions around the world, cataract remains the leading cause of avoidable blindness.

As ophthalmologists know well, cataract surgery is very successful in restoring sight, and it is among the most cost-effective of health-care interventions. Yet, millions of people remain blind from cataract, particularly in middle and low-income countries, due mostly to a lack of access to quality cataract surgical services.

Because the prevalence of cataract increases with age, the current 20 million people with severely reduced vision as a result of cataract is projected to grow to 40 million by the year 2020. The immediate but daunting challenge is to provide ready access to cataract surgery for all those who need it.

What can international ophthalmology do to make more progress in reducing preventable blindness from cataract? In this special issue of the Leader Letter, we address this topic in the hope it will stimulate ideas and spur efforts to meet this persistent and critical challenge.

The ICO is interested in hearing your suggestions on what international ophthalmology can and should do, at: info@icoph.org.

– Bruce Spivey MD, ICO President

2. Hilton Foundation Landscape Grant

The Johns Hopkins University has received a grant from the Conrad N. Hilton Foundation to work with the ICO and others to undertake a “landscape analysis” of cataract surgical services in Sub-Saharan Africa (SSA). The project will focus on identifying the obstacles to achieving greater access to sight-restoring cataract surgery and suggesting how limiting factors might be overcome by judicious investments over a relatively short period of time.

The “landscape analysis” is meant to identify specific activities and investments that might help overcome the low cataract surgical rates in Africa and help the large numbers of individuals blind and visually impaired for lack of cataract surgical services. The project was stimulated by the ICO policy statement on “Access to Cataract Surgical Services” (see below).

This particular project will focus most of its time and resources on SSA, where the problem is most acute for lack of trained ophthalmic cataract surgeons, a dearth of infrastructure (operating rooms, roads and transport), supplies (intraocular lenses, sutures and operating microscopes) and where low population density suggests the need for a different (or highly modified) approach to solving the problem than has proved practical in high-density populations like those of India and Nepal.

– Hugh Taylor, AC, MD, ICO Treasurer

3. AJO Editorial on Cataract Surgical Services

The ICO spent two years grappling with the issue of unmet cataract surgical need and has come to conclude that, since ophthalmology “owns” cataract surgery, it also “owns” the problem of unmet cataract surgical needs.

An editorial by Drs. Alfred Sommer and Bruce Spivey in the June 2011 issue of the American Journal of Ophthalmology clearly addresses obstacles impeding needed access to cataract surgical services and considers successful approaches and ways these obstacles can be overcome.

To read the editorial, Access to Cataract Surgical Services: International Ophthalmology Accepts the Challenge go to: www.ajo.com/article/S0002-9394%2811%2900149-8/fulltext.

– Jean-Jacques De Laey, MD, ICO Secretary General

4. ICO Cataract Policy Statement

In late 2010, the ICO Board of Trustees approved a policy to call attention to the wide disparities in access to cataract services, particularly for the poor and those living in rural areas. The policy was developed by the ICO over several years of reviewing the status of cataract and the delivery of cataract services worldwide.

The official document, Access to Cataract Surgical Services: A Position and Policy Statement, can be downloaded at: www.icoph.org/cataractstatement.

Thoughtful discussions and suggestions helped shape this final document, which focuses the ICO’s energies on increasing the number of well-trained ophthalmologists, as ultimately that is in the best interests of all patients.

– Alfred Sommer, MD, ICO Director for Research

5. ICO-OSCAR: ICO Surgical Assessment Tool

The Ophthalmology Surgical Competency Assessment Rubric (OSCAR) is a new surgery assessment tool endorsed by the ICO, with an initial focus on cataract: www.sciencedirect.com/science/article/pii/S0161642010010341.

The ICO-OSCAR is a standardized, internationally valid tool to both teach and assess an ophthalmologist’s competence in performing cataract surgery. The ICO-OSCAR provides ophthalmic educators with a global standard and gives residents specific, structured and formative feedback.

Unlike other surgical assessment tools, the ICO-OSCAR has succinct descriptions of the exact skill being evaluated for every rating category. This allows the assessor to be more objective in their grading, and it provides the student with a resource that specifies exactly what they are expected to learn and be able to do.

Two ICO-OSCAR tools are now available for download:

• Extracapsular Cataract Extraction: www.icoph.org/downloads/ICO-OSCAR-ECCE.doc (DOC – 94 KB)
• Phacoemulsification: www.icoph.org/downloads/ICO-OSCAR-Phaco.doc (DOC – 86 KB)
• A third ICO-OSCAR tool for small incision cataract surgery is currently “in press” and information about it will be presented after publication.

The ICO-OSCAR is available on the ICO Web site in English and Spanish, with plans for translation to Mandarin, Portuguese and Vietnamese. Please see resources to download the OSCAR in Spanish. Iterations covering additional surgical procedures are currently in development.

– Karl Golnik, MD, Chair, Task Force on Coordination and Education of Program Directors of Ophthalmology Residencies

Upcoming ICO Meetings and World Ophthalmology Congresses

Conference for Ophthalmic Educators, Busan, Korea, April 12:
New Techniques to Enhance Teaching and Learning

• Register online to attend: icoph.org/rsvp/Busan

World Ophthalmology Congress Meetings

• WOC2014: Tokyo, Japan, April 2-6, 2014, www.woc2014.org
• WOC2016: Guadalajara, Mexico, February 5–9, 2016
• WOC2018: Barcelona, Spain (provisional selection, dates to be announced)

More News

For more news of the ICO and international ophthalmology and resources for ophthalmologic leaders, see the ICO Web site at www.icoph.org.

Request for Other News and Resources

Do you have other news of international ophthalmology or know resources (particularly on the Web) that would be valuable to ophthalmologic leaders? Please let us know at leader@icoph.org.

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