EyeWorld Asia-Pacific June 2011 Issue

48 EW NEWS & OPINION June 2011 APAO Sydney 2011: Reaching out by Chiles Aedam R. Samaniego EyeWorld Asia-Pacific Senior Staff Writer EyeWorld reports on the 2011 Congress of the Asia-Pacific Academy of Ophthalmology T his year, the Asia-Pacific Academy of Ophthalmology (APAO) turned “An International Focus on Ophthalmology” with its Congress in Sydney, Australia. The Asia-Pacific region, said APAO president Frank Martin, MD, bears a “disproportionate burden of blindness,” with a third of the world’s blind population, including half of the world’s blind children. While “enjoying remarkable economic and technologic advancement over the past decade,” said APAO secretary general Dennis Lam, MD, “the region is still home to 65% of the world’s poor and underprivileged.” APAO, said Dr. Lam, is “ready to take on all the challenges that lie ahead, especially in the prevention and elimination of unnecessary blindness for the needy.” Information dissemination is an essential part of APAO’s strategy to meet this need. Dr. Martin said, “The battle against blindness can only be won by the dissemination of knowledge through education and training.” The Congress is a key element of that strategy, “providing ample opportunities for professional and scientific exchange while serving as an important platform for networking,” said Dr. Lam. Dr. Lam also announced the addition of a new weapon to APAO’s armamentarium: the Asia-Pacific Journal of Ophthalmology, to be launched later this year, with a preview issue to be released online in August. Recognizing excellence among its ranks, the APAO gives out several awards annually, including eight named awards: the ICO Golden Apple Award, this year presented to Dr. Lam; the Arthur Lim Award, presented to Ningli Wang, MD ; the Nakajima Award, presented to Yasuo Yanagi, MD; the Susruta Lecture, to Nadeem Hafeez Butt, MD ; the Holmes Lecture, to Prin RojanaPongpun, MD ; the De Ocampo Lecture, to Charles McGhee, MD ; the Jose Rizal International Medal, to Robert Ritch, MD ; and the Jose Rizal Medal, to Dr. Martin. Extending APAO’s reach Often in international ophthalmology meetings such as this Congress, the brunt of discussion revolves around the astonishing technological advances being made in the field. Yet there are parts of the world where the ancient practice of couching—a procedure in which a needle is used to dislodge a cataract, push it out of the lens capsule and into the vitreous cavity, perhaps the oldest form of cataract surgery—is still being performed. Typical of underdeveloped nations in the Asia-Pacific region, Pakistan is bursting with population growth. This population is also rapidly aging; Pakistan has one of the lowest GDPs and per capita income in the world; the country regularly contends with regional conflicts, politics, and religious extremism. This bleak portrait of Pakistan was painted by Nadeem Hassif Butt, MD , professor of ophthalmology, Lahore, Pakistan, and this year’s Susruta Lecturer. It was and is against this dark background that he and his countrymen fought and continue to fight against cataract blindness. Not too far away, in China, a country with a population of 1.8 billion, a similar battle is being fought. The WHO projects an estimated 6.7 million new cataracts a year; in China, less than one million cataract surgeries are performed annually. The problem in China, according to Dr. Lam, is basically one of geography; in China, he said, there is a city-village barrier. Most technological resources and services—including cataract surgery—are localized in the urban centers of the country. Yet more than 60% (more than 800 million) of the country’s population lives in villages, well out of reach of these services. Despite these sobering facts, the underlying message of both Dr. Butt’s Susruta Lecture and Dr. Lam’s Golden Apple Lecture was one of hope. Conquest of cataract surgery in the 21st century: The Pakistan model Cataract surgery, said Dr. Butt, poses more challenges to surgeons in underdeveloped countries. Owing to the unequal distribution of the world’s resources, patients in underdeveloped nations tend to arrive at ophthalmology clinics with eyes already riddled with complications—assuming, of course, that they get there at all and that there is even a clinic for these patients to get to. But even with limited resources, he said, they were able to control the menace of cataract blindness. Working mainly out of the Pakistan Institute of Community Ophthalmology (PICO) and the Punjabi Institute of Preventive Ophthalmology (PIPO), together with government and non- government organizations (NGOs) such as the Layton Rahmatullah Benevolent Trust (LRBT), Dr. Butt and his colleagues used public health strategies to increase awareness, while increasing the residency uptake and cataract surgery volume of participating hospitals. Executing the program through district comprehensive eyecare programs, the national prevalence of cataract blindness in Pakistan has been reduced to 0.9%. Teaching men to fish Meanwhile, Dr. Lam and his colleagues in China launched Project Vision, with the aim of raising the cataract surgery rate to 1,000,000 cataract surgeries a year. To do this, they brought cataract surgery training out of the urban centers and into county hospitals, training passionate volunteers to perform cataract surgery. The choice of cataract surgery technique is a key part of Project Vision; Dr. Lam developed a standardized technique they call manual sutureless medium-incision cataract surgery (MS-MICS), in which cataracts are extracted through an 8-mm wide incision with a 4-mm long sclera-corneal tunnel. By completely standardizing the technique, Dr. Lam and his colleagues are able to ensure good outcomes, despite having non- surgeons perform the procedure. Project Vision has already set up 20 centers in five provinces and has trained 60 independent MS- MICS surgeons, 15 of whom have become trainers; the goal of the project is to establish 100 charity eye centers, train 1,000 of these “rural doctors,” and perform at least 1,000,000 cataract surgeries a year. The model, said Dr. Lam, has matured to the point that he is confident enough to apply it beyond China; Indonesia is now expecting to launch a similar program later this year. EW Editors’ note: None of the doctors mentioned have financial interests related to the content of this article .