EyeWorld Asia-Pacific June 2015 Issue

60 EWAP NEWS & OPINION June 2015 ophthalmological, treated case to case rather than as public health issues; and 10% by age-related macular degeneration and other diseases that, at the time, no one could do anything about. Moving forward to 1996, the 30–50 million blind in the 90s was projected to double to 90 million by 2020. By the end of the decade, the World Health Organization would launch the Vision 2020 initiative, which aimed to develop sustainable programs with the goal of eliminating avoidable blindness by 2020. Vision 2020, Dr. Taylor said, “is all about partnerships”—among the ophthalmic community, represented by individuals and larger regional and international societies, non-government organizations, and the governments of the world. It has three main components: effective disease control, human resource development, and infrastructure development. Back in 1996, it was projected that “if we did what we knew,” Dr. Taylor said, the 60 million blind projected for 2010 without any intervention would be reduced to 40 million; by 2020, the projected 90 million would be reduced to 25 million. So where are we now? Actually, Dr. Taylor said, “doing what we knew to do,” there were only 32.4 million blind from avoidable causes globally in 2010. That’s a drop of 42%. While these results clearly show there’s room for optimism, they should also spur the ophthalmic community to continue the struggle. “The glass isn’t full yet,” Dr. Taylor said. “But it’s no longer empty.” Building education in ophthal- mology a major focus for Asian countries In a session on building educational programs, Mark Tso, MD , Baltimore, who introduced the session, highlighted critical building blocks of major eye centers. Some of the primary aspects of this are focusing on the delivery of quality general and specialty eye services, biomedical research discovery, and education. Education is the backbone of clinical service, the foundation of clinical and basic research, and the core value of the faculty, Dr. Tso said. “Furthermore, education builds people, and people go on to make history.” That’s why education is critical in the building of a major eye care center, he said. The Asia-Pacific Academy has 19 national members, he said, and the health spending in percentage of GDP varies from 1.9% in Myanmar to 9.8% in Malaysia (compared to 15.7% in the United States). Prashant Garg, MD , Hyderabad, India, presented on the “Opportunities and Challenges in Developing Quality and High Impact Educational Programs in Developing Countries.” There are 8.9 million people blind in India, he said. Together with those in Africa and China, this constitutes nearly 60% of global blindness. There are a number of challenges facing medical programs in India. When considering medical college-based programs, Dr. Garg said that some of the obstacles are that health is a state issue and there is a lack of funds for these programs. There is also not enough time for training and education, and there is a lack of leadership, proper attitude, and accountability. This results in residents emerging from these programs without the competence to practice independently, Dr. Garg said. India also has an NBE program, however, it is not popular, there is variability in the standards of training, and it has a centralized examination system with a poor pass percentage. Possible solutions to these challenges are to provide more funding, more resources, and more time for education, he said. Areas to focus on are the training of trainers, revision of the curriculum, e-learning, and a centralized evaluation system. All of these things are being addressed, Dr. Garg said, however, there is very little or no effort at this point in time to have a centralized certification system besides the ICO conducted exam. There is some discussion with the All India Ophthalmological Society (AIOS) to have a national certification system so there can be some improvement and uniformity in the quality of residents coming out of residency programs, he said. In conclusion, Dr. Garg said there are a number of challenges facing ophthalmic education in India. There are some good programs, but efforts need to be made to bridge the gap, and AIOS is working on this. Susruta Lecture focuses on cataract in uveitis Susruta lived in India around the 6th century B.C. Author of the Sanskrit text Susruta Samhita, he may have been the first to describe extracapsular cataract extraction (ECCE) surgery. The APAO honors this ancient physician with the Susruta Lecture. The Susruta Lecture recognizes “extraordinary contributions to the cataract subspecialty,” prioritizing ophthalmologists who contribute substantially to the control and elimination of mass cataract blindness. Cataract remains one of the leading causes of avoidable blindness around the world, and blindness from the condition remains a perennial problem in the Asia-Pacific region in particular. This year, the honor of delivering the Susruta Lecture went to Masahiko Usui, MD , Tokyo. Dr. Usui delivered his Susruta Lecture on “Cataract/IOL Surgery for Cataract with Intraocular Inflammation.” Specifically, Dr. Usui’s lecture discussed cataract in cases of uveitis —a significant problem in Japan, he said. Describing the pathogenesis of cataract in uveitis, Dr. Usui said the condition begins with inflammatory changes in the aqueous humor. Inflammation results in characteristic posterior synechiae, and inflammatory changes occur in the vitreous body. Cataract, he said, is the side effect of steroid therapy for uveitis. Dr. Usui looked at 162 eyes (115 patients) with cataract in a The 30th APAO - from page 59 continued on page 62