Saving Sight …. and LivesSaving Sight …. and Lives

HKI – March 16, 2015HKI – March 16, 2015

Alfred Sommer M.D. M.H.S.Alfred Sommer M.D. M.H.S.Johns Hopkins UniversityJohns Hopkins University

Global Trachoma Control

S urgery

A ntibiotics

F ace washing

E nvironmental hygiene

Vitamin A Deficiency and Vitamin A Deficiency and BlindnessBlindness

• 63,000 new cases corneal ulceration in 63,000 new cases corneal ulceration in Indonesia annuallyIndonesia annually

• 500,000 new cases of corneal ulceration 500,000 new cases of corneal ulceration each year in Asiaeach year in Asia

• One 2 cent capsule, twice a year, would One 2 cent capsule, twice a year, would prevent itprevent it

Vitamin A Deficiency and Vitamin A Deficiency and BlindnessBlindness

Is this enough of a Problem to Is this enough of a Problem to drive drive PolicyPolicy ? ?

NO !!NO !!

TANZANIATANZANIAMEASLES MORTALITYMEASLES MORTALITY

(In-Hospital)(In-Hospital)

0 - 6 Years Old0 - 6 Years OldDeathsDeaths

MortalityMortality

RRRR

RoutineRoutineTherapyTherapy

12/ 9212/ 92

13.0%13.0%

22 :

Vitamin AVitamin A(200,000 IU x 2)(200,000 IU x 2)

6/ 886/ 88

6.8%6.8%

11

Cataract5%

Glaucoma18%

Other4%

ARMD50%

Ch Bl3%

DR17%

CO3%

Cataract50 %

Trachoma4 %

Glaucoma12%

Oncho 0.8 %

Other14 %

ARMD6%

Ch Bl 4%

DR 4%

CO 5%

More Developed Countries

Less Developed Countries

Courtesy ofS. Resnikoff,2006

Cause of Blindness

Cataract Surgical Rates

(estimates)

N. America

N. Europe

Australia/Japan

India

China

Africa

Population(millions)

300

400

150

1,000

1,250

650

Cataractoperations

1.65

1.60 m

.08 m

3.1 m

0.6 m

0.2 m

CSR(per millions/ yr)

5,500

4,000

5,300

3,100

500

300

From A. Foster, BJO, 2001

Ophthalmologists

per Capita

USA 1 per 10,000

India 1 per 100,000

Africa 1 per 1,000,000

Ratio of Ophthalmic Surgeons : Ratio of Ophthalmic Surgeons : PopulationPopulation

AfricaAfrica

1: million1: million

Real Ratio of Ophthalmic Surgeons: Real Ratio of Ophthalmic Surgeons: PopulationPopulation

(for poor, rural Africans)(for poor, rural Africans)

< 1: 10 million< 1: 10 million

Sub-Saharan AfricaSub-Saharan Africa

CSR: 200 – 400CSR: 200 – 400

EffectiveEffective CSR: 100 – 200 CSR: 100 – 200

==

<< 1/10 Needed Rate1/10 Needed Rate

Sub-Saharan AfricaSub-Saharan Africa

• Too few cataract surgeonsToo few cataract surgeons• Doing too little Doing too little qualityquality cataract surgery cataract surgery

• To patients who most need itTo patients who most need it

(while many ophthalmologists(while many ophthalmologists

remain under-employed) remain under-employed) !!!!

Indonesia (2009)Indonesia (2009)

Population 300 million Population 300 million Ophthalmologists 1,000 Ophthalmologists 1,000

(1:300)(1:300)

Cataract Operations 70,000Cataract Operations 70,000

CSR < 250CSR < 250

Indonesia (2009)Indonesia (2009)

1000 Ophthalmologist1000 Ophthalmologist

300 Live in Jakarta300 Live in Jakarta

600 Live in Bandung/Bogor/Jogjakarta/Surabaya600 Live in Bandung/Bogor/Jogjakarta/Surabaya

Fewer than 200 for remainingFewer than 200 for remaining

250 million people250 million people

(< 1:1,000,000 )(< 1:1,000,000 )

AvoidableAvoidable Causes of BlindnessCauses of BlindnessLow Resource SettingsLow Resource Settings

• Cataract Cataract ((individualindividual ophthalmic ophthalmic surgerysurgery))

• Trachoma Trachoma ((public healthpublic health))• River Blindness River Blindness ((public healthpublic health))• Xerophthalmia Xerophthalmia ((public healthpublic health))

“ Avoidable blindness…

is an obscene and costly

anachronism.”

Sir John Wilson

World Blindness and Its Prevention,

Oxford Press, 1980

““Never doubt that a small group Never doubt that a small group of thoughtful, committed citizens of thoughtful, committed citizens can change the world. Indeed, it can change the world. Indeed, it is the only thing that ever has.”is the only thing that ever has.”

Margaret MeadMargaret Mead