Eyeworld

continued on next page Healthcare systems in extremely challenging regions are often broken or inherently corrupt, Dr. Ogilvie-Graham said. Often aid ends up in the wrong hands or never reaches the patient. Medical aid is particularly vulnerable to corruption because of its high value, he added. Support a well-estab- lished international medical aid NGO or partner with them. Finding trustworthy local support is vital, he said. Dr. Williams spoke about the outcomes monitoring he does and noted that some of the factors in outcomes reports include visual acuity, adjusting visual acuity to the situa- tion (visual improvement and preop considerations), and cataract complications (vitreous loss, corneal edema, wound leak, etc.). You also have to consider those patients lost to follow up and other factors, he said. 'Ophthalmic Care Strategies During Humanitarian Crisis: Addressing Challenges and Ensuring Patient and Physician Safety' Vasyl Shevchyk, MD, PhD, shared his experiences from prac- ticing in Ukraine. He mentioned specific challenges such as no electricity, water, heat, fuel, or medical support for the first 3 months of war. Dr. Williams spoke about optimizing outcomes in areas with limited resources. Source: ASCRS During the symposium, Dr. Shevchyk shared his experiences practicing in Ukraine and the challenges involved. Source: ASCRS 'Duke GO: Best Practices for Utilizing Limited Resources for High Quality Care' Lloyd Williams, MD, PhD, shared some of his personal ex- periences working in South Sudan. He said this area has the highest rate of blindness in the world, noting that it could be as high as 4%. However, there aren't many humanitari- an efforts in the area because of conflict during the last 60 years. This made him want to get involved in the region. He shared photos from his trips, showing the OR and indicating that they utilized manual small incision cataract surgery (MSICS) while there. How do you optimize outcomes? Dr. Williams said you need quality outcomes (excellent surgery and outcome mon- itoring) balanced with a "leave no one behind" approach. He added that empowering local leaders and utilizing skills transfer is important. In South Sudan, he used local teams and support and said they had a security advisor. Local knowledge goes a long way. We want to empower our staff to lead, Dr. Williams said, adding that he likes to give credit and pay staff when appropriate. War surgery is totally different, he said, and you have to do the best for the most and not everything for everyone. As far as ocular trauma, there is a long wait from the time of eye trauma to receiving specialized help. Patients often have to wait for evacuation from the battlefield (1–7 days) due to intensive use of first person view drones, wait at a stabili- zation point (1–7 days), and may have to wait 1–2 days for transport to a hospital. Ophthalmology-specific problems are no medical sup- plies (suture material, silicone oil, soft tissue, and bone im- plants), no specialized equipment, no skilled reconstructive oculoplastic surgeons, and the absence of protective ballistic eyeglasses. He stressed that protective ballistic eyeglasses save the eyes and should be worn 24/7.

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