OCT 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/194331

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Page 26 of 134

24 EW NEWS & OPINION October 2013 ASCRS Foundation initiative to support cataract surgical training centers of excellence in Ethiopia by David F. Chang, MD This map shows the geographic relationship of Mekele, Gondar, Jima, and Addis Ababa. O f all the challenges we must overcome in reversing the rising backlog of cataract blindness in the developing world, the most formidable is the dire shortage of properly trained cataract surgeons. Fortunately, a number of international centers have demonstrated the reproducible ability to achieve high quality outcomes with a scalable high volume approach using manual small incision cataract surgery (M-SICS)—a lower tech manual ECCE method that is much less expensive than phaco.1 A recent retrospective study of 80,000 surgeries conducted by Dr. Haripriya Aravind and I at the Madurai Aravind Hospital in southern India showed that phaco and the lower cost M-SICS method were equally safe in the hands of experienced surgeons.2 However, for inexperienced and trainee surgeons, there was a much higher rate of surgical complications with phaco compared to M-SICS. For most surgeons, the M-SICS technique is also safer for the advanced mature cataracts that are so prevalent in the poorest developing countries. The results of this large clinical study demonstrate the appropriateness of teaching M-SICS as the first procedure for cataract surgeons in the developing world. For relatively inexperienced surgeons who are treating patients blind with mature cataracts, M-SICS offers distinct advantages in terms of cost, speed, and safety. Founded by the Nepalese born ophthalmologist Sanduk Ruit, Source: Charlie Passut MD, Tilganga Eye Center (TEC) in Kathmandu, Nepal, provides a blueprint for a financially self-sustaining center of excellence in the developing world. TEC initially developed its high volume cataract surgical program using M-SICS. Over time TEC eventually incorporated phaco and subspecialty ophthalmology (glaucoma, corneal transplant, vitreoretinal surgery, pediatric ophthalmology, and refractive surgery). Phaco with foldable IOLs has attracted more affluent patients to TEC and generated revenues that underwrite the charitable M-SICS surgeries through a sustainable cost recovery system. Himalayan Cataract Project (HCP) is the international NGO founded by Dr. Ruit and Geoffrey Tabin, MD, to use TEC as a training center for ophthalmologists in developing countries throughout Asia and Africa. The remarkable Tabin-Ruit partnership and HCP's extraordinary achievements are chronicled in the newly published book Second Suns by the late David Relin, who co-authored Three Cups of Tea. Last month, TEC was honored as a co-recipient of the 2013 Champalimaud Vision Award. for an additional 1.2 million people with low vision (National Survey on Blindness, Low Vision and Trachoma in Ethiopia, 2006). The number of ophthalmologists per capita in Sub-Saharan Africa is among the lowest in the world—less than onefifth that of India. Of the roughly 100 practicing ophthalmologists in Ethiopia, one half work in the capital of Addis Ababa, which has less than 5% of the population. The result is a critical shortage of eyecare throughout the rest of Ethiopia. Virtually no one in Ethiopia is proficient in phaco. Indeed, because there is only one vitreoretinal surgeon in the entire country, a dropped nucleus generally results in a blind eye. There are currently only three residency training programs in Ethiopia. Residents from the main Addis residency program at Menelik Hospital rotate to Quiha Hospital in Mekele where Dr. Tilahun Kiros is currently doing the highest volume of cataract surgery in the country (approximately 5,000 M-SICS cases per year). A second residency program is located at Gondar University in the densely populated Amhara region in northwest Ethiopia. Dr. Yared Assefa and his program at Gondar are profiled in my accompanying "Chief medical editor's corner of the world" (page 27). The third residency program is at Jima University in the southern Oromia region. Both the Gondar and Jima residency programs need subspecialty training and the capacity to train more ophthalmologists, as they each currently graduate only one to two residents per year. continued on page 26 Dr. Tabin with a smiling patient on postop day one. Ethiopia On the African continent, Ethiopia's population of 85 million is second only to Nigeria's. Ethiopia has one of the highest rates of blindness in the world with a national prevalence rate of 1.6% (Ethiop J Health Dev 2007). Nearly 50% of blindness— more than 600,000 individuals—is due to cataract, which also accounts Drs. Tabin (rear) and Chang (front) performing M-SICS. Four patients are positioned so that each surgeon can alternate between two operating tables.

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