The document discusses the alarming rates of avoidable blindness in low-resource settings, highlighting issues such as cataract and trachoma. It emphasizes the disparity in cataract surgical rates and the inadequate number of ophthalmologists in regions like sub-Saharan Africa and Indonesia. Despite the availability of simple interventions like vitamin A supplementation and affordable surgeries, many individuals remain untreated due to systemic healthcare deficiencies.

1. 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

7. Global Trachoma Control
S urgery
A ntibiotics
F ace washing
E nvironmental hygiene

9. Vitamin A Deficiency andVitamin A Deficiency and
BlindnessBlindness
• 63,000 new cases corneal ulceration in63,000 new cases corneal ulceration in
Indonesia annuallyIndonesia annually
• 500,000 new cases of corneal ulceration500,000 new cases of corneal ulceration
each year in Asiaeach year in Asia
• One 2 cent capsule, twice a year, wouldOne 2 cent capsule, twice a year, would
prevent itprevent it

10. Vitamin A Deficiency andVitamin A Deficiency and
BlindnessBlindness
Is this enough of a Problem toIs this enough of a Problem to
drivedrive PolicyPolicy ??
NO !!NO !!

13. TANZANIATANZANIA
MEASLES MORTALITYMEASLES MORTALITY
(In-Hospital)(In-Hospital)
0 - 6 Years Old0 - 6 Years Old
DeathsDeaths
MortalityMortality
RRRR
RoutineRoutine
TherapyTherapy
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

17. Cataract
5%
Glaucoma
18%
Other
4%
ARMD
50%
Ch Bl
3%
DR
17%
CO
3%
Cataract
50 %
Trachoma
4 %
Glaucoma
12%
Oncho 0.8 %
Other
14 %
ARMD
6%
Ch Bl 4%
DR 4%
CO 5%
More Developed
Countries
Less Developed
Countries
Courtesy of
S. Resnikoff,2006
Cause of Blindness

19. Cataract Surgical Rates
(estimates)
N. America
N. Europe
Australia/
Japan
India
China
Africa
Population
(millions)
300
400
150
1,000
1,250
650
Cataract
operations
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

20. Ophthalmologists
per Capita
USA 1 per 10,000
India 1 per 100,000
Africa 1 per 1,000,000

21. Ratio of Ophthalmic Surgeons :Ratio of Ophthalmic Surgeons :
PopulationPopulation
AfricaAfrica
1: million1: million

22. 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

23. Sub-Saharan AfricaSub-Saharan Africa
CSR: 200 – 400CSR: 200 – 400
EffectiveEffective CSR: 100 – 200CSR: 100 – 200
==
<< 1/10 Needed Rate1/10 Needed Rate

24. Sub-Saharan AfricaSub-Saharan Africa
• Too few cataract surgeonsToo few cataract surgeons
• Doing too littleDoing too little qualityquality cataract surgerycataract surgery
• To patients who most need itTo patients who most need it
(while many ophthalmologists(while many ophthalmologists
remain under-employed)remain under-employed) !!!!

25. Indonesia (2009)Indonesia (2009)
Population 300 millionPopulation 300 million
Ophthalmologists 1,000Ophthalmologists 1,000
(1:300)(1:300)
Cataract Operations 70,000Cataract Operations 70,000
CSR < 250CSR < 250

26. 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 )

27. AvoidableAvoidable Causes of BlindnessCauses of Blindness
Low Resource SettingsLow Resource Settings
• CataractCataract ((individualindividual ophthalmicophthalmic
surgerysurgery))
• TrachomaTrachoma ((public healthpublic health))
• River BlindnessRiver Blindness ((public healthpublic health))
• XerophthalmiaXerophthalmia ((public healthpublic health))

28. “ Avoidable blindness…
is an obscene and costly
anachronism.”
Sir John Wilson
World Blindness and Its Prevention,
Oxford Press, 1980

29. ““Never doubt that a small groupNever doubt that a small group
of thoughtful, committed citizensof thoughtful, committed citizens
can change the world. Indeed, itcan change the world. Indeed, it
is the only thing that ever has.”is the only thing that ever has.”
Margaret MeadMargaret Mead