March 2020

OUTSIDE THE OR

Presentation Spotlight
Global ophthalmology:
A growing interest among eye surgeons


by Vanessa Caceres Contributing Writer

With a growing interest in global ophthalmology, more eye surgeons want guidance on how to effectively participate in efforts to fight blindness and vision impairment around the world. During the 2019 ASCRS ASOA Annual Meeting, several ophthalmologists shared insights during the symposium “Global Efforts in Addressing Avoidable Blindness and Models of Care/Training.” Here are some highlights from three of the presenters to help surgeons turning their eye toward global ophthalmology.

Expanding academic offerings

A 2015 survey found that 63% of medical students in eyecare had a strong interest in global ophthalmology, said Jeff Pettey, MD.1 “The question is, how do we give the residents the exposure that they want?” Dr. Pettey asked during his talk on academic-based global programs.
Dr. Pettey described global ophthalmology programs as “the Wild West,” which he said is not a criticism. “There’s extraordinarily little in common with the programs. They can vary anywhere from 1 to 4 weeks, and can range from voluntourism to rigorous academics,” he said. At each university, the connection with global training can be as small as one person in the department with connections overseas to well-developed programs in various countries, such as what the John A. Moran Eye Center offers.
Dr. Pettey suggested several ways to add structure to the global ophthalmology experience that residents have, including the use of reflective journals, deep research dives into global ophthalmology, trip reports, and the use of resources from the American Academy of Ophthalmology and Moran CORE (Clinical Ophthalmology Resource for Education).
“As we build more robust programs, we start to find ways to help young people with their skills,” he said.

Considering skillsets and a glaucoma wish list

Malik Y. Kahook, MD, discussed questions that are important for any eye specialty abroad, although he focused his remarks on glaucoma. Finding answers to these questions can help surgeons and their global programs offer the most effective care.
For instance, consider what resources may be available locally as this can differ significantly based on whether it is an urban or rural location. In urban areas, just like in the U.S., you likely will find more skilled surgeons and basic access to glaucoma medications. However, there may be limited access to skills transfer, and local doctors may not have access to the newest devices or techniques. In rural areas, there often are a limited number of trained surgeons and a higher number of patients with end-stage disease.
When getting ready to go abroad, give some serious thought to your skillset, Dr. Kahook advised. Some volunteer programs may require a minimum number of years in practice out of fellowship, for example. Also, consider if you have a niche specialty/subspecialty. “One example is pediatric glaucoma. Concentrating on aspects where you are strongest will add a lot of value,” he said.
Plan to communicate with surgeons onsite in advance of traveling to find out their stressors, both clinically and economically. Ideally, you can continue to communicate with your new surgical contacts after the trip as well, so everyone can continue to teach and learn from each other.
Sustainability is a major concern, Dr. Kahook said, sharing how he has seen fancy and expensive equipment sitting in a corner in the OR abroad. The reason? There was no one locally who could fix or service the equipment. Because of this, surgeons should focus on practical, sustainable surgical solutions.
Dr. Kahook said that cataract surgery may be one of the best glaucoma surgery options in many, but not all, global settings because it lowers IOP and can be cost effective. Trabeculectomy also has a role abroad, he said. On his “wish list,” for glaucoma surgery abroad, Dr. Kahook includes an inexpensive glaucoma drainage device and a low-maintenance cyclophotocoagulation laser with low-cost disposables.

Lessons learned from abroad

Susan MacDonald, MD, shared several incorrect assumptions she previously made about global ophthalmology. One such assumption was that she had all the solutions. “There are a lot of problems that have to do with people living in poverty and not having access to care. It’s not a simple solution,” she said.
Another assumption was that phaco could be the blanket answer for ophthalmologists abroad. However, she found that many eye surgeons abroad cannot afford to provide phaco routinely.
A third was assuming that silence means people agree with you. “Just because someone is silent or not disagreeing doesn’t mean they agree with you. It may be they are being polite. To really understand problems, you have to ask questions and listen,” she said.
Finally, she learned that forging a path in global ophthalmology is much broader than a focus on eyecare alone. “It’s about developing a system in a country where people have access to care,” she said.
Dr. MacDonald had several pearls to help others who plan to make global connections:
• Be patient when developing relationships, and it’s all about relationships.
• Mind your manners, and be kind. Ask questions like, “What do you think?” Then really listen.
• Share your knowledge and obtain knowledge from local doctors. Their knowledge is critical.
• Carefully build a team with the right skillset.
• Find leaders who can make things happen.
• Take the time to build those key relationships with nongovernmental organizations (NGOs). In Tanzania alone, where Dr. MacDonald has spent time, there are 500 NGOs. “Many of them can help you, but it’s all about people again,” she said. Similarly, plan to build relationships with businesses that want to offer help and support.
• Plan to attend government meetings. These are another important building block in developing and maintaining global ophthalmology programs.

About the doctors

Malik Y. Kahook, MD
The Slater Family Endowed Chair in Ophthalmology
UCHealth Sue Anschutz-Rodgers Eye Center
Aurora, Colorado

Susan MacDonald, MD
Clinical associate professor
Tufts University School
of Medicine
Boston, Massachusetts

Jeff Pettey, MD
Vice chair for education
John A. Moran Eye Center
Salt Lake City, Utah

Reference

1. Coombs PG, et al. Global health training in ophthalmology residency programs. J Surg Educ. 2015;72:e52–59.

Relevant disclosures

Kahook
: Alcon, Aurea Medical, Equinox, Fluent Ophthalmics, Ivantis, Johnson & Johnson Vision, New World Medical, ShapeTech, SpyGlass Ophthalmics
MacDonald: Carl Zeiss Meditec, Perfect Lens
Pettey: None

Contact

Kahook
: malik.kahook@cuanschutz.edu
Macdonald: susanmacdonaldeyecorps@gmail.com
Pettey: jeff.pettey@hsc.utah.edu

Global ophthalmology: A growing interest among eye surgeons Global ophthalmology: A growing interest among eye surgeons
Ophthalmology News - EyeWorld Magazine
283 110
220 215
,
2020-03-03T08:07:39Z
True, 3