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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
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
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