Developing international research capacity for VISION 2020

The International Eye Research Network (IERN)

Shaheen Shah, Robert Lindfield, Hessom Razavi, and Clare Gilbert on behalf of the IERN
World Ophthalmology Congress, Wednesday 9th June 2010

Funded by

Background
More than 85% of the worlds six billion population live in low- and middle-income countries Scientists from developing countries are seriously underrepresented in various areas of health research* There is a need to develop and support research capacity in a more diverse range of centres around the world, particularly from lower income settings** Capacity building in developing countries is essential to improve health research and reduce health inequity**
*Horton R. Medical journals: evidence of bias against the diseases of poverty. Lancet 2003;361: 712-3. **Lansang MA, Dennis R. Building capacity in health research in the developing world. Bull World Health Organ 2004;82: 764-70.

Major causes of blindness

Backlog

Foster . Changing patterns in global blindness: 19882008 Community Eye Health Journal Vol. 21 No.67 Sept 2008

Cataract surgery
For cataract surgical service planning purposes what is considered an operable cataract has become less clear:
Modern advances in surgery and better outcomes Increasing expectation and visual needs of patients

Increasing willingness of surgeons to perform cataract surgery

Visual acuity is still the main determinant of operable cataract

Lowering the visual threshold at which to perform surgery Dramatic increase on the volume of cataract surgery required

The cataract case mix study

WHO suggests a global volume of cataract surgery > 30 million per year by the year 2020 to control cataract blindness
But what if the majority are being operated at 6/12 ??

Aim: Establish the different visual thresholds used for cataract surgery globally

The International Eye Research Network (IERN)

A network of ophthalmologists across the world able and willing to conduct research into prevention of blindness to support VISION 2020.

Focused on where the avoidable blindness burden lies.

Recruitment to IERN
Alumni of MSc at LSHTM Contacts of ICEH/IAPB Adverts in JCEH Word of mouth

Cataract case mix study: first prospective study for the IERN
Aim: 1. Describe the variation in the proportion <6/60 preoperatively 2. Determine proportion having first eye surgery 3. Explore variations by country Human Development Index

Data Collection
Two stages:
Hospital questionnaire:
Completed online Resources available in hospital Ethical approval

Patient questionnaire
Basic demographic information 100 consecutive patients undergoing cataract surgery 100 consecutive patients age, gender, VA, first/second eye, literacy

Results
154 eye hospitals completed the hospital questionniare. 111 (72.1%) returned patient questionnaire Data provided on 11,048 patients in 51 countries in all WHO regions 84.7% of the hospitals were in middle/low income countries Just over half (54.2%) were non governmental hospitals. 60.6% of centres had a working B scan ultrasound machine Median number cataract surgeries (per year): 1,700 (IQR 800, 4000)

Origin of cataract data for case mix study

Europe 8% E Med 15%

Africa 37%
SE Asia 21%

Americas 8%

W Pacific 11%

Preoperative <6/60
Map designed by Priya Morjaria Research Assistant ICEH

60-69% 50-59% 40-49% 30-39% 20-29% 10-19% 0-9%

Preoperative visual acuity in individuals undergoing cataract surgery (better eye)

Human Dev Index [UN] High Middle Middle-low Bl/SVI 31 153 2481 % 6 13 31 MVI 105 298 2,669 % 21 26 33 Near Normal 147 364 1709 % 30 31 21 Normal vision 207 350 1234 % 42 30 15 Total 490 1,165 8,093 % 100 100 100

Low
Total

462
3127

44
29

296
3,368

28
31

165
2385

16
22

131
1,922

12
18

1,054
10,802

100
100

6% of surgeries in high income countries were on patients bilaterally SVI/blind (<6/60) compared with 44% in low income countries (p<0.001).

Surgical Eye
having their first eye operated.

Gender Age

Literacy
Proportion of first eye surgery increased with increasing country deprivation: 66.2% in high income 80.8% in low income, p<0.001.

First Eye
Volume

Male Female <50 50-59 60-69 70+ Yes No No Yes <1000 1000- <3000 3000+ High Middle Middle-low Low

n= 3945 3980 948 1266 2716 2995 2982 4943 1735 6190 2,556 2,483 2,886 125 590 6,270 940 7,925

% <6/60 73 72 77 75 73 69 58 84 64 75 84 69 66 25 50 76 88 72

HDI

Total

Conclusions
The majority of respondents were from low and middlelow income countries. Demonstration of a strong interest and willingness to collaborate in research Feedback of analysis on individual hospitals data well received by network members Internet can be used to develop and support a research network that, at low cost, can provide a timely and accurate global snapshot of activity. Information can be used to plan cataract surgical activity for VISION 2020 programmes e.g. refining the local cataract surgical rate

Next Steps
An International Situational Analysis of Glaucoma Services and Management
If you want to get involved then please contact:

Priya.Morjaria@Lshtm.ac.uk

Acknowledgements
Ophthalmologist
Jacques Rigobert Tchougna Kemabia

Town
Agogo

Hospital
Agogo Presbyterian Hospital

Shawkat Ara Shakoor

Muhammad Umar Fawad

Dhaka
Karachi

Ahmed Medical and Research Center

Al-ibrahim Eye Hospital/ Isra Postgraduate Institute of Ophthalmology

O O Bankole Mariano Yee Melgar

Hornametor Afake Yi Chen Yongzhen Bao Jos Afonso Martins de Moraes Munirujzaman Osmai Gizella Baghy Johannes Kohler Sara Varughese Syumarti MD, Ophth Ketema Amde-Michael Thodore Kadima Mutombo Janos Nemeth Ketema Amde-Michael Jitendra Jethani A.K.Khan David Steven Henry Nkumbe D.Uranchimeg Edward Nkurunziza Ashok Rangarajan Fatima Kyari Ashok Rangarajan O O Bankole O O Bankole S.C. Jacob And Sunil Kumar Singh Lutful Husain , Dr. A.K. Khan Jonathan Pons

Lagos Guatemala
Bawku, Upper East Region Beijing Benguela Chittagong Lome Abancay chhatarpur Bandung Conakry Bukavu Budapest Conakry Vadodara Jamalpur Cape Town Antsirabe Ulaanbaatar Fort Portal Calabar Funtua Ow erri Lagos Lagos Neemuch in Madhya Pradesh Dhaka Siteki

Alausa Blindness Prevention Programme Unit Asociacin para la prevencin contra la ceguera "VISUALIZA"
Bawku Presbyterian Hospital Beijing Eye Boa Vista, Sole Chittagong Eye Infirmary and training complex Centre Ophtalmologique Jean Paul II Centro Oftalmolgico Monseor Enrique Pelach - Obispado de Abancay Christian hospital Chhatarpur Cicendo Eye hospital Clinique Bartime Clinique ya Macho Department of Ophthalmology Donka National Hospital Dr. Thakorbhai V Patel Eye Institute Dristisheba O Gobeshona Eerste River Eyework programme of Flm Salfa Eye hospital First Clinical Hospital Fort Portal Regional Referral Hospital General Hospital, Calabar General Hospital, Funtua General Hospital, Ow erri General Hospital,Ajeromi General Hospital,Gbagada Gomabai Netralaya Gonoshasthaya Medical College Hospitals Good Shepherd Hospital

Madhu Kutumbaka Grarbet Tehadiso Mahber - Butajira Graeme John Rogers Parikshit M. Gogate Ashok Rangarajan Xiao Baixiang Shaheen Shah Fernando Barria von-Bischhoffshausen Nascimento FM Joao Marcello Fortes Furtado Pedro Gomez Bastar Felipe Betancourt Susan Kikira Helen Roberts Adepoju Feyisayo Grace Costa T John Wanjiku Mathenge & Levi Kandeke Edith Dogbe Jyotee Trivedy Nasir H. Ansari Saeed Khan Wahid Hussain M. Afzal Khattak Abdul Sattar Memon Salim Javed Khalid Masood Ashraf Zafar Ali Malik Rafay Aslam Hayat Hasnain Fawad Rizvi Isawumi Ma Dipak Kumar Nag Marine Nalbandyan Khumbo Kalua Lakho Khalil Ahmed

Rajahmundry Butajira Cape Town Pune Birnin Kebbi Heng Zhou Town London Concepcion Ribeirao Preto Taquaritinga, State of Sao Paulo Montemorelos, Nuevo Leon Cali Jinja Mombasa Ilorin Joypurhat Bujumbura Accra Nairobi Tando Bago Quetta (Balochistan) Akora Khattak Barikot, Swat Gambat Khanewal Mandra Lar, Multan Pasrur Rashidabad Shahpur Karachi Osogbo Dhaka Sevan Blantyre Khartoum

Goutami Eye Institute Grarbet Tehadiso Mahber - Butajira Groote Schuur Hospital H.V.Desai Eye Hospital, Pune Hafsat Eye Centre Heng County Chinese Traditional Hospital Hillingdon Hospital Hospital Clinco Regional "Guillermo Grant Benavente"| Hospital das Clinicas de Ribeirao Preto - Universidade de Sao Paulo Hospital de Olhos Lions Instituto de la Vision, Hospital "La Carlota" Instituto para Nios Ciegos y Sordos del Valle Jinja Regional Referal hospital KWALE DISTRICT EYE CENTRE KWARA EYE CARE PROGRAM Khanjanpur Mission Health Service (a project of Churches of God Mission) King Khaled Hospital Korle-Bu Teaching Hospital LIONS SIGHTFIRST EYE HOSPITAL, LORESHO LRBT Free Secondary Eye Hospital, Tando Bago LRBT Free Secondary Eye Hospital Quetta LRBT Free Secondary Eye Hospital, Akora Khattak LRBT Free Secondary Eye Hospital, Barikot, Swat LRBT Free Secondary Eye Hospital, Gambat LRBT Free Secondary Eye Hospital, Khanewal LRBT Free Secondary Eye Hospital, Mandra LRBT Free Secondary Eye Hospital, Multan LRBT Free Secondary Eye Hospital, Pasrur LRBT Free Secondary Eye Hospital, Rashidabad LRBT Free Secondary Eye Hospital, Shahpur LRBT Free Tertiary Eye Hospital, Karachi Lautech Teaching Hospital Lion's Eye Institute & Hospital Lions Regional Ophthalmic Unit of Sevan Lions Sight First Eye hospital Makkah Eye Complex

Dr Gavin Henry Arif Hussain Fatma J.Omar Robert McKay Fischer-Harder Mathew Kurian Fatima Kyari Khair Ahmed Choudhury Shawkat Ara Shakoor Wondwosen Kebede Bayu Nick Metcalfe, Will Dean Hassan Hashemi MD, Farhad Rezvan Mayo Hospital Lahore Meenakshi Gupta Muhammad Shah Jamal Joshi ND, Sabtu Khairol S.Branchevskiy Anu A Mathew Paddy Musana DR.Shamsul Hoque Mullick K. Anand Sudhan Yuliya Semenova SEWA RURAL, JHAGADIA Zhigang Yuan Sarjo Kanyi Xu Ling Khalid A. Al- Mohammadi Petja I. Vassileva Miriam R. Cano Ashok Rangarajan St Andre de Tinre, Parakou Nicholas Sargent Ruharo Eye Centre Abdull M Mahdi C. M. Moorman Manfred Mrchen Febo Domla Chugi Reeta Gurung Swati Vijay Zawar Ashaye, A.O. and Olusanya, B.A. Adepoju Feyi Grace Abhishek B Dagar David Pahau Tina Eusebio

Mandeville Lahore Stone Town, Zanzibar Madang Morgenster/Masvingo Bangalore,Karnataka Kaduna Dhaka Dhaka Nekemte Nkhoma Tehran Novi Sad, Lahore Dhakot, Gurgaon, Haryana Khulna Bandar Seri Begawan Samara ans Syzran Melbourne Mbarara Dhaka Satna, Madhya Pradesh Semey Bharuch district, Gujarat Taiyuan Banjul Shenyang Taiz city Sofia Asuncin Yola Parakou Jerusalem Bratislava Bauchi Aylesbury Takeo Llhasa Kathmandu Nashik Ibadan Ilorin New Delhi Wewak, East Sepik Province Bacolod

Mandeville Regional Hospital Mayo Hospital Lahore Mnazi Mmoja Hospital Modilon General Hospital Morgenster Hospital Narayana Nethralaya National Eye Centre National Institute Of Ophthalmology National Institute of Ophthalmology and Hospital Nekemte Community Rural Eye Clinic Nkhoma Eye Hospital Noor Eye Hospital Novi Sad Om Indu Jain Rural Hospital Rev. Abdul Wadud Memorial Hospital RIPAS Hospital Regional Medical Center Royal Victorian Eye and Ear Hospital Ruharo Eye Centre SHAHEED SURAWARDY HOSPITAL Sadguru Netra Chikitsalaya Semey Microsurgery Centre Sewa Rural hospital Shanxi Eye Hospital Sheikh Zayed Regional Eye Care Center Shenyang He Eye Clinic Skin and Venereal diseases Hospital / City of Light Sobal Academic Pashev Social Security Central Hospital Specialist Hospital St Andre de Tinre St. John Eye Hospital- Jerusalem St.Cyril and Method Hospital State Specialist hospital Stoke Mandeville Hospital, Bucks Hospital Trust Takeo Eye Hospital Tibet Autonomous Region Tibet Hospital Tilganga Institute of Ophthalmology Tulsi Eye Hospital University College Hospital University of Ilorin Teaching Hospital Venu Eye Institute & Research Centre Wewak General Hospital Riverside medical center