Eyeworld Daily News

52 | EYEWORLD DAILY NEWS | MAY 6, 2019 ASCRS SYMPOSIA ASCRS ASOA ANNUAL MEETING by Vanessa Caceres EyeWorld Contributing Writer Yousuf Khalifa, MD, Atlanta, who described his telementoring program that has expanded to developing countries such as Peru; and Jeff Pettey, MD, Salt Lake City, who addressed engaging residents in global ophthalmology efforts. Editors' note: Dr. Kahook has financial interests with Alcon, Johnson & John- son Vision, New World Medical, and other ophthalmic companies. Dr. Khalifa has financial interests with Carl Zeiss Meditec. Dr. MacDonald has financial interests with Carl Zeiss Meditec and Perfect Lens. Drs. Crandall, Pettey, and Vivekanandan have no related financial interests. is less resource dependent than other choices. Dr. Kahook would like to see glaucoma drainage devices eventually used more in global ophthalmology and would like better diagnostics to take place, to help catch disease before it becomes severe. One other pearl from Dr. Kahook: Several large ophthalmic companies, including Alcon, Al- lergan, Glaukos, and New World Medical, often provide help with global missions related to ophthal- mology and can be a resource. Other presenters during the session included David Crandall, MD, Detroit, who addressed miLOOP (Carl Zeiss Meditec), a device used to section the nucleus; more effective with phaco. How- ever, MSICS is a shorter proce- dure, and it can be a better option for some of the more difficult cases that surgeons face in devel- oping countries. Much of global ophthalmolo- gy efforts have focused on cataract surgery, but Malik Kahook, MD, Aurora, Colorado, is encouraged to see other eye disease treatments underway, including for glaucoma, the third leading cause of global blindness. However, there has been a general lack of evidence- based medicine for global treat- ments for glaucoma, he said. Dr. Kahook then shared a few pearls. When choosing glaucoma treatments for less developed countries, consider location. In urban areas, there will be better access to medications and more skilled surgeons, Dr. Kahook said. In rural areas, there will usually be more patients with end-stage disease. Another consideration is your own skill set. "We have to know ourselves when going to a differ- ent country," he said. This means performing the glaucoma proce- dure that you know best. Focus on skills transfer to help those who live and work in the area regularly. If you have a specialized skill set, such as pedi- atric glaucoma, offer that experi- ence. Also, know in advance the minimum amount of experience needed to provide your help via global ophthalmology programs. It may sound exciting to offer novel devices to other countries, but think sustainability first, Dr. Kahook cautioned. Stick with de- vices and procedures you've used multiple times. Overall, cataract surgery is the best glaucoma treatment for resource-poor areas, Dr. Kahook thinks. "It can lower IOP, it's sustainable, and it's cost effective," he said. Second to cataract surgery is trabeculectomy. Even though it can have a high failure rate, it G lobal ophthalmology isn't about surgeons from more developed countries coming in to "save" patients or provide all of the solutions. Instead, it's about building relationships, listening closely, and learning from those practicing in resource-defi- cient areas. That was a common theme from Sunday's session, "Address- ing Avoidable Blindness and Models of Care/Training." One important part of global ophthalmology efforts is challeng- ing your assumptions, said Susan MacDonald, MD, Boston, who has worked frequently in Tanzania. Concepts such as "I have all the solutions," "Phaco is standard of care," "Politeness is approval," and "It's all about ophthalmology" often turn out to be wrong, she cautioned. Instead, "it's all about relation- ships," Dr. MacDonald said. That said, building relationships at the local level abroad, including with those from nongovernmental or- ganizations, can be time consum- ing. Be patient with the effort. As you aim to expand care to underserved areas, connect with local business organizations to find support, Dr. MacDonald advised. Although phaco is standard of care in developed countries, it's not always the best choice for global ophthalmology, where access to care is a challenge and surgical quantity is crucial. V. R. Vivekanandan, MD, who is with the Aravind system in India, discussed manual small-incision cataract surgery (MSICS) versus phaco, noting that the two ap- proaches can have similar results, although astigmatism treatment is Efforts to treat avoidable blindness across the globe require special considerations Dr. MacDonald says that it is important to challenge your long- held assumptions when participating in global ophthalmology missions.

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