Bridging the Gap Between Local and Global

Meeting the burgeoning eye care needs of rapidly ageing populations across diverse locations will require greater collaboration among ophthalmic societies worldwide, according to a panel of society leaders discussing the topic at the ESCRS Annual Congress in Barcelona. Close cooperation with patients, governments, regulators, and industry will also be needed to foster the innovation required to manage demands that outpace growth in ophthalmologist supply.

Reaching rural patients

With 60% of the world’s population and the largest land mass, Asia is a prime example of the challenges, said Ronald Yeoh, president of the International Ocular Implant Club and past president of APACRS. Across four dozen countries with hundreds of languages, geographic conditions range from lowland tropical cities to remote mountain, desert, and island villages.

“In big cities, it is no issue, but getting out to the rural areas is difficult. It can create quality issues. Education and delivery of clinical services are challenges,” Dr Yeoh said. He sees encouraging national societies and different countries to participate in education and outreach programmes as essential.

Europe faces a similar landscape, but to a lesser extent, said Professor Filomena Ribeiro MD, PhD, ESCRS president. “We have the EU, which tries to provide equality among all countries.” Still, access to services varies, and multiple governments, payment schemes, and cultures make standardisation and collaboration challenging.

Brazil faces similar issues reaching patients in remote areas such as the Amazon, said Durval M Carvalho Jr, president of BRASCRS. “We access by river, trying to give more to isolated people. It’s not easy for us, we have a lot of patients. We did one million cataract surgeries last year, but it’s not enough.”

Two years ago, Australia addressed the same problem by creating a training programme to train rural and remote ophthalmologists, noted Jacqueline Beltz, co-president and secretary/treasurer of AUSCRS. It combines taking specialty and surgical simulation training in cities with rotations in rural areas.

Creating peer-to-peer support networks for rural surgeons is an important part of the programme, Dr Beltz said. Working with payers to create viable funding models is another feature. “It takes a lot of collaboration. If it doesn’t work, we need to try something else.”

Regulation and sustainability

Adopting sustainable practices, such as using the ESCRS-recommended cat pack, can help ophthalmologists do more with less. However, regulations at every level can create barriers, Prof Ribeiro said.

Stephen D McLeod MD, CEO of the AAO, agreed. “There’s no question individual choices are a big part, but you run into roadblocks of what is allowed by regulatory agencies.” Long-term advocacy is required to change regulations. “It’s frustrating, but you need to keep pushing. It is an important component of a long-term solution.”

National and international societies can help by jointly creating evidence-based guidelines for reusing and recycling medical supplies and standardising requirements for electronic medical records and devices, Prof Ribeiro added. Better educating trainees to avoid complications, which are expensive and time consuming, is another key to increasing efficiency.

Making the most of new technologies, such as telemedicine, remote monitoring, and gene therapy, also helps maximise efficiency, said Prof Vance Thompson MD, president of the ASCRS. “We all have teams supporting us who are willing to work as long as we train them well.”

At a time of decreasing reimbursement and increasing costs, effective practice management is critical, Prof Thompson added. Understanding that patients are willing to invest to receive better care is part of the solution. “We need to be better not only at keeping up our surgical and medical skills, but the business of what we do.”

AI in ophthalmology

While radiology and cardiology have the most approved AI applications, its use in ophthalmology is growing, Dr McLeod noted. He suggested that radiology applications are largely binary—either there is pathology or there is not—and cardiology applications are largely volumetric. Dermatology, on the other hand, is more pattern recognition and, therefore, harder for AI to assess.

“Ophthalmology is kind of in the middle,” he said. “Applications in [radiology and cardiology] are much more straightforward, but we will catch up.”

Dr Yeoh questioned that ophthalmology is behind, particularly with retinal imaging. “It depends on who you ask. Young doctors are fine with AI.” Currently it may be more useful for large-scale screening than individual case decision-making, he added. “We need to figure out how to make it more clinically relevant.” For example, AI may have a role in deciding which IOL is best for a given patient. 

All comments were made during iNovation Day at the 2024 ESCRS Congress in Barcelona. Jim Mazzo of Neurotech Pharmaceuticals chaired the session.

Ronald Yeoh MBBS, FRCOphth is the medical director and founding partner of Eye & Retina Surgeons, Singapore, a faculty member at the Singapore National Eye Centre, board member of the APACRS, and president of the International Ocular Implant Club.

Filomena Ribeiro MD, PhD, FEBO is head of ophthalmology at Hospital da Luz, Lisbon, Portugal, associate editor of the Journal of Cataract and Refractive Surgery, and president of the ESCRS. filomenajribeiro@gmail.com

Durval M Carvalho Jr MS, MSurg, MChir, MCh is a cataract and glaucoma surgeon at Centro Brasileiro da Visão, Brasilia, Brazil, and president of the BRASCRS.

Jacqueline Beltz BMedSci, MBBS(Hons), MSurgEd, FRANZCO is an ophthalmologist at Eye Surgery Associates, Melbourne, Australia, and co-president/ secretary-treasurer of AUSCRS.

Stephen D McLeod MD is CEO of AAO and former head of ophthalmology at the University of California, San Francisco, US. mcleods@vision.ucsf.edu

Vance Thompson MD is founder and director of Vance Thompson Vision and professor of ophthalmology at the University of South Dakota Sanford School of Medicine, both in Sioux Falls, South Dakota, US, and president of the ASCRS. thompsov@siouxvalley.org