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Innovative Approaches in the Delivery of Eye Care: Cataract

  • Varshini VaradarajEmail author
  • Rohit C. Khanna
  • Nathan Congdon
Chapter
Part of the Essentials in Ophthalmology book series (ESSENTIALS)

Abstract

Cataract is a significant cause of visual impairment and leading cause of blindness worldwide, with most of those affected residing in developing countries. While prevention of cataract has thus far proven mostly unsuccessful, it is a condition that is highly amenable to and easily treated with surgery. Despite it being a simple and cost-effective procedure, unavailability of surgical services coupled with barriers to accessing and affording services is responsible for the overwhelming numbers in some parts of the world.

Some developing countries have successfully implemented policies and programs at a national level that have been effective in tackling the cataract burden, while others are yet to follow suit. Development of comprehensive eye care services where they are lacking, and strengthening of existing eye care systems to increase cataract surgical quality and quantity is imperative to addressing the cataract problem. Evaluation of existing services using proven performance indicators, production of adequate numbers of qualified surgeons through fortification of surgical training programs, and the use of reliable tools for the assessment of surgical quality are vital to this process.

Here, in this chapter, we discuss the global burden and distribution of cataract, risk factors for cataract development, methods for the assessment of cataract surgical output, coverage, and quality of surgical outcomes, and focus on providing examples of some successfully implemented models of cataract surgical training and delivery of care in the world.

Keywords

Cataract Successful cataract models Cataract surgical training Cataract surgery quality monitoring Cataract care in developing countries 

References

  1. 1.
    Khairallah M, Kahloun R, Bourne R, Limburg H, Flaxman SR, Jonas JB, et al. Number of people blind or visually impaired by cataract worldwide and in world regions, 1990 to 2010 worldwide prevalence of cataract, 1990–2010. Invest Ophthalmol Vis Sci. 2015;56(11):6762–9.CrossRefGoogle Scholar
  2. 2.
    Bourne RR, Stevens GA, White RA, Smith JL, Flaxman SR, Price H, et al. Causes of vision loss worldwide, 1990–2010: a systematic analysis. Lancet Glob Health. 2013;1(6):e339–e49.CrossRefGoogle Scholar
  3. 3.
    Knudtson MD, Klein BE, Klein R. Age-related eye disease, visual impairment, and survival: the Beaver Dam Eye Study. Arch Ophthalmol. 2006;124(2):243–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Khanna RC, Murthy GV, Giridhar P, Krishnaiah S, Pant HB, Shantha GPS, et al. Cataract, visual impairment and long-term mortality in a rural cohort in India: the Andhra Pradesh Eye Disease Study. PLoS One. 2013;8(10):e78002.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Ono K, Hiratsuka Y, Murakami A. Global inequality in eye health: country-level analysis from the Global Burden of Disease Study. Am J Public Health. 2010;100(9):1784.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Rao GN, Khanna R, Payal A. The global burden of cataract. Curr Opin Ophthalmol. 2011;22(1):4–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Vashist P, Talwar B, Gogoi M, Maraini G, Camparini M, Ravindran RD, et al. Prevalence of cataract in an older population in India: the India study of age-related eye disease. Ophthalmology. 2011;118(2):272–8. e2PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Group EDPR. Prevalence of cataract and pseudophakia/aphakia among adults in the United States. Arch Ophthalmol. 2004;122(4):487.CrossRefGoogle Scholar
  9. 9.
    Klein BE, Klein R, Linton KL. Prevalence of age-related lens opacities in a population: the Beaver Dam Eye Study. Ophthalmology. 1992;99(4):546–52.PubMedCrossRefGoogle Scholar
  10. 10.
    Das B, Thompson J, Patel R, Rosenthal A. The prevalence of age related cataract in the Asian community in Leicester: a community based study. Eye. 1990;4(5):723–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Dandona L, Dandona R, Naduvilath TJ, McCarty CA, Srinivas M, Mandal P, et al. Burden of moderate visual impairment in an urban population in southern India. Ophthalmology. 1999;106(3):497–504.PubMedCrossRefGoogle Scholar
  12. 12.
    Giuffrè G, Giammanco R, Di Pace F, Ponte F. Casteldaccia eye study: prevalence of cataract in the adult and elderly population of a Mediterranean town. Int Ophthalmol. 1994;18(6):363–71.PubMedCrossRefGoogle Scholar
  13. 13.
    McCarty CA, Nanjan MB, Taylor HR. Operated and unoperated cataract in Australia. Clin Exp Ophthalmol. 2000;28(2):77–82.PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Mohan M, Sperduto RD, Angra SK, Milton RC, Mathur RL, Underwood BA, et al. India-US case-control study of age-related cataracts. Arch Ophthalmol. 1989;107(5):670–6.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Thompson JR. The demand incidence of cataract in Asian immigrants to Britain and their descendants. Br J Ophthalmol. 1989;73(12):950–4.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Javitt JC, Taylor HR. Cataract and latitude. Doc Ophthalmol. 1995;88(3–4):307–25.CrossRefGoogle Scholar
  17. 17.
    Nirmalan P, Robin A, Katz J, Tielsch J, Thulasiraj R, Krishnadas R, et al. Risk factors for age related cataract in a rural population of southern India: the Aravind Comprehensive Eye Study. Br J Ophthalmol. 2004;88(8):989–94.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Seddon J, Fong D, West SK, Valmadrid CT. Epidemiology of risk factors for age-related cataract. Surv Ophthalmol. 1995;39(4):323–34.CrossRefGoogle Scholar
  19. 19.
    Hodge WG, Whitcher JP, Satariano W. Risk factors for age-related cataracts. Epidemiol Rev. 1994;17(2):336–46.CrossRefGoogle Scholar
  20. 20.
    Kahn HA, Leibowitz HM, Ganley JPK, Mohandas M, Colton T, Nickerson RS, Dawber TR. The Framingham eye study I. Outline and major prevalence findings. Am J Epidemiol. 1977;106(1):17–32.PubMedCrossRefGoogle Scholar
  21. 21.
    Kanthan GL, Mitchell P, Rochtchina E, Cumming RG, Wang JJ. Myopia and the long-term incidence of cataract and cataract surgery: the Blue Mountains Eye Study. Clin Exp Ophthalmol. 2014;42(4):347–53.PubMedCrossRefGoogle Scholar
  22. 22.
    Pan C-W, Cheng C-Y, Saw S-M, Wang JJ, Wong TY. Myopia and age-related cataract: a systematic review and meta-analysis. Am J Ophthalmol. 2013;156(5):1021–33. e1.PubMedCrossRefGoogle Scholar
  23. 23.
    West S, Munoz B, Emmett EA, Taylor HR. Cigarette smoking and risk of nuclear cataracts. Arch Ophthalmol. 1989;107(8):1166–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Delcourt C, Cristol J-P, Tessier F, Léger CL, Michel F, Papoz L, et al. Risk factors for cortical, nuclear, and posterior subcapsular cataracts: the POLA study. Am J Epidemiol. 2000;151(5):497–504.PubMedCrossRefGoogle Scholar
  25. 25.
    Leske MC, Wu S-Y, Hennis A, Connell AM, Hyman L, Schachat A, et al. Diabetes, hypertension, and central obesity as cataract risk factors in a black population: The Barbados Eye Study11Members of the Barbados Eye Study Group are listed in the Appendix at the end of this article. Ophthalmology. 1999;106(1):35–41.PubMedCrossRefGoogle Scholar
  26. 26.
    Amos AF, McCarty DJ, Zimmet P. The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabet Med. 1997;14(S5):S7–S85.CrossRefGoogle Scholar
  27. 27.
    Bochow TW, West SK, Azar A, Munoz B, Sommer A, Taylor HR. Ultraviolet light exposure and risk of posterior subcapsular cataracts. Arch Ophthalmol. 1989;107(3):369–72.PubMedCrossRefGoogle Scholar
  28. 28.
    Hiller R, Podgor MJ, Sperduto RD, Nowroozi L, Wilson PW, D’Agostino RB, et al. A longitudinal study of body mass index and lens opacities: the Framingham studies. Ophthalmology. 1998;105(7):1244–50.PubMedCrossRefGoogle Scholar
  29. 29.
    Glynn RJ, Christen WG, Manson JE, Bernheimer J, Hennekens CH. Body mass index: an independent predictor of cataract. Arch Ophthalmol. 1995;113(9):1131–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Cumming RG, Mitchell P, Leeder SR. Use of inhaled corticosteroids and the risk of cataracts. N Engl J Med. 1997;337(1):8–14.PubMedCrossRefGoogle Scholar
  31. 31.
    Urban RC, Cotlier E. Corticosteroid-induced cataracts. Surv Ophthalmol. 1986;31(2):102–10.PubMedCrossRefGoogle Scholar
  32. 32.
    Hammond CJ, Duncan DD, Snieder H, de Lange M, West SK, Spector TD, et al. The heritability of age-related cortical cataract: the twin eye study. Invest Ophthalmol Vis Sci. 2001;42(3):601–5.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Congdon N, Broman KW, Lai H, Munoz B, Bowie H, Gilbert D, et al. Cortical, but not posterior subcapsular, cataract shows significant familial aggregation in an older population after adjustment for possible shared environmental factors. Ophthalmology. 2005;112(1):73–7.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Hammond CJ, Snieder H, Spector TD, Gilbert CE. Genetic and environmental factors in age-related nuclear cataracts in monozygotic and dizygotic twins. N Engl J Med. 2000;342(24):1786–90.PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Congdon N, Broman KW, Lai H, Munoz B, Bowie H, Gilber D, et al. Nuclear cataract shows significant familial aggregation in an older population after adjustment for possible shared environmental factors. Invest Ophthalmol Vis Sci. 2004;45(7):2182.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Hollows F, Moran D. Cataract-the ultraviolet risk factor. Lancet. 1981;318(8258):1249–50.CrossRefGoogle Scholar
  37. 37.
    McCarty C, Taylor H. A review of the epidemiologic evidence linking ultraviolet radiation and cataracts; progress in lens and cataract research. Dev Ophthalmol. 2002;35:21–31.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Sperduto RD, Hu TS, Milton RC. The linxian cataract studies. Two nutrition intervention trials. Arch Ophthalmol. 1993;11:1246–53.CrossRefGoogle Scholar
  39. 39.
    Christen WG, Glynn RJ, Manson JE, MacFadyen J, Bubes V, Schvartz M, et al. Effects of multivitamin supplement on cataract and age-related macular degeneration in a randomized trial of male physicians. Ophthalmology. 2014;121(2):525–34.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Chew EY, SanGiovanni JP, Ferris FL, Wong WT, Agron E, Clemons TE, et al. Lutein/zeaxanthin for the treatment of age-related cataract: AREDS2 randomized trial report no. 4. JAMA Ophthalmol. 2013;131(7):843–50.PubMedCrossRefGoogle Scholar
  41. 41.
    Age-Related Eye Disease Study Research Group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E and beta carotene for age-related cataract and vision loss: AREDS report no. 9. Arch Ophthalmol. 2001;119(10):1439.PubMedCentralCrossRefPubMedGoogle Scholar
  42. 42.
    McCarty CA, Nanjan MB, Taylor HR. Attributable risk estimates for cataract to prioritize medical and public health action. Invest Ophthalmol Vis Sci. 2000;41(12):3720–5.PubMedGoogle Scholar
  43. 43.
    Congdon NG, Friedman DS, Lietman T. Important causes of visual impairment in the world today. JAMA. 2003;290(15):2057–60.PubMedCrossRefGoogle Scholar
  44. 44.
    Abdullah A, Husten C. Promotion of smoking cessation in developing countries: a framework for urgent public health interventions. Thorax. 2004;59(7):623–30.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Fielding JE. Smoking: health effects and control. N Engl J Med. 1985;313(8):491–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Congdon NG. Prevention strategies for age related cataract: present limitations and future possibilities. Br J Ophthalmol. 2001;85(5):516–20.PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    World Health Organization. Global initiative for the elimination of avoidable blindness: action plan 2006–2011. 2007. Accessed Nov 26, 2015. Available from: http://www.vision2020.org/documents/publications/Vision2020_report.pdf.
  48. 48.
    Foster A. Vision 2020: the cataract challenge. Commun Eye Health. 2000;13(34):17–9.Google Scholar
  49. 49.
    World Health Organization. Universal eye health: a global action plan 2014–2019. Geneva: WHO; 2013. Jun 4, 2016. Available from: http://www.who.int/blindness/actionplan/en/.Google Scholar
  50. 50.
    Limburg H, Kumar R, Indrayan A, Sundaram K. Rapid assessment of prevalence of cataract blindness at district level. Int J Epidemiol. 1997;26(5):1049–54.PubMedCrossRefGoogle Scholar
  51. 51.
    Kuper H, Polack S, Limburg H. Rapid assessment of avoidable blindness. Commun Eye Health. 2006;19(60):68.Google Scholar
  52. 52.
    Rapid assessment of avoidable blindness. Dec 11, 2015. Available from: http://www.raabdata.info/repository/.
  53. 53.
    Limburg H, Foster A, Gilbert C, Johnson G, Kyndt M, Myatt M. Routine monitoring of visual outcome of cataract surgery. Part 2: results from eight study centres. Br J Ophthalmol. 2005;89(1):50–2.PubMedPubMedCentralCrossRefGoogle Scholar
  54. 54.
    Limburg H, Foster A, Gilbert C, Johnson G, Kyndt M. Routine monitoring of visual outcome of cataract surgery. Part 1: development of an instrument. Br J Ophthalmol. 2005;89(1):45–9.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    World Health Organization. Informal consultation on analysis of blindness prevention outcomes. Geneva; 1998. Nov 26, 2015. Available from: http://apps.who.int/iris/bitstream/10665/67843/1/WHO_PBL_98.68.pdf.
  56. 56.
    Congdon N, Yan X, Lansingh V, Sisay A, Müller A, Chan V, et al. Assessment of cataract surgical outcomes in settings where follow-up is poor: PRECOG, a multicentre observational study. Lancet Glob Health. 2013;1(1):e37–45.PubMedCrossRefGoogle Scholar
  57. 57.
    Jiang Y, Foster PJ. Quality assessment of cataract surgery in regions with low follow-up rates. Lancet Glob Health. 2013;1(1):e9–e10.PubMedCrossRefGoogle Scholar
  58. 58.
    Limburg H. Monitoring cataract surgical outcomes: methods and tools. Commun Eye Health. 2002;15(44):51.Google Scholar
  59. 59.
    BOOST (Better Operative Outcomes Software Tool). Dec 5, 2015. Available from: http://www.iapb.org/blog/cataract-boost-story.
  60. 60.
    Wang W, Yan W, Fotis K, Prasad NM, Lansingh VC, Taylor HR, et al. Cataract surgical rate and socioeconomics: a global study cataract surgical rate and socioeconomics. Invest Ophthalmol Vis Sci. 2016;57(14):5872–81.PubMedCrossRefGoogle Scholar
  61. 61.
    Muecke J, Sia DI, Newland H, Casson RJ, Selva D. Perspective on ophthalmic support in countries of the developing world. Clin Exp Ophthalmol. 2013;41(3):263–71.PubMedGoogle Scholar
  62. 62.
    Johns A. The International Agency for the Prevention of Blindness and non-governmental organisations: an effective network. Int Ophthalmol. 1990;14(3):227–30.PubMedCrossRefGoogle Scholar
  63. 63.
    Jose R, Bachani D. World Bank-assisted cataract blindness control project. Indian J Ophthalmol. 1995;43(1):35.PubMedGoogle Scholar
  64. 64.
    Murthy G, Gupta SK, John N, Vashist P. Current status of cataract blindness and vision 2020: the right to sight initiative in India. Indian J Ophthalmol. 2008;56(6):489.PubMedPubMedCentralCrossRefGoogle Scholar
  65. 65.
    Murthy GV, Vashist P, John N, Pokharel G, Ellwein LB. Prevalence and causes of visual impairment and blindness in older adults in an area of India with a high cataract surgical rate. Ophthalmic Epidemiol. 2010;17(4):185–95.PubMedPubMedCentralCrossRefGoogle Scholar
  66. 66.
    Natchiar G, Robin AL, Thulasiraj RD, Krishnaswamy S. Attacking the backlog of India’s curable blind: the Aravind Eye Hospital model. Arch Ophthalmol. 1994;112(7):987–93.PubMedCrossRefGoogle Scholar
  67. 67.
    Ravilla T, Ramasamy D. Efficient high-volume cataract services: the Aravind model. Commun Eye Health. 2014;27(85):7.Google Scholar
  68. 68.
    Sommer A, Taylor HR, Ravilla TD, West S, Lietman TM, Keenan JD, et al. Challenges of ophthalmic care in the developing world. JAMA Ophthalmol. 2014;132(5):640–4.PubMedPubMedCentralCrossRefGoogle Scholar
  69. 69.
    Bhandari A, Dratler S, Raube K, Thulasiraj R. Specialty care systems: a pioneering vision for global health. Health Aff (Millwood). 2008;27(4):964–76.CrossRefGoogle Scholar
  70. 70.
    Glasziou P, Straus S, Brownlee S, Trevena L, Dans L, Guyatt G, et al. Evidence for underuse of effective medical services around the world. Lancet. 2017;390:169–77.PubMedCrossRefGoogle Scholar
  71. 71.
    Rao GN, Khanna RC, Athota SM, Rajshekar V, Rani PK. Integrated model of primary and secondary eye care for underserved rural areas: the LV Prasad Eye Institute experience. Indian J Ophthalmol. 2012;60(5):396.PubMedPubMedCentralCrossRefGoogle Scholar
  72. 72.
    Broyles JR, Glick P, Hu J, Lim Y-W. Cataract blindness and simulation-based training for cataract surgeons: an assessment of the HelpMeSee approach. Santa Monica: RAND Corporation, TR-1303-HMI, 2012. Dec 15, 2015. Available from: http://www.rand.org/pubs/technical_reports/TR1303.html.
  73. 73.
    He Eye Care System. Jan 3, 2016. Available from: http://fm.hsyk.com.cn/english/intro.html.
  74. 74.
    Lewallen S, Thulasiraj R. Eliminating cataract blindness–how do we apply lessons from Asia to sub-Saharan Africa? Glob Public Health. 2010;5(6):639–48.PubMedCrossRefGoogle Scholar
  75. 75.
    Yan X, Guan C, Mueller A, Iezzi B, He M, Liang H, et al. Outcomes and projected impact on vision restoration of the China Million Cataract Surgeries Program. Ophthalmic Epidemiol. 2013;20(5):294–300.PubMedCrossRefGoogle Scholar
  76. 76.
    Young AL, Jhanji V, Liang Y, Congdon N, Chow S, Wang F, et al. A survey of perceived training differences between ophthalmology residents in Hong Kong and China. BMC Med Educ. 2015;15(1):158.PubMedPubMedCentralCrossRefGoogle Scholar
  77. 77.
    World Health Organization. Blindness as a public health problem in China; global initiative for the elimination of avoidable blindness. Fact Sheet. Geneva: WHO; 2013. Jun 6, 2016. Available from: http://www.who.int/mediacentre/factsheets/fs230/en/.Google Scholar
  78. 78.
    Yan X, Guan C, Tan L, Mueller A, Iezzi B, He M, et al. Outcomes from the China Million Cataract Surgeries Program. Invest Ophthalmol Vis Sci. 2012;53(14):2293.Google Scholar
  79. 79.
    Salowi MA. Report on the National Eye Survey 2014. Kuala Lumpur.Google Scholar
  80. 80.
    Lansingh VC, Resnikoff S, Tingley-Kelley K, Nano ME, Martens M, Silva JC, et al. Cataract surgery rates in Latin America: a four-year longitudinal study of 19 countries. Ophthalmic Epidemiol. 2010;17(2):75–81.PubMedCrossRefGoogle Scholar
  81. 81.
    Missoni E, Solimano G. Towards universal health coverage: the Chilean experience. World health report. 2010.Google Scholar
  82. 82.
    Guía Clínica 2010 Tratamiento Quirúrgico de Cataratas congénitas y adquiridas [Clinic Guide 2010 for Surgical Treatment of congenital and acquired cataract]. Santiago: Ministerio de Salud [Ministry of Health][In Spanish]; 2010.Google Scholar
  83. 83.
    World Bank. Jun 16, 2016. Available from: http://data.worldbank.org/indicator/SP.POP.TOTL.
  84. 84.
    Frenk J, Gómez-Dantés O, Knaul FM. The democratization of health in Mexico: financial innovations for universal coverage. Bull World Health Organ. 2009;87(7):542–8.PubMedPubMedCentralCrossRefGoogle Scholar
  85. 85.
    Aracena-Genao B, González-Robledo MC, González-Robledo LM, Palacio-Mejía LS, Nigenda-López G. Fund for protection against catastrophic expenses [Article in Spanish]. Salud Publica Mex. 2011;53:407–15.PubMedCrossRefGoogle Scholar
  86. 86.
    Brian G, Ramke J, Szetu J, Qoqonokana MQ. Cataract and its surgery in Fiji. Clin Exp Ophthalmol. 2011;39(5):449–55.PubMedCrossRefGoogle Scholar
  87. 87.
    du Toit R, Brian G, Palagyi A, Williams C, Ramke J. Education of eye health professionals to meet the needs of the Pacific. NZ Med J. 2009;122(1291):69–76.Google Scholar
  88. 88.
  89. 89.
    Magrabi Foundation. Jan 2, 2016. Available from: http://magrabi.org.
  90. 90.
    Chibuga E, Massae P, Geneau R, Mahande M, Lewallen S, Courtright P. Acceptance of cataract surgery in a cohort of Tanzanians with operable cataract. Eye. 2008;22(6):830–3.CrossRefGoogle Scholar
  91. 91.
    Lewallen S, Courtright P. Blindness in Africa: present situation and future needs. Br J Ophthalmol. 2001;85(8):897–903.PubMedPubMedCentralCrossRefGoogle Scholar
  92. 92.
    Lewallen S, Roberts H, Hall A, Onyange R, Temba M, Banzi J, et al. Increasing cataract surgery to meet vision 2020 targets; experience from two rural programmes in east Africa. Br J Ophthalmol. 2005;89(10):1237–40.PubMedPubMedCentralCrossRefGoogle Scholar
  93. 93.
    Oye JE, Kuper H. Prevalence and causes of blindness and visual impairment in Limbe urban area, South West Province, Cameroon. Br J Ophthalmol. 2007;91(11):1435–9.PubMedPubMedCentralCrossRefGoogle Scholar
  94. 94.
    Sommer A. Professor of epidemiology and ophthalmology at Johns Hopkins University, Personal communication. 2017.Google Scholar
  95. 95.
    Karumanchi SM, Ravilla T. Increasing sustainable cataract services in sub-Saharan Africa: an experimental initiative. Commun Eye Health J. 2014;27(88):73.Google Scholar
  96. 96.
    Samandari R, Kleefield S, Hammel J, Mehta M, Crone R. Privately funded quality health care in India: a sustainable and equitable model. Int J Qual Health Care. 2001;13(4):283–8.CrossRefGoogle Scholar
  97. 97.
    Global Sight Initiative. 09.01.16. Available from: http://globalsightinitiative.org.
  98. 98.
    Resnikoff S, Felch W, Gauthier T-M, Spivey B. The number of ophthalmologists in practice and training worldwide: a growing gap despite more than 200,000 practitioners. Br J Ophthalmol. 2012;96(6):783–7.CrossRefGoogle Scholar
  99. 99.
    ACGME Institutional Requirements. Dec 3, 2015. Available from: http://www.acgme.org/acgmeweb/Portals/0/InstitutionalRequirements_07012014.pdf.
  100. 100.
    ACGME. Required minimum number of procedures for graduating residents in ophthalmology. Review Committee for Ophthalmology. Dec 3, 2016. Available from: http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramResources/240_Oph_Minimum_Numbers.pdf.
  101. 101.
    Yeu E, Reeves SW, Wang L, Randleman JB, Physicians AY, Committee RC. Resident surgical experience with lens and corneal refractive surgery: survey of the ASCRS Young Physicians and Residents Membership. J Cataract Refract Surg. 2013;39(2):279–84.PubMedPubMedCentralCrossRefGoogle Scholar
  102. 102.
    McDonnell PJ, Kirwan TJ, Brinton GS, Golnik KC, Melendez RF, Parke DW, et al. Perceptions of recent ophthalmology residency graduates regarding preparation for practice. Ophthalmology. 2007;114(2):387–91. e3.PubMedCrossRefGoogle Scholar
  103. 103.
    Wiggins MN, Warner DB. Resident physician operative times during cataract surgery. Ophthal Surg Lasers Imaging Retin. 2010;41(5):518.CrossRefGoogle Scholar
  104. 104.
    Singapore Country Addendum to the ACGME-I advanced specialty requirements. Dec 4, 2015. Available from: http://www.healthprofessionals.gov.sg/content/hprof/sab/en/topnav/specialist_training/residency/country_addendum.html.
  105. 105.
    Chan W, Saedon H, Falcon M. Postgraduate ophthalmic training: how do we compare? Eye. 2011;25(8):965.PubMedPubMedCentralCrossRefGoogle Scholar
  106. 106.
    Mitchell P. Ophthalmology in Australia. Arch Ophthalmol. 2002;120(10):1375–6.PubMedCrossRefGoogle Scholar
  107. 107.
    Murthy G, Gupta SK, Bachani D, Sanga L, John N, Tewari HK. Status of speciality training in ophthalmology in India. Indian J Ophthalmol. 2005;53(2):135.PubMedCrossRefGoogle Scholar
  108. 108.
    Thomas R, Dogra M. An evaluation of medical college departments of ophthalmology in India and change following provision of modern instrumentation and training. Indian J Ophthalmol. 2008;56(1):9.PubMedPubMedCentralCrossRefGoogle Scholar
  109. 109.
    Thomas R, Paul P, Rao GN, Muliyil J, Mathai A. Present status of eye care in India. Surv Ophthalmol. 2005;50(1):85–101.PubMedCrossRefGoogle Scholar
  110. 110.
  111. 111.
    RANZCO (Royal Australian and New Zealand College of Ophthalmologists). Dec 3, 2015. Available from: https://ranzco.edu/international-development/international-programs.
  112. 112.
    Courtright P, Ndegwa L, Msosa J, Banzi J. Use of our existing eye care human resources: assessment of the productivity of cataract surgeons trained in eastern Africa. Arch Ophthalmol. 2007;125(5):684–7.PubMedCrossRefGoogle Scholar
  113. 113.
    Bode CO, Nwawolo CC, Giwa-Osagie OF. Surgical education at the West African College of Surgeons. World J Surg. 2008;32(10):2162–6.PubMedCrossRefGoogle Scholar
  114. 114.
    Congdon NG, Aung T. A tale of two systems: health reform in China and the United States. Ophthalmology. 2010;117(3):407–8.PubMedCrossRefGoogle Scholar
  115. 115.
    Thomas R. Residency training programs in India. Indian J Ophthalmol. 2008;56(6):525.PubMedPubMedCentralCrossRefGoogle Scholar
  116. 116.
    Choi K-S, Soo S, Chung F-L. A virtual training simulator for learning cataract surgery with phacoemulsification. Comput Biol Med. 2009;39(11):1020–31.PubMedCrossRefGoogle Scholar
  117. 117.
    Help Me See. Dec 17, 2015. Available from: http://helpmesee.org.
  118. 118.
    IAPB. 09.1.16. Available from: http://www.iapb.org/vision-2020/global-facts.
  119. 119.
    Bastawrous A, Rono HK, Livingstone IA, Weiss HA, Jordan S, Kuper H, et al. Development and validation of a smartphone-based visual acuity test (peek acuity) for clinical practice and community-based fieldwork. JAMA Ophthalmol. 2015;133(8):930–7.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Varshini Varadaraj
    • 1
    Email author
  • Rohit C. Khanna
    • 2
  • Nathan Congdon
    • 3
    • 4
    • 5
  1. 1.Johns Hopkins University School of Medicine, The Dana Center for Preventive Ophthalmology, Wilmer Eye InstituteBaltimoreUSA
  2. 2.L V Prasad Eye InstituteHyderabadIndia
  3. 3.Translational Research for Equitable Eyecare (TREE) Centre, Centre for Public HealthQueen’s University BelfastBelfastUK
  4. 4.State Key Laboratory of Ophthalmology and Division of Preventive Ophthalmology of Zhongshan Ophthalmic CenterSun Yat-sen UniversityGuangzhouChina
  5. 5.ORBIS InternationalNew YorkUSA

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