VISION 2020

Eliminating the scourge of trachoma

Working together

Sharing discoveries worldwide

Educating

Expanding learning opportunities

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Global Ophthalmology Emory

COVER STORY

SCOPE

Global Ophthalmology Emory (GO-E) impacts ophthalmic health care both abroad and in Georgia, where the program serves those with little or no access to eye care, helping to narrow disparities to good medical care.

Mission

The goals of many medical outreach programs are short term. In contrast, our teams not only provide eye care for patients, they leave a lasting legacy by training physicians and allied health workers who will be caring for patients and passing along knowledge to other medical workers long after our teams return home.

Impact

The program has extended opportunities for education and patient care to 19 countries: battled infectious diseases, trachoma being a primary target; formed important partnerships and alliances; and shared our discoveries, making an impact worldwide.

 

Ethiopia, Madagascar, Vietnam and countries in Africa all have one thing in common: little access to good eye care. Where there are physicians, few have training in ophthalmology and conditions make it difficult for them to practice effectively. Conditions also hinder access to health care by prospective patients. Through Emory Eye Center's program, Global Ophthalmology Emory (GO-E), healthcare, training, and education are being effectively and quickly delivered to these and other countries around the world by Emory Eye Center physicians, with the leadership of physician Danny Haddad, GO-E's director. Haddad brings expert knowledge, contacts and insights to the table, especially in the treatment of trachoma.

“We are supporting national programs for the elimination of trachoma in Burkina Faso, Cameroon, Chad, Ethiopia, Tanzania and Zambia. In addition to the trachoma work, faculty recently participated in projects in Ethiopia, Liberia, Madagascar, Mexico and Sierra Leone,” Haddad says.

Phoebe Lenhart (’05 M; res. ’05-08; pediatric fellow ’09) served in Burundi and Zambia. Lenhart, who just returned from Africa, served with the Partners for Global Research and Development/Kilimanjaro Centre for Community Ophthalmology at their meeting in Cape Town, South Africa (January 2016). She presented “Computing For Good: A Mobile Application for Tracking Children with Cataracts." The application facilitates the referral, documentation and follow up of children with cataracts in developing countries, Lenhart said. It's development was a joint effort between students in Georgia Institute of Technology’s "Computing For Good" course, Haddad and Lenhart over the past year and a half.

Notes from the field: Yonas Tilahun, MD, associate professor, Dept of Ophthalmology, Addis Ababa University, Ethiopia

"Dear Yousuf,

Thank you so much for your time and traveling all this distance to share your experience. Your lectures were suburb and our residents have enjoyed every minute of that. The skill transfer was more beneficial to us the staff, you are a great teacher and friend. Hope to see you again with us."

Notes from the field: Andrew Anzeljc, PGY-4 ophthalmology resident, Emory Eye Center

"A portion of my current senior research project involving a 15-year retrospective review of optic nerve sheath fenestration in idiopathic intracranial hypertension was recently accepted for presentation at The 2nd Asia-Australia Congress on Controversies in Ophthalmology in Bangkok, Thailand.

This conference is attended by practicing ophthalmologists from over 30 countries including the US, Australia, Austria, Belgium, Canada, China, Egypt, France, Germany, Hong Kong, Singapore, Israel, Italy, Philippines, Russia, South Korea, Sweden, Switzerland, The Netherlands, Thailand, UK, and was held from February 18-21, 2016.

Dr. Hee Joon Kim, Emory Oculoplastics attending, and I represented the Emory Eye Center the meeting. I presented data regarding our 15-year review of repeat optic nerve sheath fenestration for idiopathic intracranial hypertension under the direct mentorship of Hee Joon Kim, Brent Hayek and Ted Wojno.

We are currently composing the manuscript for submission as this project has been well received thus far. The trip was a unique and amazing opportunity to present at an international meeting, network with attendings from around the globe and get a brief introduction to a new culture. It also provided perspective on different practice patterns in other countries.

I am very thankful that the residency program at Emory supported this type of educational activity and hope that future residents are afforded similar experiences. "

VISION 2020
Eliminating the scourge of trachoma

The year was 1996, and Netherlands medical student Danny Haddad had just seen his first example of a woman blinded by trachoma. He photographed what looked to be an older woman but in actuality she was only in her 50s. Both eyes were scarred with the telltale evidence of trachoma—advanced to its worst conclusion, total blindness. It made an indelible impression on him, and his life was forever changed.

From that point forward, his efforts have changed the lives of many in endemic countries suffering from the ravages of trachoma. The burden of the disease, only recently coming under control, impacts entire families, local communities and trachoma patients' self worth and longevity.

The leading infectious cause of blindness in the world: trachoma

Progress is being made through the efforts of the WHO’s Alliance for the Global Elimination of Trachoma by 2020 (GET2020) and the members of the International Coalition for Trachoma Control, a membership of NGOs, professional associations, eye care and research institutions, like Emory Eye Center, and corporations.  Increased awareness, identifying resources and implementing hygiene measures are strategies to facilitate disease control.

Trachoma typically is present in developing countries: it is widespread in the Middle East, North and Sub-Saharan Africa, parts of India, Southern Asia and China. There are pockets in Latin America, Australia (in remote areas) and the Pacific Islands.

Estimates are that 7.3 million people worldwide have trichiasis and need surgery. Some 2.2 million in endemic areas are visually impaired.

Trachoma more widespread among women than men. As they care for their children, the infection is passed back and forth, and they have less access to health care and are more reluctant to use it. With re-infections, blindness becomes more likely. Internal eyelid scarring and entropion lead to trichiasis and ultimately corneal scarring and blindness.

Treatments
The disease can be successfully treated with both drugs and surgery. Today, prevention is key. WHO has instituted the SAFE program that field workers are using to educate many. Its components are simple:

•  Surgery to correct trichiasis
•  Antibiotic treatment with an annual single dose of azithromycin
•  Facial cleanliness
•  Environmental changes (clean water, fly control, health education)

Mass antibiotic treatment is available to areas where active trachoma affects more than 10 percent of young children. Surgical treatment for those with end-stage trachoma is being done by nurses in many cases. A fairly simple eyelid surgery allows for the eyelid to go back to its original state instead of turning inward. 

There are opportunities for training for high-quality surgery using mannequins followed by more training and assessment. Haddad notes that some of the patients receiving surgery for trichiasis are often in need of surgery again, due to poor surgical skills, so that the focus now is on the quality of surgery.

Georgia 2020

Building on WHO’s international Vision 2020 global initiative, Georgia’s program seeks to eliminate avoidable blindness by the year 2020 as well. At present, a baseline map of where services are available is being created from lists provided by the Georgia Optometry Association and the Georgia Society of Ophthalmology. Using the state’s CDC Behavioral Risk Factor Surveillance System (BRFSS) data, needs of the populations can be assessed and plotted to availability of services.

A funded local study on community needs is being conducted by Annette Giangiacomo.

Building partnerships

Over the past two years GO-E has developed partnerships with some of the largest trachoma programs currently in place.

“Through our partnership with Helen Keller International in the USAID’s funded Morbidity Management and Disability Prevention (MMDP) Project, we support national programs that will operate on 30,000 trichiasis cases this fiscal year,” says Haddad. “Some 21,000 of those are in Ethiopia.”

GO-E's trachoma program director, Colin Beckwith, who has led a partnership with Sightsavers since 2014, is helping to manage the UK’s Department for International Development (DFID) £39M five-year grant to a consortium of non-governmental organizations.

The funding will specifically support the national trachoma programs through partnerships with many organizations in Chad, Ethiopia, Tanzania and Zambia. Beckwith brings extensive trachoma experience, having worked with CARE USA and ITI, among other public health organizations. Last year, under this project, 9 million people were treated with zithromax in endemic areas and 11,000 had surgeries performed. This year’s target is to manage 40,000 cases of trichiasis and provide 11 million with azithromycin treatments, all within 80 health districts.

With two full-time professionals working on projects around the world, GO-E is making significant inroads into the trachoma fight. Recently joining them is newly-recruited comprehensive ophthalmologist, Jacquelyn A. Jetton O’Banion, who joined the Eye Center in January 2016, as assistant director of GO-E. Her training and background in global health will be a great asset in our growing international program. 

Local and international partners

  • Emory Global Health Institute
  • Emory School of Medicine
  • Emory School of Medicine Medical Student Ophthalmology Interest Group
  • Georgia 2020
  • Georgia Lions Lighthouse
  • Helen Keller International
  • International Coalition for Trachoma Control (ICTC)
  • Kilimanjaro Center for Community Ophthalmology (KCCO)
  • Kitwe Central Hospital
  • Knights Templar Educational Foundation, Inc.
  • Malawi Eye Hospital
  • Prevent Blindness America
  • Prevent Blindness Georgia
  • ReSpectacle Project
  • Rollins School of Public Health
  • Sightsavers
  • Vision 2020
  • WHO

Alcon Foundation Pledges $150,000

Alcon Foundation has made a pledge of $150,000 over two years to establish a Global Ophthalmology Fellowship at the Emory Eye Center. The first fellow will begin in 2017. Under the direction of Danny Haddad and Jacquelyn O’Banion, and in close collaboration with the Rollins School of Public Health, this two-year fellowship, one of only four in the nation, will provide first-person experience in both local and international settings and a strong research foundation in ophthalmic public health issues.

$2 million + Funds Telemedicine Program

To help rural veterans in the VA, April Maa, Mary Lynch and Steven Urken have developed Technology-Based Eye Care Services (TECS) to provide a routine screening eye exam for veterans at their primary care clinic. TECS uses technology to deliver components of a standard eye exam to improve access and reach to specialty eye services for the veterans who need it most. The program has been very successful, receiving more than $2 million in funding from the VA over the last two years. The technology has improved patient access, detected asymptomatic eye disease and has experienced high levels of patient satisfaction.

More about Telemedicine Program