Isolated silos: As a resident and global ophthalmology fellow, I was often aware of this term.
One eye care nonprofit could have a public health project in an eye hospital in Tanzania, and a few weeks later an academic eye institute would show up at the same place with a completely different agenda. Both had great intentions, but neither fully understood the needs of the community they were trying to serve nor worked in unison.
This is why one of the goals of the annual Global Ophthalmology (GO) Summit, which took place in Atlanta this year, is to create collaboration and more cohesive working groups in hopes of breaking down silos into strong, sustainable partnerships.
The summit and its organizers are made up of a coalition between the Academy, academic institutions and eye care nonprofits. This year’s speakers were both national and international and represented physicians, public health experts, and National Institutes of Health or National Eye Institute representatives.
Global ophthalmology includes local eye care and bringing equity to the U.S., and many talks highlighted disparities in our own backyard:
Mia Woodward, MD, MS, an associate professor at the W.K. Kellogg Eye Center, and chair of the Academy’s Task Force on Ophthalmologists in Community Health Centers, discussed her task force’s initiative to improve eye health in U.S. community health centers where many uninsured and underinsured get their health care. David Rein, a public health expert from the social research group NORC at the University of Chicago, demonstrated how zip codes and neighborhoods can be an independent social determinant of eye health.
We learned from Cambridge University Professor Rupert R. Bourne, MBBS, about large population-based estimates of blindness. We also heard about real-life examples of eye health successes and learned how to find global ophthalmology opportunities from Ciku Mathenge, MD, PhD, from the Rwanda International Institute of Ophthalmology (RIIO) and Presidents of the African Ophthalmology Council..
Pawan Sinha, PhD, an MIT graduate now based in India, shared his experience with Project Prakash, where children who have been blind since birth and have low life expectancy get free sight-restoring surgery. At the same time, a greater understanding of brain development has been studied, and he has found that the brain is much more plastic than previously understood. Even a 20-year-old with white cataracts since birth can have his visual cortex begin to “light up” and function after cataract surgery, despite decades of never being stimulated.
Racial Disparities
Some of the themes that many young ophthalmologists covered this year included racism and colonialism within Global Ophthalmology and how to bring more sensitivity and equity within international research endeavors and international trainee exchange programs.
Joana Andoh, a Yale medical student with a humanities background, covered the history of racism and colonialism in medicine, including the Hippocratic oath. Duaa Sharfi, MD, my teammate on the Academy’s YO International subcommittee, discussed “Decolonizing Global Health,” which highlights the tendency to act as if more developed nations have all the solutions and erroneously take credit for research that originates in international settings.
For YOs
YO opportunities abounded during the three-day conference and included a manual small-incision cataract surgery (MSICS) surgical simulation and hackathon (see details on the winning team). During the hackathon we tackled an eye health problem in teams and came together to formulate a sustainable, and responsible solution. These solutions were then presented, reviewed, and voted upon.
There was also a networking opportunity during which YOs were able to “speed date” with various nonprofits, Global Ophthalmology fellows, and other YOs doing GO early in their careers. There were other small group discussions on “how to” do global ophthalmology, including funding and carving out time in private practice or academics. (If any of this sounds awesome to you, make sure you come to next year’s Global Ophthalmology Summit, which will be held Aug. 9 to 11 in Portland, Ore.)
Tips for YOs
- If you are looking for an international travel experience, stop and think about your intentions before you dive in. Ask yourself whether the opportunity that you are looking at is beneficial in a bidirectional way. This might mean reframing the goals of your opportunity not solely as gaining surgical experience, but what opportunities you bring to the table in the local community to which you are traveling and what you can learn other than surgery when you visit this eye care clinic abroad.
It may help to think about the “fairness” of traveling abroad when you realize that the opportunity for YOs from low-income countries may not abound. Surgical experience is certainly almost never expected for them.
- If you engage in research with a local or international partner, think ahead about how to make authorship fair and represented in an equal way.
- There are global ophthalmology fellowship opportunities that continue to expand as well as eye care specific masters of public health at the London School of Medicine and Tropical Medicine (LSHTM). However, if that does not fit into your training plans, there are also educational opportunities via online modules available through the Academy, the London School of Medicine and through the summit meeting in the future!
- There are also opportunities for global health scholar tracks at many residency programs. These tracks were first established at the University of Wisconsin, Emory, and Moran and they have come together to create a blueprint for other academic institutions to follow and make their own. I myself have started using these blueprints to make our own residency global ophthalmology track at Mayo Clinic.
- U.S.-based ophthalmologists continue to gain insights into the public health aspect of eye care. I am pleased that we see fewer discussion topics such as “How this surgeon goes to this place to do X amount of surgeries” and more about recognizing social determinants of health, building better eye health infrastructure and how to advocate and partner with government entities and nonprofits to create sustainable and measurable impacts.
Save the date for the 2024 Global Ophthalmology Summit!
Aug. 9-11, 2024
Portland, Ore.
After all is said and done, the summit left me inspired and energized. I met new people and expanded my network of global ophthalmology contacts. This is a meeting that I plan to attend year after year.
About the author: Ashlie A. Bernhisel, MD, MS, is an assistant professor of ophthalmology at the Mayo Clinic and specializes in cornea and refractive surgery. She is currently working on expanding global ophthalmology opportunities at the Mayo Clinic including research opportunities, a residency scholarly track and increasing international partnerships. Her research interests are keratoconus and other causes of corneal blindness in Sub-Saharan Africa. Dr. Bernhisel is also a member of the Academy’s YO International Subcommittee.
Global Ophthalmology Sessions at AAO 2023
Building a Global Ophthalmology Community
LL11 | 9:30-10:30 a.m.
Location: Moscone West Expo, Booth 7007
Join participants, Emily Cole, MD; Simon Fung, MD; Jacquelyn O’Banion, MD; Jeff Pettey, MD, MBA; and Jessica Shantha, MD as they discuss how AAO and others in the global ophthalmology field are creating an enhanced community to address the global problem of vision impairment.
2023 Global YO Reception
Sunday, Nov. 5 | 9 p.m. to midnight
Location: The Grand, 520 4th St., San Francisco
Join YO colleagues for a night to remember!