Transcript Document

Lions World Sight Day 2009 Lecture
Helping the Blind to See
In the year 2000, there were 45 million blind
people in the world…
By next year (2010), there will be
58 million blind people…
Almost two-thirds of those who are blind are
women or young girls…
90% of those who are blind live in developing
countries…
ASIA, representing 60% of the world’s
population, has the largest burden of
blindness (double that of Africa)…
Asia has the largest burden of blindness
http://en.wikipedia.org/wiki/Image:World_population.PNG
Global Estimate of Visual Impairment
(WHO Report 2002)
Blindness in Asia
Up to 20-30 million Asians blind
(WHO)
1400000
Aging Asia
1000000
800000
600000
400000
200000
19
60
19
65
19
70
19
75
19
80
19
85
19
90
19
95
20
00
20
05
20
10
20
15
20
20
20
25
20
30
20
35
20
40
20
45
20
50
19
55
0
19
50
Population (x1000)
1200000
Year
60-64
65-79
80+
Major Causes of World Blindness
(WHO Report 2002)
• Lions Club International and the Lions Club
International Foundation (LCIF) are leaders in the
restoration and preservation of sight.
• SightFirst is LCIF’s flagship sight initiative, and
is the only service activity that Lions do world-wide
Lions Clubs International Sight Programs
• Sight Programs remain one of Lions Clubs International’s
defining causes.
• Lions Clubs International have gained worldwide
recognition for work to improve sight :
- Recycle glasses at 17 centers worldwide
- Support Lions Eye Banks, which annually provide
- quality eye tissue for 30,000 sight-saving surgeries,
medical education and eye research
- Provide eye screening for hundreds of thousands of
people every year
- Raise donations through programs like SightFirst and
SightFirst II
Lions World Sight Day
• Lions World Sight Day was created to recognize and
reinforce the importance of eradicating preventable
blindness.
• It is held annually in October during which Lions clubs
around the world conduct sight-related projects and
programs:
- Collecting eyeglasses
- Conducting vision and diabetic eye screenings
- Planning educational programs to inform communities
of the importance of eye health and diseases such as
diabetes that can impair sight.
• Google search on “Lions Eye
Banks”: 2,170,000 hits
• Lions have been helping eye banks
around the world for 65 years
• Currently, there are 71 official Lions
Eye Banks worldwide:
- Americas:
50
- Europe:
5
- Asia-Pacific: 16
Lions Clubs International Sight Programs
• Lions Clubs International’s Sight Programs focus on
fighting the global causes of preventable blindness:
- Cataract
- Glaucoma
- Age-related macular degeneration
- Diabetic eye disease
- Corneal blindness
- River Blindness
- Trachoma
Lions Clubs International SightFirst Program
The Lions SightFirst program was launched in 1989 to
initiative the building of comprehensive eye care systems
to tackle major causes of blindness and to provide care
for the blind and visually impaired.
A total of US$143million was raised from the program
throughout the 1990s providing millions of people in the
world with the precious gift of sight.
Lions SightFirst program
The Lions SightFirst program has restored sight to 7.5 million
people through cataract surgeries, prevented serious vision
loss for 30 million people, and improved eye care services for
hundreds of millions more - expansion of 300 eye centres,
upgraded equipment in 372 centres and trained 345,000 eye
care professionals in 100 countries
Lions Clubs International SightFirst Program
Lions Clubs International Key SightFirst initiatives include:
• Lions Eye Health Program (LEHP)
- Main SightFirst-funded initiative
- Community-based public awareness initiative
encouraging early detection and timely treatment of
glaucoma and diabetic eye disease
• River Blindness / Trachoma Control
- Supported more than 131 million treatments of river
blindness in Africa and Latin America since 1999.
• Eliminating Avoidable Childhood Blindness
- Established 34 need-based Lions eye care centre in
countries around the world
- Aimed at delivering preventative therapeutic and
rehabilitative eye care services for 100 million children
Lions Clubs International SightFirst Program
Lions Clubs International SightFirst initiatives include:
• SightFirst China Action Project Phase I
- Supported 2.1 million cataract surgeries in China
- Established surgical eye units in 104 rural countries
- Phase II SightFirst grant of US$15.5million was
matched with US$200 million from Chinese
government
- Additional 3 million cataract surgeries were performed
in Phase II
-Secondary eye units at hospitals in 200 underdeveloped provinces and Tibet
Lions Clubs International SightFirst II Program
The three-year SightFirst II Program launched in 2005 raised
US$203 million to continue to expand Lions’ SightFirst Programs.
The Singapore area headed by Past District Governor Charlie
Chan assisted by Sector Coordinator Lion Yap Bau Tan and
District Coordinator Past District Governor Philip Chua, raised a
total of US$400,000 over this period in support of Lions Clubs
International SightFirst II program.
Lions Clubs of Singapore’s Sight Initiatives
• Lions Clubs of Singapore (District 308-A1)
undertakes the role of ‘Knights of the Blind’
through several initiatives:
-‘Gift of Sight’ overseas expedition project lending
assistance to 3rd world countries like Laos, Cambodia
and Indonesia by providing used pairs of spectacles
to the less fortunate
- Collaborating with other organizations to provide eye
health checks at various community centres and
Lions Homes to benefit the elderly
- Donation of Corneas to Singapore Eye Bank for
Cornea transplants
Lions Clubs of Singapore’s Sight Initiatives
- Conduct ‘Gift of Sight’ Symposia to educate the
community of various blinding eye diseases
and treatment options available
- Sponsor cataract operations for the elderly as
well as eye tests and spectacles to needy
students
- Collection of used glasses for recycling
80% of blindness is preventable
or treatable…
Still, every minute, 12 people around the
world go blind…
So far during this talk, 144 people have gone
blind…
By the end of this talk, 360 people will have
gone blind…
In 2 weeks, 290,000 people, the size of the
population in Bedok, will go blind…
Major Causes of Blindness in Singapore
Blindness affects mainly the Elderly in Singapore
Eye Diseases of the Elderly:
•
•
•
•
Cataract
Glaucoma
Diabetes and age-related macular degeneration
Aging Corneal Degeneration
All are either treatable, or preventable if
detected early
Singapore Malay Eye Study (SiMES)
Singapore Indian Chinese Cohort (SICC)
Eye Study
10,000 persons of 3 major
racial/ethnic groups in Asia
aged between 40-80 yrs old
SiMES:
• 3,280 Malays
• Aug 2004 – June 2006
SICC:
20-25 km
• 2,600+ Indians (June 2007-)
• Chinese (Nov 2008-)
Half of the Malay Population have low vision in at least one
eye; half of these correctable by glasses
Wong TY et al. Arch Ophthalmology 2008
Visual Impairment and
Blindness in Singapore
SiMES study:
• 1 in 6 Singapore Malays are visually impaired
• In the elderly (70-80 yrs), nearly 1 in 2 are visually impaired
• Leading causes of poor vision are fortunately, easily treatable:
- uncorrected refractive errors (glasses): 54.7%
- cataract: 36.8%
• Other medical problems detected:
- 6 out of 10 Malays have high blood pressure
- 1 out of 3 have high cholesterol
- 1 in 5 have diabetes
Cataract
Lens implant
• Natural aging of the human lens
• Commonest operation performed in Singapore
• Highly sophisticated operation using an ultrasound probe
• SNEC performs over 10,000 cases a year, with near 100%
success)
• Cataract should no longer a major cause of blindness in
Singapore
Corneal Blindness
• Age-related corneal degeneration (clouding) is the commonest cause of
corneal blindness in Singapore, but is largely treatable by corneal
transplantation
• SNEC has one of the most advanced corneal transplantation programs in the
world - our success rate of 94% 1 year graft survival is the highest in the
published literature
• The Singapore Eye Bank is one of Asia’s top eye banks, but only 40% of
corneas come from Singaporean donors - we still need to import corneas
Rising number of corneal transplants grafts in
Singapore (1991 to 2008)
400
350
300
250
200
150
100
50
0
'91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08
SNEC currently performs 81% of all corneal transplants in Singapore
Year
SNEC leads in developing
new forms of Corneal
Transplantation
We are global leaders in the 2 new forms of corneal
transplantation: Anterior Lamellar Keratoplasty (ALK) and
Endothelial Keratoplasty (EK) - 10 awards, and over 50
publications, including the 2009 Inaugural President’s Science
Award (PSA)
100%
3%
7%
10%
18%
25%
26%
80%
37%
34%
8%
60%
97%
40%
29%
93%
90%
82%
75%
21%
29%
38%
37%
2007
2008
74%
ALK
EK
PK
55%
20%
0%
'91-'94 '95-97 '98-'00 '01-'03
2004
2005
2006
SNEC now performs the highest percentage
of lamellar surgery globally (69% of cases)
PK:
EK:
ALK:
USA (2008/9)
62%
33%
2%
SNEC (2009)
37%
29%
34%
Glaucoma
normal optic nerve
damaged optic nerve
gradual loss of field of vision
• Glaucoma is a condition in the elderly in which high eye pressure
causes damage to the optic nerve, resulting in permanent blindness
• commonest cause of irreversible blindness worldwide: 5.1 million
people blind from glaucoma today
• “the silent thief of sight” - often painless and only diagnosed too late
• another Asian form of glaucoma (angle closure glaucoma) - sudden
painful attack causes blindness without little warning signs
Glaucoma
normal optic nerve
damaged optic nerve
gradual loss of field of vision
• 3.2% of all Singaporeans over the age of 50 years have glaucoma
• this rises to 10-12% for those over 70 years old
• early detection or screening may provide a solution, as we can treat
glaucoma with eyedrops, laser treatment or by surgery
• blindness from glaucoma can be preventable (Asian form), or
treatable (chronic form) by reducing eye pressures or preventing sudden
build-up of eye pressure - most come to late when there is already
irreversible nerve damage and visual loss
Diabetic Retinopathy
mild retinopathy
•
•
•
•
•
•
severe retinopathy
endstage retinopathy
Diabetes is a MAJOR cause of blindness globally, especially in Asia
Diabetes causes retinal vessels to leak and bleed, causing blindness
worldwide increase in DM, related to obesity and poor lifestyles
1 in 3 diabetics here in Singapore have some degree of retinopathy
after 10 years, 50% of diabetics will have retinopathy
after 20 years, 90-100% will have retinopathy
Diabetic Retinopathy
mild retinopathy
severe retinopathy
endstage retinopathy
• Diabetes affects 8.9% of Singapore’s population (2004 National Health
Survey):
Indians: 15.3% (our SiMES study shows that Singapore
Malays: 11%
Malays with poorer blood sugar control
have more retinopathy)
Chinese: 7%
• 28% of Singapore’s elderly population suffer from diabetes
• SNEC sees over 7000 new cases of diabetic retinopathy each year
Diabetic Retinopathy
mild retinopathy
severe retinopathy
endstage retinopathy
• good control of blood sugar levels can
prevent diabetic retinopathy progression
• diabetic retinopathy is preventable,with
early detection and screening
• early laser treatment prevents retinal
bleeding and visual loss
• late disease may still benefit from retinal
surgery but this is complex, expensive,
Laser treatment prevents blindness
and often only partially restores vision
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Diabetes Prevalence in Asia Pacific (2007)
…increase with lifestyle changes
%
20
Adults aged 20-79
Age-adjusted to world population
15
10
5
0
Sicree, Shaw, Zimmet. Diabetes Atlas. IDF www.idf.org. 2006
SingHealth
Statistics of diabetic patients (2008)
Name of
Institution
Number of patients who
have at least one diabetic
related visit
Total number of Percentage of
SOC attendance diabetic patients vs
SOC attendances
CGH
19,372
344,719
5.6
KKH
2,588
494,233
0.5
NHC
10,857
98,494
11
SGH
30,196
677,358
4.5
SNEC
16,991
248,277
6.8
SHP
52,104
1,597,055
3.3
SNEC sees almost 17,000 diabetic patients a year
The increasing burden of age-related
eye diseases in SNEC
Annual increase in patient load:
•
•
•
•
Diabetic outpatients visits:
Retinal laser treatments:
Glaucoma outpatient visits:
Cataract surgeries:
7% increase per annum
9% increase per annum
4% increase per annum
5% increase per annum
Healthcare and the effect of
our aging population
• Singapore has the second fasting aging
population in Asia
• Those over 65 yrs old now account for 8.7% of
our population - by 2030, this will rise to 23% that’s about 900,000 elderly people (1 in 5
Singaporeans)
MOH recognizes that the care of the elderly, who
will have the greatest burden of chronic illness is
the priority
(PM’s National Day Rally Speech)
MOH is reorganising healthcare delivery
for continuity of care of the elderly
 Keep people
healthy and out
of hospitals as
long as possible
Primary Care
Acute &
Intermediate
Care
 Healthy ageing
 Workplace
health
promotion
 Structured
Chronic disease
management
Long-Term Care
“Care Integrators
”
Nurse educators
+ wellness
coordinators
CH
NH
Polyclinics
Screening &
Prevention
Palliative
Care
RH

Right-site
patients

Strengthen
clinical
governance
with non-public
providers

Restructure
existing
clusters to
improve
integrated care
Home
Care
FPs
Rehab &
support
services
Patient education & empowerment
IT Infrastructure
Manpower capability and capacity
Well
Frail elderly
Proposed Regional Health Services Concept
CH
NH
Polyclinics
Screening &
Prevention
Palliative
Care
RH
Home
Care
FPs
Rehab &
support
services
CH
NH
Polyclinics
Screening &
Prevention
CH
Screening &
Prevention
Palliative
Care
RH
Home
Care
FPs
CH
NH
Polyclinics
RH
Home
Care
FPs
Rehab &
support
services
Screening &
Prevention
Screening &
Prevention
NH
NH
RH
NUHS
Home
Care
FPs
Rehab &
support
services
Home
Care
FPs
Palliative
Care
Home
Care
Rehab &
support
services
RH
OUTRAM
Rehab &
support
services
Palliative
Care
RH
CH
Polyclinics
Polyclinics
Screening &
Prevention
FPs
Rehab &
support
services
CH
NH
Polyclinics
Palliative
Care
Palliative
Care
How do we change Eye Care in Singapore
to meet the demands of our aging population?
Key Concepts for success:
• early screening and detection of major age-related eye diseases prevents visual
loss and blindness - detection of disease referred to eye centres and eye depts for
early and appropriate treatment (true “sight-saving”)
• step-down facility (right siting) - provision of primary eye care for chronic
diseases - mainly for diabetes, glaucoma, but also for cataract and corneal aging
•community-based facilities - located near the community for ease of access away from SNEC and general hospitals, and near GPs and polyclinics for easy
coordination and linkages - bringing eye care to the community
• affordable and cost-effective - training of non-ophthalmologists to run clinics:
general physicians (eg GPs), optometrists, advanced nursing practitioners, all
extensively trained by SNEC
• holistic medicine approach - counseling, linkages with Singapore Diabetic
Society, geriatric care programs - co-management of the elderly patient as a whole
Solving Challenges to Community Eye Care
These key concepts directly address the challenges of community
eye care:
• shift some aspects of primary eye care and routine monitoring/screening
away from the eye centres and hospital eye departments into the community
(right siting)
• who to provide this service?
- only 160 expensive ophthalmologists, not enough doctors (3rd med sch)
- primary care currently served by GPs and polyclinic doctors (80/20 ratio)
- untapped medical manpower - nurses; optometrists (still years away from
complete training to provide primary eye care)
• providing high quality yet affordable primary eye care (training and
supervision by SNEC)
• primary eye care still requires highly expensive equipment for basic eye
exams, and extensive training to diagnose both common and rare diseases
• educating the public that the elderly have chronic, undiagnosed eye problems
The Eye Community Clinic (ECC)
A new concept of delivering primary eye care to the community:
• organized and coordinated by eye institutions (eg SNEC) in Singapore,thus
tapping on supervision and expertise of SNEC to train ECC clinic teams
• cooperative involvement of SNEC, MOH, and VWOs (Lions) and other
organizations (eg Singapore Diabetic Society)
• self-sustaining by cost-effective utilization of appropriately trained eye care
practitioners (eye physician, nurse, optometrist, eye techs)
• supports MOH’s plan of integrated care of care - direct linkages and interreferrals with:
- national specialist centre (SNEC)
- general hospital, community hospital, nursing homes, etc.
- primary care physicians (GPs, polyclinics)
- VWO support infrastructures (Lions)
• may be stand-alone, co-located with community hospital, nursing home or
govt polyclinic, but located to serve one major community/sector of Singapore
(eventual need for 2-3 centres island-wide)
Proposed Regional Health Services Concept
CH
NH
Polyclinics
Screening &
Prevention
Palliative
Care
RH
Home
Care
FPs
Rehab &
support
services
CH
NH
Polyclinics
Screening &
Prevention
CH
Screening &
Prevention
Palliative
Care
RH
Home
Care
FPs
CH
NH
Polyclinics
RH
Home
Care
FPs
Rehab &
support
services
Screening &
Prevention
Screening &
Prevention
NH
RH
NUHS
Home
Care
FPs
Home
Care
Rehab &
support
services
NH
RH
OUTRAM
Palliative
Care
Home
Care
FPs
Palliative
Care
Palliative
Care
RH
CH
Polyclinics
Polyclinics
Screening &
Prevention
FPs
Rehab &
support
services
CH
NH
Polyclinics
Palliative
Care
Rehab &
support
services
Rehab &
support
services
= Eye Community Clinic
Lions SaveSight Centre - the first ECC?
The Lions SaveSight Centre (Singapore) LSSC will be set up to provide
patients with chronic eye diseases requiring long-term eyecare with
quality step-down eye care in the most cost-effective setting to minimize
waiting time and costs to these patients, but most importantly, save sight
by screening, early diagnosis and referral for treatment to prevent
disease progression and visual loss.
The LSSC will provide the following services:
•
•
•
•
•
•
•
Detailed History Taking
Visual Acuity Test
Slit Lamp Examination
Diabetic Retinal Photography
Glaucoma Investigations
Periodic Follow-up
Counseling and Care Services
Lions SaveSight Centre - conforms to
the ECC concept, and more…
The Lions SaveSight Centre (Singapore) LSSC intends to :
• Establish a centre for the prevention of blindness with strong focus on eye
diseases of the elderly, (but also on childhood problems such as myopia)
• Develop diagnostic and prevention of blindness programs primarily for diabetic
retinopathy and glaucoma, and also for other age-related diseases such such as
cataract and aging corneal diseases
• Create care services, education and training, screening and counseling and
research to complement current developments in the prevention of blindness in
Singapore, and also in Asia
• Establish eye banking and corneal transplantation programs with links to Lion
Clubs International and its network for sight conservation and Lions eye banks, by
collaborating with the Asia Cornea Society (ACS) and the Association of Eye Banks
of Asia (AEBA), both headquartered in SNEC
• Coordinate outreach prevention of blindness programs
Lions SaveSight Centre
Lions SaveSight Centre (Singapore) Management Board
(FY2008-2009)
Chairman
Deputy Chairman
Secretary
Assistant Secretary
Treasurer
Directors
Honorary Lion Prof Arthur Lim
Honorary Lion Prof Donald Tan
PDG Han Thien Fong
Lion Charity Wai (COO, SNEC)
Lion Ho Lon Gee
Lion Ho Ching Lin (Glaucoma Snr Con, SNEC)
Lion Richard See
Lion Jenny Tan
Lion Edmund Wong (Retina Snr Con, SNEC)
Lion Yong Chiang Boon (President, Singapore
Diabetic Society)