World Sight Day (WSD) is held on the second Thursday of October and focuses global attention on blindness and vision impairment. In honor of this year’s theme, “Hope in Sight,” we reached out to our experts to talk about awareness efforts and advancements within the ophthalmology space.
Arlene Bagga, Medical Director in the US, and Maria Yankova, Medical Director in Europe and Asia Pacific, are both board-certified ophthalmologists with more than two decades of combined experience in ophthalmology. Below are their insights on this important topic.
Tell us about your experience and expertise regarding drug development for vision/eye health, as well as PRA's experience and expertise in that area.
AB: PRA has internal expertise in ophthalmology, with around 20 clinical projects completed and several ongoing in various indications. There are also PRA-run clinics conducting eye studies that are sponsor-embedded, with over 200 trials to date. Within PRA, about 15% of employees have touched ophthalmology in their work in a significant way. Maria and I bring with us about 26 years of clinical and surgical practice to the medical director role.
As a clinician, you have a limited scope of influence. You’re working locally and you're working patient-by-patient, but when you start to get involved in the clinical research industry you can make an attempt at starting to shape what clinical care is going to look like going forward.
Being a clinician for a long time and a critical thinker, you start to look at unmet needs, both at the patient level and the provider level. I think industry is really where you can have a greater effect, as a part of an organization or a team. You work to try to get those solutions into practice and make ophthalmology a more fluid practice that provides better outcomes and quality of life for patients.
What awareness efforts exist towards vision impairment and eye care?
AB: One of the first things that comes to mind as an ophthalmologist is Orbis International, which is an organization that runs a flying eye hospital out of a DC-8 plane. It travels to countries such as Bangladesh, China, Ethiopia, India, and Vietnam, as well as parts of Latin America and the Caribbean. The volunteer surgeons perform numerous surgeries in a short time. They also teach eye doctors on the ground how to carry on the work.
A number of academic institutions take groups down annually, and those groups perform cataract surgery and other much needed surgical procedures in countries such as El Salvador and the Dominican Republic. The groups also train the people locally. In the last decade, the field of global ophthalmology has grown so much that there are now formal fellowship trainings. These include the Wills Eye Center for Academic Global Ophthalmology Fellowships and other programs at Emory, University of Utah, University of Nebraska, and University of Oklahoma.
There are myriad number of efforts, both for awareness and for mitigation of global blindness. Some of the leading agencies involved are the World Health Organization (WHO) and the International Agency for the Prevention of Blindness. They have formed a collaboration called VISION 2020.
MY: We receive 80% of the information about the surrounding world through our vision, so the importance of vision care is understandable. Its preservation is a major task not only for ophthalmologists, optometrists, and all vision care workers, but society as a whole.
Much has happened over the years to raise awareness for addressing avoidable blindness. One of the driving forces here is the WHO, which is the UN's health coordinating body, and the International Agency for the Prevention of Blindness. Both are actively involved in coordinating events and activities around the world. Many universities and local clinics/hospitals have their own initiatives based on this global program. For example, age related macular degeneration initiatives or glaucoma initiatives are reflected at a local level and they initiate different campaigns for awareness.
What would you advise the public to do for their overall eye health?
MY: It is crucial for people to understand the need to have regular eye checkups. More than 75% of vision impairment and blindness are preventable if identified on time. Many diseases, such as glaucoma or macular degeneration, which can lead to vision impairment, are diseases that go undetected. It’s important that they are caught at an early stage.
Those after the age of 40 need to go to regular checkups, but a lot of people don't. They neglect their sight thinking that everything is fine. By the time they have the symptoms, it’s unfortunately too late—many of these diseases once developed fully are irreversible or much more difficult to cure at a later stage.
AB: For people with access to care, it’s important to get screened. It's important to go to an eye doctor if you’re experiencing any type of symptom. Work and general lifestyle structures are changing. People are on the computer more often. There will be more symptoms of dry eye, or as it’s referred to now, “computer vision syndrome.”
Conditions like this will bring more young people to the attention of ophthalmic care. If you know that you have a family history of a disease, get checked. If you have a symptom, get checked. Otherwise, by the time you hit 65, you should have an eye exam once a year to screen for those silent diseases. It’s like diabetes or high blood pressure—you don't know you have it until you have a side effect.
The American Academy of Ophthalmology recommends screening at age 40 for eye disease and routine examinations every one or two years over the age of 65. If you have risk factors for eye disease, such as diabetes, hypertension, or a family history of glaucoma or macular degeneration, don’t wait until age 40.
A common topic for World Sight Day is eliminating avoidable blindness as a public health problem. What are the most common causes of avoidable blindness? What might help eliminate this issue?
AB: Interestingly, the most common cause of avoidable blindness is the need for glasses, or refractive error. This affects a much younger population than some of the other chronic eye diseases.
The major issue globally is awareness and access to care, so patients can receive a relatively simple solution (such as glasses). The downside of missing a refractive error or glasses is that amblyopia can develop. This is when the brain connections to one or both eyes are weaker or don't develop due to lack of clear visual input. That causes irreversible vision loss.
Globally, after refractive error, the two most common causes of avoidable blindness are cataract and trachoma. Cataract is a clouding of the natural lens inside they eye, causing opacity that stops light from hitting the retina, and therefore reduced vision. The solution is surgical removal, and this can be implemented globally using many techniques. It can also be scaled in terms of technological needs.
Trachoma is an infection that, left untreated, can cause severe scarring of the ocular surface, blindness, and pain. The early solutions for trachoma lie in the sector of public health, including efforts to improve hygiene, gain reliable access to clean water, and treat with topical antibiotics before severe disease takes over. Once trachoma is end-stage, it does involve complex surgical repair that often does not result in restored vision.
MY: Glaucoma, diabetes, macular degeneration—all of these are preventable causes of vision loss if diagnosed at an early stage. Glaucoma is one of the leading causes of blindness. It’s believed to affect mainly people over the age of 60, but there are many exceptions to this rule. It is also known as the “silent thief of vision” because it slowly damages the eyes. By the time most people notice that they have some problems, there could be irreversible damage.
In recent decades, the possibilities have increased for diagnosis in the early stages of the disease and for successful conservative treatment. However, every day in practice, we meet people who lost their sight due to this disease. This is why regular checkups and early detection are critical to maintain vision.
Complications related to diabetes are another common cause of blindness in people ages 20 to 70. Diabetic retinopathy and associated hemorrhages and retinal detachment, as well as secondary glaucoma, lead to irreversible loss of vision. Prevention of these complications requires good collaboration between the different units of the health system and significant financial resources.
What recent significant achievements exist in the field of eye care?
AB: Specific to a discussion of global ophthalmology, refined techniques and widespread teaching of small-incision cataract surgery would be a major achievement. Historically, to remove what's called a “mature cataract” or a “white cataract,” which is common globally, you would make a large incision of about 12-14mm. Over the last couple of decades, that has been refined to allow mature cataract extraction through a small incision, about a third of that size. This is critical on the global level, where people don't have access to the correct post-operative eye drops—or in some cases, running water or post op appointments. It dramatically reduces the risk of postoperative infection.
In terms of general achievements in ophthalmology innovation, major categories include micro-invasive glaucoma surgery, new drug delivery systems for chronic eye diseases, and advances in refractive cataract surgery. With these new modalities, we are better able to treat chronic eye disease with less disruption of the ocular anatomy, better outcomes, and more patient satisfaction for the long-term.
MY: Macular degeneration associated with age is another big problem that modern ophthalmology struggles with. This disease affects central vision and may lead to visual disability, severely deteriorating quality of life. This problem is particularly relevant these days due to the rapid aging of the population. Until a few years ago, there was no cure for macular degeneration. Currently, some of its forms can be successfully treated with medications. Those meds are injected into the vitreous body and slow down or stop the disease from progressing.
Our therapeutic experts like Arlene and Maria bring a wealth of expertise and that helps to support all areas of our business and indeed our sponsors and, most importantly, the patients we work with.