Jan 23, 2024 — Michael Szkarlat, Senior Partner Development Director
We were joined by Dr. Anthony Aldave for Eversight’s first webinar of 2024 titled, “Developing a sustainable, impactful international keratoplasty skills transfer program.”
Dr. Aldave is the founder of Visionaries International nonprofit that seeks to reduce the global burden of corneal blindness by training surgeons throughout the world to perform various corneal transplantation procedures. Their philosophy is centered on a ‘teach a man to fish’ approach to sustainable change in 18 countries to date.
Dr. Aldave’s presentation is focused on conducting global ophthalmology work in a sustainable and responsible way. The webinar begins with an introduction of these principles followed by an outline that covers five important questions. Dr. Aldave then shares with us his decades-long experience with each of these questions.
Where can I contribute?
Utilizing a data-driven approach, Dr. Aldave shares statistics on which areas of the world are most affected by corneal blindness. Asia contains about 70% of the world's 5 million people suffering from corneal blindness and visual impairment.
Because of this, Asia is where Dr. Aldave has focused much of his global ophthalmology efforts. He suggests looking at which communities have access to corneal tissue—an essential ingredient in curing corneal visual impairment.
Finally, he discusses looking at the ophthalmologists per million population as another important metric to analyze. Of course, to train ophthalmologists and have a meaningful and sustainable impact in a community, there must be ophthalmologists to train.
What can I contribute?
Dr. Aldave suggests focusing efforts on matching a skill you possess with a skill that may be deficient in a region. He uses another data-based approach by comparing incidence of PBK to the prevalence of EK surgery to identify where teaching EK might be impactful.
Continuing this line of thinking, he demonstrates that in areas where the most common indications for transplant are infectious or traumatic in nature, teaching PKP, DALK or increasing the availability of corneal tissue may be more effective strategies than teaching EK.
Who should I work with?
Dr. Aldave mentions several large global ophthalmology groups that can support medical mission work, but he shares his own experience, which is that of a person who charted their own path.
He first shares an example of his experience connecting with colleagues with whom he shared a pre-existing relationship in India, which ultimately resulted in teaching Boston K-Pro transplant and the subsequent in country development of a similar product.
He also discusses attending international meetings—those of ophthalmology and professional societies based in other countries and regions—as a means of connecting with colleagues who may have needs you can assist with.
How do I ensure my efforts are sustainable?
The first two resources he suggests focusing on are funding and the supply of donor corneas. He stresses the importance of forming a nonprofit 501(c)(3) entity. It is essential to appeal for both in-kind donations of supplies and instruments and financial support from donors.
For donor corneas, there are two options: you can bring imported corneas with you, use locally recovered tissues or a combination of both. Local recoveries do not meet local need in the majority of countries, so it is typically necessary to import tissue. The drawback to this is the lack of sustainability.
For our eye bank readers, I’ll use this as a personal plug and reiterate that global eye bank development is as essential to solving worldwide corneal blindness and visual impairment as teaching keratoplasty. Dr. Aldave typically uses a combined approach of local and imported tissue, a ‘belt and suspenders’ approach as he calls it.
How do I ensure my work is impactful?
He begins by talking about the development of his personal model for effective skills transfer. His key suggestions are to have multiple faculty present, pre-screening of patients, onsite patient screening, lecture, live surgery, wet lab and finally proctored surgery by the local surgeons.
He discusses rigorous monitoring of outcomes, which is important both to ensure you are doing more good than harm, but also to make yourself available for questions so that the local surgeons feel supported and are more likely to welcome you back. Dr. Aldave stresses the importance of planning and leaving nothing to chance regarding instruments and supplies, as well as making sure that you provide instruments you will teach with to the local surgeons after your departure.
He also stresses the importance of involving U.S. trainees to expose them to medical mission work, garner continuing interest in global ophthalmology and as an extra set of hands. Dr. Aldave emphasizes the time and effort required to make a sustainable global impact. He demonstrates this by sharing his extensive work in the past and suggests that your goal should be to make yourself obsolete in these communities.
Finally, he reviews metrics that can be used to measure the effectiveness of your work. Although metrics may vary based on the work and its goals, it is essential that outcomes are measured in order to ensure that the work is effective and is doing more good than harm.
The webinar ends with a question-and-answer session where Dr. Aldave responds to audience questions. Thank you for reading and hope to see you all at the next Eversight webinar!
Key takeaways include:
Introduction
Where can I contribute?
What can I contribute?
Who should I work with?
How do I ensure my efforts are sustainable?
How do I ensure my work is impactful?
Q&A
About Anthony Aldave, MD
Anthony Aldave, MD joined the Jules Stein Eye Institute in July 2002 as a full-time member of the Cornea and Refractive Surgery Services. He is currently a professor of ophthalmology, holds the Walton Li Chair in Cornea and Uveitis, is co-chief of the Cornea and Uveitis Division and director of the Cornea and Refractive Surgery fellowship program.
Dr. Aldave has received numerous honors during his career, including:
- Alpha Omega Alpha Scholarship Award for graduating first in his medical school class
- Heed Ophthalmic Foundation Fellowship
- American Ophthalmological Society-Knapp Testimonial Fund Fellowship
- first Claes Dohlman Society Award
- Achievement, Secretariat and Senior Achievement Awards from the American Academy of Ophthalmology
- R. Townley Paton Award from the Eye Bank Association of American
- Asia Cornea Foundation Medal Award
In addition to his busy clinical practice, Dr. Aldave directs the Corneal Genetics Laboratory at the Stein Eye Institute, which is focused on elucidating the molecular genetic basis of the corneal dystrophies and developing novel gene- and cell-based therapies. Recognized as a leader in his chosen field of scientific investigation, Dr. Aldave has authored over 170 peer-reviewed scientific publications, given 500 scientific presentations at local, national and international meetings, and serves as a scientific reviewer for 20 ophthalmology and genetics journals.
Eversight's free webinars are a great way for you to connect, learn and train digitally with leading ophthalmologists and researchers from around the world. We invite you to RSVP for scheduled webinars and browse our recording library.
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