¿Por qué debo de trabajar en Prevención de ceguera?

Dr. Van C. LansinghCoordinador Regional VISIÓN 2020 LA

Bulletin of the World Health Organization

ISSN 0042-9686 versión impresa

Bull World Health Organ v.79 n.3  Genebra  2001

Policy and Practice

Theme Papers

Blindness prevention programmes: past, present, and futureSerge Resnikoff & Ramachandra PararajasegaramConclusionsThe current global backlog of needless blindness and its projected doubling by the year 2020 are a challenge to the whole of society. Individuals who, by virtue of their knowledge and skills, can make a major contribution to meet this challenge have not only a professional but also a moral responsibility in this respect.

Poverty looms large in those very countries with the greatest burden of avoidable blindness and this is compounded by the inequity in the quantity and quality of eye care services available in these countries.

The PAAO Carl Kupfer Award for Prevention of Blindness was established, in 1997, to give recognition to exemplary efforts in increasing access to eye care among poor and underserved populations. The award is given as a prize to an individual or organizational team who has demonstrated through their work an outstanding commitment to the cause of prevention of blindness within their community.

Surgeon Volumes and Selected PatientOutcomes in Cataract Surgery

A Population-Based Analysis

Chaim M. Bell, MD, PhD,1,2,3,4 Wendy V. Hatch, OD, MSc,5,6 Geta Cernat, MD,3

David R. Urbach, MD, MSc2,3,6,7,8

Objective: To study the association of annual surgeon volume of cataract procedures with the risk of

postoperative adverse events.

Design: We used population-based administrative health records to conduct a retrospective cohort study from 2001 through 2003.

Participants: The number of surgeons who performed more than 50 cataract surgeries annually ranged from 231 to 243 over the 3 years. There were 284 797 cataract surgeries in patients older than 20 years performed at 70 hospitals or eye surgery centers in the province of Ontario, Canada.

Surgeon Volumes and Selected PatientOutcomes in Cataract Surgery

A Population-Based Analysis

Methods: We calculated cataract surgery volume for each surgeon and tested for the presence of a volume–outcome association. We used generalized estimating equations to account for the effect of clusteringof patients according to individual surgeons and to adjust estimates for the potential confounding effects of patient age and gender.

Main Outcome Measures: We used a composite outcome of postoperative adverse events from cataract surgery that included billing claims for vitrectomy, vitreous aspiration or injection of medication, vitreous air or fluid exchange, and dislocated lens extraction performed by any ophthalmologist between 1 and 14 days after cataract surgery. These procedures are surrogate markers for the outcomes of retinal detachment, lost lens or lens fragment, and suspected endophthalmitis.

Surgeon Volumes and Selected PatientOutcomes in Cataract Surgery

A Population-Based Analysis

Results: In each year, fewer than 1 in 200 patients experienced an adverse event (range, 0.33%–0.41%).

Surgeons performing 50 to 250 cataract surgeries per year had an adverse event rate of 0.8%. Surgeons performing 251 to 500 cataract surgeries per year had an adverse event rate of 0.4% and an adjusted odds ratio of postoperative adverse events of 0.52 (95% confidence interval [CI], 0.39–0.69) compared with surgeons performing 50 to 250 procedures per year. Surgeons performing 501 to 1000 cataract surgeries per year had an adverse event rate of 0.2% and an adjusted odds ratio of 0.31 (95% CI, 0.22–0.43), and surgeons performing more than 1000 cataract surgeries per year had an adverse event rate of 0.1% and an adjusted odds ratio of 0.14 (95% CI, 0.09–0.23).

Conclusions: Selected adverse event rates for surgeons performing more than 50 cataract surgeries per year are low. There is a volume-outcomes relationship for cataract surgery, and this relationship persists even for very high-volume surgeons.

Ophthalmology 2007;114:405–410 © 2007 by the American Academy of Ophthalmology.

Foto Ernest Christoffel

- Urge a los estados miembro a:Urge a los estados miembro a:

- Establecer antes del 2006 un Plan Nacional de VISIÓN 2020- Establecer antes del 2006 un Plan Nacional de VISIÓN 2020 Establecer un comité nacional de VISIÓN 2020 Establecer un comité nacional de VISIÓN 2020 Comenzar la implementación de planes de VISIÓN 2020 a Comenzar la implementación de planes de VISIÓN 2020 a más tardar para el 2007 más tardar para el 2007- Establecer mecanismos de monitoreo y evaluación- Establecer mecanismos de monitoreo y evaluación- Apoyar la movilización de recursos a favor de VISIÓN 2020- Apoyar la movilización de recursos a favor de VISIÓN 2020

- Marzo 16 del 2006Marzo 16 del 2006

El Doctor Guallapalli N. Rao, Presidente de la IAPB Global, escribe a los Ministros de Salud solicitando:

Votar en favor de la aceptación de la resolución EB117.R4 Apoyar añadir a las actividades de prevención de ceguera dentro del plan estratégico a mediano plazo de la OMS 2008-2013, así como en su presupuesto bianual del 2008-2009. Apoyar la inclusión de actividades de prevención de ceguera y de impedimento visual dentro del 11vo. Programa General de Acción de la OMS.

ICO seeks to increase visibility within ophthalmology

ICO Advocacy Director Hugh Taylor, MDThe ICO Advocacy Committee met in Cape Town and defined plans for internal (within ophthalmology) and external advocacy.Director for Advocacy Hugh R. Taylor, AC, MD, has set a goal of having every ophthalmologist in the world recognize what the ICO is and does. In addition to asking IFOS Representatives to arrange brief presentations about ICO work on key issues during plenary sessions at their society Congresses, and the Council will work to increase coverage in society newsletters and other ophthalmic publications.

ICO seeks to increase visibility within ophthalmology

Focus on Increasing Support for Eye Care

On the external side, the focus of ICO advocacy will be on increasing support for prevention of blindness and eye care, particularly from WHO and national governments.“In many countries, ophthalmologists have connections with their ministers of health and other key officials that put them in a unique position to encourage support for eye care,” said Committee Member Abdulaziz AlRajhi, MD. The ICO will try to identify one ophthalmologist in each country to work with it as an advocate.In coming months, the Council will ask societies to contact ministers of health to request their support for inclusion of prevention of blindness in the WHO Medium Term Strategic Plan (2008 – 2013) and in “Country Cooperation Strategy (CCS)” documents, which define how each country will work with WHO.The Advocacy Committee will also ask one ophthalmologist in each WHO region to represent the ICO at WHO Regional Meetings and coordinate the work of national advocates within their region.

Planilla de costos por cirugía de catarata

Insumo precio unidad/nºcx costo

quirófano y esteril.ropa x cx $ 50.00 ($ 300 el día)rotante x cx $ 20.00insntrumentista x cx ($400xmes 8cx/mes prom) $ 50.00laboratorio x cx $ 5.00Queratometria ecobiom. x cx $ 25.00Gastos administrativos (sin contar sueldo ni transporte: por cx) $ 35.00equipos $ 77.00

subtotal $ 262.00

No incluye honorario cirujano

Planilla de costos por cirugía de catarata Agosto 2006 (para 6 cx)

Planilla de costos por cirugía de catarata

Acetona 1L =>$9 $ 1.50Cortipyren B40 1caja=20comp; $70 (3com/cx - $70/7) $ 10.00diamox 5 comp/cx(caja$46 x 50 comp) 46/10 $ 4.60Ciloxadex ung 1pomo x 15 ptes. $44.31 / 15 $ 2.95alcohol 1Lx12 ptes (1l $3.21) $ 0.26azul 1 ampolla/20cx $ 1.39tela adhesiva $ 0.50gasa $ 0.50bicarbonato 1/6cx $2.95 / 6 $ 0.50ringer 1/3cx $ 1.20adrenalina 1/3cx ($75) $ 0.25glucosa hipertonica 1/3cx ($8.4) $ 2.80ciprofloxacina 10 comp/cx ($2) $ 2.00perfus 1/cx $ 0.60yodo $ 0.35tropioftal 1fco/4cx ($9.20) $ 1.50gentamicina 1fco/20cx ($2.0) $ 0.10col. Tobra-dexa 2fco/cx $ 12.00jerirngas 6x pte (caja 100 $21.31) $ 12.00agujas $ 1.20xilocaína no se usa en subtenoniana $ 0.00bupivacaína 1fco 20ml/5cx ($3.35 el fco/5) $ 0.67

subtotal $ 56.87

Planilla de costos por cirugía de catarata

Donados por precio precioguantes 2pares/cx $ 1.00 $ 250.00crescent 1x 3cx $ 1.50 $ 18.00bisturí 1x 3cx $ 0.05 $ 6.00bisturí 3.0 1x 3cx $ 1.50 $ 18.00viscoelástico 2x 3cx $ 5.10 $ 55.00IOL 1x cx $ 7.14 $ 110.00nylon 10.0 1x 2cx $ 2.00 $ 28.00

extras 10%de medicamentos + materiales $ 7.51 $ 54.10

subototal $ 25.80 $ 539.10

total costo sin ayuda $ 857.97

total costo con ayuda $ 344.67

se considera justo que el precio de una cirugía sea igual a un mes de sueldo del paciente

Cirugías Subsidiadasaportó x cirugía subsidio por cx = Pte

$ 25.80 $ 90.20 $ 116.00 $ 228.67

InSSSeP no subsidiadas = Pteaportó x cirugía subsidio por cx

$ 25.80 $ 0.00 $ 25.80 $ 318.87

equipos tiempo de uso a 130 cx/añomicroscopio + cosnultorio $ 80,000.00 8 años $ 77.00caja de cx.cauterio, etc.

(The magnitude and cost of global blindness: an increasing problem that can be alleviated.

Kevin Frick, Allen Foster. Am J Ophthalmol 2003;135:471-476)

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20

40

60

80

2000 2005 2010 2015 2020

Año

US

$ (

mill

on

es

)

sin V2020

con V2020

$150 millardos en pérdida de productividad

Costos directos: 18%Costos directos: 18%

Costos indirectos: 33%Costos indirectos: 33%

Pérdida productivaPérdida productiva

HospitalHospitalMedicinas…Medicinas…

Costo del sufrimiento: 49%

““Años de ceguera"Años de ceguera"DepresiónDepresiónCaídasCaídasFracturas de caderaFracturas de caderaDependencia socialDependencia social(asilos)(asilos)

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