Developing a sustainable, impactful international keratoplasty skills transfer program | Eversight webinar recap

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. 

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. 

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.  

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. 

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.