15 Jul Blindness: Israel Dramatically Reduces New Cases

MedicalResearch.com Interview with: Michael Belkin, MA, MD
Professor of Ophthalmology
Director, Ophthalmic Technologies Laboratory
Goldschleger Eye Research Institute
Tel Aviv University
Sheba Medical Center Tel Hashomer 52621
Israel

MedicalResearch.com: What are the main findings of the study?

Dr. Belkin: Modern ophthalmic treatment, when freely available is able to reduce the incidence of blindness, and presumably visual impairment considerably. In Israel the rate of new cases of blindness per 100.000 people [age adjusted] was reduced between 1999 and 2010 from 33.8 to 14.8, i.e., by over 56%. The reduction was in all major causes of blindness, Age-related Macular Degeneration (AMD), Glaucoma, Diabetic Retinopathy and Cataract. In the non-treatable retinal dystrophies such as retinitis pigmentosa, there was no significant changes over this period.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Belkin: While the reduction in blindness resulting from AMD was expected after the introduction of cheap very effective anti VEGF therapy in 2003 [there is an interesting medicoeconomic story here], the decline in blindness due to the other three causes was not expected or reported from other countries. The presumed reasons [cannot perform a clinical trial to support them] are as follows:

1. Glaucoma – the introduction of [then] very expensive prostaglandins analogues as first-line treatment. In Israel, as we know from other diseases, adherence with therapy is better than in most other countries.
2. Diabetic Retinopathy – the public medicine campaign against diabetes which ensured that most diabetes patients are examined by ophthalmologists and treated on time. The decline in retinopathy effects is probably also due to better systemic control of the diabetes.
3. Cataract – the introduction of private practice on a large scale. This reduced the waiting list for cataract surgery from years to a few weeks.
   

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Belkin: Nothing of the above will be effective if all children and adults are not examined regularly by ophthalmologists and, if diagnosed, adhere to the recommendations.

For medical systems – the semi-social model of Israeli medicine, where universal comprehensive coverage co-exists with private medicine seems to work in ophthalmology. If it can be adopted it might yield similar results. Admittedly – a lot of ophthalmologists are needed.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Belkin: The number of ophthalmologists and the technologies that need to be emulated to achieve similar results are not available in most of the world. [See attached article, published today, on the magnitude of the problem].

A lot of research is needed to automate and simplify the technologies mentioned above to make them available to all humanity. E.g., some feasible technologies,

1. A simple glaucoma laser treatment.
2. Semi-automated cataract surgery
3. Slow-release drug implants

Last Updated on July 16, 2013 by Marie Benz MD FAAD