Encouraging Subspecialty Practice by Constructively Influencing Trainees Early in their Careers Will Improve Advocacy for Neuro-Ophthalmology among Nigerian Ophthalmologists

Ophthalmology training in sub-Saharan Africa: a scoping review

Sub-Saharan Africa is home to 12% of the global population, and 4.3 million are blind and over 15 million are visually impaired. There are only 2.5 ophthalmologists per million people in SSA. Training of ophthalmologists is critical. We designed a systematic literature review protocol, searched MEDLINE Ovid and Embase OVID on 1 August 2019 and limited these searches to the year 2000 onwards. We also searched Google Scholar and websites of ophthalmic institutions for additional information. We include a total of 49 references in this review and used a narrative approach to synthesise the results. There are 56 training institutions for ophthalmologists in eleven Anglophone, eleven Francophone, and two Lusophone SSA countries. The median duration of ophthalmology training programmes was 4 years. Most curricula have been regionally standardised. National, regional and international collaborations are a key feature to ophthalmology training in more than half of ophthalmology training programmes. There is a drive, although perhaps not always evidence-based, for sub-specialisation in the region. Available published scientific data on ophthalmic medical and surgical training in SSA is sparse, especially for Francophone and Lusophone countries. However, through a broad scoping review strategy it has been possible to obtain a valuable and detailed view of ophthalmology training in SSA. Training of ophthalmologists is a complex and multi-faceted task. There are challenges in appropriate selection, capacity, and funding of available training institutions. Numerous learning outcomes demand curriculum, time, faculty, support, and appropriate assessment. There are opportunities provided by modern training approaches. Partnership is key.

Neuro-ophthalmology in Saudi Arabia: Clinical practice, challenges, and future directions

PURPOSE

This study provides an overview of neuro-ophthalmology in Saudi Arabia, evaluates the clinical practice of neuro-ophthalmology in the country, identifies the challenges, and implements recommendations to improve practice in this field.

METHODS

This cross-sectional study consisted of two surveys: The first survey was conducted with 32 general ophthalmologists and neurologists, while the second was conducted with six practicing neuro-ophthalmologists in Saudi Arabia.

RESULTS

All six neuro-ophthalmologists reported that they were Saudi Arabian nationals who worked either in Riyadh or other major cities in the Eastern and Western regions of the country. Only one of the six neuro-ophthalmologists was trained as a neurologist. Fifty percent of the neuro-ophthalmologists were trained in Saudi Arabia. Two out of the six neuro-ophthalmologists also reported providing services that were related to other specialties. Poor salary prospects for a neuro-ophthalmologist and the lack of availability of local fellowship programs were the most frequently reported reasons accounting for the lack of career interest in neuro-ophthalmology among medical residents.

CONCLUSION

The study findings revealed that there is inadequate access to neuro-ophthalmologists in Saudi Arabia and that career interest in neuro-ophthalmology is very low among Saudi ophthalmologists and neurologists. Provision of sponsored subspecialty training opportunities, local fellowship programs, and early exposure may help increase interest in the field. The future of neuro-ophthalmology in Saudi Arabia will be determined by curious, creative, and passionate young physicians.

Oculoplastic surgical services in Nigeria: status and challenges

PURPOSE

To assess the status and challenges of oculoplastic surgical services in Nigeria.

METHODS

An IRB-exempt, web-based survey was distributed to Ophthalmological Society of Nigeria members via e-mail. Information regarding demographics, type and location of practice, subspecialization training, availability and barriers of oculoplastic surgical services, pattern of oculoplastic diseases and surgical procedures was obtained. Responses were analyzed using standard statistical methods.

RESULTS

Forty-four percent (155/356) of ophthalmologists invited completed the online survey. Of these respondents, 104 (67.1%) do provide oculoplastic surgical services with 8 (5.2%) trained in oculoplastic surgery. Respondents reported most commonly treating eyelid trauma (98.1%), orbital inflammatory diseases (92.1%) and lacrimal system disorders (86.5%) with globe removal procedures (98.1%), eyelid reconstruction (92.1%) and lacrimal drainage procedures (84.5%) being the most common procedures performed in their practices. Barriers to availability of oculoplastic surgical services identified by respondents were few trained oculoplastic surgeons (92.9%), lack of training centers (70.3%) and accessibility of services (60%). On multivariable analysis, predictors of availability of oculoplastic surgical services were greater number of years in practice (P < 0.001) and subspecialty training (P < 0.001).

CONCLUSIONS

The availability and geographical distribution of oculoplastic surgical services in Nigeria are suboptimal with training deficiencies identified as the main challenge. Strategies to improve availability of oculoplastic care should entail a sustainable training program for this emerging subspecialty and physician deployment to under-resourced areas of the country.