History

The idea for what is now called Global Ophthalmology at Emory (GO-Emory) originated in 2009 when Danny Haddad, then director of the International Trachoma Initiative (ITI), joined EEC’s director Timothy Olsen and faculty member Paul Courtright in a seminal conversation about building a global vision initiative at Emory.

The idea took hold, aided by some dedicated advocates and partners. Courtright and fellow faculty member Susan Lewallen helped provide framework and architecture for the program early on. Emory Global Health vice president Jeffrey Koplan and world-renowned epidemiologist Willam Foege provided guidance to help the program take shape. The group sought partnerships with Atlanta organizations such as ITI, The Carter Center, and the CDC and with vision-focused groups such as the Lions Lighthouse and Center for the Visually Impaired.

Haddad joined the faculty as the program’s full-time director in 2013 and continues the work of those who helped get it off the ground, working with local, national, and international organizations. They include the International Coalition for Trachoma Control, Helen Keller International, the Kilimanjaro Centre for Community Ophthalmology and Sightsavers.

“Dr. Haddad brings a wealth of knowledge and global connections to Emory. He is a well-respected international leader in trachoma and has created a remarkable track record in effective public health strategies to help eradicate this blinding disorder. We are very fortunate to have him as our first director of Global Ophthalmology at Emory."
Timothy Olsen

Today

Haddad remains very active in elimination of blinding trachoma. He works in partnership with many non-governmental organizations, such as Helen Keller International, the Fred Hollows Foundation and Sightsavers to provide technical advice. He and SAFE Program Director Colin Beckwith travel frequently to countries such as Ethiopia, Burkina Faso, Cameroon, Kenya, Tanzania and Zambia to support national programs for the elimination of trachoma.

“We’re closing in on eliminating blinding trachoma globally. In the past years we have gained much support for the WHO Global Alliance to Eliminate Trachoma (GET 2020). Although much work still lies ahead of us, we’re well on our way to reach this important goal and eliminate the suffering from this blinding disease.”
Danny Haddad

Local efforts

Haddad’s vision for GO-Emory focuses considerable attention on local needs in Georgia. His goal is to eliminate avoidable blindness through GO-Emory’s Vision 2020 Georgia project, which aligns with Vision 2020, the right-to-sight initiative of the World Health Organization (WHO) and the International Agency for the Prevention of Blindness, to eliminate avoidable blindness globally by 2020. Locally, GO-Emory will work in partnership with the Georgia Vision Collaborative.

WHO and some 20 international non-government organizations provide guidance and technical and resource support to countries whose people are affected by trachoma and other preventable and/or treatable eye diseases.

Through GO-Emory initiatives, Haddad’s five-year plan is to bring the same kind of resources to Georgia, where considerable challenges exist to provide vision care to populations who desperately need it, yet are left out because of vast disparities in access. Many Georgians who have a potentially blinding disorder may be unaware of their condition. Glaucoma, for example, has no early symptoms. It is typically detected during a comprehensive eye exam. Haddad stresses that a plan to fill in the gaps for provision of eye care is absolutely necessary in Georgia for adults and children in at-risk populations, especially with the forecasted increase in eye pathology in the coming decade.

One such population is migrant farmworkers in rural Georgia, near Bainbridge and Valdosta. Last summer, Emory medical student Rebecca Russ organized a two-week pediatric vision screening initiative, the Farmworker Vision Project, as part of a rural migrant farmworker’s project organized each year by Emory schools of medicine and nursing. She and others screened 177 children for vision problems and eye disease and found problems in 25% of the children. Pediatric ophthalmologist Phoebe Lenhart and Russ saw 40 children in follow-up exams; 68% subsequently received glasses from the Georgia Lions Lighthouse.

In other work close to home, Haddad leads a course in Emory’s Rollins School of Public Health to teach students about the burden of eye disease in this and other countries. The course, “Vision Health: A Global Perspective,” now in its third year, continues to grow in enrollment. Eye Center faculty joined Haddad in teaching of the one-week course.

Efforts abroad

Over the past year, GO-Emory physicians have traveled to various destinations around the globe to treat patients and provide training to clinicians there. More than 80% of blindness in developing countries is avoidable or curable. "We’re closing in on eliminating blinding trachoma globally. In the past years we have gained much support for the WHO Global Alliance to Eliminate Trachoma (GET 2020). Although much work still lies ahead of us, we’re well on our way to reach this important goal and eliminate the suffering from this blinding disease.” Danny Haddad.

Shantha examines child
street scene Ethiopia
Hayek, Shantha with fellow physician

Ethiopia

In 2013 the EEC began collaboration with the Emory University School of Medicine Global Health Residency Scholars Program. This program, that consists of a year of monthly seminars about global health and a one-month rotation at the University of Addis Ababa in Ethiopia, has provided ophthalmology residents with the opportunity of a global experience. Haddad, who has been teaching at the program since early 2013, feels that it is crucial for our residents to be able to experience eye health in other countries.

Then third-year ophthalmology resident Christopher Stelton (res. ’11-14 res.) joined previous residency program director Paul Pruett (M ’00-04 M; res. ’05-08 ; glaucoma fellow ’08-09) as the first Emory Eye Center participants in this program and visited Menelik II Hospital’s eye department in March 2014. Pruett and Stelton taught in the government hospital—not unlike Grady Memorial Hospital in Atlanta—in hopes of forging a partnership with the department of ophthalmology. Teaching some 18 residents in the university’s four-year program, they observed a scarcity of resources in the clinics. Privacy was not possible: often 10 patients were in one exam room, and teaching occurred in front of everyone—physicians, patients, family members, and others. All surgical instruments were sterilized and re-used, whereas in developed countries like the United States, such instruments are largely disposable. “These physicians have learned how to do a lot with very little,” said Pruett.

And, in 2015, Eye Center physicians again participated in the Emory Global Health Residency Scholars Program. Third-year resident Jessica Shantha (res. ’12-15) and attending Brent Hayek (oculoplastics) traveled to Addis Ababa to share ideas and collaborate on patient care with the Department of Ophthalmology at Menelik II Hospital.

“We spent two weeks there seeing patients, performing operations and teaching their residents,” says Hayek. “Through a mini-grant, Jessica and I taught trachoma surgery to residents on a model that could be used for further training.”

“The Ethiopia global health rotation was an incredible learning opportunity,” says Shantha. “It provided me with a glimpse of how ophthalmology is practiced in a resource-limited setting. The trip gave me a framework for the skills necessary for a presence in ophthalmology abroad.”

Vietnam

In late 2013 Haddad traveled to this country, where historically women have had little access to health care. As a result, trachoma has been very prevalent, many children having contracted it from their mothers or vice versa. Today’s outlook is far better than in the past.

Hayek examines patient
Madagascar physician with patient

Madagascar

A team of three Emory Eye Center physicians traveled to this country this year, for the second year in a row, with a dual mission of fact finding and helping train local ophthalmologists in clinics in Antsirabe and in Antananarivo (Tana), the capital. The team included oculoplastics surgeon Brent Hayek, glaucoma expert Annette Giangiacomo, and retina specialist Andrew Hendrick. Hayek says conditions there are a challenge for those needing eye care: there are only 25 to 35 ophthalmologists in Madagascar to serve some 20 million people.

Hayek taught local ophthalmologists practical oculoplastic procedures by performing and supervising more than a dozen surgeries. Giangiacomo worked with local ophthalmologists to train them in current glaucoma treatments, and Hendrick brought retinal expertise to enhance the local surgeons’ skills. Training was accomplished both in the clinic and operating room, and, didactically, with presentations at the annual ‘Semaine de l’Ophtalmologie’ meeting.

“We have partnered with the local ophthalmologists through their national society and residency training programs to maintain an ongoing relationship,” says Hendrick. “The impact of working directly with these group annually reinforces the skill acquisition that will improve ophthalmic care for generations."

Hoping to make this a long-term initiative, GO-Emory made meaningful connections with governmental and academic organizations, including the Malagasy Ophthalmology Society, the Residency Eye Program in Tana, and the non-communicable disease department of the Ministry of Health.

Note: Funding for the trip to Madagascar was made possible by Emory Eye Center Advisory Board member Gordon Knight and by Marguerite Kimball of Atlanta. Advisory Board member Charles Ginden also provided support for the project.