The ISOO Africa 2023 Congress
The first International Society of Ocular Oncology (ISOO) [1] conference to be held in Africa took place in Mombasa, Kenya, from 21-23 August 2023. Participants came from all over Africa, as well as the US, UK and Europe, to share their knowledge and expertise on ocular oncology.
ISOO aims to advance and promote ocular oncology across the world. Africa presents unique challenges in this field. Retinoblastoma (Rb) continues to impact children all over sub-Saharan Africa (SSA). In high-income countries, it is almost always curable, and management is geared towards saving the eye and vision. However, in low-income countries, survival rates for children are often below 50% due to late diagnosis, advanced presentation and sometimes low compliance, often due to inability to pay for the treatment costs.
On the first day, presentations highlighted studies on the genetics of Rb undertaken in Kenya, the use of vitrectomy in Rb patients as salvage therapy and the online International Retinoblastoma Comprehensive Course (IRBCC), which introduces ophthalmologists and oncologists to the pathogenesis and management of Rb [2]. Retinoblastoma survivors, Marissa Gonzalez and Michael Ongaro, presented their life experiences and their work to increase advocacy about Rb. Michael also spoke movingly about the son he lost to Rb. And Ciku Mathenge, key note speaker at ISOO representing COECSA, brought context to the sharing of data that followed from various African countries demonstrating the variability of children with Retinoblastoma in different countries.
Conference delegates included Professor Dupe Ademola-Popoola, whose new intra-arterial chemotherapy (IAC) service in Nigeria was featured in an early 2023 issue of Eye News [3]. Her talk included the availability of the new IAC service, but sadly financial constraints were preventing most children from receiving this potentially life-saving therapy.
Rb specialists Vera Essuman from Ghana, Didi Fabian from Israel and Dupe Ademola-Popoola from Nigeria.
The second day of the conference saw sharing of information and experiences as representatives from all over Africa presented their national data on Rb presentation, treatment and outcomes. In the afternoon a workshop was held during which Rb treatment in SSA was discussed and strengths and weaknesses identified. The weaknesses were commonly the economic burden, loss of follow-up, lack of standardised care and lack of specialists. However, all agreed that the use of a multidisciplinary approach enables comprehensive treatment for Rb from an ophthalmic, paediatric oncological, radiological and psychosocial perspective. With the advent of the Rb-NET and specifically the Rb-NET multidisciplinary team (MDT) meetings [4, 5], it is now possible to communicate, consult and debate treatment strategies for children with Rb all over the world.
The final day of ISOO was run jointly with the first day of the College of Ophthalmology of Eastern, Central and Southern Africa (COECSA) Congress. The ISOO session focused on another cancer of the eye, more typically found among adults: ocular surface squamous neoplasia (OSSN). The epidemiology of OSSN in Africa was reviewed by leading experts from Kenya and the US. The keynote speaker was Carol Shields, Director of the Oncology Service at Wills Eye Hospital in Philadelphia.
Group work during the ISOO Rb session.
The conference was superbly organised by Kahaki Kimani of Kenya and Didi Fabian of Israel. Holding the annual ISOO conference for the first time in Africa was an excellent opportunity for ocular oncologists and ophthalmologists from all over the world to come together to network, share their knowledge and expertise and support each other in addressing the challenging reality of treating ocular cancers in low and middle income countries (LMICs). We hope that ISOO will bring the conference back to Africa again very soon!
The 10th COECSA (College of Ophthalmology of Eastern, Central and Southern Africa) Congress 2023
The COECSA Congress was held from 23-25 August in the same venue as the ISOO Congress and attended by 600 delegates. The first day was Subspecialty Day and overlapped with the final day of ISOO. Delegates could choose between a variety of topics including glaucoma, uveitis and paediatrics as well as ocular oncology.
Public health session
New this year during Subspecialty Day was a public health session, which attracted huge interest in a very packed room. Sixteen presentations from Ethiopia, Kenya, Malawi, Tanzania and Zambia held the audience’s attention throughout the morning. There was a situation analysis of glaucoma services across Malawi, from which the top four priority recommendations for moving towards universal health coverage were identified. From Kenya we heard about barriers to accessing cataract surgery and from Zambia about using the results of a Rapid Assessment of Avoidable Blindness (RAAB) survey [6] to inform a new national strategic plan for eyecare and a provincial plan for the Southern Province. A RAAB carried out in south-western Ethiopia showed a gender difference in prevalence of blindness (women 4.1%; men 2.5%) and that 88% of blindness there was avoidable.
An informal panel discussion then shed light on the value of networking and mentoring for developing a research career in the region.
Marcia Zondervan and Ciku Mathenge at the Women Leaders session.
Graduation ceremony and official opening of the COECSA Congress
The first day of the congress included the graduation ceremony for new COECSA fellows, with sessions on technology, research and innovation. Opening the congress, the president of COECSA, John Nkurikiye, highlighted the value of collaboration, networking and long-lasting partnerships in enabling people to learn from one another and embrace innovative practices. COECSA Membership exams became available online for the first time in 2023 and were taken in 14 accredited centres in seven countries, with 116 candidates.
Women Leaders in Eye Health
Also new this year was a session on Women Leaders in Eye Health. This was extremely popular and well-attended despite its start time of 07:00! The panel included Professor Ciku Mathenge from Rwanda and Marcia Zondervan from the International Centre for Eye Health (ICEH), and the discussion focused on mentoring and teamwork in pursuit of one’s goals. Ciku and Marcia shared invaluable advice for younger eye health professionals in a vibrant, interactive and entertaining session. Marcia talked about the mentoring she received early in her career from Professor Hannah Faal and Professor Allen Foster, and the audience joined in when she quoted Allen’s well-known phrase at the heart of eye health planning: “where are we now, where do we want to be, and how are we going to get there?”
Attendees at the ICEH alumni reception during COECSA.
The development of COECSA
Guest speaker Mike Burdon traced the history of COECSA and its development, particularly since its establishment in its present form following the merger between the Eastern Africa College of Ophthalmologists (EACO) and the Ophthalmological Society of Eastern Africa (OSEA) in 2012. It had undergone remarkable growth and change in a very short time. The Royal College of Ophthalmologists (RCOphth) had wholeheartedly embraced its LINK partnership with COECSA and supported its goals.
Numerous exchange training visits over the years had strengthened all facets of the College, including examinations, ‘train the trainers’ (TTT) and research capacity. It was good to see that Melanie Corbett’s vision of TTT becoming sustainable had come to fruition and COECSA was taking the programme forward, including cascading down to institutional level. The benefits of the LINK were entirely mutual, with RCOphth members benefiting personally and professionally from the collaboration.
The LINK is strengthened by John Nkurikiye being a member of the Global Ophthalmology Subcommittee of the RCOphth. Mike urged the members and secretariat of COECSA to write the history of the college, so that in future years their successors would be able to draw on it when they celebrate milestones like its centenary.
The organisers of the Mombasa COECSA Congress, Dorothy Mutie and Amos Kibata, had attended the RCOphth Congress in Birmingham in May 2023 to learn about its organisation as part of the COECSA-RCOphth LINK partnership. Reflecting on the learning from the RCOphth Congress, Dorothy said “At the RCOphth Congress we saw that there was a team dedicated to ensuring the presentations were ready for the following day. We adopted that system for COECSA, having a dedicated team handling the presentations and asking all presenters to confirm their presentations the day before. We were therefore able to identify any speakers who were absent and make the necessary programme adjustments.
“The RCOphth website provided for expressions of interest in the various sessions. Building on this, we sent out a poll ahead of the COECSA Congress to gauge interest in various subspecialty sessions. We were able to allocate rooms accordingly, although in practice, some rooms were still overflowing (because not all delegates responded to the poll)!
“In Birmingham we saw scanning of all delegate badges as they got into the venue. We adopted this in Mombasa, to improve security, reduce unauthorised access to the Congress and we also got a more accurate count of the delegates.”
ICEH MSc Public Health for Eye Care Alumni reception
About 30 former students of ICEH who were attending the COECSA Congress came together to network and reminisce about their experiences during the Masters course and share the positive impact the training had on their subsequent work in eye health care research, planning and delivery.
Summary
Having two conferences back-to-back was a boost to eye health care in Africa, drawing participants together from across the world. Themes of networking, collaboration and mentoring ran throughout both events. Presentations and discussions offered clear evidence of improvements in eye health care in Africa coming about through research, training and collaboration. The upbeat, positive air to the sessions made it a pleasure to be there and to participate.
The next COECSA Congress will be in Victoria Falls, Zimbabwe in August 2024. The ICEH LINKS & Networks team is planning to host an international workshop for the Retinoblastoma Network, Rb-NET, the day before it starts, to share progress in improving the outcome for children with Rb in Africa. Funding towards the workshop is needed – please contact marcia.zondervan@lshtm.ac.uk if you can help.
Gladys Atto – ICEH MSc alumna
Keynote speaker Gladys Atto gave an inspirational talk about her work. As the first and only ophthalmologist in Uganda’s Karamoja subregion, Gladys was recently awarded the Uganda Medical Association’s prestigious Prof Josephine Nambooze Women in Medicine award, which is named after the first female doctor in East Africa.
Gladys is Head of the Department of Ophthalmology at Moroto Regional Referral Hospital and passionate about ‘leaving no one behind’ when it comes to eye health in this remote region of 1.2 million people, of whom two-thirds live below the poverty line of $2 US per day.
(Top) Gladys receiving an award at the COECSA Gala Dinner; (Above) Gladys flanked by
some of the ICEH team and Hillary Rono, Ophthalmologist and Researcher in Kenya.
Before moving to Karamoja, Gladys attended the MSc in Public Health for Eye Care at the ICEH, London School of Hygiene & Tropical Medicine (LSHTM), where she was encouraged and mentored by Prof Allen Foster. She said: “Allen Foster changed my perspective. He explained concepts simply. Everyone needs an Allen Foster in their lives when it comes to research!”
Gladys has carried out 7000 cataract surgeries over the last three years, mainly on outreach visits to smaller health facilities in the area she covers. Her work in Karamoja has been supported by Sightsavers, which has helped in upgrading and equipping the health facilities. Across the subregion there are nine health facilities, and thanks to Dr Atto’s advocacy activities, all of them now have a trained ophthalmic clinical officer and all are equipped with slit-lamps – Karamoja is the only part of Uganda to have a slit-lamp in every district hospital.
It is clear that, over the last three years, Gladys has transformed eye health care in Karamoja through her hard work, commitment, tenacity and the sheer force of her engaging and inspiring personality.
References
1. About. ISOO Africa 2023. https://isooafrica2023.com/about
2. The Eye Cancer Foundation. IRBCC - THE EYE CANCER FOUNDATION
(www.eyecancercure.com)
3. Arazi M, Bowman R, Fabian ID, et al. Establishing an intra-arterial chemotherapy service for children with retinoblastoma in Nigeria for the first time. Eye News 2023;29(6):32-36.
4. Fabian ID, Astbury N, Nkanga E, et al. The role of virtual Rb-NET Multidisciplinary Team meetings in the management of children with retinoblastoma in low- and middle-income countries. Eye News 2021;27(6):36-38.
5. Rb-NET MDT. https://www.rb-net-mdt.org
6. Rapid Assessment of Avoidable Blindness (RAAB). International Centre for Eye Health.
https://iceh.lshtm.ac.uk/raab
[all links last accessed October 2023]
COMMENTS ARE WELCOME
