UPFRONT

Global Perspective

JASON S. SLAKTER, MD

Globalization describes a process in which regional economies, cultures and societies become integrated through an expanding network of communication and trade. In a sense, medicine has led the way in globalization through the interaction of physicians and scientists sharing concepts and technology through both peer-reviewed journals and international conferences. In this month's issue of Retinal Physician, we make our own small contribution to the globalization process with the introduction of a new column entitled “Eyes of the World,” covering issues in retina around the globe.

While certain features of medicine are fundamental and transnational in nature, such as basic biological processes, it's been long recognized that the incidence and expression of some diseases may vary among different ethnic groups. Some of these differences have genetic bases, while others may be related to environmental or even societal cultural practices. This month's column clearly highlights the nature of these differences in “macular degeneration.”

Globalization of medicine has also led to an increased frequency of clinical trials being conducted with investigational sites in multiple countries. In fact, some large pharmaceutical companies require that a minimum number of countries in different continents be involved in trials to validate the international applicability of their therapeutic approach. These trials, however, often present challenges in their design and execution. Although diagnostic technology has spread worldwide, some of the latest equipment, such as spectral-domain OCT and autofluorescence imaging, may not be available in certain areas, even though these imaging modalities may be critical in assessing outcomes.

In addition, most trials now use an Internet-based communication method for data collection, case report form filing, and image transfer to centralized reading centers. The access to high-speed Internet and the infrastructure to support these systems varies greatly between nations. In addition, differences in regulatory requirements can also pose a significant challenge. Some European nations prohibit the transition of even the patient's initials across borders, thus making it difficult to properly complete a standardized case report form or provide proper labeling of needed laboratory samples and imaging studies.

Another issue with the spread of medical technology is economics. While individuals, health insurers and government agencies in the United States and Europe may be able to afford expensive diagnostic testing and therapeutics for the treatment of chronic disease, other nations don't have the monetary resources to be able to afford these new and potentially valuable treatments. Some obvious examples include the anti-VEGF drugs for AMD and retinal vascular disease, as well as the newer generation of “high-tech” instrumentation that provides for improved surgical outcomes. Beyond money, there's also the issue of simple physical access to appropriately trained and qualified medical personnel, often based solely on distance and sheer numbers of those needing care.

It's clear that globalization provides both opportunities and challenges for us in the delivery of medical care throughout the world. Although these hurdles are many, and often seen insurmountable, it's a problem we must face and find ways to overcome. Given the ingenuity and creativity of retinal specialists in finding innovative ways to manage difficult problems, I remain optimistic.