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 Table of Contents  
SPECIAL REPORT
Year : 2014  |  Volume : 4  |  Issue : 2  |  Page : 59-62

Ophthalmology in Taiwan☆


1 Department of Ophthalmology, Shuang Ho Hospital; Department of Ophthalmology, School of Medicine, College of Medicine; Department of Ophthalmology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
2 Department of Ophthalmology, Cheng Hsin Medical Center, Taipei, Taiwan

Date of Web Publication6-Jun-2014

Correspondence Address:
Wen-Ming Hsu
Department of Ophthalmology, Shuang Ho Hospital, Taipei Medical University, 291 Zhongzheng Road, Zhonghe District, New Taipei City 23516
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.1016/j.tjo.2014.03.004

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  Abstract 


We herein report the current status of ophthalmology in Taiwan. There are 1667 ophthalmologists in Taiwan (up to the year 2011), with an average of 7.22 eye specialists/100,000 people. The ophthalmology residency program is a 4-year course in Taiwan, and around 40–44 new residents pass out each year. The Ophthalmological Society of Taiwan and many other professional ophthalmological organizations, and 30 teaching hospitals provide continuing education for practicing ophthalmologists and hospital staff. From 2002 to 2010, the average yearly cataract surgery rate in Taiwan was 5350/million people. Taiwan has held many international congresses. The major areas of biomedical research in ophthalmology in Taiwan are ophthalmic epidemiology, glaucoma, vitreoretinal diseases, cornea, and stem cells. From 1990 to 2010, Taiwan ophthalmologists have published 15 monographs, 15 textbooks, and 2184 scientific articles. The future objectives of Taiwanese ophthalmologists are to promote preventive ophthalmology, to expand efforts in basic research, to establish a national eye-diseases registry, and to support the Taiwan Journal of Ophthalmology in becoming a Science Citation Index journal.

Keywords: education, man power, ophthalmic service, ophthalmology, Taiwan


How to cite this article:
Hsu WM, Liu JH. Ophthalmology in Taiwan☆. Taiwan J Ophthalmol 2014;4:59-62

How to cite this URL:
Hsu WM, Liu JH. Ophthalmology in Taiwan☆. Taiwan J Ophthalmol [serial online] 2014 [cited 2020 Sep 21];4:59-62. Available from: http://www.e-tjo.org/text.asp?2014/4/2/59/204026




  1. Introduction Top


Many articles reviewing ophthalmology in various countries have been published.[1],[2],[3],[4],[5],[6],[7] We herein report the current status of ophthalmology in Taiwan after reviewing the current literature and other relevant data sources from publications of the Ophthalmological Society of Taiwan (OST), the Taiwan Medical Association (TMA), and the National Health Insurance Bureau of the Taiwanese Government.

Taiwan is a 36,000-km2 island located off the southeastern coast of Mainland China. According to the 2011 census, Taiwan had a population of approximately 23.1 million, with a population density of 650 persons/km2. Over 9.8% of the population is aged 65 years or older, which exceeds the World Health Organization criteria for an “aging society”. The average life expectancy in Taiwan was 78.6 years in 2010 (76.2 and 82.8 for males and females, respectively), which is similar to that in many other developed countries.

The National Health Insurance (NHI) system provides coverage for 99.6% of the population of Taiwan. The health care budget amounts to 5.8–6.0% of the gross domestic product. The purchase power parity was US$20,150 in 2011.


  2. Development of ophthalmology in Taiwan Top


The development of ophthalmology in Taiwan may be divided into three periods. The first was the “Catholic medicine” period, during which ophthalmic services were provided primarily by Catholic physicians, including well-known physicians like Dr Mayako (1865, Tainan), Dr Mackay (1871, Tam-Shui), and Dr Lang (1896, Chang-Hua). The second period was the “Japanese occupation” period, which lasted from 1895 to 1945. During this period, the Japanese government emphasized that eye divisions and clinics were essential in most hospitals. The “modern ophthalmology” period began in 1945, during which the Taiwanese government’s continued support of ophthalmology divisions and clinics has ensured a high standard of clinical services to ophthalmology patients [Table 1].[8],[9]
Table 1: History of development of ophthalmology in Taiwan.

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  3. Ophthalmological Society of Taiwan (OST) Top


Founded on May 15, 1960, the OST is the largest and oldest professional society of ophthalmologists in Taiwan.[9] Professor Yen-Fei Yang was the first President of the OST. The following presidents, including Chen-Wu Chen, Liang-Shi Ko, Jorn-Hon Liu, Te-Tsaw Chen, Por-Tying Hung, Wen-Ming Hsu, Chih-Chin Pan, Hong-Yu Lin, and Fong-Rong Hu, have made many outstanding contributions in both clinical and academic fields. The society’s membership has grown from 107 at its inception to 1667 in 2011.[9],[10] Similar to other such societies, the OST has an Executive Board and a Control Board that oversee 23 committees, special assignment groups, and a Secretariat and provide services for OST members. The Society has a rich tradition of education and leadership in the ophthalmic profession. The society provides continuing education courses for practicing ophthalmologists, and serves as a coordinator between ophthalmologists and the Bureau of National Health Insurance (BNHI).

The OST began publishing its official quarterly journal, Acta Societatis Ophthalmologicae Sinicae, in 1961, which was renamed as the Taiwan Journal of Ophthalmology in 2011. The OST has also published bimonthly bulletins since 1981. A total of 52 annual national and 48 regional conferences have been held by the OST since 1960, in addition to the following international conferences: (1) the 18th Con gress of the Asia-Pacific Academy of Ophthalmology (APAO 2001); (2) the Second Global Chinese Ophthalmic Conference (2002); (3) the Seventh International Symposium on Myopia (1998); (4) the Fifth Conference of the Asia Society of Neuro-Ophthalmology (2008); (5) the Fourth Congress of the Asia-Pacific Vitreo-retinal Society (2009); (6) the First Asia-Pacific Joint Glaucoma Congress (2010); (7) the 1st–14th Taipei International Symposium on Current Ophthalmology (1997–2010); and (8) four Taiwan—Japan Joint Meetings on Ophthalmology (between 1994 and 2008). Many Taiwanese ophthalmologists have participated in meetings ofthe International Council of Ophthalmology(ICO) since 1966 and APAO meetings since the first APAO Congress in 1960.[9]


  4. Man power of ophthalmologists Top


Eighty ophthalmologists practiced in Taiwan in 1960. Since then, the number of ophthalmologists has increased at a rate of 40–60/year, with the most rapid increases occurring since 1980. (320 ophthalmologists in 1980, 580 in 1985, 816 in 1990, 1112 in 1995, 1329 in 2000, 1494 in 2005 and 1663 in 2010) In 2011, 56% of the 1667 practicing ophthalmologists provided outpatient services, and the remaining 44% provided hospital-based care.[9],[10] With 7.09 ophthalmologists/100,000 people (one ophthalmologist for every 13,850 inhabitants in 2010;), the ophthalmology man power in Taiwan is adequate, relative to that of many other countries (11.0 ophthalmologists/100,000 people in Japan, 3.3 in Hong Kong, 2.1 in Mainland China, 0.9 in India, 8.1 in the USA, 5.2 in UK, 4.0 in Australia, and 13.6 in Cuba).[11] However, an inequitable distribution of ophthalmologists exists between the urban and rural areas in Taiwan.


  5. Ophthalmic education and training Top


Twelve medical schools exist in Taiwan, and enroll approximately 1300 new medical students every year. After completing a 5-year undergraduate education program, a 1-year clerkship, and a 1-year internship, medical students obtain an MD degree (Medical Doctor). Ophthalmology residency programs are offered by 29 qualified training hospitals that accept 40–44 new residents each year. After completing the 4-year residency program, physicians must pass both written and oral board examinations in ophthalmology prior to receiving their board certification in ophthalmology. Ophthalmologists may continue subspecialty training in any of the following categories, which are provided at most teaching hospitals in Taiwan: refraction, cataract, cornea, oculoplastic and orbital surgery, refractive surgery, glaucoma, vitreoretina, pediatric ophthalmology, neuro-ophthalmology, strabismus, and uveitis. Approximately 30% pursue fellowship training in the United States and Europe.


  6. ICO assessment and examination Top


Since 2003, Taiwanese ophthalmologists have participated in ICO assessments (examinations),[12] with a passing rate of 83% (58/70) for the basic part examination and 90.7% (29/32) for the clinical part examination [Table 2].
Table 2: International Council of Ophthalmology examination passing rates for Taiwan.

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  7. Continuing education Top


To renew their board certification, ophthalmologists must take 200 hours of continuing education courses for every 6 years of practice (including 18 hours in medical ethics) that are received through various hospital-based activities, such as case conferences, journal meetings, laboratory meetings, local annual meetings, and international conferences. Continuing education courses are also provided by various ophthalmological societies, which offer the following quarterly courses: (1) problem-oriented courses, such as problem solving in daily practice; (2) instructional courses in academic, ethical, insurance, and financial issues; (3) 2-day review courses; and (4) live-surgery demonstrations of advanced techniques in cataract surgery with intraocular lens (IOL), laser-assisted in situ keratomileusis (LASIK), Botox treatment, and intravitreal injection.


  8. Ophthalmic services Top


In Taiwan, 95 institutions provide 520 beds for ophthalmic patients. From 2002 to 2010, the average cataract surgery rate (CSR) was 5350/million people/year, with an average of 121,500 cases (range 116,000–148,000) of cataract extraction with IOL implantation every year (92% with phacoemulsification),[13] and approximately 740 keratoplasty surgeries, 1600 retinal-detachment surgeries (sclera buckling and/or pars plana vitrectomy), and 35,000 refractive surgeries (LASIK, photorefractive keratectomy, and laser-assisted epithelial keratomileusis) were performed annually.[13] Taiwan ophthalmologists have also provided charity services in underdeveloped countries, such as Honduras and El Salvador, through Orbis international programs.[14] They have also provided eye health care in Haiti, Swaziland, São Tomé and Príncipe, Palau, the Marshall Islands, Kiribati, India, Sri Lanka, and the Fu-Ken, Fu-Nan, and Queiu-Chou provinces of mainland China, and other countries or areas through various international nongovernmental organizations.


  9. Publications and biomedical research Top


Ophthalmic researchers in Taiwan have principally focused on ophthalmic epidemiology, angle-closure glaucoma, cornea diseases, vitreoretinal diseases, and stem cell studies. From 1990 to 2010, Taiwan ophthalmologists have published 16 monographs; 15 textbooks, including three in Chinese and 12 that were translated from English to Chinese; and 2184 scientific articles, including 872 in Science Citation Index (SCI) journals and 1312 in non-SCI journals. Many research articles have received a high citation rate, including articles regarding the use of mitomycin C in refractory glaucoma,[15] corneal limbal epithelial cell transplantation,[16] ex vivo corneal endothelium transplantation,[17] the epidemiology of childhood refraction,[18] the prevalence and causes of visual impairment and dry eye in the elderly Chinese population,[19],[20] Leber’s hereditary optic neuropathy,[21] and orbital fat stem cells.[22]


  10. Future objectives Top


In the future, ophthalmologists in Taiwan plan to increase their efforts in preventive ophthalmology, such as their Vision 2020 program for preventing the progression of myopia in school-aged children. In addition, they will expand their basic researches in visual science, establish a national eye-diseases registry, and support the Taiwan Journal of Ophthalmology[23] in becoming an internationally recognized SCI journal.


  11. Comments Top


The Taiwanese BNHI has a huge and comprehensive data concerning the operation number. The Bulletin of Ophthalmologic Society of Taiwan (OST) provided the profiles of OST members and their activities. The TMA edits and publishes Statistics Yearbook of Practicing Physicians and Health Care Organizations in Taiwan every year. It provides detailed statistical information and reports on medical man power in Taiwan and the deployment of medical organizational resources. From these organizations, we can obtain the most accurate and comprehensive profiles of physicians. Many articles reviewing ophthalmologists man power in other countries have been published in the past 10 years.[1],[2],[3],[4],[5],[6],[7] A worldwide analysis of ophthalmologists man power reviewed by the ICO is also very important.[11]

The NHI system in Taiwan provides coverage for 99.6% of the population of Taiwan. Because of its access, convenience, and relatively cheap payment options, Taiwan has adequate medical resources and a health care system.

However, there is much work to do to improve ophthalmic education and the eye care. In Taiwan, besides the OST, there are another six national ophthalmological societies, including the Taiwan Academy of Ophthalmology, the Taiwan Society of Cataract and Refractive Surgery, the Taiwan Agent for Prevention of Blindness, the Taiwan Society of Refraction Education and Research, the Taiwan Retina Society, and the Taiwan Society of Ophthalmic Plastic and Reconstructive Surgery, which have provided many continuing education courses every year.


  12. Conclusion Top


In conclusion, at present, the workforce of ophthalmologists in Taiwan is relatively abundant at 72 ophthalmologists/million people. Ophthalmic education in Taiwan is adequate in both basic and continuing education. Ophthalmic services are adequately available, with an average CSR of 5350/million people/year. Taiwanese ophthalmologists have published many clinically significant scientific articles. The future objectives of ophthalmology in Taiwan are to promote preventive ophthalmology, expand efforts in basic research, to establish a national eye-diseases registry, and support the Taiwan Journal of Ophthalmology in becoming an SCI journal.

Conflicts of interest: The authors have no financial interests related to the manuscript.



 
  References Top

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Sahel JA. On French ophthalmology. Arch Ophthalmol. 1998;116:1364–1365.  Back to cited text no. 2
    
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Mitchell P. Ophthalmology in Australia. Arch Ophthalmol. 2002;120: 1375–1376.  Back to cited text no. 6
    
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Gleiser-Boiko J. Ophthalmology in Peru. Arch Ophthalmol. 2002;120: 1373–1374.  Back to cited text no. 7
    
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10.
Taiwan Medical Association. Statistics Yearbook of Practicing Physicians and Health Care Organizations in Taiwan. Taipei, Taiwan: Taiwan Medical Association; 2002–2012 [in Chinese].  Back to cited text no. 10
    
11.
Resnikoff S, Felch W, Gauthier TM, Spivey B. The number of ophthalmologists in practice and training worldwide: a growing gap despite more than 200,000 practitioners. Br J Ophthalmol. 2012;96:783–787.  Back to cited text no. 11
    
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International Council of Ophthalmology. International Council of Ophthalmology examinations. www.icoexams.org. 2003–2012.  Back to cited text no. 12
    
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Bureau of National Health Insurance. Statistics and Survey: the National Health Insurance Statistics. Taipei, Taiwan: Bureau of National Health Insurance Department of Health, Executive Yuan, R.O.C; 2001–2010 [in Chinese].  Back to cited text no. 13
    
14.
Taiwan Orbis. Bulletin of Orbis Taiwan. Taipei, Taiwan: Orbis Taiwan; 2002–2010 [in Chinese].  Back to cited text no. 14
    
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Chen CW, Huang HT, Bair JS, Lee CC. Trabeculectomy with simultaneous topical application of mitomycin-C in refractory glaucoma. J Ocul Pharmacol. 1990;6: 175–182.  Back to cited text no. 15
    
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Tsai RJ, Li LM, Chen JK. Reconstruction of damaged corneas by transplantation of autologous limbal epithelial cells. N Engl J Med. 2000;343:86–93.  Back to cited text no. 16
    
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Chen KH, Azar D, Joyce NC. Transplantation of adult human corneal endothe-lium ex vivo: a morphologic study. Cornea. 2001;20:731–737.  Back to cited text no. 17
    
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Lin LL, Shih YF, Tsai CB, Chen CJ, Lee LA, Hung PT, et al. Epidemiologic study of ocular refraction among schoolchildren in Taiwan in 1995. Optom Vis Sci. 1999;76:275–281.  Back to cited text no. 18
    
19.
Hsu WM, Cheng CY, Liu JH, Tsai SY, Chou P. Prevalence and causes of visual impairment in an elderly Chinese population in Taiwan: the Shihpai Eye Study. Ophthalmology. 2004;111:62–69.  Back to cited text no. 19
    
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Lin PY, Tsai SY, Cheng CY, Liu JH, Chou P, Hsu WM. Prevalence of dry eye among an elderly Chinese population in Taiwan: the Shihpai Eye Study. Ophthalmology. 2003;110:1096–1101.  Back to cited text no. 20
    
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Yen MY, Wang AG, Wei YH. Leber’s hereditary optic neuropathy: a multifactorial disease. ProgRetin Eye Res. 2006;25:381–396.  Back to cited text no. 21
    
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Ho JH, Ma WH, Tseng TC, Chen YF, Chen MH, Lee OK. Isolation and characterization of multi-potent stem cells from human orbital fat tissues. Tissue Eng Part A. 2011;17:255–266.  Back to cited text no. 22
    
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    Tables

  [Table 1], [Table 2]


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Abstract
1. Introduction
2. Development o...
3. Ophthalmologi...
4. Man power of ...
5. Ophthalmic ed...
6. ICO assessmen...
7. Continuing ed...
8. Ophthalmic se...
9. Publications ...
10. Future objec...
11. Comments
12. Conclusion
References
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