The goal of this project is to reduce the incidence of preventable blindness associated
with diabetic retinopathy and other forms of blindness in Mongolia.

The goal of this project is to reduce the incidence of preventable blindness associated
with diabetic retinopathy and other forms of blindness in Mongolia. This will be
achieved through the accomplishment of the following objectives:

• To improve the current diagnostics and treatment practices and skills of the
  Mongolian ophthalmologists, especially in the field of early diagnostics of
  diabetic retinopathy.
• To provide much necessary early diagnostics services of preventable blindness
  among adults and children in rural Mongolia.
• To support the educational and learning desires of the blind children, educate
  their parents and improve social inclusion of the blind people

The project will target the diabetic patients and blind children in Ulaanbaatar and 4
selected aimags (provinces) of Mongolia. It will also benefit the selected Mongolian eye
doctors. The key activities of the project include:
1. Screening and treatment services to patients with diabetic retinopathy in
Ulaanbaatar and provinces:
1. 1. To organize brief medical visits by Taiwan ophthalmologists to
Ulaanbaatar to provide hands –on support and training to the Mongolian eye
doctors and provide advanced care that is not available in Mongolia at this
stage.
1. 2. To organize mass screening of retinopathy among patients with diabetes
in collaboration with district hospitals and eye centers of tertiary hospitals in
Ulaanbaatar;
1. 3. To equip the selected eye hospitals with diagnostic machines for diabetic
retinopathy
1. 4. To establish a referral system for diabetic retinopathy between provincial
hospitals and a network of well trained eye doctors in 3 selected eye
hospitals in Ulaanbaatar (using telemedicine); endocrinology doctors.
2. Update the skills of Mongolian ophthalmologists and improve existing diagnostic and
treatment practices for diabetic retinopathy and other prevalent eye conditions in
Mongolia:
2. 1. To organize regular online consultation and distant back up support by
Taiwan top ophthalmologists to Mongolian eye doctors for complicated and
advanced cases of diabetic retinopathy;

The project addresses the need for early diagnostics services of preventable blindness
associated diabetic retinopathy in patients with diabetes living in the capital city of
Ulaanbaatar and rural parts of Mongolia.
Diabetic retinopathy is retinopathy (damage to the retina) caused by complications
of diabetes, which can eventually lead to blindness. It affects up to 80 percent of all
patients who have had diabetes for 10 years or more. However, at least 90% of these
new cases could be reduced if there was proper and vigilant treatment and monitoring
of the eyes. Treatment includes laser surgery, injection of corticosteroids or Anti-VEGF
into the eye, and vitrectomy.
Diabetic Retinopathy (DR) is a rapidly growing cause of blindness in Mongolia due to an
epidemic of diabetes, as elsewhere in Asia. There is little infrastructure, training and
equipment to recognize and treat DR. A study among diabetics in urban and rural
Mongolia in 2010 found that the prevalence of diabetic retinopathy among diabetics
was 30.7% and 96% of patients with treatable DR were untreated 1 .
It is shown that Mongolia has a very high prevalence of diabetic retinopathy and due to
the lack of accessible diagnostic services to recognize the condition at early stages,
many of those people who suffered from diabetes for a long period of time end up
becoming irreversibly blind. Mongolia is located in high latitudes, hence the background
high level of ultraviolet radiation exposure compound the problem even more (solar
retinopathy).
The current project also aims to prevent people becoming blind not only from diabetic
retinopathy, but prevent other forms of preventable blindness such as the cataract and
glaucoma.
Cataract remains the most common cause of blindness in the Mongolia, and the
cataract surgical rate of 790 million per year is among the lowest in Asia. Glaucoma is
the second leading cause of blindness in the country, accounting for 35% of blind
persons nearly the almost same as cataract.
The WHO estimates that between 0.3 and 0.5% of the population of Mongolia is blind
and 2-3% of the population experiences low vision. Between 9,400 and 15,666
Mongolians are living with blindness From this, it is estimated that 2,000 blind people
live in Ulaanbaatar and the rest live in rural areas, across 21 aimags (provinces). The
unofficial statistics indicate that there estimated 13,000 people living with visual

impairment disability (both blindness and low vision) in Mongolia. Of those people, 1211
were children between ages of 0-16 years old. 985 of those children live in the
countryside and the rest live in capital city of Mongolia, Ulaanbaatar.
Blindness has high human and social costs: visually impaired people become not only a
burden for their own family, but also requires a person to support them their entire
lives6
The studies have shown that with the blindness, the person loses 80% of his or her
ability to receive information.
The project aims to reach out approximately 450 diabetic patients who are on patient
registry of selected district hospitals in Ulaanbaatar and provide follow up treatment to
approximately 45 pre-selected patients.

This project is a part of a larger, three year project, which is a joint collaboration of
three Rotary Clubs in Mongolia and 2 Rotary Clubs in Taiwan, D3520. It is envisioned
that after getting a support from D3450, the hosting clubs will apply for a global grant
for 2013-2014 Rotary Year. Prior to the below described project, the five participating
clubs have organized a World Community Service project in July 2013, which included
pre-screening of all diabetic patients in two districts of Ulaanbaatar for diabetic
retinopathy (total 450 patients) and a medical visit by 4 renowned Taiwan doctors who
volunteered their time to treat Mongolian patients.
Rotary Club of Ulaanbaatar D3450 will be the primary host club. It will be implemented
jointly with Rotary club of UB Peace Avenue in Mongolia. The project will involve three
local eye hospitals and the Mongolian Blind People Association as partner organizations
for this project.
Names of Mongolian eye hospitals participating in this project:
1) BolorMelmii Eye Hospital
2) Orbita Eye Hospital
3) Gerel Eye Hospital
The cooperating teaching institution and three eye hospitals will offer the necessary
medical facilities and equipments required to organize mass screening, diagnostic and
treatment services to diabetic patients within this project. The experienced eye doctors
from these hospitals have kindly agreed to volunteer their time to provide such services
to the preselected pool of patients free of charge.

The partnering eye hospitals will make pre-selection of patients in consultation with the
implementing Rotary Clubs in Mongolia.
Due to the lack of some diabetic retinopathy equipments in Mongolia, for the purpose
of screening and diagnostic services, the project will provide three portable optomed
equipments to these hospitals. The hospitals will be responsible for maintaining these
equipments and make them available to the Rotary project whenever they are needed.
The implementing Rotary clubs in Mongolia will make an agreement with the
cooperating eye hospitals outlining these responsibilities.

1) Taiwan Retina Society
The members from the Taiwan Retina Society will work as volunteer doctors for this
project and teach and exchange professional experience with the Mongolian eye
doctors.
2) CHANG GUNG MEDICALFOUNDATION
No.199, Tunghwa Rd., Taipei, Taiwan
3) CHENG HSIN GENERAL HOSPITAL
No.45,ChengHsin St.,Pai-Tou, Taipei, Taiwan
The experienced eye doctors from two cooperating hospitals in Taiwan will provide back
up or 2 nd opinion services to the project’s cooperating eye hospitals in Mongolia. This
will pave the way to upgrading significantly over a short period of time the current
diagnostic and treatment skills and practices of Mongolian eye doctors in the field of
diabetic retinopathy, glaucoma, cataract and other main conditions leading to the
blindness in Mongolia. The professional collaboration that will be established within the
framework of this project will extend well beyond the project scope and duration,
helping to elevate the ophthalmological care standards in Mongolia to the international
level, with the help of hands-on and distant support of Taiwan doctors.