Michael Maizel, finishing his first-year of medical school, describes how his undergraduate research in global eye‑health began with Dr. Emily Gower, expanded to studies about vision impairment among adolescents in Tanzania with Dr. Joy Noel Baumgartner, and continued with “Unite for Sight” in Ghana. He hopes to become an ophthalmologist who advocates for health policy reform.
How did you first get involved in global eye‑health research as an undergraduate?
I first became involved in global eye-health research when I was a freshman, working with Dr. Emily Gower. That year, I worked with her to train a model on how to detect trichiasis in sub-Saharan Africa. Reviewing thousands of images of eyes, I trained the model to be able to differentiate the cornea, sclera, and eyelid margin. Since then, I’ve worked with her on numerous other studies, ranging from assessing the feasibility of integrating diabetic retinopathy screenings in pharmacy settings (which I recently presented at the Association for Research in Vision and Ophthalmology) to evaluating the use of self-administered visual acuity tests in seniors.
As a Health Policy and Management major with the Gillings School of Global Public Health, I wanted to do a senior project that involved ophthalmology and global health, two areas I’m passionate about. Dr. Gower introduced me to Dr. Baumgartner from the UNC School of Social Work. Her work in Tanzania is helping teens have early positive experiences with health clinics so that they will seek out services on their own if they need them later in life, especially those at greatest risk of unintended pregnancies or sexually transmitted infections. Part of this work included an adolescent vision study that she was starting. I worked with her team during my senior year to write a paper looking at vision health among primary school students in Tanzania. That paper was published in February.
What was the focus of your research project, and what were the key findings?
Adolescents in lower-resource countries face a high burden of eye health problems. The study in Tanzania estimated how common distance vision impairment is among young adolescents, compared academic performance by vision status, and examined what helps or hinders school-based vision screening and follow-up eye care. Participants were 7th-grade students who were a part of the “Youth Health Check” program. They attended school-facilitated, clinic-based health check-ups that included distance vision screening. Data included adolescent surveys, medical record extraction, and primary school leaving examination scores. Semi-structured interviews with parents and focus groups with school and clinic staff were conducted. Overall, based on their worst eye, 6.9% of students had mildly reduced vision, and 4.3% had impaired vision on screening. 71.9% of students with mildly reduced or impaired vision scored a C or lower on the PSLE compared to 59.9% with normal vision. Less than 10% of students referred received follow-up care. School-based vision screenings were deemed largely successful by clinicians and teachers, but there were challenges related to follow-up care, including referral linkages, households’ financial barriers to vision care, and insufficient parental knowledge of the importance of timely pediatric eye care. Given the prevalence of visual impairment and its potential link to academic performance, we’ve suggested governments consider requiring school-based distance vision screenings. Further research on screening implementation strategies and strengthening follow-up care is needed.
At what point did you realize that contributing to global health doesn’t always require traveling overseas?
After majoring in Health Policy and Management during my junior and senior years, I realized that I do not have to travel overseas to help people in need. There are many problems with the U.S. healthcare system that need to be addressed. So, when the opportunity to get involved with this project for my senior honors thesis came about, it seemed like it perfectly intertwined all three areas for me: ophthalmology, global health, and public health. My interest in ophthalmology began after I got my first migraine towards the end of middle school/beginning of high school. The auras I get from migraines are super debilitating to me, and I can’t imagine what people with permanent visual impairments must deal with daily. This was the spark for me to get interested in ophthalmology, and my experiences over the years have only further reinforced that.
What did you take away from your global eye‑health experience in Ghana, and how has it shaped your goals in medicine?
During the summer after my sophomore year of undergrad, I worked with ophthalmologists in Ghana through Unite for Sight, and the experience was very rewarding for me. The stark disparities in access to care were glaring, and I remain dedicated to serving low- and middle-income nations in some capacity as a future physician. I learned a lot from this experience, most notably that vision is not only a component of eye health but also a factor in overall quality of life. I was also reminded of the glaring differences in eye health between high-income countries and low and middle-income nations, and these disparities were worse than I originally thought. As of 2022, 89% of people with vision impairments stem from low and middle-income nations, and 90% of these cases could have been prevented or treated. Most importantly, I learned that there are solutions to these problems and that they can start on a community level. I truly hope these school-based vision screenings gain traction in Tanzania and are implemented more widely across the country. In the future, I hope to become an ophthalmologist who advocates for health policy reform.