Reports define magnitude of vision loss, focus on access to eye care

Reviewed by Sandra S. Block, OD, M Ed, MPH

Several major movements have identified the scope of visual impairment worldwide, according to Sandra Block, OD, M Ed, MPH, a professor emeritus at Illinois College of Optometry, and chairperson of the Public Health Com at the World Council of Optometry.

According to Block, speaking at the American Academy of Optometry’s 2021 annual meeting in Boston, the first major report was by the National Academies of Science, Engineering, and Medicine (NASEM) in 2016 that focused on the state of eye care and its needs.

Block noted that this report was focused on the US population, and highlighted the impact of vision and eye health issues on Americans. The report outlined 9 recommendations and it was hoped that there would be a response to address the problems and recommendations identified.

WHO World Report2 on Vision (WRV) 2019

According to Block, WRV was the first comprehensive report to focus on the status of vision and eye health worldwide. The report summarized the best available evidence on the global magnitude of eye conditions and visual impairment, took stock of the progress made and the remaining challenges facing the eye care sector, and outlined a framework for action, ie, universal health care and integrated people-centered eye care (IPCE), to address population eye care needs.

Billions of people globally are affected by sight-threatening conditions such as myopia, diabetic retinopathy, glaucoma, trichiasis, and age-related macular degeneration (AMD). Diseases such as myopia along with its complications, glaucoma and AMD are projected to increase as the result of aging and changes in lifestyle.

There are other ocular conditions that impact quality of life but are not sight-threatening. These include presbyopia, blepharitis, conjunctivitis, and dry eye among others concerns outlined in the WRV.

Sandra Block, OD, M Ed, MPH

Block pointed out that at least 2.2 billion people are visually impaired, about half of those cases could have been prevented, including corneal opacities, diabetic retinopathy, trachoma, glaucoma, cataract, and unaddressed refractive errors and presbyopia. 

Lack of access to eye care

The WRV pinpointed a lack of access to appropriate care as a major issue, especially noting the inequalities in rural and low-income areas, and among women, elderly individuals, indigenous people, ethnic minorities, and disabled individuals.

In light of this, the WRV emphasized 2 priority areas, ie, advancement of universal health coverage through eye care and implementation of IPEC care.

The stated goals are to provide quality eye care services according to population needs, improve service coverage and reduce inequality, ensure that the cost of priority eye care interventions is included in service packages covered by pre-paid pooled financing, and provide a package of high-quality integrated and people-centered health services.

Block also pointed out that at the core of IPEC is service that is managed and delivered so that people receive a continuum of health interventions covering promotion, prevention, treatment, and rehabilitation addressing the full spectrum of eye conditions according to their need. It also is coordinated across the different levels and sites of care within and beyond the health sector.

Specific settings include eye care delivered in specialized hospitals and clinics and integrated into in-patient and out-patient settings across medical specialties, in primary care, and in homes schools, and other community settings.

The WRV, according to Block, also envisions eye care as an integral part of universal health coverage.

Eye care packages

The WHO is in the process of overseeing the creation of eye care packages to outline mechanisms to diagnose and treat specific eye diseases and make recommendations for countries to integrate into their health models.

The objective of eye care interventions are to develop an evidence-based package of priority eye care interventions, including the required resources, to be used by countries to plan, budget, and integrate eye care interventions at all service delivery platforms. Seven areas of eye care development were identified. They include pediatrics, anterior segment and adnexa, cataract, glaucoma, refractive error, vitreoretinal and vision rehabilitation.

World Health Assembly

The 74th World Health Assembly of the WHO in May 2021 approved a resolution to prevent visual impairment and blindness, increasing effective coverage of uncorrected refractive error by 40% and effective coverage for cataract surgery by 30% by 2030. The adoption of this proposal addresses the enormous unmet need for eye care.

This is a major step in ensuring that the country members are focusing their attention on the enormous magnitude of preventable vision impairment and blindness, Block explained.

The United Nations (UN) in 2021 adopted the following resolution: “An eye test for a child can be the difference between inclusion and or exclusion; a pair of prescription glasses, the difference between access to information and seeking a livelihood and not. Corrective eye treatment, the difference between improved sight and total loss of sight. The gift of sight for the 1.1 billion people living with preventable sight loss is within reach if we ensure world leaders deliver on this moment.”

All of these key actions bring together governments, donors and financial institutions, UN institutions and the private sector, civil society, academic and scientific communities to achieve vision care for everyone.

What this means for eye care, according to Block, is that eye health will be recognized as a global development issue.

“There will be a commitment to reach 1.1 billion people who have vision problems and no access to care,” she concluded. “Vision and eye health will be integrated in UN frameworks since it has been shown eye health impacts countries’ performance. Finally, there will be a push for countries to link eye health to other developmental programs.”

Sandra Block, OD, M Ed, MPH

E: block@ico.edu

This article is adapted from Block’s presentation at the American Academy of Optometry 2021 annual meeting in Boston. She has no financial interest in this subject matter.

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References

1 National Academies of Sciences, Engineering, and Medicine.
2016. Making Eye Health a Population Health Imperative: Vision for Tomorrow. Washington, DC: The National Academies Press. https://doi.org/10.17226/23471.

2 World Health Organization. World report on vision. World Health Organization. 2019. https://apps.who.int/iris/handle/10665/328717. License: CC BY-NC-SA 3.0 IGO