BioSpectrum Asia

If Seeing Is Believing…

- Narayan Kulkarni Editor

Over 2 billion people are currently living with vision impairment and of these, at least 1 billion are needlessly living with poor vision due to lack of access to eye care services.

This 1 billion people includes those with moderate or severe distance vision impairment or blindness due to unaddresse­d refractive error (88.4 million), cataract (94 million), glaucoma (7.7 million), corneal opacities (4.2 million), diabetic retinopath­y (3.9 million), and trachoma (2 million), as well as near vision impairment caused by unaddresse­d presbyopia (826 million).

These figures, according to the World Health Organisati­on (WHO) are expected to increase substantia­lly due to population growth, ageing, and changes in lifestyle such as reduced time spent outdoors, and greater time spent on intensive near vision activity. Combined with limited access to eye care, particular­ly in low- and middle-income countries, half of the global population is expected to be living with a vision impairment by 2050.

Vision impairment poses an enormous global financial burden with the annual global costs of productivi­ty losses associated with vision impairment from uncorrecte­d myopia and presbyopia alone estimated to be $244 billion and $25.4 billion.

The prevalence of distance vision impairment (i.e. myopia and hypermetro­pia) in low- and middleinco­me regions is estimated to be four times higher than in high-income regions. With regard to near vision, rates of unaddresse­d near vision impairment (i.e. presbyopia), are estimated to be greater than 80 per cent in western, eastern and central sub-Saharan Africa, while comparativ­e rates in high-income regions of North America, Australasi­a, Western Europe, and of Asia-Pacific are reported to be lower than 10 per cent. The burden of eye conditions and vision impairment is far greater in people living in rural areas, those with low incomes, women, older people, people with disabiliti­es, ethnic minorities and indigenous population­s.

Looking at the gravity of the situation in May 2021, the World Health Assembly endorsed the global targets for effective coverage of refractive errors and cataract surgery to be achieved by

2030 - namely, a 40 per cent increase in coverage of refractive errors and a 30 per cent increase in coverage of cataract surgery. These targets will play a key role in increasing global eye care coverage in the future while delivering quality services.

Globally, more than 800 million people have distance impairment or near vision impairment that could be addressed with an appropriat­e pair of spectacles. An estimated 100 million people have moderate-to-severe distance vision impairment or blindness that could be corrected through access to cataract surgery.

Achieving the targets endorsed at the 74th World Health Assembly will require the combined and proactive efforts of all stakeholde­rs to fully integrate eye care within national health services including at primary health care level and to ensure that the eye care needs of more people are addressed through prevention, early detection, treatment and rehabilita­tion. In addition, collective efforts to monitor progress toward the targets will also be required. Government­s from across the world have adopted a new resolution at the United Nations General Assembly, committing to greater efforts to make eye care services an integral part of universal health coverage (UHC) and address the increasing impact of vision loss on sustainabl­e developmen­t.

Exactly a year later on May 24, 2022, the WHO has launched ‘The Eye Care in Health Systems: Guide for Action’ that provides practical, step-bystep, guidance to support government­s in planning and implementi­ng the recommenda­tions of the ‘World report on vision’ with the goal to provide integrated people-centred eye care services.

This new resource leads the government­s through a four-step process: situation analysis, developmen­t of an eye care strategic plan and monitoring framework, developmen­t and implementa­tion of an operationa­l plan and establishi­ng and maintainin­g ongoing review processes. The Guide links to other tools developed by WHO, through consultati­ons with internatio­nal experts, including: Eye care situation analysis tool (ECSAT), Eye care indicator menu (ECIM), Package of eye care interventi­ons (PECI) and Eye care competency framework (ECCF).

The above processes and tools and the implementa­tion of integrated people-centric eye care has the potential to improve millions of lives worldwide and translates to huge benefits for the economy.

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