Disparities in Global Eye Care

Vision is one of our most precious possessions. Multiple polls globally show that most people are more fearful of becoming blind than losing any other sense. (1,2) With sight being such a valuable asset, one would assume that eyecare is at the forefront of medical services across the world.

Living in the developed world, we perhaps take for granted the simple and yet crucial services available to us such as regular eye tests, glasses, contact lenses and high-quality ophthalmic care - most of which can be accessed for free or at a subsidised price. However, in many parts of the world this is not the case. 285 million people worldwide are visually impaired, with 90% being from developing countries. (3) In China, for example, levels of blindness are increasing each year, however critically, rates of blindness have been reported at up to 4 times higher in the developing world as compared to more economically developed countries (4, 5).

This is particularly worrying given that around 80% of world blindness is considered to be preventable. (6) For example, cataracts is the leading cause of global blindness, with 99% of people experiencing vision loss due to cataracts (clouding of the lens) being from the developing world. They can be cured in a fairly simple 15-minute operation, but treatment isn’t attainable for much of our global population. (3) Another 100 million people have impaired vision due to uncorrected refractive errors, which would be easily restored if they had access to eyeglasses. (6)  The reality is that these conditions, along with many others such as trachoma (a bacterial infection that can cause irreversible blindness) and glaucoma (damage to the retinal nerve fibres, often secondary to raised intraocular pressures), could be prevented and/or cured if the correct resources were available. Ultimately, much of the blindness seen in developing nations can be attributed to a lack of resources, infrastructure, education and skilled ophthalmologists. (4, 5)

Several attempts have been made to address these global eyecare disparities. One such initiative was VISION 2020: The Right to Sight, an ambitious campaign jointly led by the World Health Organisation (WHO) and the International Agency for the Prevention of Blindness (IAPB). VISION 2020 was launched in February 1999, with the aim of ‘eliminating the main causes of preventable and treatable blindness as a public health issue by the year 2020’. (7) VISION 2020 had a number of notable successes, both in advocating for visually impaired people (through the creation of World Sight Day), and by dramatically increasing the funding and resources available for eye care from governments and non-governmental organisations. (7) VISION 2020 was responsible for a number of positive outcomes in eyecare across the world, with notable impacts on the prevalence of overall visual impairment and childhood blindness, progress in new treatments for cataracts, and greater accessibility to low-cost eyeglasses. (5) However, despite the breakthroughs achieved, the high rates of preventable blindness still present across the developing world suggest that VISION 2020 did not go far enough in acknowledging and tackling the causes of avoidable visual impairment. There is still much to be done to meet the aim of eradicating preventable blindness, with socio-economic and geographical disparities in eyecare still being a major factor. (7)

Like many other health conditions, blindness and visual impairment will never be completely eradicated- such an assertion would be unrealistic. However, the fact that 80% of the incidences of visual impairment would be entirely avoidable with access to the appropriate resources, infrastructure and personnel suggests that more has to be done to combat global blindness. This is even more important when considering the fairly basic nature of some of the interventions required to restore visual function in many patients. Initiatives such as VISION 2020 are welcome and important in progressing global eyecare, but the reality is that far too many people unjustifiably go about their day-to-day life with preventable visual impairment.

Sight is a wonderful gift, and everyone deserves the opportunity to see the world around them. Progress is being made, but access to quality eyecare for all- regardless of geography or wealth- remains a distant prospect. Further global initiatives like VISION 2020 are important in accelerating the improvement of eyecare across the world.

Written by Amaan Sharih

References

1) Nguyen,H. ‘Of the five senses, a majority would miss sight the most’ [Internet] 2018 [Cited 2021 Nov 5] Available from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjMg63juYT0AhUCYsAKHZUXDBUQFnoECAIQAQ&url=https%3A%2F%2Ftoday.yougov.com%2Ftopics%2Fhealth%2Farticles-reports%2F2018%2F07%2F25%2Ffive-senses-majority-would-miss-sight-most&usg=AOvVaw3RKX7aSiwOMLk2TuaQPczm

2) Enoch J, McDonald L, Jones L, et al. ‘Evaluating whether sight is the most values sense’. JAMA Ophthalmol [Internet] 2019 [Cited 2021 Nov 6] Available from:  https://pubmed.ncbi.nlm.nih.gov/31580383/

3) Green K. ‘Which eye conditions are most common in different countries around the world?’[Internet] 2019 [Cited 2021 Nov 5] Available from: https://www.optimax.co.uk/blog/eye-conditions-different-countries-world/

4) EyeQue. ‘A look at vision care around the world’ [Internet] 2017 [Cited 2021 Nov 6] Available from: https://www.eyeque.com/knowledge-center/a-look-at-vision-care-around-the-world/

5) Sommer A, Taylor HR, Ravilla TD, et al. ‘Challenges of ophthalmic care in the developing world.’ JAMA Ophthalmol [Internet] 2014 [Cited 2021 Nov 5] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4063878/

6) Light for the world. ‘Avoidable blindness’. [Internet] [Cited 2021 Nov 5] Available from: https://www.light-for-the-world.uk/avoidable-blindness

7) Rao, GN. ‘IN FOCUS- The achievements and lasting effects of VISION 2020’. [Internet] 2020 [Cited 2021 Nov 6] Available from: https://www.eyenews.uk.com/features/humanitarian/post/in-focus-the-achievements-and-lasting-effects-of-vision-2020