Global Blindness: VISION 2020: The right to sight
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In the mid 1990s it was projected that the magnitude of global blindness would double, from 38 million in 1990 to 76 million by 2020. This projection was based on service levels available at the time and the anticipated population growth and ageing across the world. It highlighted that immediate action was required. In this presentation we look at how programmes have been implemented in order to address the growing burden of visual impairment and introduce VISION 2020: The Right to Sight, the global initiative to end avoidable blindness. © 2016 International Centre for Eye Health, London School of Hygiene & Tropical Medicine. This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license. Taken from the free online course: Global Blindness: Planning and Managing Eye Care Services. We encourage the use and adaptation of this resource for teaching and learning. Find more Open Educational Resources for eye care on our website at http://iceh.lshtm.ac.uk/oer
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Global Blindness: VISION 2020: The right to sight
- 1. Global Blindness: Planning and managing eye care services VISION 2020: The right to sight
- 2. Learning outcomes Know the brief history behind VISION 2020: the right to sight Understand the concept and priorities of VISION 2020 Assess the actions taken to date and their impact
- 3. Projections for global blindness1995 38 76 Millionsofblind 80 60 40 20 0
- 4. Main causes of blindness 1995 Cataract and refractive errors: 25 million Trachoma, onchocerciasis, vit. A deficiency: 10 million Glaucoma, diabetic retinopathy: 5 million >75% Other: 5 million
- 5. Aim of programme for preventing avoidable blindness 80 60 40 20 Millionsblind Without VISION 2020 With VISION 2020 20202000 2010 100 million
- 6. Focus on… Strengthening services for cataract and refractive error
- 7. Focus on… Prevention of trachoma, onchocerciasis, vitamin A deficiency, child blindness
- 9. Essential VISION 2020 Disease control strategies
- 10. Essential VISION 2020 Eye care team
- 11. Essential VISION 2020 Infrastructure and technology
- 12. VISION 2020 model for district level Control strategies Infrastructure & technology Eye care team 1 million people
- 13. Global blindness data in 2010 80 60 40 20 Millionsblind Without VISION 2020 With VISION 2020 20202000 2010 39 million blind
- 14. What has happened to global blindness since VISION 2020 began? 45 million blind 2002/2004 39 million blind 2010
- 15. Impact of cataract surgery on poverty 30 20 10 0 Dollarsperday Before surgery 1 year after surgery Control Operated
- 16. Impact of cataract surgery on quality of life Control Operated 100 80 60 40 20 0 Qualityoflifescore Before surgery 1 year after surgery
- 17. Summary We have effective models for service delivery in some locations Challenge now is scale up Next, plan for ‘harder’ countries and for chronic diseases
- 18. Written by Dr Daksha Patel © 2016 International Centre for Eye Health, London School of Hygiene & Tropical Medicine. This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license. Taken from the free online course: Global Blindness: Planning and Managing Eye Care Services. We encourage the use and adaptation of this resource for teaching and learning. Find more Open Educational Resources for eye care on our website at http://iceh.lshtm.ac.uk/oer
Editor's Notes
- In this presentation we are going to look at how programmes have been implemented in order to address the growing burden of visual impairment. By the end of the presentation you should be able to: Know the brief history behind VISION 2020: the right to sight Understand the concept, and priorities, of VISION 2020 Assess the actions taken to date and their impact
- In the mid 1990s it was projected that the magnitude of global blindness would increase from 38 million in 1990 to 76 million by 2020. This projection was based on existing service levels and on anticipated population growth and ageing across the world. It highlighted that immediate action was required. Data in 2002 estimated the global blindness had increased to 45 million with 269 million with low vision.
- In 1995, the main causes of blindness were found to be cataract and refractive error, which occur across all populations and for which there are clear methods of treatment. The other important causes of blindness were trachoma, onchocerciasis and vitamin A deficiency in children. These conditions are focal, occurring only in certain groups within populations, and they require a targeted approach. There is no treatment for end stage blindness from these conditions, and so interventions are focused on prevention: Ivermectin distribution in endemic zones for onchocerciasis Azythromycin distribution for trachoma Vitamin A supplementation and immmunisation for measles for childhood blindness. Glaucoma, diabetic retinopathy and other causes such as age-related macular degeneration (ARMD) were felt to be difficult diseases to identify and manage. It was therefore decided that the focus should be on the main causes of blindness where strengthening prevention efforts would address over 75% of avoidable blindness.
- The aim of implementing a programme for preventing avoidable blindness was to change the trend and bring about a decline in global blindness.
- Efforts would be focussed on strengthening services for cataract and refractive error… Jenny Matthews/Sightsavers CC BY-NC 2.0 flic.kr/p/9oPfvP
- …and on prevention activities for trachoma, onchocerciasis, vitamin A deficiency and childhood blindness. This would mean, over a 20 year period, 100 million people would be treated or prevented from going blind. Image: Anthony Solomon CC BY-NC 2.0 flic.kr/p/9wV6Hw
- This idea led to the launch in 1999, of a global initiative to eliminate avoidable blindness – known as VISION 2020: the right to sight. To co-ordinate the initiative, a unique partnership was set up between the World Health Organization and the International Agency for Prevention of Blindness, IAPB. The IAPB is a global consortium of non-governmental organisations working in eye care. This partnership has worked towards setting goals and targets which countries can use to address blindness at a local level.
- The three essential elements for VISION 2020 were: 1. To develop appropriate control strategies and targets for service delivery for: cataract, trachoma, onchocerciasis and childhood blindness Image: Ferdinand Ama CC BY-NC 2.0 flic.kr/p/9FY2wv
- 2. To develop human resources Image: AusAID CC BY 2.0 flic.kr/p/hgbv47
- 3. To develop infrastructure and appropriate technology Image: Heiko Philippin CC BY 2.0 flic.kr/p/hDfexQ
- The suggested model for development was based on a population of 1 million people. It was expected that if these three essential elements (the eye team, working with good infrastructure and equipment and a disease focused action) were put together and managed well, the result would be the elimination of avoidable blindness. National prevention of blindness programmes were developed and acted upon locally.
- What has happened to global blindness since VISION 2020 began? Recent data from 2010 shows a downward trend. The most important observation is that despite the growth in the global population, the number of blind people is decreasing. Evidence indicates that surgical rates are going up and that prevention is being strengthened.
- When we compare data from 2002/2004 with data from 2010 we can see there has been a global decrease in the number of blind people, from 45 to 39 million, and a reduction in the prevalence of visual impairment, from 5% to 4.2%. Encouragingly, this has been achieved despite a world population increase of half a billion to 6.7 billion, and a rise of 18% in the number of people aged over 50.
- The impact of sight restoration on poverty is felt both by individuals and their communities. A study of patient groups showed that one year after cataract surgery, people whose sight had been restored had become economically active and were able to bring in contributions almost at the same level as other similar members within their community.
- The impact of restoring sight to the blind can be measured using a quality of life score. The patient group study found that the quality of life score of blind people was a quarter that of the seeing persons in the same community. One year after cataract surgery their quality of life score was equal to others in the community.
- In summary. A great deal has been achieved in the first decade of the VISION 2020 initiative. Importantly we know what needs to be done and we have effective models for service delivery in some locations. We have also learnt that thinking globally but implementing locally has an impact and resources can be directed in a strategic manner. This decade, the big challenge is to scale up at national level and integrate VISION 2020 into the health system. This will make models of eye care sustainable. We also need to assess where we are likely to be by the year 2020 and begin make plans for the “harder” countries and chronic diseases like glaucoma and diabetes. Written by Dr Daksha Patel © 2015 London School of Hygiene & Tropical Medicine. This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license.