Ivo Kocur

Global data on visual impairment in the year 2002

This paper presents estimates of the prevalence of visual impairment and its causes in 2002, based on the best available evidence derived from recent studies. Estimates were determined from data on low vision and blindness as defined in the International statistical classification of diseases, injuries and causes of death, 10th revision. The number of people with visual impairment worldwide in 2002 was in excess of 161 million, of whom about 37 million were blind. The burden of visual impairment is not distributed uniformly throughout the world: the least developed regions carry the largest share. Visual impairment is also unequally distributed across age groups, being largely confined to adults 50 years of age and older. A distribution imbalance is also found with regard to gender throughout the world: females have a significantly higher risk of having visual impairment than males. Notwithstanding the progress in surgical intervention that has been made in many countries over the last few decades, cataract remains the leading cause of visual impairment in all regions of the world, except in the most developed countries. Other major causes of visual impairment are, in order of importance, glaucoma, age-related macular degeneration, diabetic retinopathy and trachoma.

Securing support for eye health policy in low- and middle-income countries: Identifying stakeholders through a multi-level analysis

This article empirically evaluates advocacy in low- and middle-income countries as a key tool for raising policy priority and securing high-level decision maker support in eye health. We used a unique data set based on a survey conducted by World Health Organization in 2011 on eye care and prevention of blindness in 82 low- and middle-income countries. The theoretical framework derives from the idea that a plethora of stakeholders at local and global level pressure national governments, acting in economic and the political spheres. Previously, eye care has not been investigated in such a framework. We found structural differences across countries with different income levels and proposed policy recommendations to secure high-level decision makers’ support for promoting eye health. Three case studies suggest that, in order to secure more support and resources for eye health, domestic and international stakeholders must strengthen their engagement with ministries of health at political and above all economic levels.

New challenges for VISION 2020.

Ivo Kocur, MA, MSc and Serge Resnikoff, PhD World Health Organization, Geneva, Switzerland Over the past six years of its existence, VISION 2020 has gained a prominent role in many countries in shaping the public health agenda for eye care services. Its launch on 18 February 1999 was an important milestone in the collaborative effort of WHO with a group of dedicated non-governmental organizations to establish a global coalition of those working in the field of visual health. At the time of its launch, the agenda of VISION 2020 was determined by the most prominent needs and known interventions available to control the major causes of blindness. Blindness due to cataract was seen as the main global challenge and addressed the many millions of people needlessly suffering from visual impairment caused by a treatable disease. Infectious diseases such as trachoma and onchocerciasis followed on the list and their elimination was shown to be achievable through known interventions and poverty alleviation. Children’s eye health was recognized to require special attention as preservation of their sight has a direct impact on their entire life. It was also acknowledged that people with various less-easily treatable eye diseases, as well as with significant refractive errors, would benefit from widely available adequate refraction and in some cases from low vision services. Considering that the greatest need was in less-developed countries and underserved communities, the VISION 2020 agenda has targeted mostly countries in Africa and some parts of Asia. When the World Health Assembly adopted the Resolution on Elimination of Avoidable Blindness in 2003, the agenda of VISION 2020 acquired a truly political and global dimension. Six years after the launch of VISION 2020, it is now a fitting time for a midterm review of its accomplishments and impact. In the light of new information on the magnitude and causes of blindness, it is also a suitable opportunity to assess global trends in the pattern of visual impairment and identify the most appropriate responses VISION 2020 should adopt in its working agenda. As we have witnessed over the last three decades, the threat posed to people by infectious diseases is gradually diminishing, due partly to the developmental progress achieved in many countries and partly to the implementation of known and successfully tested interventions for their prevention and treatment. This has been recorded in the case of trachoma and onchocerciasis in addition to other infectious external eye conditions. Thanks to broad international alliances, these infectious eye conditions are already successfully controlled in many countries, and every year there is significant progress towards their elimination as a public health problem. Being driven by its successes, this process must continue. However, the ever-increasing number of cases of chronic eye diseases, such as diabetic retinopathy, glaucoma, and age-related macular degeneration, demands adequate attention. The global trends indicate Accepted 1 July 2005

The Future of Eye Care in a Changing World: Call for Papers

667 Eyesight plays a critical role in health and in people achieving a good quality of life. It has a pivotal influence on the way a person relates to and integrates into society, and an impact on many other areas, such as education and employment.1–3 Throughout the life course, vision affects child cognitive development, mental health, professional and personal trajectories and functional capacity in older people.4–7 Past investments in blindness prevention programmes have improved outcomes for individuals and generated economic benefits through enabling people to work – those directly affected and their caregivers.8,9 The age-standardized prevalence of severe, moderate and mild vision impairment is no longer increasing significantly, reflecting a shift in causes from communicable to chronic diseases.10 However it is estimated that population growth and ageing could contribute towards a tripling in the number of people with vision impairment; by 2050 there could be 115 million people who are blind, up from 38.5 million in 2020.10 New estimates also show that approximately 1 billion people over 35 years are currently affected by near vision impairment due to uncorrected presbyopia, 668 million of whom are over 50 years.10 However prevalence statistics only tell part of the story. Many people are affected by diseases or conditions that impact their vision and do not have timely access to services. There are also discrepancies in how different populations are affected. For example, women are estimated to have higher prevalence of blindness than men across all regions of the world.10In Australia, Aboriginal and Torres Strait Islander people have six times the rate of blindness of other Australians.11 There is however, a dearth of evidence about which groups miss out, why and what can be done about it.12 Eye care is often not well integrated into health systems, and often receives insufficient attention in workforce strategies and health information management systems, for example. Some health systems are therefore supporting service delivery models and approaches that may not be the most effective. Ineffective service delivery impacts on efficiency, reducing opportunities to free up and reallocate resources that could be used to improve quality or to reach groups that miss out. These resources are substantial; the annual global health system costs of recognizing, preventing and treating visual impairment have been estimated to be US

VISION 2020: The Right to Sight: A Global Initiative to Eliminate Avoidable Blindness

2.3 trillion.13 Increased efforts to provide timely and high-quality comprehensive eye care are needed in the context of population growth, non-communicable diseases and ageing. These demographic trends will lead to increased numbers of people with preventable and or irreversible vision loss. Eye care needs to be an integral part of universal health coverage to achieve the Sustainable Development Goals, in particular Goal 3 ensure healthy lives and promote well-being for all at all ages.14 The Bulletin of the World Health Organization will publish a theme issue on vision. Papers for all sections of the Bulletin are welcomed around the central theme of ‘what works’. The theme issue will also supplement a forthcoming World report on vision. The report is expected to provide evidence on the prevalence and magnitude of eye diseases/conditions and vision loss globally, as well as its prevention, treatment and rehabilitation. It will offer recommendations, including a number focused on ensuring universal access to quality comprehensive and integrated eye care services in countries. We welcome papers for the theme issue that provide evidence across all health strategies (promotion, prevention, treatment and rehabilitation) and systems building blocks, in particular, those that focus on best practices, innovation and the use of technology. Papers that identify gaps and provide solutions to ensure equitable access to services are encouraged. Papers should seek to integrate examples from lowand middle-income countries and different age groups. We strongly encourage papers that address health system issues, rather than focusing solely on one specific disease or condition. The deadline for submissions is 15 March 2018. Manuscripts should be submitted in accordance with the Bulletin’s Guidelines for contributors (http://submit.bwho.org), and the cover letter should mention this call for papers. ■