Image: The International Agency for the Prevention of Blindness (IAPB)
More than 2.2 billion people around the world live with vision impairment, the World Health Organization’s first World Report on Vision shows. What role can research play in changing this and giving more people the gift of sight?
Vision is a precious sense, helping us connect with the world and the people around us. It’s a gift we can easily take for granted in our everyday lives as we navigate a crowded street, read a news article, enjoy vibrant colours and scenery, or watch the kids play.
But around the world, more than 2.2 billion people live with some form of vision impairment or blindness. Most troublingly, at least one billion of these people have a vision impairment that could have been prevented or is yet to be treated.
This reality is highlighted in a new landmark report from the World Health Organization, the World Report on Vision.
Released in the lead up to World Sight Day, the highly anticipated report outlines the challenges of delivering eye care through the existing health systems, along with clear proposals for actions to create change. The focus is on ‘people-centred eye care’, embedded in health systems and accessible to all.
“It is time to make sure that as many people as possible in all countries can see as well as current health technologies and health systems allow,” says Dr Tedros Adhanom Ghebreyesus, WHO Director-General.
“People who need eye care must be able to receive quality interventions without suffering financial hardship. Including eye care in national health plans and essential packages of care is an important part of every country’s journey towards universal health coverage.”
Making a difference where it’s needed most
Bringing eye care into focus and improving services in Australia is important. But to really create change globally, we also need to support countries who are struggling the most with poor vision.
“Almost 90% of vision impairment and blindness occurs in low- and middle-income countries,” says Dr Andreas Mueller, Deputy Director of the World Health Organization Collaborating Centre for the Prevention of Blindness at the Centre for Eye Research Australia.
“It’s important not only to raise awareness about our own eye health here in a country like Australia, but also awareness that there is a huge burden and an unmet need in poorer countries.”
The WHO Collaborating Centre at CERA carries out research that can be applied in low-and middle-income countries. In particular, the focus is on developing technology for early detection of eye diseases, which can be used in the field where no eye specialists are available.
Here, Dr Mueller explains more about his team’s work, and what we can do to reduce the impact of vision impairment around the world.
What is the biggest cause of blindness around the world, and what can we do to reduce its impact?
Dr Mueller: By far the main cause of blindness in poorer countries is unoperated cataracts.
We know that cataract surgery is highly cost effective. For a relatively small amount of money, somebody can regain their vision after a 30-minute surgery. Yet still around 50% of blindness in the world is due to unoperated cataract.
We need to advocate to governments that this is a significant problem, and that increasing resources for cataract surgeries in poorer countries is money very well spent.
We need to make sure services for cataracts are affordable and accessible to all. Cataract surgeries ideally should be reimbursed by national insurance systems. There also needs to be services available not just in capital cities, but in smaller towns and villages.
How could eye care services be made more accessible in areas with the biggest need?
Dr Mueller: To address the issue of blindness we need to make sure eye care services are available not only in specialised hospitals, but also at the primary and secondary level of the health system.
This is something we are advocating very strongly for. If a patient walks into a health centre in a village or a small town, there should be someone right there who understands eye care, is able to address minor problems, and can identify which cases need to be referred to an eye specialist.
This might mean training more nurses and health workers in eye care and providing the equipment they might need to identify and treat these cases.
It’s also important to note that 55% of vision impairment and blindness is found in women. This shows us that more effort needs to be taken to ensure access to eye care services to women around the world.
What role can medical research institutes like the Centre for Eye Research Australia play in this?
Dr Mueller: As a research institute, it’s important to make sure our research findings are applicable and affordable and can be made available where they’re most needed.
A lot of the work that we do here is about developing technology to screen or diagnose people at the lower level of the health system. This means people can be trained with equipment that doesn’t cost tens of thousands of dollars, but is affordable to a smaller hospital or clinic.
For example, we are working on projects using artificial intelligence, where a simple laptop might have a piece of software loaded onto it. An image taken of the back of the eye could then be diagnosed by the computer, rather than having to have an eye specialist available.
The nurse or health worker who took the photo can then immediately understand whether or not this patient needs to be referred to a specialist.
The value of being a WHO Collaborating Centre is that it gives us the opportunity to take some of our research directly into the field to test and develop further, and make sure this research is used on the ground in low- and middle-income countries where it’s needed the most.