Healthy eyes for everyone
- In the Western Pacific Region, over 90 million people experience visual impairment. Over 10 million are blind.
- Four out of five cases of visual impairment are preventable or treatable.
- 90% of visual impairment in the world occurs in low and middle income countries.
- The increasing proportion of older people in the Region's population creates a correspondingly higher proportion of people with visual impairment.
Most cases of visual impairment, including blindness, are preventable and treatable with simple and cost-effective interventions. For example, providing spectacles is a simple intervention to correct errors of refraction; cataract surgery dramatically improves eyesight, in most cases almost instantly. Healthy eyes for all is only achievable through the combined efforts of policy-makers, health workers, and communities.
The range of visual impairment
It is crucial for health-care delivery systems to be able to diagnose vision problems at their onset to prevent further deterioration. It is also necessary for health workers to identify and address other health issues that could lead to visual impairment.
The International Classification of Diseases defines the levels of vision as follows:
Visual impairment is more prevalent in economically-challenged settings, with 9 out of 10 visually impaired people in the world living in developing countries.
Visual impairment due to chronic eye diseases is more likely to be experienced by older people. While only a fifth of a country’s population is above age 50 on average, this group accounts for 82% of all people who are blind.
Reduced birth rates are causing demographic ageing in countries of the Western Pacific Region, while improvements in health-care services are enabling more people to live healthily into their old age. Thus, the proportion of the population experiencing visual impairment is increasing.
Visual impairment is also experienced by younger persons, with almost 19 million globally aged 14 and below suffering from some form of visual impairment. Although some of them are irreversibly blind, 12 million could be helped to regain or improve their vision.
Suitable people who can no longer acquire or recover their vision should be provided with appropriate rehabilitation services to enable them to be more functional and to help them integrate into mainstream society. Such services can include the distribution of assistive low vision devices (magnifiers, loupes, etc.) or mobility training.
Addressing the causes of visual impairment
Uncorrected errors of refraction are the most common causes of moderate and severe visual impairment in people all over the world. Almost half of cases of visual impairment are due to uncorrected refractive errors. This includes conditions such as myopia, hyperopia and presbyopia. Such conditions can be effectively diagnosed by qualified professionals performing eye examinations and refractive tests to determine the type and degree of refractive error. These errors can be corrected by providing high quality and low cost spectacles..
One third of cases of blindness are the result of opaqueness of the lens of the eye due to cataract. This is even more pronounced in low- and middle-income countries, where cataracts commonly are the leading cause of blindness. This condition can be corrected through highly cost-effective surgery, with the insertion of an intra-ocular lens.
Other causes of visual impairment include eye diseases such as glaucoma, accounting for around 2% of cases globally, and age-associated conditions such as macular degeneration.
Trachoma is an infectious disease that can also compromise vision or lead to blindness. Infections can be prevented through improved sanitation, treated with antibiotics while lid surgery can effectively pevent permanent.
In recent years, concern has been raised about increasing cases of visual impairment caused by diabetic retinopathy. All people with diabetes are at risk of developing this eye disease and many require treatment to avoid irreversible vision loss. Primary care professionals need to be attuned to and capable of diagnosing diabetic retinopathy so patients can be referred for surgical, medical or vitrectomy treatment to preserve vision.
The role of WHO
The World Health Organization works to strengthen country-level efforts to ensure that no people in the Region are needlessly visually impaired, and that all people with unavoidable vision loss can achieve their full potential. This entails ensuring universal coverage of comprehensive eye-care services in Member States. More concretely, the global target is a reduction in visual impairments by 25% by the year 2019, compared to 2010. This is embodied in the Global Eye Health Action Plan 2014–2019 endorsed by the World Health Assembly in 2013.
WHO coordinates international and multisectoral efforts to reduce visual impairments within Member States through:
- monitoring visual impairment trends in specific countries;
- formulating blindness prevention policies and strategies that are appropriate to various levels of development;
- providing technical assistance to Member States and partner agencies;
- planning, monitoring, and evaluating blindness prevention programmes; and
- fostering effective international partnerships in support of national efforts.
Towards Universal Eye Health: a Regional Action Plan in the Western Pacific (2014–2019) proposes the following actions for Member States and partner agencies in coordination with the WHO Secretariat.
- Address the need to generate evidence on the magnitude and causes of visual impairment and on eye-care services, and utilize such evidence to advocate greater political and financial commitment of Member States to eye health.
- Encourage the development and implementation of integrated national eye health policies, plans and programmes to enhance universal eye health with activities in line with the WHO framework for action, Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes.
- Strive for multisectoral engagement and effective partnerships to strengthen eye health.
So much for so little
Restoring eyesight creates immeasurable gains in the well-being of people in all parts of the world. The science, technology, and interventions necessary to make this possible are tried and tested, and are largely accessible to the Member States of the Western Pacific Region. Visual impairment from unoperated cataract should not be accepted as a public health burden, considering the availability of surgical treatment that is as cost-effective as some vaccinations.
WHO has worked with countries of the Region and a network of international partners and private sector organizations to ensure that appropriate, state-of-the-art, high-quality eye care solutions are made available to those in need. The various stakeholders in these efforts need to mobilize further in the following areas.
- Individuals and families need to be aware of the threats to good vision, and seek help when they suspect any problems.
- Health professionals need to be equipped with the skills and knowledge to diagnose and manage eye diseases, advocate for prevention of these diseases, and refer cases to appropriate specialists.
- Governments need to muster the political will to provide policy and financial support to eye health service capabilities in their respective countries for prevention, disease management, and rehabilitation.
- Partner agencies need to augment and support efforts of public health care and social services systems to promote healthy eyes for everyone.