Globally, 2.2 billion people are affected by poor eye health – and one billion of these cases could have been prevented. This is according to a World Health Organization (WHO) report released in advance of World Sight Day, observed today. The observance offers an opportunity for India to take note of its own visually impaired population and what it can do to prevent and treat cases.
“In a world built on the ability to see, vision, the most dominant of our senses, is vital at every turn of our lives,” reads the opening of the World Report on Vision, the agency’s first report on the issue. “Yet,” it goes on to state, “as this report shows, eye conditions and vision impairment are widespread, and far too often they still go untreated.”
“Over sixty million people in India are blind and with some form of vision impairment or the other,” Vinod Daniel, chief executive officer and managing director of the not-for-profit trust India Vision Institute (IVI), told Health Issues India. However, he goes on to note, “the challenge is huge but not insurmountable.” India is home to twenty percent of the world’s visually impaired population.
Expanding on the work of the IVI in the field, Daniel adds “we are working across India in eighteen states and union territories to provide the less privileged access to vision screening and free eye glasses. This becomes important specially to prevent avoidable blindness. For people with uncorrected refractive errors, a simple pair of spectacles would in most cases suffice to address the issue.”
Indeed, as The Hindustan Times reported last year, 75 percent of blindness cases are preventable. Lack of access to treatment are major hindrances to those with visual impairment and can negatively affect outcomes to the extent that one is left with a lifelong disability – simply because of a lack of access to care.
“It is unacceptable that 65 million people are blind or have impaired sight when their vision could have been corrected overnight with a cataract operation, or that over 800 million struggle in everyday activities because they lack access to a pair of glasses,” says WHO Director-General Dr Tedros Adhanom Ghebreyesus. “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.”
As the WHO report notes, “eye conditions are remarkably common. Those who live long enough will experience at least one eye condition during their lifetime.” At a time of increasing urbanisation and ageing populations – both trends being witnessed in India – visual impairment will exert an even bigger footprint, making concerted action vital.
The causes of blindness vary. Of the one billion people worldwide with moderate to severe vision impairment or blindness, unaddressed refractive error accounted for 123.7 million cases; cataract for 65.2 million cases; glaucoma for 6.9 million cases; corneal opacities for 4.2 million; diabetic retinopathy for three million; and trachoma for two million. In low- and middle-income countries, cataract exerts a particular toll compared to high-income nations. Health Issues India has reported previously on commonplace conditions such as dry eye disease which can result in blindness if not treated.Diagnostics and access to treatment are key in preventing lasting sight-related disability. Yet in India, as with other conditions, there is a treatment gap.
In 2000, a report noted issues such as uptake of treatment and access to facilities owing to a disproportionate clustering of medical facilities in urban areas as opposed to rural environments were impediments in the treatment of eye disorders in 2000. In the almost twenty years since, the situation is familiar.
As reported last year by CBMUK – The Overseas Christian Disability Charity noted that “for many people in India, particularly those living in poorer rural areas, sight-saving health services are out of reach.” As Devex reported last year “India itself still has a way to go, say many — from staffing to better use of data, ensuring access to care, and moving to a more comprehensive system.”
Staffing levels in the field of eye care are a major issue. “There are only an estimated 15,000 ophthalmologists in India and only 45,000 optometrists against a required 125,000,” Sandeep Bothra wrote in ExpressHealthcare earlier this year, with significant disparities between rural and urban areas. “This means,” he added, “a serious shortage of medical professionals leading to severe handicap in both screening and treatment of eye ailments in the country.”
The same is true globally. According to the WHO, “the burden of eye conditions and vision impairment is not borne equally: it is often far greater in people living in rural areas, those with low incomes, women, older people, people with disabilities, ethnic minorities and indigenous populations.”
The IVI has engaged in efforts to expand access to eye disorder treatment across India, including in underserved populations. “IVI has, to date, undertaken 588 vision screening programs in and around Chennai and other cities in Andhra Pradesh, Goa, Gujarat, Haryana, Jharkhand, Karnataka, Kerala, Maharashtra, Mizoram, New Delhi, Odisha, Pondicherry, Rajasthan, Tamil Nadu, Telangana and West Bengal,” Daniel told Health Issues India. “Over 244,509 individuals from the underprivileged communities (including over 187,030 children) were screened and free spectacles distributed to 37,704 individuals (including 20,148 children).”
Bridging the accessibility gap, the WHO report notes, ought to form a key component of the route to achieving universal health coverage (UHC) – a goal India aims to achieve, with Prime Minister Narendra Modi affirming his administration’s commitment to UHC at last month’s United Nations General Assembly. As such, it recommends that countries “implement integrated people-centred eye care in health systems; promote high-quality implementation and health systems research complementing existing evidence for effective eye care interventions; monitor trends and evaluate progress towards implementing integrated people-centred eye care; raise awareness and engage and empower people and communities about eye care needs.”
It is clear that India has work to do in this field but, as Daniel reminds us, “the challenge is huge but not insurmountable.” Indeed, India has made progress in this field. The WHO report credits the “concerted efforts” of the government’s National Programme for the Control of Blindness with effecting “an overall reduction in prevalence of blindness was reported from 1.1 percent in 2001-02 to 0.45 percent during the years 2015–18.” Going forward, implementing robust, targeted strategies and expanding access to screening are needed to improve standards and accessibility of eye care. World Sight Day is an opportunity to remind ourselves of this need, and to build momentum towards achieving it.
“As we commemorate World Sight Day to focus global attention on blindness and vision impairment on the theme ‘Vision First’,” says Vinod Daniel, “it is imperative that we continue with our work towards achieving vision care with access to all, especially the unreached and communities in far-flung and remote corners.”
The World Report on Vision can be accessed here.