|Year : 2012 | Volume
| Issue : 5 | Page : 349-350
A model initiative
Departments of Ophthalmology, Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, E6527 Baltimore, MD 21205, USA
|Date of Web Publication||4-Sep-2012|
Departments of Ophthalmology, Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, E6527 Baltimore, MD 21205
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sommer A. A model initiative. Indian J Ophthalmol 2012;60:349-50
Much has changed since Sir John Wilson and Ed Maumenee decided, over lunch at a blindness prevention gathering in Jerusalem in the early 1970s, to join nongovernment organizations (NGOs) (The World Council for the Welfare of the Blind) with organized ophthalmology (The International Federation of Ophthalmic Societies) in a new initiative, creating the International Agency for Prevention of Blindness (IAPB). Their initial, highly successful priority was to garner global support for the creation of a dedicated blindness prevention unit (Programme for Prevention of Blindness (PBL) within the World Health Organization (WHO) Despite the inevitable ups and downs of all 'marriages,' IAPB has flourished and produced, in a relatively short period, truly astonishing progress in the fight against avoidable blindness.
Importantly, WHO hosted numerous advisory committees and anointed 'collaborating centers,' which encouraged the discovery and sharing of new insights and their practical application to the prevention of blindness. Early advisory meetings led to a formal, graded definition of visual impairment and blindness; established standardized field tools for collecting and comparing data; designated the criteria for blindness reaching 'public health significance'; and recommended treatment modalities and prevention paradigms based on the best available evidence at the time. IAPB's periodic General Assembly provided a global forum for sharing new information and debating the merits of alternative prevention strategies. IAPB provided a 'big tent,' under which both local and international NGOs, professional societies, government officials, and others keen to join the mission could gather to share insights and form alliances.
The triumphs, often told, have been little short of staggering. Ivermectin, a drug developed to prevent heartworm for the livestock industry, now prevents river blindness among millions of Africans. The SAFE strategy, combining new insights into the importance of face washing, environmental hygiene, a standardized and proven approach to lid surgery, and annual or biannual dosing with the near-miracle antibiotic azithromycin (which replaced months of daily application of a visually disruptive ointment) has dramatically reduced the burden of trachoma and its attendant misery and blindness. Twice yearly high-dose oral vitamin A has eliminated xerophthalmia (and drastically reduced mortality) among the hundreds of millions of young children who receive appropriate dosing each year. These community-based, population-wide public health interventions have had a dramatic impact on three of the four major causes of blindness that initially most concerned IAPB and WHO.
But the fourth cause of concern, cataract, has proved far more problematic. Nothing truly prevents it, and treatment requires one-on-one interaction between a willing patient and a skilled surgeon. Cataract dominated much of the discussion at the second IAPB General Assembly, held in Bethesda, Maryland in 1982. Emerging data suggested there might be as many as 3 million new cataract blind in India every year, a staggering burden seemingly incapable of ever being dealt with. There were clearly insufficient numbers of surgeons, and few patients who would even agree to free aphakic surgery. The issue was compounded by vigorous disagreement about the appropriateness of extracapsular surgery and the use of IOLs in low and middle income countries, with those favoring aphakia carrying the day-but only for a few years, until experience demonstrated that high quality pseudophakic surgery was not only safe under less-developed country conditions, but also produced more 'satisfied customers' who eagerly spread the word among those who previously shunned cataract surgery. New, self-sustaining models of cataract surgical delivery, enhanced by the availability of IOLs that cost only 2% the price then prevailing in wealthy nations, dramatically upended long established delivery patterns in those countries and cultures that were prepared to change. India increased the number of cataract operations performed 10-fold, from half a million in 1980, to 5 million in 2005, handily exceeding the previously dreaded incidence of 3 million new cases each year.
The problems of cataract surgical service delivery are not yet entirely solved-urban dwellers are far more likely to receive surgery than those in the countryside; relatively wealthy emerging economies, like China, have yet to make significant investments in low cost, high quality surgery needed by the masses; and Sub-Saharan Africa, with only one ophthalmologist per million population (one-tenth that of India) and little cash to spare, awaits development and adoption of innovative approaches to tackling the problem.
Today IAPB and WHO, through their joint program, VISION 2020, are turning their attention to newly emerging threats to sight in the developing world: diabetic retinopathy, growing with the increased prevalence of obesity in nations still wracked by poverty and hunger; and retinopathy of prematurity in countries where low birth weight infants are more likely to be better cared for, and therefore to survive. Practical, effective approaches to identifying and preventing blindness from the 'glaucomas' (open angle and closed) in poor societies remains a challenge.
Regularly updated metrics on burden and impact, and careful documentation of program effectiveness, remain critical to effective advocacy and planning, the paramount concerns of IAPB. These, and new innovations for delivery of services, will no doubt dominate discussions at the 9 th General Assembly being held in Hyderabad. India, which gave the world pioneering institutions and approaches in the battle for sight, like the Aravind Eye Care System, the L.V. Prasad Eye Institute, and others, is an appropriate venue to formulate and deliberate plans for the final, eight year push to achieve VISION 2020's goals.
In his opening remarks at IAPB's first General Assembly, its founding President, Sir John Wilson, famously noted that 'avoidable blindness… is an obscene and costly anachronism'.  Much has been accomplished since IAPB was first founded, but much is yet to be done. Pioneering approaches have elucidated proven strategies awaiting more widespread, locally appropriate, adoption. Blindness prevention has proven an effective, organized movement that now serves as a model to emerging health initiatives in other spheres.  '2020' is but 8 years away.
| References|| |
International Agency for the Prevention of Blindness, Sir John Wilson, editor. World Blindness and its Prevention. Oxford: Oxford University Press; 1980.
Sommer A. DOHaD: from "hypothesis" to practice. J DOHaD 2012;3:2-3.