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Year : 1998  |  Volume : 46  |  Issue : 3  |  Page : 129-130

A global initiative for the elimination of avoidable blindness

Correspondence Address:
B Thylefors

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Source of Support: None, Conflict of Interest: None

PMID: 10085623

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How to cite this article:
Thylefors B. A global initiative for the elimination of avoidable blindness. Indian J Ophthalmol 1998;46:129-30

How to cite this URL:
Thylefors B. A global initiative for the elimination of avoidable blindness. Indian J Ophthalmol [serial online] 1998 [cited 2023 Sep 25];46:129-30. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?1998/46/3/129/14962

Despite considerable efforts in many developing countries, through national blindness prevention programmes, the global number of blind and visually disabled seems to be growing, mainly as an effect of population increase and aging. Thus, the most recent (1997) projected estimate for world blindness points to some 45 million blind, and an additional 135 million visually disabled (low vision). About 80% of blindness is avoidable (preventable or curable), and 90% of the world's blind live in a developing country.

Given this alarming situation, with a potential doubling of the world's blindness burden by 2020, a series of consultations were held during 1996 and 1997, between the WHO Programme and the Task Force to the Partnership Committee of collaborating Non-Governmental Organisations, with a view to developing a common agenda for global action against avoidable blindness. The expected result would be a strengthened and accelerated movement for blindness prevention, particularly in the developing world. As a result of these discussions, the Global Initiative for the elimination of avoidable blindness is focusing on a few priority disorders, and on what action needs to be taken from now to the year 2020, in terms of (i) disease control; (ii) human resource development; and (iii) infrastructure strengthening and appropriate technology development for eye-care delivery.

  Disease Control Top

Cataract stands out as the first priority amongst the major causes of blindness, with an estimated backlog of 16-20 million unoperated cases. The number of cataract operations/million population/per year is a useful measure of the delivery of eye care in different settings. This varies widely across different regions: the number of operations/million population/per year in Africa is about 200, in Latin America 500-1,500, India about 2,000, Europe about 3,000, and in USA above 5,000.

Thus, there is a need to increase drastically the number of cataract surgeries performed in the developing world. According to present estimates, approximately 7 million operations were performed globally in 1995, and 12 million surgeries will be needed in the year 2000, to prevent a further growth of the backlog. Similarly, by the year 2010, 20 million operations should be done, and in 2020, a staggering 32 million cataract operations will be needed. At the same time, as the numbers go up there should also be a progressive change in quality of surgery and technology, with intraocular lens implantation as a common standard, and the proper follow-up. This will call for better management and monitoring of services, including patient satisfaction.

Trachoma is still the most common cause of preventable blindness in the world, with some 5.6 million blind, and around 146 million cases of active disease in need of treatment. A suitable strategy, referred to as 'SAFE' (Surgery, Antibiotics, Facial Cleanliness and Environmental Hygiene) has been defined, and is being increasingly applied in endemic countries. A recently established (1997) WHO Alliance for the Global Elimination of Trachoma will facilitate collaboration with all interested parties, including 46 endemic countries with blinding trachoma. Actions envisaged under the Global Initiative include the provision of around 5 million trichiasis operations from the year 2000 to 2010, and treating at least 60 million people with active disease in the same period. By the year 2020, blindness due to trachoma should be eliminated globally.

Onchocerciasis will be brought under control by the year 2010 if ongoing operations in endemic countries are successfully completed. The recent development of community-directed treatment with annual doses of ivermectin will make it possible to eliminate this burden of blinding disease from the affected countries in Africa and Latin America.

Childhood blindness is caused mainly by vitamin A deficiency, measles, conjunctivitis in the newborn, congenital cataract and retinopathy of prematurity. There is rapid progress in eliminating xerophthalmia and measles, as part of 'child survival' initiatives supported by several UN and other organisations. However, much more work is needed for the early detection and optimal management of other causes of childhood blindness.

Refractive errors and low vision constitute another priority in terms of visual disability. There is an enormous need globally for spectacles and low-vision devices. The Global Initiative will focus on refractive services as part of primary health care and school services, and low-cost local production of glasses and optical devices will be promoted.

  Human Resource Development Top

In the field of human resource development emphasis will be on the primary health-care approach to blindness prevention. This implies continuing support for primary eye-care training in developing countries. In addition, there will be strengthened efforts to train more ophthalmologists, from the present situation of one ophthalmologist per 500,000 people in Africa, to achieve 1:250,000 by the year 2020. The corresponding figures for Asia would be from 1:200,000 today, to 1:50000 in 2020. Similarly, increased training of ophthalmic medical assistants and ophthalmic nurses should result in a ratio of 1:100,000 or 150,000 in the year 2020, as compared to 1:400,000 today in Africa and 1:200,000 in Asia respectively. It is also envisaged that there should be 100% coverage of training in basic eye care in medical schools by the year 2020. Other categories of staff to be trained under the Global Initiative include refractionists, managers for national/regional programmes and for major clinics, and also equipment technicians.

  Infrastructure and Appropriate Technology Top

Infrastructure and appropriate technology development is the third essential component of the Global Initiative. Standards for the availability of eye beds, refraction facilities, and basic eye medicines will be applied to ensure that the availability, access, utilisation and coverage of basic eye care will be at least 90% to all populations in the year 2020.

With regard to appropriate technology development, emphasis will be placed on the sustainable use of modern technology, making use of local production in developing countries whenever appropriate. The particular fields of interest concern instruments and consumables for cataract surgery, basic eye examinations, trichiasis surgery, glasses and other optical devices, as well as computers and other communications systems for effective management and coordination of work.

The Global Initiative is still in its early planning phase, but there is a clearly recognised need for a global awareness campaign, to sensitise decision-makers and health care providers as to the rationale and benefits of blindness prevention. The future scenario of a doubling of world blindness by the year 2020, unless more preventive action is taken, is unacceptable from a humanitarian point of view, and would have far-reaching socioeconomic and developmental consequences. This is why a strengthened partnership between all those working for blindness prevention is essential for optimal utilisation of resources available now and in the future.


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