Vision for a better future: lessons from The Lancet Global Health Commission on Global Eye Health
Vision impairment affects more than the individual, and its prevalence and impacts are of global concern. There are many strategies we can implement to help address the causes of vision impairment and to help improve equitable access to eye care.
Article by Daisy De Windt, BBus, BSc in BiomedSc, MHL; Associate Director, Medical Writing – Independent Medical Education
In 2021 The Lancet Global Health Commission on Global Eye Health published their report, Vision Beyond 2020, which was a culmination of work contributed by 73 experts in 25 countries1. The report is extensive, outlining the common causes of vision impairment and blindness, barriers to accessing eye health care, and strategies to improve access and improve vision globally. The report proposes potential solutions, however it is up to policymakers, healthcare leaders and individuals to enact the changes suggested in order to realise the benefits for people and societies globally.
Almost every single person will experience an eye condition or vision impairment and have the need for eye care services during their lifetime. It has been estimated that moderate or severe vision impairment affects 295.09 million people globally, representing approximately 3.74% of the world’s population2.
As many as 895 million people will have distance vision impairment by 2050, 61 million of whom will be blind2
Good progress has been made over the past 30 years, with a 28.5% reduction in the age-standardised global prevalence of blindness, and a substantial reduction in the prevalence of the major infectious causes of blindness. However, due to our ageing global population the crude prevalence of age-related causes of blindness has in fact increased, and as a result there are higher rates of people with blindness in some regions2.
Eye health remains a global challenge: requiring urgent attention from all players in the healthcare landscape
Vision impairment has been associated with effects on mental wellbeing, reductions in mobility, higher risk of car accidents, greater need for social care, higher falls risk, a higher risk of dementia, depression, cardiovascular disease and lung cancer, educational and workplace disadvantage, and higher rates of mortality. Its impacts affect the person experiencing vision impairment, as well as their families and communities. The global productivity loss from vision impairment is estimated to be approximately US$410.7 billion purchasing power parity per annum2.
Access to eye health care is far from universal, with a number of barriers such as cost, a lack of equipment and consumables, and insufficient quantity and distribution of suitably trained personnel. Although these obstacles are widespread in low- and middle-income countries, they also occur in high-income countries. Unsurprisingly, social determinants impact access to eye health care, with issues such as gender inequity, racism and social exclusion playing a role2.
By addressing these inequities, we have a greater chance at improving vision globally, which would reasonably lead to improved employment prospects, greater workplace efficiency, higher household income and better overall wellbeing and quality of life for many millions of people2.
The report found that eye health remains deprioritised by national and international political leaders, with insufficient resourcing and poor integration into national health systems. Sadly, good eye health was found to be limited to urban or wealthy areas, and those who access eye health care can risk falling into poverty as a result. The report calls for leaders to consider eye health as a key part of universal health coverage, recommending they bring eye health into mainstream health policy and plan and deliver eye health services that are comprehensive and cover all eye conditions2.
Universal health coverage is not universal without eye care
A number of initiatives have been identified which can help reduce the burden of vision impairment. While some interventions require systemic changes – such as integrating eye health care within wider healthcare services – some interventions can be implemented more easily. The report highlights the following interventions as solutions that are relatively low cost and high impact:
- Cataract surgery
- Provision of reading glasses for vision correction
- Screening and treating uncorrected refractive error in schoolchildren
- Widespread screening using fundus imaging with artificial intelligence-assisted grading to diagnose glaucoma and the other major causes of blindness
- Screening using low-cost retinal cameras operated by nonspecialists, with the images graded remotely
- Services that cover all examination and transportation costs to detect glaucoma2
Eye care interventions including cataract surgery and refraction correction are some of the most cost-effective interventions in all of health care, and would meet >90% of unmet needs2
Glaucoma, diabetic retinopathy, age-related macular degeneration, cataract and uncorrected refractive error are the main causes of vision impairment globally, and although treatments that can reduce or prevent blindness in these conditions have been identified, the report calls for them to be prioritised for delivery to those most at need2.
Thanks to recent developments in mobile health, distance learning, artificial intelligence and telemedicine, there are now more opportunities for eye care professionals to deliver quality care to more individuals. However, the need remains for promotional, preventive, treatment and rehabilitative interventions to address the causes of vision loss globally2.
Traditionally the eye health sector has focused on treatment and rehabilitation, and underutilised strategies for health promotion and prevention to blunt the impact of eye disease and minimise inequality2
- The International Agency for the Prevention of Blindness. The Lancet Global Health Commission on Global Eye Health. https://www.iapb.org/learn/vision-atlas/about/contributors/lancet-global-eye-health-commission/. Accessed 22 August 2022.
- Burton MJ, Ramke J, Marques AP, Bourne RRA, Congdon N, Jones I, et al. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. The Lancet Global Health. 2021;9(4):e489-e551.