Seeing is believing: What field work showed me of curable vision loss
Written by Anagha Joshi
May 19, 2020
People with dwindling eyesight often face a dark future. Children who can’t see letters and numbers lag behind in school. Workers without reading glasses are forced to give up their livelihoods prematurely. When a person with vision loss gets behind the wheel, it is not only his own life that is at risk. And the problem is staggering: According to the World Health Organisation’s World Report on Vision (October 2019), 2.2 billion people suffer from vision impairment. 1 billion of those are preventable or have not yet been treated.
Challenges in eye health
It is heartbreaking for me, as an optometrist, to see a child that has lagged behind in school or lost confidence because of uncorrected refractive error (URE). As an Optometrist and Eyecare Coordinator with Australian South Asian Healthcare Association (ASHA), I witness how URE is the leading cause of vision impairment. In many cases, there is a ‘quick fix’ to URE—such as using the correct spectacles or contact lenses. Although the solution seems simple, it is often a question of access to and awareness of eye health.
Like other health problems, the burden of poor vision is unequally distributed. People living in poverty, rural populations, women and the disabled are suffering the most. Eye care often operates independently from health systems. This exemplifies the challenges of an aging population and the rise of non-communicable diseases such as diabetes. China and India account for 45% of visual impairment, which could be explained by the size and geographic distribution of these populations, with more people living in rural, hard to reach locations, as well as the rise of myopia (short-sightedness) which is disproportionately higher in Asian countries.
Tackling eye health barriers requires tackling beliefs such as ‘losing vision is a part of getting older’ or ‘my glasses are going to make my vision worse’. Therefore, it is critical to build awareness in the community about eye health. Studies suggest that ‘perceived high cost’ is a major barrier for individuals seeking eye health care. This includes both the direct costs, such as the price of the treatment, and indirect, such as the loss of income to go for an appointment and transportation costs. A lack of adequate human resources such as ophthalmologists, optometrists and eye health professionals also limits access to eye health. Poor countries have an average of 3.7 ophthalmologists per million inhabitants. In rich countries, the number is 76.2 per million.
How eye health is critical in achieving the SDGs
Vision impairment is inherently intertwined with the achievement of the Sustainable Development Goals (SDGs). SDG 3: healthy lives and well-being of all ages is particularly relevant. Under SDG 3, Universal Health Coverage calls for access to health services for those who need it, without financial hardship. Eye health care is an essential service and requires strengthening in low and middle-income countries.
A recent scoping review has looked at how interventions to improve eye health can contribute to the SDGs. Eye health intervention has a direct effect on SDG 3, but also indirectly improves education (SDG 4), reduces poverty (SDG 1), and promotes decent work opportunities and economic growth (SDG 8). Tackling vision loss can help reduce inequalities (SDG 10), as good eyesight empowers people to seek out work and education to improve their opportunities.
Global movements in eye health
The release of the World Report on Vision was an important milestone in assessing eye care and demands for the future. The World Health Organization (WHO) is developing a Package of Eye Care Interventions (PECI) which will provide guidance to countries on how to address eye care needs. A critical part of achieving integrated people-centred eye care, according to WHO, is to have eye health recognised in national health strategic plans.
Additionally, the Lancet have announced a Commission on Global Eye Health which will be fundamental in fueling research in the epidemiological and economic burden of eye care globally, providing rigorous evidence for decision making.
Grassroots charities can get to the ‘root’ of the problem
As important as ‘top-down’ strategic direction for eye health is at the global level, ‘bottom-up’ charities continue to work with communities to improve eye health according to the local need. Australian South Asian Healthcare Association (ASHA) is one such charity aimed at improving access and quality of eye health through training of optometrists. Their work is based in Bhopal, India has been operating over 5 years.
Anagha Joshi is a recent LIDC intern, an optometrist and also the Eyecare Coordinator for ASHA. If you want to find out more about her work please email her at email@example.com or watch LIDC’s recent research seminar.