WHO: Need exists for data and accessible, affordable eye care
ORLANDO, Fla. – The World Health Organization feels challenged and feels a sense of urgency in light of the findings in its World Vision Report, which was shared here at the American Academy of Optometry meeting by Alarcos Cieza, MSc, MPH, PhD, coordinator of WHO Blindness and Deafness Prevention, Disability and Rehabilitation.
“We hope the eye care sector feels the same urgency for action that we at WHO feel,” Cieza said during the academy’s plenary session, which was partially sponsored by Healio/Primary Care Optometry News.
The content of this report does not provide the necessary information; it merely summarizes existing information that was collected, she said.
Eye conditions are universal, Cieza said. “Anyone who will live long enough will have an eye condition,” she said.
The data indicate that 196 million people worldwide have age-related macular degeneration, 146 million have diabetic retinopathy, 76 million have glaucoma, 2.8 million have Trachoma, 2.6 billion have myopia (312 million are younger than 18 years), and 1.8 billion have presbyopia.
“The significance of these numbers is that they portray the huge need for eye care around the world,” Cieza told attendees, “but we cannot even add them up because we know they overlap. We can’t say how many people total around the world have at least one eye condition.”
According to the World Vision Report, at least 2.2 billion people have vision impairment, and at least 1 billion have not received the care they need.
“Access is a big reason,” Cieza said, and “vision impairment is not distributed equally.”
It is four times higher in low income countries and more prevalent in rural areas, among women, the elderly, ethnic minorities, the disabled and indigenous populations.
Cieza said her colleagues from other programs cannot believe this situation exists among such a mature health sector. “How can this be?” they ask.
“There are many possible answers to this question, but one we have found over and over is that there is a lack of integration of the eye care sector, and this has consequences,” she said. “The eye care sector is often like a black box. You don’t know who needs care or who provides it, and one of the reasons for that is because it’s not even sometimes seen as an integral part of the health system.”
She said a large proportion of services are provided by the private sector, but without coordination with the public sector.
“Knowledge and information are not shared,” Cieza said. “We see an uncoordinated and unregulated workforce. Eight of the 24 countries from which we collect data do not recognize optometry as a profession or do not have educational requirements.”
She explained that countries typically have a national strategic plan divided into sectors.
“If eye care is not part of the health sector strategic plan, it will not be prioritized,” Cieza said. “We need to advocate to make sure that eye care is an integral part of the health sector strategic plan so it can be not only prioritized but integrated and considered in the planning,” she said.
Some countries have universal health coverage, but with budgets typically too small to cover all services for everyone, Cieza said.
“So the attempt is to cover at least some basic services so as many people as possible get the care they need without having to suffer hardship,” she said. “Still, basic interventions like cataract surgery or provision of glasses are not part of those packages of care.”
Cieza said it must be determined exactly how many people are in need of refractive care and cataract surgery and how many of those receive the care, with the intended gain of seeing well.
“It is not only about coverage, but effective coverage,” she said. “The intended outcomes need to be achieved. We have an opportunity; however, if we cannot provide the data we will miss this opportunity. That is why we see urgency for action.”
The World Report on Vision recommends:
Make eye care an integral part of universal health coverage.
Implement integrated people-centered eye care in health systems.
Promote high quality research.
Monitor trends and evaluate progress.
Raise awareness and engage and empower people and communities.
“Thirty years from now we should not be where we are today,” Cieza concluded. “Read the report and tell WHO what you think.” – by Nancy Hemphill, ELS, FAAO
McMahon T, et al. Plenary session: Today’s research, tomorrow’s practice, WHO World Vision Report, opportunities for optometry to make an impact. Presented at: American Academy of Optometry meeting; Orlando, Fla.; October 23-27, 2019.
Disclosure: Cieza is employed by WHO.