Based on data from the World Health Organization, about 285 million people globally were visually impaired in 2010, of whom 39 million were blind. However, about 80% of blindness would be preventable with early diagnosis and treatment. Blindness and low vision are great socioeconomic problems in central and east European countries, as both the eye health care segment and visual rehabilitation are seriously underfinanced in this region.
At the beginning of the 21st century, the Vision 2020 global initiative made it possible to fight locally for better prevention and rehabilitation of blindness. Hungary has joined this global initiative and taken some major steps toward the prevention of blindness. One of the first actions was to collect reliable data on newly registered blind persons in Hungary. Our results were published in 2005 and 2006 and showed that the most common causes of blindness were age-related macular degeneration and glaucoma in the elderly, diabetic retinopathy (DR) and myopia in the working population, and retinopathy of prematurity (ROP) in children.
Considering the high number of visually impaired people, a nationwide vision rehabilitation program was started in 2001 in Hungary with the cooperation of the Ministry of Social Affairs and Labour. A network of counseling services and a network of rehabilitation facilities including optical rehabilitation centers were built, and as a result, the capacity has increased in the last 10 years from 40 to 1,800 clients per year. The key to our success was that ophthalmological leadership, rehabilitation institutes, nongovernmental organizations, and foundations and organizations for the blind were lobbying with joint forces in the government and developed a national vision rehabilitation project together. In 2013, the government devoted more than 1 billion HUF (more than 3.2 million) to upgrading and developing regional vision rehabilitation centers. Furthermore, in order to educate ophthalmologists on vision rehabilitation, low vision rehabilitation guidelines were officially published and teaching courses were organized.
We placed great emphasis on blindness prevention in the last decade. In order to fight against amblyopia and childhood blindness, a screening protocol and national childhood program were developed in cooperation with the Ministry of Health. Online guidelines were created for nurses and parents. A well-established screening program for ROP was also organized; regional routine telemedicine screening has been operating since 2010, and more than 3,000 newborns have been screened. The program is sponsored by two foundations (Peter Cerny and For Our Eyesights). In 2013, a national general children screening program was announced by the government, and discussion has been initiated from our side to place ROP and developmental anomalies in the focus of the program.
In the last 5 years, we also achieved significant improvements in the prevention of diabetic retinopathy. A pilot program on telemedicine DR screening was started in cooperation with the Hungarian Diabetes Association in 2008. The results were promising, and when the program was presented to the state secretary responsible for health care, we got a positive response. Today, 12 digital fundus cameras are operating, along with a reading center where the fundus images are graded. A treatment protocol for AMD has not been reached because treatment possibilities are limited due to the high expense of anti-VEGF therapy.
World Sight Day has been celebrated every year in our country since 2001. We use this opportunity to present our results in blindness prevention through the media and to introduce our new programs. The government has also participated in this event since 2011.
The International Agency for the Prevention of Blindness (IAPB) is an organization committed to fighting blindness worldwide. The aim of IAPB Europe Region is to improve the coverage of eye health care and to prevent blindness across Europe. A new strategic plan was established in 2013, and work has already begun in the fields of two target diseases, ROP and DR. Last year, IAPB Europe organized two joint sessions on ROP during the Black Sea Ophthalmological Society meeting in Tbilisi, Georgia, and participated in the organization of an ROP workshop held during the annual congress of the South-East European Ophthalmological Society (SEEOS) in Ohrid, Macedonia. Data collection about the national ROP services (diagnosis and treatment) was started at these events, in order to determine needs and look at ways to provide support for the development of ROP programs. In connection with DR, a workshop was held last year during the SEE-ARVO session at the SEEOS congress, and at the end of 2013, a workshop on DR was held in the Prague Lions Ophthalmology Educational Center for participants from the central and eastern parts of Europe.
Last year, the most significant event in blindness prevention was the development of the new global action plan from WHO. Universal Eye Health: a Global Action Plan 2014-2019 was unanimously endorsed by the Member States of the WHO at the World Health Assembly in May 2013. This action plan is expected to have a huge effect on blindness prevention programs in the next few years all over the world, including Europe. The aim of the action plan is to reduce the prevalence of avoidable visual impairment by 25% by 2019 from the baseline of 2010.
The strategic plan is structured around three objectives: generating evidence on the magnitude and causes of visual impairment and on the state of eye health services and using this evidence to advocate for increased political and financial commitment of eye health by the national governments of Member States; developing integrated national policies, plans and programs for enhancing universal eye health; and strengthening multisectoral engagement and effective partnerships for improved eye health. Each of the three objectives has specific actions to be performed by the Member States, by the WHO secretariat and by international partners. The key of making this action plan successful is the active participation of the Member States. National ophthalmological societies and governments have to work together to implement the goals and actions at national levels. This is our most important task today and the next few years in the fight against blindness in Europe.
- Pascolini D et al. Br J Ophthalmol. 2012;doi:10.1136/bjophthalmol-2011-300539.
- Pizzarello L, et al. Arch Ophthalmol. 2004;doi:10.1001/archopht.122.4.615.
- Resolution 66.4. Towards universal eye health: a global action plan 2014-2019. World Health Organization website. apps.who.int/gb/or/e/e_wha66r1.html. Accessed Feb. 6, 2014.
- For more information:
János Németh, MD, PhD, DSc, is the immediate past president of the Hungarian Ophthalmological Society and chair of IAPB Europe. He can be reached at the Department of Ophthalmology, Semmelweis University, 39 Mária Str., 1085 Budapest, Hungary; +361-4591500 ext. 4534; fax: +361-3179061; email: firstname.lastname@example.org.
Disclosure: Németh has no relevant financial disclosures.