Retinopathy of Prematurity

Beyond Vision 2020: It’s back to the future for eye health

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By Mark L. Dlugoss
Senior Contributing Editor

As eye care providers may recall, the World Health Organization (WHO) launched its Vision 2020 in 1999. This global initiative sought to eliminate avoidable blindness by the year 2020. WHO’s plan at the time was considered a breakthrough in addressing a major worldwide problem.

The objective of Vision 2020 was to integrate comprehensive and equitable eye care worldwide through national healthcare systems. Working through WHO member nations, Vision 2020 would develop a plan to control eye disease, to provide human resources, to establish infrastructure, and to provide a proactive advocacy to halt blindness. Vision 2020 looked to target cataract, glaucoma, trachoma, onchocerciasis, childhood blindness, and uncorrected refractive errors.

What sparked this initiative was that eye care projections in 1990 reported that if blindness was not addressed, avoidable vision impairment would more than double by the year 2020.

VISION 2020 presented a clear directive for advocacy and planning services. It created a global partnership in public health that included the private sector and non-governmental organizations. The results lead to more resources and a common goal to fight blindness.

Vision 2020 accomplished a lot. Global blindness overall declined over 28% between 1990 and 2020. While cataracts and uncorrected refractive errors are still an issue worldwide, progress has been made in the areas of glaucoma and childhood blindness, with onchocerciasis and trachoma declining substantially.

What Vision 2020 achieved is that the elimination of avoidable blindness is possible. Eyecare experts are hopeful that the onchocerciasis will be in check and trachoma will be totally eliminated worldwide by 2030.

So how does the eye care industry proceed after Vision 2020? While that initiative made strides with its objectives, it did not totally eliminate avoidable blindness by 2020. Now, eye care providers are facing a new landscape of vision problems.

Over the next 30 years, age-related eye diseases will present a new set of challenges. As the world population continues to age, an influx in blindness will surface with the growing cases of age-related macular degeneration, diabetic retinopathy, glaucoma, high myopia, and retinopathy of prematurity. In some regions of the world, the causes of blindness are expected to increase significantly.

Those same experts are issuing an urgent call-for-action to all sectors of the eye care industry. They say more innovative treatments are needed and eye health services, such as promotion, prevention, treatment, and rehabilitation, will be required to address the causes of blindness expected on a larger scale beyond Vision 2020.

The challenge for the eye care industry is how can it deliver on innovation and services, deliver it in a relative amount of time, and address all of it within universal health coverage. It appears to be a tall order! Is there a plan? If so, what is the plan?

Surprisingly, a worldwide group of eye care providers and researchers may have answers to these questions. They have given serious thought to the future of vision care post-Vision 2020. In February 2021, Lancet published a thorough and comprehensive plan to address the future of eye care—“The Lancet Global Health Commission on Global Eye Health: Vision Beyond 2020,” (Matthew J. Burton, Hannah B. Faal, Jacqueline Ramke, Thulasiraj Ravilla, Peter Holland, Ningli Wang, et al.)

The 63-page report, authored by over 70 collaborators, thoroughly addresses the issues and problems eye care providers and the industry will face in the next 30 years. The commission covered many aspects of the past, present, and future of vision care. It looked at the lessons of Vision 2020, and determined that after 20 years, there is still hope that avoidable blindness can be eradicated.

The commission challenged itself by developing priority lists that would highlight the pivotal areas for research and a course of action. It reviewed 3,400 suggested eye-related issues, proposed by 336 individuals from 118 countries, and outlined the most compelling of those issues to frame a research agenda for global eye health in the future.

The report offers a solid social-economic understanding of how quality eye care can have a life-changing impact on those in need. Finally, the commission consulted with experts inside and outside of the eye care arena to help the commission in its efforts to inform governments and stakeholders about the importance of quality eye health beyond 2020.

Here are the key points of the Lancet Global Health Commission’s report as presented in the Lancet article:

• Eye health is essential to achieve sustainable development goals. Vision needs to be reframed as a development issue;

• Almost everyone will experience impaired vision or an eye condition during their lifetime and require eye care services. Urgent action is necessary to meet the rapidly growing eye health need;

• Eye health is an essential component of universal health coverage. It must be included in planning, resourcing, and delivery of health care;

• High-quality eye health services are not universally delivered. Concerted action is needed to improve quality and outcomes, providing effective, efficient, safe, timely, equitable, and people-centered care;

• Financial barriers to accessing eye care leave many people behind. Eye health needs to be included in national health financing to pool the risk;

• The eye health workforce is unable to meet population needs in many countries. A major expansion in service capacity is required through increased numbers, sharing tasks, strengthened training, enabling work environments, and effective leadership;

• Technology and treatment developments offer new tools to improve eye health.  Thoughtful application is needed to maximize the potential to improve coverage, accessibility, quality, efficiency, and affordability;

• Reliable survey and service data are key to progress in eye health. Robust indicator data are needed to shape change and drive action;

• Research has been crucial to advances in understanding and treating eye disease. Solution-focused, contextually relevant research is urgently needed to deliver innovative prevention and treatment strategies and inform the implementation of eye health within universal health coverage.

As you can see, the commission covered a lot of ground and offered a comprehensive look of what needs to be addressed. I encourage all eye care providers, researchers, clinicians, support staff, experts, and industry to spend a little time to read and digest what this report outlines. You can download the report here.

What I found amazing about this report is there were over 70 vision-care professionals who worked together on a numerous points and issues, looking at every imaginable scenario. The data drawn from this report about vision care offers a solid snapshot why this commission report should be read and the key points/conclusions should be considered and incorporated by everyone in the eye care industry.

The future challenges of eye care are not really new, but the growing number of age-related eye diseases expected and the declining number of eye care providers over the next 30 years, will place a major burden on the eye care industry to treat and eradicate avoidable blindness.

The Lancet Global Health Commission on Global Eye Health has provided the industry with a clear path as to what needs to be addressed. Like Vision 2020, this report will enhance the hope that avoidable blindness can be eradicated.

Editor’s Note: I want to thank to David E.I. Pyott, president of the Ophthalmology Foundation, who directed me to “The Lancet Global Health Commission on Global Eye Health: Vision Beyond 2020” report. Many of the objectives of the newly formed Ophthalmology Foundation falls in line with what this report looks to achieve in the next 30 years. If you want to learn more about Ophthalmology Foundation, check out this edition of the Ophthalmic Project, here.

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