WHO’s Blindness Prevention StrategyThe World Health Organization (WHO) has developed specific strategies to tackle blindness and related diseases through strategies including VISION 2020 and SAFE. Other countries may see progress in eye care support by implementing such strategies after the 74th World Health Assembly introduced a resolution to the improvement and accessibility of eye care services. Governments have adopted the resolution to make greater efforts to incorporate eye care in primary care. Methods from VISION 2020, SAFE and the recent PECI from WHO’s blindness prevention strategy may help bring the resolution to fruition.

Eye Disease: A Global Public Health Issue

WHO reported that at least 2.2 billion people suffer from visual impairment. Nearly half of these cases could have been prevented or have yet to undergo identification. A range of factors, including complications from disease, age, trauma and more can cause eye impairment. Some individuals do not receive timely treatment for preventative eye care, which can result in lifelong damage. Visual impairment can affect every aspect of a person’s life, ranging from career and school opportunities to independence and overall health.

For example, trachoma remains a public health issue in 44 countries. WHO says, using June 2021 data, that 136 million people reside in areas where trachoma is common. The individuals are also at risk of contracting trachoma-related blindness.

Visual impairment, such as blindness, leads to tremendous economic burdens and productivity loss. WHO estimates the cost of productivity losses from blindness and visual impairment at $2.9-5.3 billion per year. Some methods of treatment for visual impairments include surgery, corrective glasses and contacts as well as medication. The advancements in medicine allow more people to live without lifelong damage similar to blindness as such solutions are not as readily available for those living in rural areas or those of low income. VISION 2020 and SAFE are variations of the WHO’s blindness prevention strategy that aim to extend treatment for visual impairment and preventable blindness to regions where treatment is not readily available.

The Package of Eye Care Interventions (PECI)

According to the WHO, those living in developing countries or rural regions face inequities in the quality, rate and accessibility of eye care. Because of limited resources for eye care in low- and middle-income countries, estimates project that 50% of the global population will be living with vision impairment by 2050.

To support countries struggling with cases of vision impairment, some of which are preventable, WHO’s blindness prevention strategy has materialized in various solutions in the past two decades. One recent strategy from WHO is the Package of Eye Care Interventions (PECI) in 2020. This evidence-based approach, if implemented, allows countries to carefully determine where to prioritize budgets and integrate eye care interventions. The strategy will support work competency, fulfill medication and equipment needs and more. However, WHO’s blindness prevention strategy did not begin here.

VISION 2020 “Right to Sight” and SAFE

Before PECI, WHO developed the strategies VISION 2020 “Right to Sight” and SAFE. VISION 2020 began in the hopes of eliminating preventable blindness by the year 2020. Some of the goals of the strategy aimed to safeguard an estimated 100 million people, primarily in developing countries, from avoidable blindness. VISION 2020 also intended to save an estimated $102 billion in lost productivity from the time the strategy was implemented to 2020. This strategy, similar to PECI, focused on developing quality eye care facilities with trained eye care workers, implementing programs that help prevent major causes of blindness and promoting the integration of eye care in primary care.

Since then, WHO has recommended Surgery, Antibiotics, Facial cleanliness and Environmental improvement (SAFE) along with the previously mentioned strategies to prevent avoidable blindness. After the 74th World Health Assembly, more countries that have adopted the resolution may see progress in supporting their citizens with eye care and eliminating preventable eye diseases. By using WHO’s blindness prevention strategy, rates of preventable blindness may reduce.

– Michelanie Allcock
Photo: Flickr

Free Vision Care
With roughly 1.39 billion people, India is the second most populated nation in the world after China. India holds more than 20% of all blind people globally and it has more blind children than any other country. While wealthier people can afford eye care, the impoverished in rural areas or city slums usually go without it. In addition, there are fewer doctors and ophthalmologists in the countryside, which means that people in those regions are underserved. Rural persons with visual disability or blindness often lack accessible health care and education, and for these individuals, it is difficult to find employment. Yet, 80% of visual impairments are preventable or treatable with timely care, according to the World Health Organization (WHO) in 2013. One organization working to reverse this trend is the nonprofit Sankara Nethralaya, which provides free vision care for impoverished people in India.

Major Causes of Blindness

According to a 2019 article by India’s National Health Portal, glaucoma affects approximately 12 million Indians and causes the majority of irreversible blindness in India, with close to 1.2 million people left sightless. Yet, a staggering 90% of glaucoma cases in India never receive a diagnosis. Furthermore, refractive error, an eye disorder in which the inability to focus creates blurred vision, causes visual impairments or blindness in the eyesight of almost 40 million Indians. This sobering figure includes 1.6 million children. Many people enduring uncorrected refractive errors are impoverished villagers without access to prescription glasses.

Four Decades of Eye Care

Founded in 1978 in Chennai, India, by Dr. S. S. Badrinath, Sankara Nethralaya’s goal is to provide high-quality free vision care for the impoverished people of India. For those who can pay for these services, Sankara Nethralaya offers affordable vision care. Funded by the nonprofit Sankara Nethralaya OM Trust, each year the Sankara Nethralaya hospital provides 4,000 major eye surgeries to destitute patients in Chennai. It also has branches in Andhra Pradesh, Kolkata and Sri City. Over the past 40 years, Sankara Nethralaya has helped millions of patients to preserve and regain their eyesight.

A Mobile Unit Travels to Remote Villages

The hospital sends out a Mobile Eye Surgical Unit that does free cataract surgeries on up to 200 people over two weeks in rural villages. The unit also screens adults for glaucoma and diabetic retinopathy, major causes of blindness in India. In addition, “Sankara Nethralaya provides teleophthalmology services in Tamil Nadu and West Bengal, thereby reducing the need for travel.” Finally, the organization’s research division, the Kamalnayan Bajaj Institute for Research, focuses on topics such as nanobiotechnology in relation to visual impairments.

Blindness Creates a Cycle of Poverty

Because of vision issues such as cataracts, many low-wage earners are unable to continue working, thereby reducing the resources of the entire family and creating more financial hardships. With sight restored, individuals can resume work and earn an income to raise their families out of poverty. WHO estimates that preventable visual disorders led to a global economic loss of $110 billion in 2020.

For its excellent work in helping patients with cataracts, glaucoma and other eye disorders, in 2021, Newsweek ranked Sankara Nethralaya as “one of the World’s Best Hospitals” for ophthalmology. The nonprofit continues its decades-long tradition of providing free vision care for the impoverished of India.

– Sarah Betuel
Photo: Flickr

Sightsavers Treats Visual Disorders
According to Sightsavers, roughly 90% of all people suffering from visual impairments or blindness reside in developing nations. Because the organization recognizes the link between poverty and visual impairments, Sightsavers treats visual disorders, takes steps to combat preventable blindness and provides assistance to people with irreversible blindness. The organization, established in 1950, works in developing nations across Africa, the Caribbean and Asia.

Economic Impacts of Visual Impairments

Visual impairments have far-reaching impacts. The Centers for Disease Control and Prevention (CDC) explains that “good vision is important for good quality of life and loss of vision leads to disability, morbidity and loss of productivity.”

Disabilities and morbidities that arise from visual impairment take away from the human capital of a nation because the affected person can no longer serve as a productive member of the workforce and contribute to the economy. On a household level, there are economic impacts too. Households incur significant costs to treat advanced visual disorders.

The inability to work means reduced household income, exacerbating conditions of poverty in the home. Also, untreated visual impairments can lead to diseases or conditions that place a strain on the health care system of a developing country, which usually lacks the resources, infrastructure and personnel to take on this added burden.

In a study that the Investigative Ophthalmology and Visual Science journal published in 2018, researchers determined that a blind or visually impaired person suffers from a significant amount of fatigue in comparison to those without these afflictions. In turn, high levels of fatigue lead to a loss of productivity that materializes as “increased societal costs” and an intensified economic burden. Sightsavers treats visual disorders to prevent avoidable blindness and the consequences that come with a loss of vision.

The Year 2021 in Review

Over the last year, Sightsavers made several accomplishments despite the onset of the COVID-19 pandemic. Sightsavers and its partner organizations were able to “deliver millions of treatments to combat neglected tropical diseases.” For instance, trachoma is an infectious neglected tropical disease that affects the eyes. Without treatment, trachoma can lead to blindness or visual impairment. With the help of Sightsavers, in April 2021, The Gambia was able to fully eradicate trachoma, one of the leading causes of blindness within the country.

Through the support of Sightsavers’ Equal world advocacy campaign, after years of efforts, in September 2021, Mali put into legislation legal provisions that safeguard the rights of people with disabilities, including those with visual impairments, so that they can obtain access to the same employment opportunities, education possibilities and social benefits as other people.

Sightsavers’ Other Accomplishments

In December 2021, Sightsavers won the Zero Project Award, an honor that “recognizes innovative policies and practices that improve the lives and support the rights of people with disabilities.” The award gives praise to a Sightsavers toolkit that launched in 2018, which provides recommendations on performing “an audit of health care facilities” and gives guidelines “on accessibility standards and examples of best practice.” Since the toolkit’s release, Sightsavers has utilized the specialized toolkit to provide training to more than 200 staff members from organizations that support people with disabilities as well as “governments and the private sector.” Sightsavers has also used the toolkit to “conduct accessibility audits in 50 hospitals across eight countries and complete priority accessibility renovations in 16 health facilities.”

Kareen Atekem, a neglected tropical disease (NTD) researcher from Sightsavers, was a finalist for the 2021 NTD Innovation Prize competition. Her project entails an innovative trap for Chrysops flies that spread a parasitic disease called loiasis, which affects the eyes. Atekem told Sightsavers that “If successful, our innovative trap will also allow us to monitor ‘Chrysops’ populations and eventually, control the spread of these biting flies. This could reduce the risk of loiasis for whole communities and regions.” By preventing loiasis, Sightsavers can safeguard the lives and livelihoods of people within high-risk areas.

The economies of all nations rely on the good health and well-being of citizens so that people can hold positions as productive members of the workforce. Sightsavers’ mission to safeguard vision is necessary for the growth and prosperity of countries. With a 90% rate of visually impaired individuals in developing nations, Sightsavers treats visual disorders to promote both well-being and economic growth.

– Kyle Swingle
Photo: Flickr

healthcare access in LMICs
Around 2 billion people around the world lack proper access to surgical care or advanced medical care. On average, low-and-middle-income countries (LMICs) have fewer than two operating rooms and one trained surgeon per 100,000 people. Due to this, treatable maladies often result in death. In 2011, around 5 million people died of injuries in LMICs. The barrier between proper medical care and patients is the cost of care. More often, the costs of admission, medications and food are based on the strained economic conditions of impoverished countries. The shortage of medical professionals in LMICs has been identified as one of the most significant obstacles to achieving health-related U.N. Millennium Development Goals (MDGs). One can see the severity of this lack of healthcare access in LMICs in countries such as Mozambique, with only 548 doctors for more than 22 million people.

Lack of Medical Professionals

The absence of medical professionals in LMICs is often due to the poor economic situation of these countries. This results in limited financial resources to support a good healthcare system and provide proper training for doctors. Even when training is available, many skilled doctors work overseas due to others offering them a better medical career abroad, leading to a lack of healthcare access in LMICs. The British Medical Journal claims that “African countries have lost about $2.6 billion…training doctors who are now living in western countries.”

On average, there is less than one doctor for every 20,000 people in Chad. In addition, an equipment shortage in Chad means there are fewer than four hospital beds for every 10,000 people. Furthermore, inequitable distribution of service is a major problem in these countries. Due to a limited number of doctors being available to treat millions of people, often patients with a higher income receive what little medical support is available. Those of a lower income in these countries find it more difficult to afford treatment and especially cannot afford emergency medical procedures.

Consequences for Patients

Lack of trained medical professionals often means that diseases, surgeries, injuries and complications often result in death. Disease is excessive and often untreatable in these countries. Medical procedures often require advanced training and experience to be conducted successfully. The demand for these procedures greatly exceeds the supply of surgeons and institutions, leading to low healthcare access in LMICs.

For example, 90% of those who are visually impaired live in LMICs. According to the World Health Organization (WHO), 80% of cases involving visual disability are preventable. Eye surgery, an effective method of treating blindness, is rarely available. Furthermore, according to the National Library of Medicine, 6 billion people in LMICs lack access to safe and affordable cardiac surgery.

According to WHO, 94% of all maternal deaths occur in low- and lower-middle-income countries. Many women facing birth complications rarely have access to trained professionals who can handle these complications. Sometimes, doctors with insufficient training may perform emergency procedures improperly, resulting in debilitating injuries or even death. Furthermore, 99% of hemorrhage-related peripartum deaths occur in LMICs. These problems all stem from the fact that a qualified medical professional attends less than 50% of all births in LMICs.

Rising Cancer Rates

Another consequence of a poor global healthcare system is the rising cancer mortality rates in LMICs. More than half of the 10 million cancer deaths in 2020 occurred in LMICs. When comparing the healthcare systems of different regions, high-income countries usually spend around five to 10 times more per person. As a result, less than 50% of those diagnosed with cancer in high-income countries die from the disease. On the other hand, 66% of those diagnosed with cancer in LMICs die from the disease. This is mostly due to the fact that LMICs do not have the resources for treatment facilities or radiation therapy centers.

Organizations Making an Impact

Organizations like the Medical Education Partnership Initiative (MEPI) support the training of doctors to improve healthcare access in LMICs. MEPI works to increase the number of new healthcare workers, strengthen medical education systems and build clinical and research capacity in LMICs. Charities such as Mercy Ships send volunteer surgeons to provide lifesaving surgical procedures and invite local doctors to expand upon their surgical skills alongside the volunteer surgeons. Mercy Ships also provides mentoring programs for surgeons, anesthesia providers, ward nurses, operating nurses and biomedical technicians. By providing new medical tools and resources, constructing new medical facilities, providing training for local professionals and working with local governments, Mercy Ships leaves a long-lasting impact.

Poverty and disease are closely related. In order to have significant improvement in global health, economic development of LMICs and improved medical education is essential. The growing disparity in surgical access and other health services requires urgent attention. We can put this into action through the comprehensive development of healthcare access in LMICs.

– Arya Baladevigan
Photo: Unsplash

How Vision Health Affects Global Poverty
About 9.2% of the world lives in extreme poverty today. Vision health affects poverty as well. Additionally, 87% of blind people live in developing nations. About 87% of the blind population lives in developing nations. In fact, poverty is the leading cause of poor vision health. Impoverished countries often do not have the resources and funds to ensure positive vision health.

Poor vision results in a lack of opportunities for people. In addition, it takes a heavy toll on families in poverty. About 75% of the visually impaired require some sort of assistance. As a result, many must forfeit educational opportunities in order to care for visually impaired family members. Consequently, the familial unit becomes cemented in poverty due to the lack of opportunities for higher-paying jobs. Additionally, the world loses about $168 billion as a result of poor vision health.

Significant efforts have emerged to improve vision health in developing countries. Here are three examples of organizations coming together to distribute resources in a sustainable manner.

Eyes On Africa

Eyes On Africa is a nonprofit organization that aims to provide free eyewear to Africans. The organization recognizes the importance of eyewear in improving quality of life and productivity. Over the last 15 years, the organization has partnered with DIFF Eyewear, the Peace Corps and multiple NGOs in order to bring eyewear to communities across Africa. Furthermore, Eyes on Africa places an emphasis on working directly with communities. It distributes eyewear and connects with individuals to provide sustainable solutions. To date, Eyes on Africa has been able to provide over 20,000 pairs of glasses to those in need.

VOSH

VOSH is an organization that connects with optometrists to provide people with eyewear. In the last 50 years, VOSH has worked in numerous countries and has started over 75 chapters all over the world in an effort to provide eye care to areas in need. The organization primarily provides eye exams and treatments. VOSH is passionate about sustainability. Thus, it bolsters pre-existing eye care practices instead of starting new ones. The organization has successfully reached over 10,000 people worldwide.

OneSight

OneSight is a nonprofit organization that aims to improve global vision health by providing eyewear and eye care to vulnerable communities. The organization implemented a two-step plan to build sustainable centers and charitable clinics. These clinics focus on community outreach to make certain that their methods are applicable to them. OneSight accomplishes this by providing both urgent care and permanent solutions. This organization has successfully aided 1.5 million people in Gambia and Rwanda.

With the help of these nonprofit organizations, vision health has improved drastically. Furthermore, with eyesight improvements, people are able to find jobs and improve economic conditions.

Project PrakashMore than one million children in developing countries are blind. The majority of these children live in rural India, where more than six million people are blind. However, most hospitals in India do not possess specialty care for children who are blind. For children who do have access to special services, transportation acts as a significant obstacle to getting treatment. Many rural children also often do not know that their condition is reversible and cannot afford treatment. Pawan Sinha, a professor at M.I.T. and a father himself, hypothesized that most of the children suffering could have their vision restored. He founded Project Prakash to make his idea into a reality.

Blindness and Poverty

In rural areas, a lack of knowledge about blindness means that blind children are often subject to lifelong stigma. Some people, for example, may believe that blind children possess demons. Parents often turn to someone who is not in the medical field to perform a ritual to rid them of their evil spirits.

Importantly, if children do not receive medical treatment early on, their condition can get worse with age. This deprives them of education and puts them at a higher risk of dying young. Furthermore, blind girls often face a high risk of sexual abuse. Blind children in rural India may also never have the opportunity to escape poverty, as they are unlikely to find future job opportunities if they reach adulthood.

Project Prakash: A Solution

Project Prakash provides free treatment to any child who needs it. It operates in many hospitals throughout India to provide non-surgical intervention for blind children. This type of treatment may include glasses or an eye patch. For children who do require surgical treatment, the organization works with the Charity Eye Hospital in Delhi to treat cataracts, congenital infections and misaligned eyes. Most importantly, the entire process of treatment, transportation, hospital stay, surgery and recovery costs nothing for the child or their family.

Project Prakash’s work also extends beyond treatment itself. Instead of letting children go after they receive medical intervention, the organization helps them throughout the recovery process. Sinha understands that blind children regaining vision do not immediately have perfect sight; much like a baby, it is a process. Children’s vision is often blurred at first, and it takes time to make out finer details.

Over 40 weeks, children learn how to use their new sense through a variety of tests. The full scale of the tests range from the sensitivity of vision, shape matching, identifying different colors, detection of facial features and recognizing objects. Once the child can process multiple pieces of visual information at once, their vision improves.

Research

The effects of Project Prakash’s work go beyond the children themselves. The hospital where children receive surgery also operates as a research facility to study neurology and vision. By providing such an intensive process for children to learn how to use their vision, the organization can learn a lot about the brain’s ability to learn and adapt.

The organization’s findings challenge the theory developed by David H. Hubel and Torsten N. Wiesel that the connection between brain stimulation and visual information forms during a particular developmental period. They theorized that if a child does not go through this stage, they will never be able to adapt later in life. However, Sinha proved that teenagers with various congenital conditions were able to recover their eyesight after never having seen before. He therefore determined that people learn to see through experience. This valuable information makes it more likely that other blind children can receive treatment, knowing that it will help them see no matter their age.

The Future of Project Prakash

Project Prakash’s mission may soon extend beyond blindness. Its research could provide insight into other developmental disorders caused by genetics or the harsh conditions of poverty. Overall, the organization’s findings open up the possibility that these factors’ negative effect on the brain may be reversible, like blindness.

So far, Project Prakash has treated 2,000 children in underserved communities in rural India. More than half have received surgical treatment to restore their vision. By doing so, the organization is helping children live longer, better lives with more opportunities for the future.

Zoe Schlagel
Photo: Flickr

Universal Eye Care in Rwanda
Rwanda has become the first low-income country to provide universal eye care to its citizens. This is in an attempt to reach out to those suffering from largely preventable visual disabilities. In Rwanda, a country in Central/Eastern Africa, 34 percent of its population struggles with vision impairments. The most common vision impairment in Rwanda is shortsightedness, and 80 percent of these cases are preventable.

Vision Impairment is a Big Problem

Approximately 2.5 billion people worldwide require vision or eye care. Moreover, 32,700 per 1 million people living in Africa have some form of vision impairment. Vision impairment has proven to increase the challenges a person faces when trying to escape poverty. Without the ability to see well, children may struggle in school and parents can struggle at work.

Without the ability to learn easily, one may have difficulty finding a job, and the ability to work easily can make it difficult for one to keep whatever job they may find. Vision-related disabilities are a big problem among impoverished communities where eye care is difficult to find. These disabilities often only reinforce the cycle of poverty.

The Vision 2020 Initiative

Rwanda signed the Vision 2020 initiative in 2002, formulating a plan to meet the needs of the 34 percent of Rwandans in need of primary eye care. With the help of the Vision for a Nation Foundation, the Rwandan government has managed to provide universal eye care in Rwanda to its 11.8 million inhabitants. This is possible by training more than 3,000 nurses in an eye health course and sending these nurses to visit all 15,000 of the country’s villages to offer their help.

This nationwide program has deployed its nurses to all 502 health clinics throughout the country and has performed more than 2.4 million eye screenings. It has also provided more than 1.2 million basic eye treatments to Rwandans in need. Additionally, it has worked hard to establish a source of medications and glasses from Asia that supply all the health clinics.

The Government of Rwanda completely overtook the finances and management of the health program in January 2018. The Rwandan government was ready to fully support the program without further help from the Vision for a Nation Foundation, 16 years after signing the initiative. This marks Rwanda as the first developing country to give universal eye care to its citizens.

In a nation where only 19.8 percent of inhabitants have easy access to electricity, providing eye care for the entire population of the country is quite an impressive feat. Rwanda’s initiative is a leading example of African health care reform. This shows that it is possible to offer eye care on such a large scale in impoverished countries. One can only assume what Rwanda’s next move will be in furthering its health care availability.

– Amanda Gibson
Photo: Flickr

vision care in developing countries
DIFF is a sunglass company in Southern California that emerged in 2014. DIFF began with the intention of challenging the norm and doing good in the world. It has partnered with many charities over the years to help supply vision care in developing countries.

The Need for Vision Care in Developing Countries

Over one billion people in developing countries suffer from presbyopia. Presbyopia typically starts around the age of 40 and causes a gradual loss of close-up vision. For people in developing or impoverished countries, having clear vision is incredibly important in the workforce, especially if the jobs include skills like sewing, weaving and carving. About 2.5 billion people worldwide need eyeglasses to see clearly but are unable to access them. As many as 239 million children live with uncorrected vision. A lack of access to vision care puts another obstacle in the way of children in school without the ability to read easily and inhibits the ability of those in the workforce to do their jobs.

Eyeglasses for Everyone

For every pair of glasses that DIFF sells, it donates a pair of reading glasses to someone in need. DIFF partnered with many charities over the years to achieve this, including its original partner, Eyes on Africa. Eyes on Africa is a nonprofit organization that emerged in 2005 that provides eyeglasses to those in Africa who lack access to vision care. Through this partnership alone, DIFF has provided glasses to over 20,000 people in need. Restoring Vision is another organization DIFF has partnered with. Restoring Vision is the largest nonprofit provider of reading glasses to people living in poverty. Through DIFF’s partnership with Restoring Vision, it has helped over 150,000 people improve their vision.

Vision Care for All

DIFF has also partnered with an organization called SVOSH. SVOSH is a student chapter of the larger Volunteer Optometric Services to Humanity (VOSH). Under this organization, groups of optometry students provide eye exams to impoverished communities in developing countries. It also provides visual assistance and treatments for visual ailments with the help of DIFF’s funding. Projections determined that this partnership would provide vision aid to over 10,000 people around the world in 2017.

The necessity for vision aid is a facet of poverty that people often overlook, but should not neglect. Providing vision care to people in developing countries, whether that be optometry visits or providing a pair of reading glasses, can change the lives of those 2.5 billion people in need of vision aid. Accessible vision care will help millions of children struggling in school in developing countries. According to research, giving a child the appropriate vision aid is beneficial to the equivalent of an extra six months of schooling. Giving people in poverty the gift of sight makes work easier to find and to keep.

Amanda Gibson
Photo: PeakPx