VISION 2020: The Right to Sight

SPEAKER: In this presentation, we’re going to look at how programmes have been implemented in order to address the growing burden of vision impairment. By the end of the presentation, you should be able to know the brief history behind VISION 2020 the Right to Sight, understand the concept and priorities of VISION 2020, and assess the actions taken to date and their impact. In the mid 1990s, it was projected that the magnitude of global blindness would increase from 38 million in 1990 to 76 million by 2020. This projection was based on existing service levels and on anticipated population growth and ageing across the world. It highlighted that immediate action was required.

And data in 2002 estimated that global blindness had increased to 45 million with 269 million with low vision. In 1995, the main causes of blindness were found to be cataract and refractive error, which occur across all populations and for which there are clear methods of treatment. The other important causes of blindness were trachoma, onchocerciasis and vitamin A deficiency in children. These conditions are focal occurring only in certain groups within populations and they require a targeted approach. There is no treatment for end stage blindness from these conditions. And so, interventions are focused on prevention. Ivermectin distribution in endemic zones for onchocerciasis. Azithromycin distribution for trachoma. And vitamin A supplementation and immunisation for measles and childhood blindness.

Glaucoma, diabetic retinopathy, and other causes such as age related macular degeneration were felt to be difficult diseases to identify and manage. It was therefore decided that the focus should be on the main causes of blindness where strengthening prevention efforts would address over 75% of avoidable blindness.

The aim of implementing a programme for preventing avoidable blindness was to change the trend and bring about a decline in global blindness. Efforts would be focused on strengthening services for cataract and refractive error, and on prevention activities for trachoma, onchocerciasis vitamin A deficiency, and childhood blindness. This would mean, over a 20 year period, 100 million people would be treated or prevented from going blind. This idea led to the launch, in 1999, of a global initiative to eliminate avoidable blindness, known as VISION 2020 the Right to Sight. To co-ordinate the initiative, a unique partnership was set up between the World Health Organization and the International Agency for the Prevention of Blindness, IAPB.

The IAPB is a global consortium of non-governmental organisations working in eye care. This partnership has worked towards setting goals and targets, which countries can use to address blindness at a local level. The three essential elements for VISION 2020 were to develop appropriate control strategies and targets for service delivery for cataract, trachoma, onchocerciasis and childhood blindness, to develop human resources, and to develop infrastructure and appropriate technology.

The suggested model for development was based on a population of one million people. It was expected that if these three essential elements– the eye team, working with good infrastructure and equipment, and a disease focused action– were put together and managed well, the result would be the elimination of avoidable blindness. National Prevention of Blindness programmes were developed and acted upon locally.

What has happened to global blindness since VISION 2020 began? Recent data from 2010 does show a downward trend. The most important observation here is that despite the growth in the global population, the number of blind people is decreasing. Evidence indicates that surgical rates are going up and that prevention is being strengthened.

When we compare data from 2002/ 2004 with data from 2010 we can see that there has been a global decrease in the number of blind people from 45 to 39 million, and a reduction in the prevalence of vision impairment from 5% to 4.2%. Encouragingly, this has been achieved despite a world population increase of half a billion to 6.7 billion, and a rise of 18% in the number of people aged over 50.

The impact of sight restoration on poverty is felt both by individuals and their communities. A study of patient groups showed that one year after cataract surgery people whose sight had been restored had become economically active and were able to bring in contributions almost at the same level as other similar members within their community. The impact of restoring sight to the blind can be measured using a quality of life score. The patient group study found that the quality of life score of blind people was a quarter of that of the same person’s in the same community. One year after cataract surgery, their quality of life score was equal to others in the community.

In summary, a great deal has been achieved in the first decade of the VISION 2020 initiative. Importantly, we know what needs to be done and we have effective models for service delivery in some locations. We have also learned that thinking globally, but implementing locally has an impact and resources can be directed in a strategic manner. This decade, the big challenge is to scale up at national level and integrate VISION 2020 into the health system. This will make models of eye care sustainable. We also need to assess where we are likely to be by the year 2020 and begin to make plans for the harder countries and chronic diseases, like glaucoma and diabetes.