Vision beyond 2020: Why the next decade will be a defining period for eye health

Eye health is an essential component of human health and wellbeing. Good vision enables people to lead productive lives and plays a significant role at every stage of human life from learning to walk and read to participating in the work force. However, eye conditions are remarkably common worldwide. In fact, 2.2 billion people around the world are estimated to have some form of vision impairment, of which one million cases are preventable or yet to be treated.

The economic impact of vision impairment, and the costs and benefits of interventions are only partly understood. In February 2021, The Lancet Global Commission on Global Eye Health estimated that lost economic productivity due to vision impairment to be at least $410.7 billion (purchasing power parity). The full cost of vision impairment, however, is expected to be significantly higher and requires further research.

Although highly effective and cost-effective treatments are available for several major causes of vision impairment, including cataracts and refractive error, ageing populations and changes in lifestyles are projected to triple the prevalence of blindness by 2050. Without action, global increases in diabetic retinopathy, high myopia, retinopathy of prematurity, and chronic eye diseases of ageing such as glaucoma and age-related macular degeneration, have the potential to overwhelm already strained eye health services.

New innovations will play an important role to overcome many challenges in the delivery of eye health, including a shortage and maldistribution of well-trained personnel to deliver services across high- and low-income settings alike. Cost-effective technologies, such as home health monitoring and telemedicine, have the potential to significantly increase access to high quality eye health services in underserved areas and are essential tools to ensure the continuity of services during the COVID-19 pandemic. Furthermore, strategic investments in technology provide opportunities to enable non-specialist health workers in primary health care systems to identify and refer people that need services — a practice known as task sharing.

Solving the challenges faced to achieve universal eye health coverage will undoubtedly require increased collaboration to bring multiple sectors together towards shared goals. Partnerships between eye health, education and water, sanitation and hygiene sectors, for example, can facilitate cost-effective and sustainable strategies, including health promotion. Increased collaboration with non-communicable and neglected tropical diseases can also provide entry points and opportunities to align and advocate for the integration of eye health activities into national health plans. This is particularly important to reduce financial barriers to accessing eye care — a central component to the achievement of universal health coverage.

The World Health Organization World Report on Vision, launched in 2019, recommends an integrated people-centred approach to advance progress towards universal eye health coverage. It emphasises the importance of innovative evidence-based and people-centred solutions to deliver comprehensive eye health services across the spectrum of promotion, prevention, treatment, and rehabilitation, to address the full range of eye conditions within the context of universal health coverage.

As the eye health community marks #WorldGlaucomaWeek, it is timely to recognise the importance people-centred care. Like many eye health conditions, vision impairment and blindness from Glaucoma can be prevented through effective management. However, this will require a fundamental paradigm shift towards a holistic model of care that incorporates patient education, acceptability of interventions, quality of life, in addition to intraocular pressure control.

The next decade will be a defining period for eye health. Although significant progress has been made to develop new technologies, population demographics are rapidly changing the health needs of populations. The achievement of universal eye health coverage will have profound benefits, not only for the people affected by vision impairment or blindness, but entire communities. To achieve this goal, however, eye health must be prioritised within national health plans, and investments must be made to develop innovative people-centred solutions that can be delivered equitably at scale, and that leave no one behind.