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VISION 2020: Global Campaign to Eliminate Avoidable Blindness

Policy Date: 11/1/2011
Policy Number: 201112

The American Public Health Association (APHA) recognizes the enormous burden that blindness and visual impairment places on individuals, families, and their communities, and affirms the World Health Organization (WHO) global initiative for the elimination of avoidable blindness by the year 2020, which has demonstrated 10 years of success.[1]

The challenges of health systems throughout the world that have inadequately and unfairly distributed resources in a manner threatens to compromise access to effective community-based vision and eye care.[2,3]

The WHO VISION 2020—The Right to Sight campaign has offered an unprecedented opportunity as a worldwide partnership and collaboration to marshal the resources and experiences of a broad global coalition of public and private nongovernmental organizations that are dedicated to the shared goal of eliminating avoidable blindness by the year 2020.[4,5]

There are an estimated 285 million individuals globally presenting with visual impairment; approximately 246 million have low vision and 39 million are blind. Nine out of 10 of the world’s blind live in developing countries; of these, 60% live in India, China, and sub-Saharan Africa.[6,7]

A comprehensive program for the prevention of blindness requires a community-based strategy that focuses on childhood blindness, trachoma, blinding malnutrition, onchocerciasis, cataract, ocular trauma, glaucoma, age-related macular degeneration, and diabetic retinopathy.[8,9] Globally, the major causes of visual impairment are uncorrected refractive errors (43%), cataract (33%), and glaucoma (2%).
It is important to expand prevention of blindness programs to include refractive errors and low vision; recognize that uncorrected refractive errors are a significant source of avoidable visual disability and functional blindness, especially in developing countries; and note that there are approximately 246 million persons needing low-vision services.[10–18]

A number of cost-effective models for the delivery of vision care that utilize new technologies and incorporate novel training and delivery paradigms are available. These offer the promise of significantly expanding access to vision care, especially in underserved communities in both developed and developing countries. They include the Aravind Eye Care System for improving cataract surgical rates; the Get 2020 and SAFE strategies for the control and elimination of blinding trachoma; and the African Program for Onchocerciasis Control for eliminating river blindness.[19–23]

We recognize the value of mobilizing optometrists, ophthalmologists, allied vision care personnel, and community health workers, as well as the critical importance of forging strategic alliances among these professionals, their organizations, and the significant number of nongovernmental organizations working in the field of blindness prevention. The global economic burden of blindness, which is estimated to reach $110 billion by 2020, can be reduced through increased investment in national eye care strategies.[3,24–27]

We further recognize that health, including good eyesight, is a human right; we note the global health challenge of addressing the significant disparities in access to vision care, in both developed and developing countries, and in harmony with the Millennium Development Goals and the Istanbul Declaration on Health: The First Human Right.[28–34]

APHA recommends—

1. The advancement of WHO’s VISION 2020: The Right to Sight global initiative for the elimination of avoidable blindness, especially by encouraging educational programs that increase awareness of the broad societal impact of blindness and visual disability; the adoption of new intervention strategies; and the scaling up of global collaboration.

2. That eye care professional organizations promote coordinated prevention and primary care strategies that advance global partnerships that transcend political boundaries and emphasize a team approach.

3. The expansion of the ophthalmic public health workforce to address the needs in strategic planning, human resource development, and population-based health services research.

4. That targeted projects that address gender, racial, ethnic, geographic, political, and economic disparities in access to primary vision care be developed and implemented.

REFERENCES

1. Prevention of Blindness Program. Global Initiative for the Elimination of Avoidable Blindness: Vision 2020—The Right To Sight. Geneva, Switzerland: World Health Organization; 2000. Fact Sheet 213.

2. The World Health Report 2000. Health Systems: Improving Performance. Geneva, Switzerland: World Health Organization; 2000.

3. 2010 Report. London, England: International Agency for Prevention of Blindness; 2010.

4. Prevention of Blindness Program. Global Initiative for the Elimination of Avoidable Blindness: Vision 2020—The Right To Sight. Geneva, Switzerland: World Health Organization; 1997.
5. State of the World’s Sight: VISION 2020: The Right to Sight: 1995–2005. Geneva, Switzerland: World Health Organization; 2005.

6. Prevention of Blindness and Visual Impairment. WHO releases the new global estimates on visual impairment. Vision 2020—The Right To Sight. Geneva, Switzerland: World Health Organization; 2010. http://www.vision2020.org/main.cfm?Type=NI&objectid=4266. Accessed June 2011.

7. West S, Sommer A. Prevention of blindness and priorities for the future. Bull World Health Organ. 2001;79(3):244–248.

8. Strategies for the Prevention of Blindness in National Programs. Geneva, Switzerland: World Health Organization; 1997.

9. Sommer A. Vitamin Deficiency and its Consequences. Geneva, Switzerland: World Health Organization; 1995.

10. Resnikoff S, et al. Global magnitude of visual impairment caused by uncorrected refractive errors in 2004. Bull World Health Organ. 2008;86:63–70.

11. Holden B, et al. Global vision impairment due to uncorrected presbyopia. Arch Ophthalmol. 2008;126(12):1731–1739.

12. He M, et al. Refractive error and visual impairment in school children in rural southern China. Ophthalmology. 2007;114:374–382.

13. He M, et al. Refractive error and visual impairment in urban children in southern China. Invest Ophthalmol Vis Sci. 2004;45(3):793–799.

14. Smith T, et al. Potential lost productivity resulting from the global burden of uncorrected refractive error. Bull World Health Organ. 2009;87:431–437.

15. IAPB Refractive Error Programme Committee. Strategy for the Elimination of Vision Impairment From Uncorrected Refractive Error. Hyderabad, India: International Agency for the Prevention of Blindness; 2008.

16. Lin LL, et al. Prevalence of myopia in Taiwanese schoolchildren: 1983 to 2000. Ann Acad Med Singapore. 2004;33(1):27–33.

17. Vitale S, et al. Increased prevalence of myopia in the United States between 1971–1972 and 1999–2004. Arch Ophthalmol. 2009;127(12):1632–1639.

18. Naidoo S. Meeting the challenges of providing global eye care: role of optometry in the next ten years. Paper presented at: Symposium on VISION 2020: Assessing the Past and Planning for the Future, American Academy of Optometry; November 19, 2011; San Francisco, CA.

19. Aravind S, et al. Cataract surgery and intraocular lens manufacturing in India. Curr Opin Ophthalmol. 2008;19(1):60–65.

20. Roba AA, et al. Effects of intervention with the SAFE strategy on trachoma across Ethiopia. J Epidemiol Community Health. 2011;65:626–631.

21. Naidoo K. Towards a new model in training and delivery of optometric education. Optom Educ. 2000;25:8–14.

22. Berger IB, Pike S, et al. A new paradigm for primary eye care in developing countries. Paper presented at: 128th Annual Meeting of the American Public Health Association; November 12–16, 2000; Boston, MA.

23. Pizzarello L, Tilp M, et al. A new school-based program to provide eyeglasses: ChildSight. J AAPOS. 1998;2(6):372–374.

24. Di Stefano AF. Push to prevent blindness. World Optometry. 2000;115:1,4.

25. Mesnick K. Narrowing the gap between eye care needs and service provision: the service-training nexus. Hum Resour Health. 2009;7:35.

26. Holden BA, Resnikoff S. The role of optometry in VISION 2020. Comm Eye Health J. 2002;15(43):33–36.

27. Frick KD, Foster A. The magnitude and cost of global blindness: an increasing problem that can be alleviated. Am J Ophthalmol. 2003;135(4):471–476.

28. World Health Assembly. Resolutions in support of VISION 2020: WHA 56.26 (2003); WHA 59.25 (2006); and WHA 62.1 and the 2009–2013 Action Plan (2009). Geneva: WHO, 2010.

29. Reducing gender disparities in blindness: a global perspective. Ophthalmology Times Meeting E-News, May 4, 2009.

30. Faal H, Gilbert C. Convincing governments to act: VISION 2020 and the Millennium Development Goals. Community Eye Health. 2007;20(64):62–64.

31. Crews E, et al. The view from the crossroads of public health and vision (re)habilitation. J Vis Impair Blind. 2009;100:.

32. Crews J. Vision, Aging, and Public Health: A Module for Public Health Professionals. Vision Health Initiative, Centers for Disease Control and Prevention; November 17, 2010.

33. The Istanbul Declaration. Health: The First Human Right. Presented at: World Federation of Public Health Associations, 12th Congress on Public Health; April 27–May 1, 2009; Istanbul, Turkey.

34. Mangham LJ, Hanson K. Scaling up in international health: what are the key issues? Health Policy Plan. 2010;25(2):85–96.