Transcript
VISION 2020:The Right to Sight
Part One: The Need
Magnitude of Visual Impairment
(Visual Acuity <6/18)
153 Million
UncorrectedRefractive Errors
161 Million
Eye Diseases
= 314 Million
People severely visually impaired
517million uncorrected presbyopes
In addition, recent studies indicate that there are:
Refractive Error Awareness
Definition Number of People (Millions)Blind (eye disease)
<3/60-NLP37
Blind (refractive error) <3/60-NLP
8
Sub-Total Blind All Causes 45
Severe Visual Impairment (eye disease) <6/18 to 3/60
124
SVI (refractive error) <6/18 to 3/60 145
Sub-Total SVI All Causes 269
Total Blind + SVI 314
Causes of 45 million cases of blindness (<3/60)
Millions Blind
Two-thirds of blindpeople are women and girls
82% of blind people are aged 50 or above
Prevalence of blindness by age in Nigeria
National B lindness and Low Vision
S u r v e y P r o j e c t
Analysis: Causes of Blindness
45 million Blind
Cataract
Refractive Error
Trachoma
Onchocerciasis
Vitamin A Deficiency
Glaucoma
Diabetic Retinopathy
ARMD
RP
Others
Treatable
25 million
Preventable
3 million
Partly Preventable
7 million
Research
10 million
Part Two: Money
The cure and prevention of blindness contributes to the alleviation of poverty and the achievement of the 1st Millennium Development Goal
The Economics of Blindness
Frick & Foster estimate that:In the year 2000 $42billion of economic productivity was lost due to blindness and low vision;
If nothing is done this will increase to $110billion per annum by 2020;
With VISION 2020 this will only increase to $57billion per annum.
$310billion increase in productivity over twenty years if VISION 2020 is implemented
Total cost of Vision Disorders in Australia, 2004
Clear Insight 2004
Cost effectiveness of eye health programmesThe Gambian Eye Care programme succeeded in reducing Blindness by 40% over ten years. The economic rate of return was estimated to be 19%;
The Onchocerciasis Control Programme prevented 600,000 cases of blindness. It restored 25million hectares of land to productive use. It did so at an economic rate of return of 20%;
The African Programme for Onchocerciasis Control continues and is providing protection to >70m people at an economic return of 17%.
Household per Capita Expenditure ($)
Cataract Impact Study: Kuper, Polack et al 2008
0
5
10
15
20
25
30
Before surgery One year after surgery
Control Operated$ per day
Opportunities & Quality of Life
Cataract Impact Study: Kuper, Polack et al 2008
0
10
20
30
40
50
60
70
80
90
100
Before surgery One year after surgery
Control OperatedQuality of Life Score
Part Three: VISION 2020
Trends & Projections in Global Blindness
Projected Trends in Global Blindness
2000 2010 2020
Without VISION 2020
With VISION 2020
=100M fewer people with blindness
VISION 2020 Partnership
WHOVISION
2020
NGDOs
Professions
Corporations
NATIONAL
VISION 2020
BODIES
IAPB
Ministries of
Health
DISTRICT VISION 2020 SERVICE UNITS
District Level Implementation
Eye Care Team
Equipment & Supplies
Community-Patients
Service Delivery Model for VISION 2020
Advanced Tertiary
Tertiary
Secondary
Primary
80% of eye conditions can be effectively dealt with at primary health level
PrinciplesImplementing VISION 2020 at the District Level:
Integrated
Sustainable
Equitable
Excellent
Implementation Unit
I - SEE
Part Four: IAPB
International Agency for the Prevention of Blindness
Founded in 1975 it now has 108 members: International NGOs
Professional Bodies
Universities
Corporate Companies
Governed by a Board of Trustees and Council of Members
Head office in London, UK
IAPB has seven regions
N. America &The Caribbean
Latin America
Africa
Europe
EasternMed.
S. E. Asia
WestPacific
IAPB’s VISION & MISSION
VISIONA world in which no one is needlessly blind or visually impaired and where those with unavoidable vision loss can achieve their full potential.
MISSIONIAPB promotes the global initiative VISION 2020: The Right to Sight,
which aims to eliminate the main causes of avoidable blindness by the year 2020.
IAPB brings together governments and non-governmental agencies to facilitate the planning, development and implementation of sustainable national eye care programmes based on the three core strategies of disease control, human resource development and infrastructure development, incorporating the principles of primary health care.
IAPB is the partner of the World Health Organization (WHO) in VISION 2020: The Right to Sight
IAPB’s Strategic Plan 2009-12Strategic Aim:“Eye health is given greater priority within overall health policy; becomes integrated into health systems and receives increased budgetary allocations from national governments and other donors.”
Strategic Objective 1Advocating, and holding governments to account, for the implementation of the WHO Action Plan and WHA resolutions on the elimination of avoidable blindness and visual impairment; and national VISION 2020 eye care plans.
Strategic Objective 2Creating and disseminating knowledge of VISION 2020 and promoting learning from good practice in eye health programmes.
Strategic Objective 3Facilitating a collaborative approach amongst all stakeholders involved in VISION 2020.
IAPB and WHO advocacy priorities Two WHA Resolutions on avoidable blindness in 2003 and
2006 (WHA 56.26 and 59.25)
WHO Medium Term Strategic Plan 2008-13. Prevention of visual impairment is included in objective three
WHO Action Plan for the prevention of avoidable blindness & visual impairment - passed at the WHA Assembly in May 2009
IAPB and knowledge/awareness raising of VISION 2020 151 countries have participated in a national VISION
2020 planning workshop
118 countries have established a prevention of
blindness committee
104 countries have a national eye care plan
The advocacy challenge for IAPBThe Indian government recently pledged $265m towards implementing VISION 2020 between 2008-12;
The Pakistan government committed $50m for implementing VISION 2020 between 2006-10;
The Australian government has pledged an initial A$45m for work in the Western Pacific region.
BUT the major advocacy challenge going forward is IMPLEMENTATION of the national plans and holding governments to account for what they have committed to in the WHO Action Plan & resolutions.
Part Five: 10 Years of SUCCESS
Trends in Causes of Blindness 1995 -2002
0.4
1.8
1.9
0.9
4.1
5.9
0 2 4 6 8
Oncho
Corneal Scar
Trachoma
2002 1995
11 to 4 million
Trends in Causes of Blindness 1995 -2002
1.8
4.4
17.3
2
6.3
18.9
0 5 10 15 20
Diab Ret
Glaucoma
Cataract
2002 1995
Cataract , projected to rise to 25, actual = 17
CATARACT
Reduced from a projected 25m to 17.3m Low cost IOLs
Training in ECCE initially and now SICS
High volume surgery in S.E Asia region
Sustainability models
INDIA: Cataract Operations 1985-2005(Data from Aravind Eye Care System)
0.0
1.0
2.0
3.0
4.0
5.0
5% with IOL in 1993 increased to 90% in 2005
Fourfold Increase over 20 years
TRACHOMA
Blinding trachoma reduced from 5.9m to 1.9m Donation of 135m treatments of Azithromycin by Pfizer and
emergence of community distribution programmes
Training of ophthalmic nurses in surgery
Improved water, sanitation and hygiene
Trachoma “S” and “A” 2004-2007
0
20000
40000
60000
80000
100000
120000
2004 2005 2006 2007
0
5000000
10000000
15000000
20000000
25000000
30000000
2004 2005 2006 2007
Global TT surgeries 100,000
Azithromycin Treatments25 million
ONCHOCERCIASIS (River Blindness)
Blinding Onchocerciasis reduced from 0.9m to 0.4m
More than 70m people protected from the disease.
Donation of >1800m Mectizan tablets by Merck
Community Directed Distribution
Partnership between APOC, governments and NGOs
Mectizan treatments for Onchocerciasis
The success of the onchocerciasis control programme and its philosophy of community directed distribution has led to USAID, Gates Foundation, DFID, and other major donor interest in the Neglected Tropical Disease initiative
Prevalence of blindness: declining in some countries
The Gambia Survey 1986 & 1996
Blind people per million population
Overall 40% decrease in
the prevalence of
blindness
Trends in blindness
15 million fewer than projected
Acknowledgements Bruce Spivey – slides 3,4 Allen Foster – slides 5,6,10,16,17,19,20,21,22,25,33,34,36,38,40,43,44 G.V.S. Murthy – slide 9 Hugh Taylor – slide 14
References Global Magnitude of Visual Impairment Caused by Uncorrected Refractive Errors in 2004, Resnikoff S, et al, Bulletin of the World Health Organization 2008,86:63-70
Global Vision Impairment Due to Uncorrected Presbyopia, Holden BA et al. Archives of ophthalmology accepted for publication.
The Impact of VISION 2020 on Global Blindness, Foster A and Resnikoff S, Eye (2005) 0, 000-000.doi:10.1038/sj.eye.6701973
The Magnitude and Cost of Blindness: An Increasing Problem that can be Alleviated, Frick,K.D and Foster A, American Journal of Ophthalmology 2003; 135(4): 471-6
THANK YOU!
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