Eye Care Needs

The global need for vision correction has created disability and a poverty-inducing health crisis worldwide. More than 640 million people are unnecessarily blind or vision impaired due to refractive error simply because they don’t have access to an eye examination and a pair of glasses.

Refractive Error

In 2010, 123 million had significant vision impairment (< 6/18 in the better eye) due to uncorrected refractive errors including myopia, hyperopia and astigmatism – all affecting distance vision. This figure includes at least eight million people with blindness (< 3/60 in the better eye).In 2010, the World Health Organization (WHO) estimated that more than 285 million people globally have distance vision impairment, of which 39 million are blind, and 246 million have low vision.¹

Of these an estimated 43% are vision impaired due to uncorrected refractive error (representing 123 million). In addition, 65% of people of those visually impaired and 82% of those who are blind, are 50 years and older.

The estimated numbers of people with significant distance vision impairment and blindness classified by WHO regions is as follows:

• Western Pacific: 90 million
• South East Asia: 90 million
• Africa: 26 million
• Americas: 26 million
• Europe: 28 million
• Eastern Mediterranean: 23 million¹

Presbyopia

In addition to the estimates, there were an estimated 517 million people without adequate correction for functional presbyopia in 2005 (mostly occurring in the developing world).  Presbyopia is the natural hardening of the eye’s lens that occurs with age, which causes refractive error affecting the near vision of older people. In many countries this is typically treated with the prescription of a pair of reading glasses, however hundreds of millions are currently unable to access eye care to correct this condition.

The estimated numbers of people with significant near vision impairment and blindness classified by United Nations sub-regions includes the following:

• Eastern Asia: 155 million
• South-Central Asia: 125 million
• Africa: 84 million
• South-Eastern Asia: 47 million
• South America: 40 million
• Central America: 13 million.²

Typically in the developed world people with vision impairment such as myopia, hyperopia and astigmatism, and presbyopia will receive appropriate vision correction. However, in many areas in the developing world basic eye care services do not exist.

The Impact

The effects of avoidable blindness and vision impairment on individuals, communities and governments are numerous and include:

• Established link between blindness and vision impairment and poverty
• Fewer employment opportunities
• Impact on education (especially for children)
• Economic cost to society in lost productivity and lost opportunities for growth and innovation
• Social isolation and reduced participation by individuals
• Increased mortality, morbidity and creation of other health problems potentially both physical and emotional
• Diminished quality of life through reduced independence, mobility and confidence.

Global cost

In 2009, an international study by the Brien Holden Vision Institute Foundation and partners, revealed that the global economic cost in lost productivity due to avoidable distance vision impairment was a staggering I$269* billion each year.  It is estimated that a long-term sustainable solution, based on the need for glasses (to correct distance refractive error) to be replaced every three years, would cost in the vicinity of $26 billion – an investment that would repay the world economy at a rate of 1000% per annum.³ That would be money well spent.

(*The international dollar (I) is a hypothetical unit of currency with the same purchasing power that the U.S. dollar has in the United States at a given point in time. It shows how much a local currency unit is worth within the country's borders. Conversions to international dollars are calculated using purchasing power parities. If all the dollars were to be spent in the USA, then I$1 = 1USD.)

Priority for World Health Organization

Uncorrected refractive error is one of six priority areas in eye care identified by the World Health Organization (WHO). Urgent international efforts by groups such as WHO and International Agency for the Prevention of Blindness are bringing eye care to the attention of government and are supporting the growth of eye care in areas of need.

The solution

A simple eye examination and the appropriate pair of glasses would restore vision to more than 640 million people. At the heart of this problem is a lack of access to eye care services, many developing communities are missing enough skilled practitioners to perform eye examinations, prescribe appropriate glasses, and provide a referral for more serious conditions when necessary, in an accessible location with the resources to dispense ready-made or custom-made spectacles.

The Brien Holden Vision Institute Foundation is contributing to this solution by working with local governments, health care systems, the eye care industry, communities and individuals to generate the commitment necessary tobuild sustainable and affordable vision care systems that are symbiotic and culturally acceptable for communities in need and will provide ongoing services for vision impaired people.

So far, the Foundation has helped build sustainable eye care in 54 countries though our co-ordinated human resource development, service development, and advocacy efforts. We have established 13 offices worldwide andhelped deliver eye examinations, spectacles and referrals for further treatment in more than 429 vision centres and sites for eye care. The Foundation has also facilitated the growth and establishment of optometry schools, building the institutional capacity for  sustained generation of optometric personnel.

 References

1. Pascolini, D. &Mariotti, S.P. 2011. Global Estimates of Visual Impairment: 2010. British Journal of Ophthalmology, doi:10.1136/bjophthalmol-2011-300539. Pp. 1-5
2. Holden BA, Fricke TR, May Ho S, Wong R, Schlenther G, Cronje S, Burnett A, Papas E, Naidoo KS, Frick KD, ‘Global vision impairment due to uncorrected presbyopia’, Archives of Ophthalmology, Vol 126 (No. 12), Dec 2008
3. Smith TST, Frick KD, Holden BA, Fricke TR, Naidoo KS, ‘Potential lost productivity resulting from the global burden of uncorrected refractive error’ in Bulletin of the World Health Organization, 2009; 87