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VISION 2020: The Right to Sight

Part One: The Need

Magnitude of Visual Impairment


(Visual Acuity <6/18)
153 Million 161 Million

Uncorrected Refractive Errors

Eye Diseases

= 314 Million
People severely visually impaired

In addition, recent studies indicate that there are:


517million uncorrected presbyopes

Refractive Error Awareness


Definition
Blind (eye disease) <3/60-NLP Blind (refractive error) <3/60-NLP Sub-Total Blind All Causes

Number of People (Millions)


37

8
45

Severe Visual Impairment (eye disease) <6/18 to 3/60 SVI (refractive error) <6/18 to 3/60 Sub-Total SVI All Causes

124 145 269

Total Blind + SVI

314

Causes of 45 million cases of blindness (<3/60)

Millions Blind

Two-thirds of blind people are women and girls

82% of blind people are aged 50 or above

Prevalence of blindness by age in Nigeria

indness and Low l Bl Vis na tio ion Na


Su
ct

rvey Proje

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; VISION 2020 this will only increase to $57billion per annum.

With

$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 programmes


The

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
$ per day
30 Control Operated

25

20

15

10

0 Before surgery One year after surgery

Opportunities & Quality of Life


Cataract Impact Study: Kuper, Polack et al 2008
Quality of Life Score
100 90 80 70 60 50 40 30 20 10 0 Before surgery One year after surgery Control Operated

Part Three: VISION 2020

Trends & Projections in Global Blindness

Projected Trends in Global Blindness


Without VISION 2020 =100M fewer people with blindness

With VISION 2020

2000

2010

2020

VISION 2020 Partnership


WHO VISION 2020 IAPB

Ministries of Health

NATIONAL VISION 2020 BODIES

NGDOs Professions Corporations

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

Implementation Unit
Principles
Implementing VISION 2020 at the District Level:
Integrated

Sustainable
Equitable Excellent

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

Europe N. America & The Caribbean Eastern Med. West Pacific Africa Latin America S. E. Asia

IAPBs VISION & MISSION


VISION
A world in which no one is needlessly blind or visually impaired and where those with unavoidable vision loss can achieve their full potential.

MISSION
IAPB 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

IAPBs Strategic Plan 2009-12


Strategic 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 1 Advocating, 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 2 Creating and disseminating knowledge of VISION 2020 and promoting learning from good practice in eye health programmes.

Strategic Objective 3 Facilitating 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 IAPB


The

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


2002 Trachoma 1995 5.9 1.9 4.1 1.8 0.9 0.4 0 2 4
11 to 4 million

Corneal Scar

Oncho

Trends in Causes of Blindness 1995 -2002


2002 Cataract 1995 18.9 17.3 6.3 4.4 2 1.8 0 5
Cataract , projected to rise to 25, actual = 17

Glaucoma

Diab Ret

10

15

20

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)
Fourfold Increase over 20 years

5.0 4.0 3.0 2.0 1.0 0.0

5% with IOL in 1993 increased to 90% in 2005

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


120000 100000 80000 60000 40000 20000 0 2004 2005 2006 2007

Global TT surgeries 100,000

30000000 25000000 20000000

Azithromycin Treatments 25 million

15000000 10000000 5000000 0 2004 2005 2006 2007

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

Overall 40% decrease in the prevalence of blindness

Blind people per million population

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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