The Lancet Global Health Commission on Global Eye Health: vision beyond 2020
Journal – The Lancet Global Health
Article type – Book chapter
Publication date – Feb – 2021
Authors – Prof Matthew J Burton, PhD Jacqueline Ramke, PhD Ana Patricia Marques, PhD Prof Rupert R A Bourne, MD Rupert R A Bourne Affiliations Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK Department of Ophthalmology, Cambridge University Hospitals, Cambridge, UK Search for articles by this author Prof Nathan Congdon, MD Iain Jones, MSc Brandon A M Ah Tong, BSocSci Simon Arunga, PhD Damodar Bachani, MD Covadonga Bascaran, MSc Andrew Bastawrous, PhD Prof Karl Blanchet, PhD Tasanee Braithwaite, DM John C Buchan, MD Prof John Cairns, MPhil Anasaini Cama, MPH Margarida Chagunda, MSc Chimgee Chuluunkhuu, MD Andrew Cooper, PhD Jessica Crofts-Lawrence, MSt William H Dean, PhD Prof Alastair K Denniston, PhD Joshua R Ehrlich, MD Paul M Emerson, PhD Jennifer R Evans, PhD Prof Kevin D Frick, PhD Prof David S Friedman, PhD João M Furtado, PhD Michael M Gichangi, MMed Stephen Gichuhi, PhD Suzanne S Gilbert, PhD Reeta Gurung, MD Esmael Habtamu, PhD Peter Holland, MSc Prof Jost B Jonas, PhD Prof Pearse A Keane, MD Prof Lisa Keay, PhD Rohit C Khanna, MPH Prof Peng Tee Khaw, PhD Prof Hannah Kuper, ScD Fatima Kyari, PhD Prof Van C Lansingh, PhD Islay Mactaggart, PhD Milka M Mafwiri, MMed Prof Wanjiku Mathenge, PhD Ian McCormick, MSc Priya Morjaria, PhD Lizette Mowatt, FRCOphth Debbie Muirhead, MSc Prof Gudlavalleti V S Murthy, MD Nyawira Mwangi, PhD Daksha B Patel, MD Prof Tunde Peto, PhD Babar M Qureshi, MD Prof Solange R Salomão, PhD Virginia Sarah, BA Bernadetha R Shilio, MMed Anthony W Solomon, PhD Bonnielin K Swenor, PhD Prof Hugh R Taylor, FRANZCO Prof Ningli Wang, PhD Aubrey Webson, DBA Prof Sheila K West, PhD Prof Tien Yin Wong, MD Richard Wormald, MSc Sumrana Yasmin, MSc Mayinuer Yusufu, MTI Juan Carlos Silva, MD Prof Serge Resnikoff, PhD Thulasiraj Ravilla, MBA Prof Clare E Gilbert, MD Prof Allen Foster, FRCOphth Prof Hannah B Faal, FRCOphth
Keywords – Global Eye Health, LMIC, ophthalmology
Open access – Yes
Speciality – Ophthalmology
World region Global
Language – English
Submitted to the One Surgery Index on February 26, 2021 at 12:26 am
Eye health and vision have widespread and profound implications for many aspects of life, health, sustainable development, and the economy. Yet nowadays, many people, families, and populations continue to suffer the consequences of poor access to high-quality, affordable eye care, leading to vision impairment and blindness.
In 2020, an estimated 596 million people had distance vision impairment worldwide, of whom 43 million were blind. Another 510 million people had uncorrected near vision impairment, simply because of not having reading spectacles. A large proportion of those affected (90%), live in low-income and middle-income countries (LMICs). However, encouragingly, more than 90% of people with vision impairment have a preventable or treatable cause with existing highly cost-effective interventions. Eye conditions affect all stages of life, with young children and older people being particularly affected. Crucially, women, rural populations, and ethnic minority groups are more likely to have vision impairment, and this pervasive inequality needs to be addressed. By 2050, population ageing, growth, and urbanisation might lead to an estimated 895 million people with distance vision impairment, of whom 61 million will be blind. Action to prioritise eye health is needed now.
This Commission defines eye health as maximised vision, ocular health, and functional ability, thereby contributing to overall health and wellbeing, social inclusion, and quality of life. Eye health is essential to achieve many of the Sustainable Development Goals (SDGs). Poor eye health and impaired vision have a negative effect on quality of life and restrict equitable access to and achievement in education and the workplace. Vision loss has substantial financial implications for affected individuals, families, and communities. Although high-quality data for global economic estimates are scarce, particularly for LMICs, conservative assessments based on the latest prevalence figures for 2020 suggest that annual global productivity loss from vision impairment is approximately US$410·7 billion purchasing power parity. Vision impairment reduces mobility, affects mental wellbeing, exacerbates risk of dementia, increases likelihood of falls and road traffic crashes, increases the need for social care, and ultimately leads to higher mortality rates.
By contrast, vision facilitates many daily life activities, enables better educational outcomes, and increases work productivity, reducing inequality. An increasing amount of evidence shows the potential for vision to advance the SDGs, by contributing towards poverty reduction, zero hunger, good health and wellbeing, quality education, gender equality, and decent work. Eye health is a global public priority, transforming lives in both poor and wealthy communities. Therefore, eye health needs to be reframed as a development as well as a health issue and given greater prominence within the global development and health agendas.
Vision loss has many causes that require promotional, preventive, treatment, and rehabilitative interventions. Cataract, uncorrected refractive error, glaucoma, age-related macular degeneration, and diabetic retinopathy are responsible for most global vision impairment. Research has identified treatments to reduce or eliminate blindness from all these conditions; the priority is to deliver treatments where they are most needed. Proven eye care interventions, such as cataract surgery and spectacle provision, are among the most cost-effective in all of health care. Greater financial investment is needed so that millions of people living with unnecessary vision impairment and blindness can benefit from these interventions.
Lessons from the past three decades give hope that this challenge can be met. Between 1990 and 2020, the age-standardised global prevalence of blindness fell by 28·5%. Since the 1990s, prevalence of major infectious causes of blindness—onchocerciasis and trachoma—have declined substantially. Hope remains that by 2030, the transmission of onchocerciasis will be interrupted, and trachoma will be eliminated as a public health problem in every country worldwide. However, the ageing population has led to a higher crude prevalence of age-related causes of blindness, and thus an increased total number of people with blindness in some regions.
OSI Number – 20953