1. VISION 2020 Kovin Naidoo, Allen Foster, ICEH

2. GLOBAL BLINDNESS • What do we know? • What is being done? • What is VISION 2020?

3. GLOBAL BLINDNESS • FOUR QUESTIONS • 1. What is it? DEFINITION • 2. How many? MAGNITUDE • 3. Why? CAUSES • 4. What can be done? CONTROL

4. GLOBAL BLINDNESS DEFINITION NORMAL 6/6-6/18 VISUAL IMPAIRMENT <6/18-6/60 SEVERE VISUAL IMPAIRMENT <6/60-3/60 BLIND <3/60 In the better eye with available correction

5. GLOBAL BLINDNESS • FOUR QUESTIONS • 1. What is it? DEFINITION • 2. How many? MAGNITUDE • 3. Why? CAUSES • 4. What can be done? CONTROL

6. Prevalence of Blindness EUROPE 0.3% Asia 0.7 % Africa 1.0 + % Lat. Amer. 0.5%

7. HOW MANY ARE BLIND? ECONOMY/ % BLIND / HEALTH CAREBLINDMILLION GOOD 0.25 2500 O.K. 0.50 5000 POOR 0.75 7500 VERY POOR 1.00+ 10,000+

8. YEAR 2000

9. Blindness and Impaired Vision • 45m people are blind • 135m have impaired vision Twice as many people will be affected by the year 2020 unless we do something about it! *WHO Global Initiative: Vision 2020, Feb 1999

10. GLOBAL BLINDNESS BLIND (millions)

11. WHY? • More people are going blind than we are treating or are dying.

12. GLOBAL BLINDNESS

13. ESTIMATED GLOBAL DISTRIBUTION OF BLINDNESS (1995) (TOTAL 45 MILLION) REGION NUMBER BLIND (MILLIONS) India 11.0 Africa 8,5 China 7,0 Rest of Asia 4,5 Eastern Mediterranean 4,5 Latin America 3,0 Industrialised countries 2,5 Eastern Europe 1,5 TOTAL 45,0

14. MAGNITUDE OF BLINDNESS BLIND PERSON YEARS = Number blind x Average number of years a person lives blind with this disease This is a measure of disability over time and indicates that the younger a person the greater the impact of blindness and the greater the effects on the individual and society.

15. BLIND PERSON YEARS GLOBAL ESTIMATES (1995) • Cataract 20m x 5 years = 100 million blind years • Glaucoma 6m x 10 years = 60 million blind years • Diab. retinopathy 3m x 5 years = 15 million blind years • Child blindness 1,5m x 50 years = 75 million blind years

16. TRENDS IN AGEING POPULATION + BLINDNESS • The number of blind people is increasing in the poor areas of the world because of 3 major factors:- • Increase in population • Increase in life expectancy • Inadequate eye care services (contribution of optometrists can reverse this)

17. GLOBAL BLINDNESS • The Future?

18. GLOBAL ESTIMATESVISUAL LOSS and BLINDNESS 45m <3/60 BLIND 25m S.V.I. <6/60-3/60 110m V.I. <6/18-6/60 6/6-6/18 6,000 MILLION PEOPLE

19. GLOBAL BLINDNESS • FOUR QUESTIONS • 1. What is it? DEFINITION • 2. How many? MAGNITUDE • 3. Why? CAUSES • 4. What can be done? CONTROL

20. GLOBAL BLINDNESS

21. GLOBAL BLINDNESS • SUMMARY • APPROXIMATELY 45 MILLION • INCREASING BY 1-2 MILLION/YR • 90% POORER AREAS OF THE WORLD • 60% TREATABLE • 20% PREVENTABLE ? OUT OF CONTROL ?

22. VISION 2020 Diseases AMD and otherdiseases Cataract RefractiveErrors Trachoma Vit A Def Oncho’ciasis DiabeticRetinopathy Glaucoma FOCAL DISEASES MORE DIFFICULT TREAT- ABLE ?

23. GLOBAL BLINDNESS • FOUR QUESTIONS • 1. What is it? DEFINITION • 2. How many? MAGNITUDE • 3. Why? CAUSES • 4. What can be done? CONTROL

24. PREVENTION OF BLINDNESS • PRIMARY PREVENTION • stop disease occurring • SECONDARY PREVENTION • stop visual loss from established disease • TERTIARY PREVENTION • restore vision • EDUCATION, TRAINING & REHABILITATION

25. GLOBAL BLINDNESS • What do we know? • What is being done? • What is VISION 2020?

26. GLOBAL BLINDNESS What is being done - disease control? • Cataract surgery is increasing 10 million ops / yr. • Endemic areas for Trachoma are decreasing. • Onchocerciasis is being brought under control. • Vitamin A deficiency is becoming less common. • Refractive Errors and Low Vision - there is greater awareness of the size of the problem but service delivery activities are still limited.

27. GLOBAL BLINDNESS What is being done - resources? • Over 100 countries have established programs. • A group of 40 non-governmental organisationscontribute approx. $100 million / year. • Good co-ordination in VISION 2020 programme • ministries of health • ophthalmologists and other professional groups • non - governmental organisations

28. World Health Organisation- IAPB Global Initiative to Eliminate Avoidable Blindness by the Year 2020

29. VISION 2020 Aim Elimination of all Needless Blindness

30. Childhood Blindness Refractive Error & Low Vision Cataract Trachoma Onchocerciasis • CBMI • Fred Hollows • Foundation • CBMI • Sight Savers • International • WCO • CEE • Lighthouse • CBMI • Helen Keller • Lions Clubs • International • Trachoma Initiative WHO-IAPB VISION 2020 The Right to Sight

31. The broader picture W H OPrevention Blindness I A P B Task force Vision 20/20 Ophthalmology/Optometry Societies NGO’s Professional bodies Governments National PBL Committees

32. GLOBAL BLINDNESS • The Future?

33. VISION 2020 BLIND (millions)

34. Progress • Data based on the 2002 global population show a reduction in the number of people who are blind or visually impaired, and those who are blind from the effects of infectious diseases, but an increase in the number of people who are blind from conditions related to longer life spans. • This underscores the need to modify the health care agenda to include the management of the diseases that are now becoming prevalent.

35. More than 161 million people were visually impaired, of whom 124 million people had low vision and 37 million were blind.

36. GLOBAL BLINDNESS • What is possible with todays knowledge and technology?

37. VISION 2020 • COMPONENTS • 1 Disease control • 2 Infrastructure development • 3 Human resource development

38. Leading Causes of Blindness Cataract Trachoma Childhood Blindness Refractive Errors Low Vision

39. CONTROL OF BLINDNESS - TERMINOLOGIES • Primary prevention = prevent the disease from occurring. Eg trachoma. • Secondary prevention = prevent loss of vision from established disease. Eg glaucoma. • Tertiary prevention = restore vision to a blind patient. Eg cataract.

40. VISION 2020 Diseases AMD and otherdiseases Cataract RefractiveErrors Trachoma Vit A Def Oncho’ciasis DiabeticRetinopathy Glaucoma 15% 15% 60% 10%

41. MAJOR CAUSES OF BLINDNESS • AFRICA + ASIA - Cataract, trachoma, corneal disease, glaucoma, vitamin A deficiency • LATIN AMERICA - Cataract, glaucoma, diabetic retinopathy • NORTH AMERICA + EUROPE - Macular degeneration, diabetic retinopathy, glaucoma

42. VISION 2020 • COMPONENTS • 1 Disease control • 2 Infrastructure development • 3 Human resource development

43. Infrastructure • Development of: -Delivery systems -Clinics -Access to equipment -Access to consumable and appliances eg. Spectacle frames at affordable rates

44. VISION 2020INTERNATIONAL STRUCTURE TERTIARY SECONDARY PRIMARY (community eye care)

45. MODEL FOR 0.5 - 1.0 MILLION POPULATION Training; Motivation Equipment; Supplies Cataract Ops /yr Errors of Refraction Refraction Spectacles Glaucoma Diab Ret. Trachoma Screening & Control

46. VISION 2020 • COMPONENTS • 1 Disease control • 2 Infrastructure development • 3 Human resource development

47. VISION 2020 PERSONNEL IN EYE CARE • Ophthalmologists • Cataract Surgeons • Optometrists and Refractionists • Ophthalmic Assistants / Nurses • Community Workers • Managers & Administrative Personnel

48. EYE DOCTORS / MILLION POPULATION 0 10 20 30 40 50 • AMERICAS • EUROPE • INDIA • CHINA • AFRICA 50 40 10 10 1

49. District Health SystemWHO: Framework for Delivery HEALTH DISTRICT SPECIALIST & SUPER-SPECIALIST CARE (30) 2o LEVEL CARE SPECIALISED SERVICES NON- SPECIALIST CLINIC COMMUNITY HEALTH CENTRE REGIONAL HOSPITAL DISTRICT HOSPITAL PROVINCIAL HOSPITAL CLINIC COMMUNITY HEALTH CENTRE DISTRICT HOSPITAL REGIONAL HOSPITAL CLINIC

50. SUMMMARY OF SERVICE DELIVERY FOR VISION 2020 • For a region of 1 000 000 population:- • Ophthalmologist/ 3 Regional clinic • ophthalmic medical (1 per 500 000) • officer • Optometrist/ 2 District eye clinic • Ophthalmic nurse (1 per 100 000) • Clinic nurse 1 District PHC clinic (1 per 10 000)