1. Meeting the Vision 2020 Goals
Hugh R Taylor AC
Chairman, Western Pacific Region
Shenyang, 7th April 2007

3. Outline Review of Vision2020 Global data on vision loss
Disease control strategies
Human Resource Development
Health System Development

4. VISION 2020: The Right to Sight
Goal
The elimination of avoidable blindness by 2020, in order to give all people in the world, the right to sight

5. VISION 2020 Partnerships W H O Technical Assistance Capacity Building
National Partners - National Vision 2020 Plans
Sustainable program delivery

6. VISION 2020: The Right to Sight
Launched in 1999
World Health Assembly Resolution calls on all member states to
- develop a national plan by 2005
- implement their national plan by 2007
- reduce avoidable blindness by 2010
WHA calls for further priority and support to Vision 2020

7. Causes of Global Blindness
45 million
Cataract
Refractive Errors
Trachoma
Vit A Def
Oncho
Diabetic Retinopathy
Glaucoma
AMD and other diseases
60%
15%
15%
10%

8. Global Blindness millions 100 90 75 60 50 50 40 38 30 25 25 1980 1990
1980
1990
2000
2010
2020 1

9. VISION 2020 Components Effective disease control
Cataract
Trachoma
Onchocerciasis
Childhood Blindness
Refractive Error and Low Vision
Human resource development
Infrastructure development

10. Cataract operations/million population/year
First cause of blindness (~50%)
backlog: 20 million unoperated cases
only 10 million surgeries year
major constraints :
coverage
access
quality
CSR
Cataract operations/million population/year

11. Cataract Surgery Rates
4000+
no data
0-499
WHO 2004

12. Cataract Surgical Rate in India
WHO 2004

13. Cataract Surgery Capacity Building Efficiency of programs
Surgical Team building and management
Sustainability and Cost recovery
Outcome Monitoring
Visual acuity outcome
Surgical coverage rates
Cost efficiency

14. Trachoma- 2004, 84m with active trachoma
trachoma is known to be a public health problem
trachoma is believed to be a problem, but no data are available
known that trachoma is not a problem
WHO 2004

15. Top 20 countries with Active Trachoma

17. Zithromax Donation Program Pfizer

18. Onchocerciasis - 80 million to be treated

19. Mectizan Donation Program Merck

20. Childhood Blindness Everywhere: congenital cataract / glaucoma
hereditary retinal diseases
R.O.P
R.O.P
Measles
Vitamin A deficiency
R.O.P
R.O.P

21. Refractive Error and Low Vision
Huge numbers with uncorrected refractive error
under-estimated for a long time
particularly in developing countries
1/3 of low vision due to uncorrected refractive errors
risk factors: age, social isolation …
Low vision care services
Either non-existent in most countries
or are fragmented and patchy

22. Myopia affects 2.1 billion worldwide
Prevalence of Myopia
Europe
26-35%
China 88%
USA
27%
Japan
45%
Nepal 3%
Mexico
44% HK
80%
India
19%
We we are seeing very high prevalance rates of myopia in Asia. In Australia it is around 20-30%
Australia
20%
Chile
20%
South Africa
10%
Myopia affects 2.1 billion worldwide

23. Major challenge: How to close the increasing gap
Continent
Country
City
Durban - South Africa
Shanghai
Sao Paulo
Sangha - Mali
Rural China
Sao Paulo

25. Global Blindness 1995 45 million 37 million 2004 Corneal Opacities
Trachoma
Other
Childhood
Blindness
Other
Trachoma
Oncho
AMD
Glaucoma
Diabetic Retinopathy
Glaucoma
Oncho
Cataract
Cataract
45 million
37 million

26. World Blindness 2005 Global estimate (best corrected VA)
Vision Impairment: 161 million
37 million Blind
124 million Low Vision
Refractive Error 153 million (2006)
Total estimate 314 million Vision Loss

27. Visual Impairment Regional Distribution
Best corrected
Visual Acuity
< 6/18 (0.3)
WHO 2004

28. Number of Visually Impaired per Million Population
X 2.2
WHO 2004

29. Global Trends in Blindness
Many original factors remain unchanged…
Vision 2020
still relevant!
Ageing + Population growth + Underdevelopment

30. Immediate Challenges Unfinished agenda refractive error cataract
trachoma
onchocerciasis
xerophthalmia

31. Medium/ Long Term Challenges
Changing patterns:
more linked to life style and more chronic
have significant impact on health expenditures
Diabetic retinopathy
Glaucoma
less avoidable or treatable and of increasing relative importance
Age-related Macular Degeneration
3rd global cause of blindness
1st cause in many developed countries
Retinitis Pigmentosa and other genetic conditions
awareness
compliance
adherence…

32. Prevalence of obesity (BMI ≥ 30kg/m2) Females > 15

33. Number of Persons with Diabetes
Millions
WHO, Wild & Roglic, 2004

34. Number of People with Glaucoma
Quigley. Brit J Ophthalmol 1996

35. Number of People with Glaucoma in China
Number affected
Number blinded
PACG: 4.5 M
POAG: 3.5 M
SecG: 1.4 M
TOTAL: 9.4 M
Foster. Br J Ophthalmol 2001;85:

36. Blindness from Glaucoma in China
Urban
Rural
Foster PJ 2005

37. Unilateral Glaucoma Blindness, Asia
Range 11-27%
Range 33-75%
Proportion of unilateral blindness in population surveys

38. Traditional Classification of Angle-closure Glaucoma
Acute ACG severe symptoms
Intermittent ACG remitting symptoms
Chronic ACG high IOP, no symptoms
Latent ACG angle-closure inducible
Therefore
Term “glaucoma” used regardless of presence of neuropathy
Emphasis is on IOP and presence/absence of symptoms
Does not differentiate people with and without visual loss

39. Distribution of Angle-closure in Mongolia
Foster PJ, et al. GJ. Arch Ophthalmol 1996;114:

40. Prevalence of Angle-closure
Mongolia Singapore
Occludable angles 6.4% (4.3, 8.5) 6.3% (4.9, 7.6)
Angle-closure 2.0% (1.3, 3.1) 2.2% (1.4, 3.1)
PACG % (0.4, 1.2) 0.8% (0.4, 1.2)
Rates are age- and gender-standardised (95% Confidence intervals)
Foster 2005

41. Numbers of People with Angle-closure in China
Foster. Br J Ophthalmol 2001;85:1277

42. Incidence of Symptomatic Angle-closure
NOTE: Only 30-40% of all angle-closure in Asians is symptomatic

43. Incidence of Acute Angle Closure in Singapore
Incidence 12.2/100,000/year
Risk factors
Female : 1
Age > : 1
Chinese > Malay or Indian : 1
S Seah, et al.Arch. Ophthalmol 1997:115;1436.

44. Incidence of Primary Angle-Closure in Singapore
Wong TY, et al. Br J Ophthalmol 2000;84:990

45. Missed Diagnoses, Australia
Time since last reported eye examination (n = 72)
< 1 year
< 2 years
< 5 year
Undiagnosed Glaucoma
51.4
31.9
15.3
Unoperated Cataract
43.4
26.3
11.8
Undercorrected Refractive Error
59.4
44.3
25.1
Diabetes Mellitus
34.4
21.6
8.8
Age-related Macular Degeneration
48.0
30.6
Visual Acuity < 612
11.4
15.8
25.3
Blysma et al CEO 2004

46. Summary Angle Closure Glaucoma is more important than often recognised
Especially a problem in East Asia
Care must be taken in routine examinations to assess angle closure
Prompt treatment is required

47. Human Resource Development
Increase in Training Programmes
Improved Quality of Training
Access to Education Materials
Increased International Collaborations
Improved Programme Management

48. World Health Report 2006 Make the most of existing health workers
availability, competence, responsiveness and productivity
Supervision
firm, fair and supportive
Crucial support systems
Life-long learning
Institutions produce an appropriate mix
using regional resources and IT to drive down cost
Gearing recruitment
for right skills, right place, social compatibility between workers and clients

49. Key Issues Related to Training
Particularly in developing countries:
Not enough ophthalmologists and other eye care providers to provide the care needed
Mal-distribution: Lack of providers where most needed
Not enough training programs
Existing training programs not focused on public needs, e.g., for community eye health
Lack of infrastructure and professional development for those who are trained

50. Eye Care Personnel Needed
Teams of:
Ophthalmologists (surgeons and “eye doctors”)
Subspecialists (pediatric, retina, etc.)
Primary physicians trained in eye care
Mid level eye personnel (MLEP) and nurses
Optometrists or refractionists and opticians
Managers and community eye health workers

51. Training Principles Training in ophthalmology Needs are best met
focus on needs of communities and populations, not just individuals
Needs are best met
by eye care teams, trained together to work toghether
Comprehensive eye care
should be an integral part of the health care system

52. Training Principles (2)
Community-level primary eye care
should be integrated into primary health care
Eye care training
should be integrated with training for the rest of the health care system
Those who are trained need
infrastructure and continuing professional development

53. Infrastructure and Appropriate Technology
Models of Care at All Levels of Eye Care
Affordable Products to all
Construction of appropriate Facilities

54. Infrastructure Model Proposed LVPEI
Centre of Excellence
50 million
CEC
Training Centre
5 million TC
Service Centre
500,000 SC
You can sit with Azam or Shubhra and make these slides more contrasting. Explain the model! – may take 2 minutes and concentrate on the role of Vision centres
Vision Centre
50,000 VC

55. Global Burden Of Disease
Perinatal Condition
Lower Respiratory Infection
Ischaemic Heart Disease
Cerebro-Vascular Disease
HIV/AIDS
Eye Conditions (include DRN)
Diarrhoeal Disease
Unipolar Depressive Disorders
Malaria
Ch Obstructive Pulmonary Dis TB
Road Traffic Injuries
Percentage
Chiang et al Lancet 2006

56. Economic Impact of Blindness
In many parts of the world, blindness leads to individual, family and community poverty
Effective interventions are available that can prevent or cure 80% of blindness
These interventions can be very inexpensive;
Vitamin A capsules US$2/QALY
Cataract surgery US$2020/QALY
Diabetic retinopathy screening US$15,000/QALY

57. Annual Productivity Loss Due to Blindness
$150 billion saved in productivity loss

58. Summary Vision 2020 is already highly successful
Blindness will continue to increase with ageing of population
Even greater effort is required to achieve
“the right to sight for all”

59. VISION 2020: the Right to Sight
World Free of Avoidable Blindness

61. WHA Resolution 59-25 Adopted by World Health Association in May 2006
Calls on countries to:
reinforce efforts to define national VISION 2020 plans
mobilize domestic funding to support VISION 2020
include prevention of blindness in national development plans and goals
integrate prevention of blindness into primary health care

62. WHA Resolution 59-25 Adopted by World Health Association in May 2006
Calls on countries to:
develop and strengthen eye care services and integrate them in the existing health care system, including training and re-training of health workers in visual health
Calls on WHO to:
provide support to collaboration among countries for the prevention of avoidable blindness and visual impairment in particular in the area of training of all categories of relevant staff

63. WHA Resolution 59-25 Offers an unprecedented opportunity to:
Convince national governments to assign higher priority to prevention of blindness and visual loss, and
Advocate for increased support for training of ophthalmologists and other eye care providers to meet public needs

64. Unmet Public Need for Eye Care
Worldwide at least 161 million people are severely visually impaired: 37 million blind million with low vision
In addition 153 million have under-corrected refractive error – the total is 314 million
Burden of blindness greatest in the least developed regions of the globe.
Global vision loss is certain to increase, particularly in developing countries, due to population growth and aging, unless concerted action is taken.