Unaddressed health issue shames us all

Peter Ackland, chief executive of the International Agency for the Prevention of Blindness, highlights the plight of the blind and visually impaired in the UK and around the world

The state of the world’s eye health is currently appalling, but there are some big things going on out there that are going to make it a whole lot worse over the next 20 to 30 years – unless we choose to invest now in simple and highly cost-effective eye health services.

As people get older so they become much more susceptible to many eye diseases, including age-related macular degeneration – the cause of most blindness in countries like the UK – and cataracts – the leading cause of blindness in low and middle-income countries.

By 2050 there will be some two billion people worldwide over the age of 60 compared to 600 million at the start of the century. It is estimated that the number of people with significant sight loss in the UK will double from two million now to four million by 2050.

According to World Health Organisation (WHO) estimates, some 285 million people in the world are blind or have a severely disabling visual impairment – global ageing could see a three-fold increase in this number.

Another major concern is the global trend towards urbanisation and more sedentary life styles, together with less healthy eating which, along with ageing, are major causes of diabetes.

Presently, it is estimated there are 300 million people with diabetes worldwide, with the number set to rise to 450 million within 20 years.

Diabetic retinopathy is a potentially blinding eye disease that typically develops between ten and twenty years after the onset of diabetes, and develops faster when diabetes is undiagnosed and untreated.

Studies in UK show that an alarmingly high number of diabetes patients do not attend regular eye examinations which would enable preventive measures to be taken. In lower-income countries very few diabetics are able to control their condition, resulting in higher levels of visual impairment as well as other disabling conditions associated with diabetes.

Some 285 million people in the world are blind or have a severely disabling visual impairment – global ageing could see a three-fold increase in this number

While we should be worried about the future, we should be outraged by the situation now. Although virtually no one is going to go blind from a cataract in the UK, that is not the case in poorer countries – some 90 million people worldwide are blind or severely visually impaired from a condition that can be fixed in 20 minutes for as little as £20 and which health policy makers know to be one of the most cost-effective of all health interventions.

Equally incredible is the fact that 120 million people are severely disabled and another 400 million cannot read the newspaper simply because they cannot access a pair of spectacles – a technology that has been around for a thousand years and which can be provided for less than £5.

What is really shocking is that 80 per cent of global blindness could be avoided through prevention or cure. And even worse, we know how to do it, but we lack the political will to devote the tiny amount of resources needed to improve the lives of hundreds of millions of visually disabled people.

It was against this background that the WHO and the International Agency for the Blind jointly launched the global initiative VISION 2020: The Right to Sight in 1999. The aim was straightforward – to eliminate avoidable blindness by the year 2020.

Twelve years later, there have been some remarkable achievements. Levels of blindness from trachoma, river blindness and corneal scar have been more than halved, and cataract surgical coverage has greatly increased in many parts of the world, particularly in South-East Asia. But with the threats from ageing and changing lifestyles this progress is under grave threat.

This is one health problem that could be largely solved throughout the world. Doing so would bring huge economic benefits and lift hundreds of millions of people out of poverty. It is a “no-brainer” – why aren’t we doing it?