Finding solutions to prevent and treat reversible blindness in developing countries around the world will eliminate phenomenal suffering for a large number of fellow human beings. Anyone who has spent time in developing countries understands the hardships that arise from poverty, let alone from blindness. Suffering aside, the economic impact to the family (and in turn to the community and the nation) is considerable; a blind person is often dependent on a younger family member, who in all likelihood must forego his or her education to care for their elder. In many countries, survival in the blind population is low, which is often the result of neglect. Some nations and cultures have better support mechanisms than others. Fortunately, there are many individuals, communities, and organizations that are motivated to develop sight-saving projects in these areas.
Three articles in the bonus feature in this issue illustrate the efforts made by several individuals dedicated to saving sight globally. Each inspiring article illustrates what can be accomplished with the appropriate set of ingredients—often in different proportions—for each environment.
ADDRESSING THE NEED
Based on 2002 figures from the World Health Organization (WHO),1 161 million people in the world are visually impaired, 37 million of whom are blind as a result of various conditions, cataract being the source in most cases (Table 1). These figures are almost 10 years old, and with the exponential growth in population in many developing countries, the figures are bound to be higher today. In Africa, the incidence of childhood blindness is 0.124%, and cataract prevalence is an incredible 9%. The predominance of these conditions reflects a number of issues, in particular poverty. Prevalence may be lower in other regions, but the size of the population in these regions means the overall numbers of blind vary by location. According to the WHO, Southeast Asia and the Western Pacific have the highest global distributions of the blind (Table 2).
The ideal strategy for the elimination of blindness requires massive coordination and strong leadership from a global organization. The WHO is spearheading a global initiative to eliminate avoidable blindness with its VISION 2020: The Right to Sight program, which aims to eliminate the causes of preventable blindness as a public health problem by the year 2020. Cataract, onchocerciasis, and trachoma are the principal diseases for which world strategies and programs have been developed. For other preventable causes, including glaucoma, diabetic retinopathy, uncorrected refractive errors, and childhood blindness (except for xerophthalmia), the WHO is in the midst of developing screening and management strategies for use at the primary care level.
VISION 20/20 is an ambitious project, and those at the helm are to be congratulated. This is not to say that world blindness will be resolved, but the contributions WHO has made help considerably in achieving these goals. Many ophthalmologists, as illustrated by this month's bonus feature on the humanitarian effort, already play a huge role in the fight against preventable blindness. Many more examples can be cited. A bit of lateral thinking helps to increase the rate of progress. One example is Project Orbis, founded by my mentor David Paton. His concept of a flying eye hospital to educate ophthalmologists was treated at first as a far-out idea. In his recent autobiography, Second Sight, David discusses his incredible passion to make a significant contribution to the elimination of world blindness. Despite the ridicule he faced from colleagues, the flying eye hospital made so much sense to David that he followed through, and, although it took a while, his hospital did “take off.” Proceeds from David's book will be used in part to support a new global ophthalmology fellowship at Orbis International.
Effective delivery of humanitarian work is fairly complex, and, as in so many areas, success depends on the passion and drive of people. However, as many who have been involved in these efforts will convey, the intention is goodbut there are some hard realities, many of which are unique to the areas where programs are being delivered. Some common threads include the need for education, technology, and funding.
Education. Many ophthalmologists travel to developing countries and donate their time to performing sightsaving surgery. However, educating the hosts is an even more valuable contribution in terms of lasting impact. Education can be transferred to others and can lead to true transformation within the population. Educational efforts are vital at all levels, from highly specialized surgical training to development of operational systems and methods of implementing high quality, high-volume, cost-effective care, and should be directed toward nurses, technicians, and administrators. Adopting best practices from other successful models of care is useful for these developing countries.
Technology. Education must be balanced with the availability and provision of appropriate technology to accomplish sight-saving goals. The level of technology required will vary depending on the environment, and often recalibration of standards is required in a developing country. For instance, small-incision cataract surgery (SICS) may be a better alternative to phacoemulsification in terms of cost, simplicity, speed, and type of cataract. Adopted by many cataract programs worldwide, SICS is helping accomplish the goal of eliminating blindness.
Funding. A major factor in accomplishing the goal of eliminating worldwide blindness is funding. Funding is like oil: It facilitates development and is a valuable resource that is hard to come by but must be used maximally to be effective. Many economic arguments can be made to justify funding blindness prevention and elimination. For instance, cataracts often occur earlier in developing countries, in the age group of people who work. If untreated, the loss of their contribution combined with the economic drain to their family and community is considerable— as is the human suffering. Poor governments with limited resources face the hard task of prioritizing funding. There just is not enough money available, and they often can only cope with the immediate issues at hand.
Charities, nongovernmental institutions, and benefactors can provide funding to eliminate blindness and encourage the establishment of models of sustainable care. Frank Bucci, MD, of Pennsylvania, has adopted this model in Lima, Peru (Figure 1). While working toward self-sustainability, Frank is personally funding the project. He has also obtained contributions from the Clinton Foundation to help reduce cataract blindness in Peru. An interesting video of his work and Bill Clinton's visit to his center can be found at http://eyetube.net/?v=rajepi.
A good portion of the readership is, I am sure, involved in the elimination of world blindness at some level. From financial contributions (large or small), donation of old equipment, and hosting visiting ophthalmologists and nurses to contributing their own or their staff's valuable time to work and educate colleagues in developing countries, every little bit helps to solve the problem of world blindness. Ophthalmologists who are incredibly passionate about this cause and dedicate considerable time and resources to developing sustainable institutions and systems to combat preventable blindness should be applauded and encouraged to continue.
Although we in the industrialized world have our own set of problems and difficulties, they pale in comparison to those of fellow human beings suffering from blindness. Keep doing everything you can to alleviate that suffering, and hopefully we will see avoidable blindness eliminated within our lifetime.
- Resnikoff S,Pascolini D,Etya'ale D,Kocur I,Pararajasegaram R,Pokharel GP,et al.Global data on visual impairment in the year 2002.Bulletin of the World Health Organization.2004;82(11):844-851.