World Sight Day: “Eye care was not prioritised by many in the developing world prior to the pandemic”

Eye care is one of the most effective ways to bring communities out of poverty, increase life chances and improve productivity – things that are going to be hugely important when the economy globally is recovering from the pandemic. Could you speak a bit about why eye care specifically needs to be invested in at this time, and in the months (and potentially years) ahead?

While it is true that eye care is an effective way to address many of these problems, it was not prioritised by many countries in the developing world prior to the pandemic. The pandemic has resulted in further de-prioritisation of already neglected eye health.

The World Health Organization’s World Report on Vision (WRV) estimated that at least 2.2 billion people suffer from vision impairment or blindness, and at least 1 billion of these live with vision impairment that could have been prevented or have yet to be treated. The report also warned that this is likely to increase dramatically in the coming decades due to population growth, aging, urbanisation, and behavioural and lifestyle changes. The report recommended dramatic changes to the current state of eye care to address this issue. This report was released in October of 2019, before COVID-19 began to take over health systems around the world.

One can therefore conclude that if no significant investments are made in eye care at this time, we will be witnessing a scenario in which an even larger proportion of world’s population will be suffering from blindness and visual impairment. This means greater loss of livelihood opportunities, dependency, hunger and malnutrition and definitely a poorer world.

The scenario can be addressed and lead to more positive outcomes if appropriate investments are made in eye health and in other determinants of eye health such as maternal, newborn, immunisation and nutritional services. If this is not taken seriously, the negative impact of neglecting eye health and its determinants will probably be far more serious than the pandemic itself. To ensure eye health doesn’t become an overwhelming burden on health systems and economies, it needs to be addressed immediately.

If no significant investments are made in eye care at this time, we will be witnessing a scenario in which an even larger proportion of world’s population will be suffering from blindness and visual impairment

By following the WRV’s recommendations and incorporating Integrated People-Centred Eye Health into Universal Health Care, countries will be taking the first step towards ensuring that vision impairment doesn’t hold their citizens back in a cycle of poverty, costing entire economies millions in the long run. Solutions exist right now, and the sooner they are employed, the better off countries will be as they recover from the effects of the pandemic. Operation Eyesight is at the forefront of implementing the WRV’s recommendations through its proven hospital-based community eye health model, which has been implemented in seven countries in South Asia and Africa.

Do you worry that those with disabilities and/or sight loss will be left behind by governments in the recovery planning?

Yes. Governments are doing their best to address the needs of their citizens, but containing the spread of the virus and treating infected people can be overwhelming. While health systems have been given additional resources in many cases to address the immediate needs of those suffering from COVID-19, it’s not always easy to ensure other priorities are addressed at this time. In the areas where we work, our partner hospitals are overwhelmed, the patient in-flow has declined significantly, community-based interventions have been halted and all this means a mounting number of backlog cases. Some may even lose sight. Our worry is, when the pandemic is behind us, will the governments have adequate resources to bounce back, and will they have the capacity to address highly aggravated challenges affecting an increased number of people with disabilities?

The negative impact of neglecting eye health and its determinants will probably be far more serious than the pandemic itself

When COVID-19 was declared a pandemic, Operation Eyesight pivoted our day-to-day activities to provide immediately needed aid in the regions where we work. Since then, we have been working with our hospital and government partners to educate the communities we serve on the prevention of COVID-19 spread, and to support them with the provision of clean water and hygiene supplies. We’re also supporting our partner hospitals to strengthen their infection prevention and control measures so that they are able to deliver quality eye care services in a safe environment. Our response is helping our partner hospitals to keep from becoming overwhelmed, allowing them to bounce back sooner and get back to eye health as a priority.

One thing that is very promising to us is the recent adoption of the IPEC resolution by the World Health Assembly in August. Member countries agreed to elevate eye health as a priority, integrating it into their national health systems as part of universal health coverage. The fact that this resolution was passed at a time when global health care is still very distracted by COVID-19 makes us very optimistic that eye health care is a priority. Organisations like ours will be working to help provide the solutions that governments need to make this happen.

The loss to the global economy from uncorrected myopia is estimated to be $244 billion USD, whilst the cost of effectively treating 1 billion people is estimated to be between $7 billion and $14 billion. Often governments need to see the economic impact in order to really make them pay attention. How can those in the optical community get the financial importance of sight care across?

Vision is something that is easy to take for granted when you have it. If governments and other key international players can be made to see how cost-effective it is to address the needs of those who live with a treatable vision impairment and the long-term benefits in terms of reduction in poverty, increase in GDP and other factors, it becomes an easy decision to invest in eye care. In other words, we, the eye health NGOs and INGOs, should get better at working together, and we should make concerted efforts to influence the governments and other key stakeholders to make this investment come through. Certainly, we see a clear role for the International Agency for the Prevention of Blindness (IAPB) here.

Solutions exist right now, and the sooner they are employed, the better off countries will be as they recover from the effects of the pandemic

Operation Eyesight has worked with ministries of health to demonstrate how our hospital-based community eye health model creates sustainable change in communities – identifying those in vulnerable communities who need help, and working with hospitals to strengthen their capacity and their ability to provide that help. And it’s designed to create change that will last, because it incorporates education and increased health-seeking behaviours so communities can take control over their own health. Such models should be advocated for so more tangible results can be attained, which in turn will promote increased levels of investment in eye health.

How are travel restrictions affecting those in remote areas accessing/not accessing sight-saving care currently? 

Travel restrictions have certainly impacted those in remote areas. Most of those who are living in such areas are not currently able to access eye care services, especially at secondary-level hospitals. In some of the African countries where we work, where there is acute shortage of ophthalmologists/surgeons, the problem is all the more serious. In the past, surgeons have periodically travelled to district and other secondary facilities to conduct surgeries. Due to travel restrictions, they are no longer able to do this, and if surgeries aren’t happening, it will increase the number of backlog cases.

When the pandemic is behind us, will the governments have adequate resources to bounce back, and will they have the capacity to address highly aggravated challenges affecting an increased number of people with disabilities?

Highly restricted international travel has had its own impact. In countries dependent on imports for equipment, medicines and other essential supplies have been affected, crippling the pace of implementation of our projects related to the strengthening of hospitals. Another impact is an increase in the cost of projects.

Do you see the global economic consequences of COVID-19 negatively effecting eye health, either in the short or longer term?

In the short term, there is a threat that governments will struggle to invest in eye health. They may recognise the importance of eye health, but a lot of work must be done to ensure it is a priority in their health programmes.

Since the pandemic has had a significant negative effect on national economies and less developed countries are only getting poorer, we do anticipate a negative impact on eye health in the long term. However, it doesn’t have to be a serious problem. NGOs like Operation Eyesight can support governments by providing solutions to help them meet the commitments they’ve made through the World Health Assembly’s IPEC (integrated people-centred eye care) resolution, eventually leading to long-term improvements to the eye health of their citizens.

How do you think that those providing essential sight saving care globally will be able to go about dealing with the backlog of treatment that’s needed?

There are many people who have lived with treatable eye conditions long before COVID-19 was a factor. It is especially difficult to address the needs of people who live in remote communities and who either don’t know where to go for help or can’t afford it (or both), and that’s where innovative solutions are needed.

At Operation Eyesight, we have addressed this backlog in the countries where we work by addressing both the supply for quality eye care by strengthening the capacity of our partner hospitals, and the demand by mapping out surrounding communities to ensure every person who needs eye treatment gets it.

If governments and other key international players can be made to see how cost-effective it is to address the needs of those who live with a treatable vision impairment and the long-term benefits in terms of reduction in poverty, increase in GDP and other factors, it becomes an easy decision to invest in eye care

COVID-19 has slowed down this process, but as the provision of eye care services resume in the regions where we work, we will continue to partner with governments who need this kind of support to address the needs of their citizens. The WRV laid out recommendations for how governments and NGOs can work together to contribute to the backlog of necessary treatment, and that is even more important now than it was before the pandemic.

Additionally, eye care service providers will have to make significant investments to create safe environments for both patients and care providers. This essentially means that the cost of care will most likely increase. This also provides us with an opportunity. Promoting teleophthalmology and strengthening primary eye care services can be explored to avoid a looming sight-related crisis.