WHO’s report may lead to greater awareness and deliver better eye health for all

In the land of the blind, the one-eyed is king, so the saying goes.

Of the world's 7.8 billion people, 2.2 billion have impaired vision. Of this number, about half are treatable. In effect, they are one-eyed kings who are better off than the 39 million who are completely blind. Nevertheless, they are handicapped for normal living, as we gleaned from the first world report on vision by WHO.

People with impaired vision are less productive than other sectors of society and considered a drag on the world economy. The sad part is that at least half the impairments are treatable. The most common cause of visual impairment is refractive error.

A refractive error is a very common eye disorder that occurs when the eye cannot clearly focus the images from the outside world. The result of refractive errors is blurred vision, the most common of which are

• Myopia (near sightedness): difficulty in seeing distant objects clearly
• Hyperopia (far sightedness): difficulty in seeing close objects clearly, and
• Astigmatism: distorted vision resulting from an irregularly curved cornea, the clear covering of the eyeball

Vision impairment: unequal opportunity condition

In the first world report on vision released ahead of World Sight Day, October 8, the WHO warned that with a growing, ageing population, visual impairment is set to grow dramatically, although it can be prevented with proper measures.

Vision impairment is not an equal opportunity condition or disability. It afflicts the poor more than the rich and the senior citizens more than the young. It is estimated to be four times higher in low-income than in high-income regions. And the burden tends to be greater in rural areas and for women, persons with disabilities, ethnic minorities and indigenous populations.

The good news is that while refractive errors cannot be prevented, they can be diagnosed and treated. For most instances, impaired vision can be remedied through straightforward use of a pair of glasses.

Economic impact of vision impairment

It is ironic that governments generally ignore the impact of vision impairment on their economies and societies. The UN has estimated that the loss to the global economy totals US$244 billion per year from uncorrected myopia (near sightedness) alone. The losses come from a range of causes, including reduced labour productivity and poor educational outcomes.

And yet governments would spend much less if they were to treat these one billion impairments, the cost of which is estimated by the UN at between US$7 billion and US$14 billion, respectively.

It is interesting to note that when we think of buying spectacles and eyeglasses we only think of aesthetics. It is about time that governments open their eyes to the problem of visual impairment among their citizens as an economic and social problem. Think of the economic benefits they would get from a healthy population able to work efficiently, earn just wages, and contribute to national growth.

An NGO working with the visually impaired, Sightsavers, tells SciDev.Net that:
• A 2017 study it did in Assam, India, examined whether giving a pair of glasses to workers picking tea would improve their productivity. It did - by around 25 per cent.
• A recent project to improve the eye health of 15,000 female factory workers in Vietnam halved injuries and saw a significant productivity gain.
• The Sightsavers' School Health Integrated Programming (SHIP) project delivers integrated health interventions, including vision screening. Studies in Vietnam and Ghana showed that the cost to screen a child was around US$1.50 and to correct any refractive error was US$230.
• Research showed that correcting refractive error with properly prescribed glasses results in a greater impact on academic performance than any other health intervention.

The WHO report is a call to action for all governments. We hope it will lead to greater awareness, galvanize political will and deliver better eye health for all, particularly those who are most marginalized.

National health care systems especially in developing countries such as the Philippine Health Insurance Corporation, which is in-charge of the universal health coverage in the Philippines, must include in its policies the provision to cover prescription glasses.

The topic of this column on vision and blindness is up close and personal indeed to this writer, whose brother became blind at the age of six and died at 12 from another illness. The cause of his blindness, our family learned later, was Vitamin A deficiency, which afflicts the undernourished poorest of the poor. They are the ones who need most help from governments.