Eyeworld

EW INTERNATIONAL 118 October 2016 by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer Global action plan targets avoidable blindness in Europe and around the world V isual impairment and blindness are still signifi- cant global health issues; however, an initiative is putting steps in place to root out avoidable blindness on a worldwide scale. Universal Eye Health: A global action plan 2014–2019 (www. who.int/blindness/actionplan) was endorsed by the World Health Assembly in 2013 to reduce the global prevalence of avoidable visual impairment by 25% by 2019, and provide universal access to com- prehensive eyecare services for the visually impaired. EyeWorld spoke to János Németh, MD, professor, Department of Ophthalmology, Semmelweis University, Faculty of Medicine, Budapest, Hungary, and chair of the International Agency for the Pre- vention of Blindness (IAPB) Europe, who organized the first European regional global action plan (GAP) meeting in 2015, about the Europe- an survey outcomes to date. Global statistics The World Health Organization (WHO) estimates that 285 million people suffered from visual impair- ments in 2010, which included 39 million cases of blindness. Experts think that 80% of blindness can be avoided through preventive mea- sures, diagnosis, and timely treat- ment. Study estimates 1 have shown that 42% of global visual impair- ment results from uncorrected refractive errors and 33% from cat- aract, with glaucoma (2%), corneal opacities (1%), diabetic retinopathy (1%), childhood blindness (1%), AMD (1%), trachoma (1%), and other causes (18%) making up the remainder. Furthermore, more than half of global blindness is caused by cataract (51%) alone. Other causes are glaucoma (8%), diabetic retinop- athy (1%), AMD (5%), uncorrected refractive error (3%), trachoma (3%), childhood blindness (4%), corneal opacities (4%), and others (21%). "The high prevalence of visu- al impairment and blindness on a worldwide scale shows the impor- tance of developing a global action plan in which trained surgeons and staff help treat the avoidable causes of visual impairment, like cataracts and refractive errors," Dr. Németh said. "Although most of the blind and visually impaired live in devel- oping or low-income countries, we should not forget that blindness is an important health issue in Europe as well. Diabetic retinopathy, al- though seen to represent only 1% of visual impairment in 2010, should be highlighted because due to our aging population, the number of diabetic patients will increase in the next 10 to 20 years." GAP GAP focuses on three main objec- tives: evidence-based advocacy, a health system-based approach for strengthening comprehen- sive eyecare, and a multi-sectoral engagement approach fostering effective partnerships. Dr. Németh explained, "Each of the three objec- tives has specific actions and a set of measurable indicators to chart progress. Data collection in Europe is an important source of informa- tion that will be used for planning purposes and advocacy. GAP aims to generate evidence on the magnitude and causes of visual impairment and use it to advocate increased commitment from countries. It will develop integrated national eye health policies, plans and programs for enhancing universal eye health and strengthen eye health through multi-sectoral engagement and building of effective partnerships." The global action plan measures progress at the national level using three main indicators: data reflecting the prevalence and causes of visual impairment; information on the number and types of eyecare per- sonnel, such as ophthalmologists, optometrists, and allied ophthalmic personnel (AOP); and the nature of local cataract surgical service deliv- ery, including the cataract surgical rate and the extent of cataract surgi- cal coverage. Regional initiatives Dr. Németh organized the first Euro- pean regional GAP meeting in June 2015 in Vienna, Austria, with the IAPB European Region and in coop- eration with the European Society of Ophthalmology (SOE), the Interna- tional Council of Ophthalmology (ICO), and WHO. The IAPB "Europe Towards Universal Eye Health" GAP meeting also included 21 presidents and representatives from national ophthalmologic societies. "The meeting allowed the participants to become familiar with the Universal Eye Health GAP and most importantly to establish part- nerships and form national commit- tees for GAP implementation," Dr. Németh said. GAP investigators used Rapid Assessment of Avoidable Blindness (RAAB) with diabetic retinopathy (DR) module surveys on the regional level, a rapid population-based sur- vey of blindness, visual impairment, diabetic eye complications, and eye- care services among people aged 50 years and older, to acquire reliable European epidemiological data. The survey provides information on the prevalence of blindness and visual impairment, main causes, output and quality of eyecare services, bar- riers, cataract surgical coverage, and other indicators of eyecare services in a specific geographical area. The survey was completed in the Republic of Moldova and in Hungary. According to the results of the RAAB+DR in the Republic of Moldova, the prevalence of blind- ness was 1.4%. The major causes of blindness and severe visual im- pairment were: untreated cataract (58.2%), glaucoma (10.9%), and other posterior segment diseases (10.9%). 2 "The RAAB+DR survey in the Republic of Moldova established that untreated cataract is the major cause of avoidable blindness in rural areas. This needs to be tackled by expanding the geographic coverage of cataract surgical services," Dr. Németh said. In Hungary, the survey involved 3,523 screenings of people aged 50 years and older in 105 dis- tricts around the country, and was completed in July 2015. The study was supported by the Lions Club International Foundation (LCIF) SightFirst research grant. Dr. Németh explained, "The Hungarian implementation involved 5 days of training carried out at the Department of Ophthalmology in Budapest. There were five survey teams, each including an ophthal- mologist, an ophthalmic assistant for surveys, records, and visual acuity exams, a nurse who was New plan to reduce global visual impairment by 25% within 5 years Categories of blindness Source: János Németh, MD Treatable Preventable Non-avoidable Avoidable 54.6% 21.2% 24.2%

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