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Vision 2020 The right to sight

• Dr.Rajesh Babu B
• MS, FMRF, MSc (CEH) ICEH,LSHTM UK
• Consultant
• Uveitis Ocular Immunology
• Ocular Epidemiology Community Eye Health
• Narayana Nethralaya , Bangalore

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Vision 2020 The right to sight

• An estimated 45 million people worldwide are
  blind.
• Every year, an additional 1-2 million persons go
  blind.
• More than two-thirds of this blindness is
  treatable and preventable.
• A majority of the blind live in the poorest
  section of the developing world.
• Without proper interventions the number of blind
  will increase to 75 million by 2020.
• Restoration of sight is one of the most
  cost-effective interventions in health care.

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Introduction

• The World Health Organization (WHO) and the
  International Agency for the Prevention of
  Blindness have developed a global initiative for
  the elimination of avoidable blindness by the
  year 2020 "Vision 2020 the right to sight".

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Vision 2020 The right to sight
Ministries of Health
International NGOs
IAPB,UK Sightsavers international,UK CBM,
Germany ORBIS,USA OEU,Canada
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Major corporate members
Established 20 years ago, the MECTIZAN Donation
Program is the single largest, longest standing
public/private partnership of its kind and is
widely regarded as one of the most successful
public-private health collaborations in the world.
Under the VISION 2020 programme Carl Zeiss will
be major supporter for the establishment of five
training centres within the next five years. The
funds will be used for training staff and
equipping the centre.
Seeing is Believing  programme has contributed
substantially to the global VISION 2020
initiative, combining awareness-creating,
volunteering as well as millions of dollars in
fundraising support. 
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Vision 2020 The right to sight

• The name is suggestive both of the goal, the
  prevention of avoidable vision loss and blindness
  by the year 2020 and the notion of good vision,
  20/20 (6/6) vision as the target.

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Five key areas for action

• Cataract,
• Trachoma,
• Onchocerciasis,
• Childhood blindness,
• Refractive error and low vision.

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Three strategies
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Specific activities

• Intensified surgical intervention for Cataract,
  which at present accounts for half of all
  blindness
• Provision of spectacles, especially for school
  children.
• Prevention and treatment of nutritional
  deficiencies that lead to blindness in children.

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VISION 2020 APPROACH

• Groups of communities with high levels of
  blindness will be identified.
• Eye-care infrastructure and manpower will be
  provided to these communities-within catchment
  populations of 500,000 to 1 million people.
• Affordable high quality eye care services would
  be provided using these resources.

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Ivermectin distribution, vector control, OCP
SAFE strategy
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Childhood Blindness

• To identify areas where childhood blindness from
  preventable disease is common and to encourage
  preventive measures, for example
• (a) Measles immunization
• (b) Vitamin A supplementation
• (c) Nutrition education
• (d) Avoidance of harmful traditional practices
• (e) Monitoring of use of oxygen in newborns.
• To provide specialist training and services for
  the management of surgically remediable visual
  loss in children from
• (a) Congenital cataract
• (b) Congenital glaucoma
• (c) Corneal scar
• (d) Retinopathy of prematurity.

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Childhood Blindness

• To develop low vision services for visually
  handicapped children.
• To promote school screening programmes for the
  diagnosis and management of common conditions,
  i.e.
• (a) Refractive errors, particularly myopia
• (b) trachoma (in endemic areas).
• To promote education about "How to look after
  your eyes" as part of the normal school
  curriculum for children.
• To make sure that all children in blind schools
  are examined by an ophthalmologist (using the
  WHO form where possible) and receive
  medical,surgical, optical or low vision service
  to maximise potential vision.
• Vitamin A deficiency.
• To work closely with nutrition, immunisation and
  PHC systems to achieve and sustain elimination of
  vitamin A deficiency.
• To establish surveillance systems to identify any
  new cases of blinding xerophthalmia and report
  the occurrence for action by child survival
  programmes.

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Refractive Error and Low Vision

• Create awareness and demand for refractive
  services through community-based services/primary
  eye care and school screening.
• Develop accessible refractive services for
  individuals identified with significant
  refractive errors.
• Training in refraction and dispensing for
  paramedical eye workers if ophthalmologists
  and/or refractionists are not available in
  sufficient number.
• Ensure that optical services provide affordable
  spectacles for individuals with significant
  refractive errors.
• Develop and make available low vision services
  and optical devices for all those in need,
  including children in blind-school or integrated
  education.
• Certain low vision devices can be manufactured
  locally, or purchased externally in bulk supplies
  to reduce costs.
• Include the provision of comprehensive low vision
  care as an integral part of national programmes
  for the prevention of blindness, or
  rehabilitative services for the visually
  disabled.

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Infrastructure Development

• Development of district-level eye care services,
  with primary eye care integrated into the PHC
  system for a population of between 0.5 and 2
  million people.
• To provide practitioners, hospitals and clinics
  with information on good-quality and affordable
  appropriate technology.
• To provide appropriate donated equipment to
  countries which cannot afford its purchase.
• To assist users to evaluate, select and purchase
  appropriate equipment using methods which will
  help to prolong its useful life.
• To introduce new technologies such as computers
  and computer networks to improve management
  efficiency and information exchange.
• Conduct feasibility studies on new technologies
  to ensure cost-effectiveness.

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Human Resource Development

• Create one ophthalmologist post and facility per
  250 000 population through government and/or
  private
• Sector with equal distribution for urban and
  rural populations.
• Where there are insufficient ophthalmologists,
  train OMAs and ophthalmic nurses for secondary
  eye care.
• All medical graduates to be trained in basic eye
  care.
• Train sufficient and appropriate staff for
  refraction of underserved populations.
• Provide training in basic principles of
  management for medical/paramedical staff.
• Develop manpower for equipment maintenance/repair,
  low-cost spectacle production and eye drop
  preparation.

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Achievements

• Thanks to VISION 2020 advocacy, all 193 WHO
  member states are formally committed to investing
  in eye care
• Two World Health Assembly resolutions have urged
  WHO member states to develop and implement VISION
  2020 national plans, and WHO to provide technical
  assistance
• A WHO Action Plan for Prevention of Blindness and
  Visual Impairment has now been prepared and was
  unanimously adopted at the 2009 World Health
  Assembly 
• 135 countries have participated in a VISION 2020
  workshop
• 107 countries have formed national VISION 2020
  committees
• 91 countries have drafted national eye care
  plans
• To date, 15 million fewer people are blind
  compared with projections made when the
  initiative was launched
• The many successes of VISION 2020 have been
  achieved through a unique, cross-sector
  collaboration, which enables public, private and
  philanthropic interests to work together, helping
  people to see, all over the world.

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Useful resources

• http//www.vision2020.org/main.cfm
• http//www.iceh.org.uk
• http//www.iapb.org/
• http//www.who.int/blindness/partnerships/vision20
  20/en/
• www.v2020eresource.org
• www.seeingisbelieving.org.uk
• www.worldblindunion.org
• www.sightsavers.org
• www.cbm.org
• www.icoph.org

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MSc (Ocular Epidemiology Community Eye Health)
Batch of 2008-09 ICEH, LSHTM
UK