“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

“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.

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".

“Vision 2020: The right to sight” Ministries of Health International NGOs IAPB,UK Sightsavers international,UK CBM, Germany ORBIS,USA OEU,Canada

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. 

“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.

Five key areas for action Cataract, Trachoma, Onchocerciasis, Childhood blindness, Refractive error and low vision.

Three strategies Human Resource Development Infrastructure Development Implementing specific programmes to control the major causes of blindness. Creating adequate eye-care facilities, particularly in underprivileged areas using appropriate technology. Creating a foundation of well-trained eye-care workers. Creating a foundation of well-trained eye-care workers. Human Resource Development Infrastructure Development Disease Control Programmes

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.

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.

Disease Control Programmes Implementing specific programmes to control the major causes of blindness. Disease Control Programmes Cataract Refractive Error Diabetic Retinopathy Glaucoma Onchocerciasis Trachoma Childhood Blindness Ivermectin distribution, vector control, OCP SAFE strategy

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.

Childhood Blindness Vitamin A deficiency. 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.

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.

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. Creating adequate eye-care facilities, particularly in underprivileged areas using appropriate technology. Creating a foundation of well-trained eye-care workers. Infrastructure Development

Human Resource Development Creating a foundation of well-trained eye-care workers. 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.

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.

Useful resources http://www.vision2020.org/main.cfm http://www.iceh.org.uk http://www.iapb.org/ http://www.who.int/blindness/partnerships/vision2020/en/ www.v2020eresource.org www.seeingisbelieving.org.uk www.worldblindunion.org www.sightsavers.org www.cbm.org www.icoph.org

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