Nina Holst, Betanien Hospital, Skien. Bergen 15. June 2015 VISION 2020 Nina Holst, Betanien Hospital, Skien. Bergen 15. June 2015

Every second one person in our world goes blind! Every minute a child goes blind!

Facts about global blindness A total of 40 million people are blind Another 150 million people are victims of severe disability 90 % of the worlds blind live in developing countries 80 % of this blindness is avoidable ; preventable or treatable

HISTORY OF VISION 2020 / 1950 WHO early efforts on blinding prevention programmes Prevention and treatment of Trachoma Assess the magnitude of the problem Institute control activities Research of treatment options

TRACHOMA Repetitive infections with chlamydia Trachomatis (childhood, adolescens) Conjunctival scarring Entropium – corneal scarring BLINDNESS Poor hygiene, sanitation, water supply

HISTORY OF VISION 2020 / 1972 - 1978 The earliest epidemiological data of Global blindness PROBLEM: different methods SOLUTION: standardized guidelines Later on WHO produced standardized protocols for grading systems in surveys of Trachoma and Childhood blindness

HISTORY OF VISION 2020 / 1987/93 Thylefors B et al. A simplified system for assessment of trachoma and its complications. Bulletin of the World Health Organization, 1987, 65 (4): 477–483. Gilbert C et al. Childhood blindness: a new form for recording causes of visual loss in children. Bulletin of the World Health Organization, 1993, 71: 485–489.

Childhood blindness A group of diseases occurring in childhood, result in blindness or severe visual impairement Wide variety from region to region Determination of socio-economic development Access of Eye Health Care Services

Causes of childhood blindness High income countries CNS disorders Retinal conditions Middle income countries Retinal conditions, mainly hereditary, retinal dystrophies, ROP

Causes of childhood blindness cont. Low income countries Corneal scarring (Vitamin A deficiency, measles,ophthalmia neonatorum, harmful traditional practices)

HISTORY OF VISION 2020 / 1975

Onchocerciasis – river blindness Parasite transmitted by blackflies. Flies abounding in running water (riverside)

Onchocerca volvulus cycle in man.

Onchocerciasis –distribution

Onchocerciasis - treatment

Onchocerciasis -treatment 1987 MSD committed to donation of Mectizan® (Ivermectin) “for as long as necessary for the control of onchocerciasis”

HISTORY OF VISION 2020 / 1993 Global database on blindness and visual impairment was developed. 1990 – 38 mill blind, 110 mill visually impaired 1996 – 45 mill blind, 135 mill visually impaired 2020 - double ???!!! Graying population

The VISION 2020: The right to sight is the global initiative for the elimination of avoidable blindness launched by Gro Harlem Brundtland, WHO general director in February 1999

Three main Objectives. Identify the causes and the solutions Train and mobilize the necessary resources Facilitate, planning and development of three core strategies in VISION 2020 training program

Three core strategies Disease control Human resource development Infrastructure and appropriate technology development

VISION 2020 committees and workshops Meet the local needs

HISTORY OF VISION 2020 /2004 Am J Ophthalm 2003 Apr; 135(4):471 -6 The magnitude and cost of global blindness, an increasing problem that can be alleviated. Frick KD, Foster A.

Human consequence Economic impact 102 000 000 000 $ No intervention: 2020 – 76 mill blind Successful VISION 2020: 2020 – 24 mill blind

Avoiding 429 mill blind-person-years DALY,s.Poverty Aging Family Education QALY,s

Proportion of cases of blindness due to each major cause. ( Foster A Proportion of cases of blindness due to each major cause. ( Foster A., Gilberrt C., Johnsen G., CEHJ Vol 21 No 67 2008)

Cataract Ca 40 % of world blindness aging population both developed and developing countries

Prevention?? Risk factors: Smoking UV-radiation

Cataract SURGERY High volume High quality Low cost Sustainable programs

Refractive errors and low vision Include myopia and hyperopia with or without astigmatism Recent studies have confirmed a large burden of uncorrected refractive errors > 100 mill people with low vision, ¼ will benefit from low vision services

Diabetic retinopathy Priority disease

Glaucoma Priority disease

Age related macular degeneration AMD Priority disease

Global Action Plan 2014 - 2019 A world in which nobody is needlessly visually impaired, where those with unavoidable vision loss can achieve their full potential and where there is universal access to comprehensive eye care services.

London School of Hygiene and Tropical Medicine Bloomsbury

Norwegian Ophthalmologists -a resource in VISION 2020 right to sight initiative

Ophthalmologists per million population (Resnikoff et al, Br j Ophthalmol 2012)

Would you consider working with EHCS in a developing country?

Information Organizing Economy Leave How to increase interest for Eye Health care Services in developing countries in The Norwegian Ophthalmological society Information Organizing Economy Leave

Suggestion of activities Eye care for all Suggestion of activities Thursday 8 October

Thank you!