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Vision loss: Why we must tackle it

Image credit: Rudra Narayan Mitra / 123rf. Concept: eye exam to tackle vision loss and visual impairment
A man is examined at an eye testing camp in Kolkata, West Bengal. Image credit: Rudra Narayan Mitra / 123rf

The global fight against vision loss can yield vast rewards by “unlocking human potential and accelerating global development” if the estimated 1.1 billion people living with untreated visual impairment are reached. This is one of the findings of a Lancet Commission report focused on the issue, which anticipates an economic benefit of US$411 billion a year if preventable vision loss is addressed.

“Eye health and vision have widespread and profound implications for many aspects of life, health, sustainable development, and the economy,” the report reads in its executive summary. “Yet nowadays, many people, families, and populations continue to suffer the consequences of poor access to high-quality, affordable eye care, leading to vision impairment and blindness.” 

The Minto Eye Hospital in Bengaluru. Image credit: Shezzyboy96 [CC BY-SA 4.0 (]
Untreated vision impairment is an entirely avoidable public health concern, but 1.8 billion could be affected by 2050. However, as the report outlines, more than ninety percent of such cases can be either averted or treated with interventions that both exist and are highly cost-effective. The benefits of ensuring these interventions are put into place and the suffering such interventions can prevent are patent. As Professor Matthew Burton, co-chair of the Commission and director of the International Centre for Eye Health at the London School of Hygiene & Tropical Medicine, puts it 

“It is unacceptable that more than a billion people worldwide are needlessly living with treatable vision impairment. Vision impairment leads to detrimental effects for health, wellbeing, and economic development including reduced education and employment opportunities, social isolation, and shorter life expectancy. As the COVID-19 pandemic brings renewed emphasis on building resilient and responsive health systems, eye health must take its rightful place within the mainstream health agenda and global development.”

The report finds that, in 2020, “an estimated 596 million people had distance vision impairment worldwide, of whom 43 million were blind. Another 510 million people had uncorrected near vision impairment, simply because of not having reading spectacles.” 

When it comes to visual impairment and vision loss, there is a substantive socioeconomic disparity at the global level and within countries and communities. According to the Commission, “a large proportion of those affected (ninety percent), live in low-income and middle-income countries (LMICs). However, encouragingly, more than ninety percent of people with vision impairment have a preventable or treatable cause with existing highly cost-effective interventions. 

“Eye conditions affect all stages of life, with young children and older people being particularly affected. Crucially, women, rural populations, and ethnic minority groups are more likely to have vision impairment, and this pervasive inequality needs to be addressed. By 2050, population ageing, growth, and urbanisation might lead to an estimated 895 million people with distance vision impairment, of whom 61 million will be blind. Action to prioritise eye health is needed now.” 

Stock Photo - Retina of diabetic - diabetic retinopathy Image credit: Satit Umong / 123rf
A human eye affected by diabetic retinopathy. Image credit: Satit Umong / 123rf

India is no stranger to the public health scourge of vision loss and other forms of visual impairment. As previously reported by Health Issues India, more than sixty million India are affected by visual impairment to some degree. Factors such as air pollution and the country’s high prevalence of diabetes – the latter upping the risk of conditions such as diabetic retinopathy – exacerbate the risk. In addition, many Indians miss out on their eye checkups. Behavioural factors and lack of access to treatment are to blame. As Health Issues India noted

“The country has a shortage of eye health specialists, such as optometrists and ophthalmologists. As such, eye health checkups may be difficult to access for many. However, 84 percent of those recently surveyed by Signify have said they do not follow medical advice on caring for their eyes, despite 65 percent identifying good eye health as a priority for their wellbeing.” 

Improved eye health is not only a benefit for one’s personal wellbeing; it carries broader socioeconomic benefits. As the Lancet Commission report notes, “eye health is essential to achieve many of the Sustainable Development Goals (SDGs). Poor eye health and impaired vision have a negative effect on quality of life and restrict equitable access to and achievement in education and the workplace. Vision loss has substantial financial implications for affected individuals, families, and communities

“Although high-quality data for global economic estimates are scarce, particularly for LMICs, conservative assessments based on the latest prevalence figures for 2020 suggest that annual global productivity loss from vision impairment is approximately US$410·7 billion purchasing power parity. Vision impairment reduces mobility, affects mental wellbeing, exacerbates risk of dementia, increases likelihood of falls and road traffic crashes, increases the need for social care, and ultimately leads to higher mortality rates.”

The world has indeed made much progress in recent decades, but where we are now is precarious – due to demographic trends and also due to the state of public health overall. The Commission outlines that “between 1990 and 2020, the age standardised global prevalence of blindness fell by 28·5 percent. Since the 1990s, prevalence of major infectious causes of blindness—onchocerciasis and trachoma—have declined substantially. Hope remains that by 2030, the transmission of onchocerciasis will be interrupted, and trachoma will be eliminated as a public health problem in every country worldwide. However, the ageing population has led to a higher crude prevalence of age-related causes of blindness, and thus an increased total number of people with blindness in some regions.”

A robust, substantive effort is required to tackle vision loss, visual impairment, and improve eye health overall. This must address universal health coverage. It must address inequities along the lines of gender and socioeconomic class. It must be fair-minded and equitable, because vision loss is fundamentally not a challenge the world can be blind to. There is much to lose and much to gain – but relying on the same approach and failing to address the inherent issues simply will not suffice.

“Business as usual will not address these inequities or keep pace with rapidly increasing and ageing populations,” said Professor Hannah Faal, Commission co-Chair and professor of international eye health at the University of Calabar, Nigeria. “This is particularly true in Asia and sub-Saharan Africa, which account for over two-thirds of global cases. With urgent investment and a coordinated response, we have an opportunity to help create a fairer society for future generations through improved eye health.” 

“The Lancet Global Health Commission on Global Eye Health: vision beyond 2020” can be accessed here.

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