October 9 was World Sight Day, which is in principle an advocacy event, where eye health practitioners, organisations, researchers, partners and supporters raise public awareness of blindness & vision impairment as major international public health issues. So what do we know about blindness and visual impairment? It is estimated that about 285 million people are visually impaired worldwide: 39 million are blind and 246 million have low vision (severe or moderate visual impairment). Preventable causes are as high as 80% of the total global visual impairment burden. About 90% of the world’s visually impaired people live in developing countries.
Uncorrected refractive error is when the eye cannot clearly focus. Dr Susan Cooper, President, World Council of Optometry said, “Uncorrected refractive errors represent 43% of the causes of visual impairment – and World Sight Day is a great occasion to draw attention to this fact and to the solutions”. The burden can be easily reduced as most cases can be addressed through corrective spectacles/glasses. Human resource development – the training of eye health professionals – is central to ensuring people get the care they deserve and require.
Spectacles/glasses are recognised as one of the most straightforward and least expensive assistive devices available. Evidence presented in a recently published HEART Topic Guide on Inclusive Learning found that the economic benefits of providing school girls and boys with eye glasses outweigh the costs while also improving educational test scores. Based on evidence from a study in China, the educational benefits of addressing uncorrected refractive error through spectacles are clearly greater for under-performing students.
Africa contributes 15% of all cases of visual impairment globally. In a bid to address this problem, the Mozambique Eyecare Project (MEP) is a partnership to facilitate the development, implementation and evaluation of the first and only optometry programme in Mozambique. This includes the establishment of a four-year BSc optometry course at Universidade Lúrio, a public university, in Nampula, northern Mozambique. The first optometrists graduated and entered the public health system in 2013.
Some research I recently published, in collaboration with the MEP partners and the African Vision Research Institute, focused on developing optometry as a profession in Mozambique. We demonstrated that a programme designed to address the burden of refractive error in Mozambique through human resource development is economically justifiable in terms of the increased productivity that would result due to its implementation.
In Africa, there are 17 established institutions offering optometry degree programs, of which 14 are fully accredited. There are also several other ophthalmic focused human resource initiatives on the continent. However, the findings of a recent mapping exercise of human resources for eye health in Africa illustrated how woefully insufficient human resourcing levels currently are. From the countries sampled, a minority had reached suggested ophthalmic cadre targets and none had reached targets for refractionists.
While we have reason to celebrate recent successes and progress made, we also need to recognise that a substantially more targeted investment in human resources for eye health is required if avoidable blindness is to be eliminated. There is still work to be done!