Chapter 59: Visual Disorders

INTRODUCTION

Visual disorders such as uncorrected refractive error (URE), cataract, glaucoma, diabetic retinopathy, and retinopathy of prematurity (ROP) are leading public health problems worldwide, causing significant morbidity and dramatically affecting the lives of hundreds of millions of people daily. Overall, 75–80% of the causes of blindness and visual impairment (VI) are avoidable or treatable with early detection, evidence-based screening, and timely treatment. More specifically, for 2015, it was estimated that 81.2% of the blindness is preventable or treatable.¹ Unfortunately, 90% of avoidable blindness disproportionately affects the most vulnerable communities including the poor, women, children, the elderly, and people living in rural areas.^1,2

In recent years, there has been an international “call to action” to break down barriers to eye health and to improve equity in eye care across all communities and age groups. In 2013, all Member States of the World Health Organization (WHO) signed, Universal eye health: a global action plan 2014–19.³ For the past 5 years, the global community has been committed to reduce the prevalence of blindness and VI and to increase eye-care coverage among the most vulnerable populations. While there has been much progress and innovation in the early detection and treatment of visual disorders over the years, currently many blindness prevention and control strategies are still implemented in disease-specific silos that work independently of other vision and public health programs. However, in order to successfully eliminate avoidable blindness worldwide, and to effectively address visual disorders in a timely, systematic, and sustainable fashion, it is imperative that existing silos are torn down and replaced with effective bridges that integrate vision into existing public health programs and infrastructure in a horizontal and vertical manner across multiple sectors.^3,4 Successful eye-care integration needs to start at the primary health level and needs to be implemented simultaneously to the strengthening of health systems. For this to occur, intersectoral, multistakeholder synergistic collaboration among governments, non-for-profit organizations, academic institutions, schools, hospitals, research centers, the United Nations, and socially minded programs of the private sector, is not only optimal but in fact essential.

Additionally, local and global blindness prevention and treatment programs should be successfully embedded within current health and legal systems, with collaborative and inclusive policies to have the most sustainable, lasting, and cost-effective impact. These policies must address the multifaceted causes of blindness and VI across ages, diseases, and regions. They also require creative, innovative multipronged and interdisciplinary solutions based on collaborative synergy among ophthalmologists, optometrists, nurses, public health experts, community health workers, school system leaders, pediatricians, neonatologists, hospital leadership, policy experts, legislators, nonprofits, government programs, private sector, and academic institutions. This collaborative and partnership approach should also emphasize advocacy for high-quality, affordable, and sustainable blindness prevention and treatment programs and universal eye health coverage for all patients regardless of their age, demographic or geographic location.³

The implementation of the most recent WHO global action plan has come ...