BLINDNESS AND VISUAL DISABILITY

Part V of VII: Seeing Ahead - Projections Into the Next Century

Worldwide, there are close to 150 million people with significant visual disability of whom almost 38 million are blind. Many of the major avoidable (preventable and treatable) and unavoidable causes of blindness are ageing-related. This means that the older a person is, the greater the chance of developing such conditions.

· The major age-related causes of blindness and visual disability include cataract (which accounts for around 16 million blind people), glaucoma (5.2 mln.), diabetic retinopathy (around 2 mln.) and age-related macular degeneration (around 3 mln.).

* These diseases have come to the forefront as the number of people affected by trachoma (about 6 million blind), xerophthalmia (blindness due to vitamin A deficiency) and “river blindness” (onchocerciasis) have been gradually reduced. However, the latter conditions still remain important causes of preventable blindness in some regions of the world. Where they have been endemic in the past, blindness and visual impairment may persist or even increase with ageing, as in trachoma-related blindness.

* *The number of people who become blind each year is estimated to be in the region of 7 million. Over 70% of these people receive treatment and their vision is restored. Thus, the number of blind persons worldwide is currently increasing by up to 2 million per year. Eighty percent of these new cases are ageing-related.

· Demographic trends indicate that the global population will increase from 5.8 billion in 1996 to an estimated 7.9 billion by 2020. While changes in fertility rates over the next two decades may influence these projections, the estimates for the older age groups are expected to be accurate. By 2020, the number of elderly persons (60 years of age and above) will almost double and reach 1.2 billion, of whom more than three-quarters will be in developing countries.

* If no additional resources become available, it is projected that, by the year 2020, there will be about 54 million blind people aged 60 and over living in the world, 50 million of them in developing countries. It follows that population ageing presents a major challenge to eye health care providers. This is true globally, but particularly important in the middle and low income countries where demographic changes are likely to outstrip economic progress.

· Spiralling Needs and Demands: In view of the demographic and epidemiological transition, the burden of disabling eye diseases and the consequent need and demand for eye care services will increase in absolute terms. The challenge for governments and health care providers will be to meet this demand.

* Better education and awareness among communities would break down some of the current barriers to greater utilization of existing services. Available and affordable technologies that provide better quality of eye care will further induce more patients to seek treatment and often at an earlier stage.

* Types of treatment such as day surgery, which reduces costs and minimises patient inconvenience, are also likely to enhance demand, particularly for cataract surgical services.

* Finally, due to rapid urbanization, 60% of the populations in developing countries is expected to live in cities or large towns by the year 2020. This will increase the demand for urban-based services. However, in rural areas, a marginalised elderly population may still remain with their needs unmet.

· Increasing Costs: Because of increased demand and as a result of the introduction of new technologies, the costs for eye care and surgery are expected to escalate. “Fee for service” and other payment schemes may become common practice in most countries, given the limited national health budgets that will be available. It may, therefore, be necessary to contain costs in developing countries through the transfer of new technologies and adaptation of existing ones.

· Equity and Accessibility of Services: One of the future challenges will be to tackle the twin issues of equity and inequality of services. With the growth of market economies, and health care becoming market-oriented, wide disparities in income levels could still be a feature in many parts of the world. It is well known that the burden of visual disability is greatest in economically deprived populations; women and the elderly are generally in the most disadvantaged positions.

* Access to eye care for these populations could be ensured through appropriate technological development that renders such care affordable. Some of these cost-effective technologies have already been identified and are currently being applied. The use of low-cost intra ocular lenses (IOL) in cataract surgery is one such example. Because of the transfer of technology to developing countries, the IOL cost has now decreased some thirty fold. Greater efforts will be made to develop and evaluate new low-cost preventive and curative options.

· Human Resources and Technology Development: A major challenge in eliminating avoidable blindness in the future will be that of ensuring an appropriately trained and skilled workforce. At present, there is a wide disparity in eye care provider/population ratios between and within countries. With more widespread economic development, this ratio is likely to decrease.

By 2020, a global challenge will be to provide full coverage and improved quality of services for the prevention of blindness and the alleviation of low vision.

Such a challenge calls for a global response from a wide constituency - governments that are convinced that there is much to be gained from investment in eye health, professionals who are conscious of their societal responsibility, as well as nongovernmental organizations and the private sector who are committed to meet this challenge.

It is an opportunity for bilateral, multilateral and intergovernmental organizations and institutions to contribute to development through improved health, enhanced wellbeing and economic productivity. To make it happen, informed individuals and their communities need to become active and committed partners in the global response.

For further information, please contact Health Communications and Public Relations, WHO, Geneva (41 22) 791 2532/2584. Fax (41 22) 791 4858.

All WHO Press Releases, Facts Sheets and Features can be obtained on Internet on the WHO home page http: //www.who.ch/