Global Efforts to Generate Evidence for Vision 2020

The 66th World Health Assembly approved the Global Action Plan (GAP) for the prevention of avoidable blindness and visual impairment 2014–2019. The GAP is a commitment endorsed by all World Health Organization (WHO) member states to improve eye health for everyone in the next 5 years. For WHO, the GAP builds on and replaces Vision 2020: The Right to Sight initiative. In the Vision 2020 initiative, the goal was broadly defined as “the elimination of avoidable blindness by 2020.” WHO has re-defined the goal with GAP to be a 25% reduction in avoidable blindness and visual impairment by 2019 from the baseline of 2010. WHO specifies that at least three indicators should be collected: prevalence and causes of visual impairment, number of eye care personnel, and cataract surgical rate. Adoption of the GAP should not lead eye care professionals to perceive that Vision 2020 has “expired” or that ongoing Vision 2020 activities should be abandoned; key tenets underpinning Vision 2020 remain just as important today as they did in 1999, namely, prioritization of resources to the major conditions leading to vision loss, and planning and implementing programs at the “district” level (population around one million) – and planners need data to plan.

District and national survey data will continue to be an important mechanism for both planning and monitoring; such data can be pooled and extrapolated to estimate the global prevalence and to measure progress towards the GAP goal. In this issue, Li and colleagues1 report the prevalence, causes and risk factors of visual impairment in the Shanxi province of China. While the findings in the article are valuable for monitoring for GAP, critical information at the provincial or district level such as cataract surgical coverage and outcomes are not provided. This is a shortcoming of many surveys and one that the rapid assessment of avoidable blindness (RAAB) survey was designed to overcome. On the other hand, RAAB relies on a very simple examination with limited equipment that is not necessarily suitable for differentiating important causes of vision loss, particularly as we lower the threshold of visual acuity that is measured. Different survey methodologies will be required for different purposes.2

Population-based surveys of specific groups for specific disease entities, such as the study by Yamamah and co-authors3 of refractive error in children in Egypt, will continue to provide useful information for planning. As the authors note, however, comparison with other studies of refractive error in children is difficult due to a wide range of definitions used. To improve value of the data and comparability across studies, defining refractive error in a standard fashion (such as requiring myopia to be more than 0.5 diopters) is critically important, but from a planning standpoint, it is not clear that this is a useful definition, as few children with minor refractive error will wear glasses.4^,5

Both GAP and Vision 2020 prioritize cataract, so it is appropriate to find several articles on cataract in this issue. Measuring the uptake (and barriers) to use of cataract surgery as well as the outcome of cataract surgical services are critical indicators for monitoring progress. In this issue, Mitsuhiro and co-workers6 report on the uptake, barriers, and outcomes of patients attending free cataract surgery in a Sao Paulo population-based study, noting that quality of surgery is a likely contributor to poor uptake in their setting. Shields and colleagues7 and Thavikulwat and colleagues8 report the outcome of cataract surgery in rural Lao People’s Democratic Republic (Lao PDR) and a mobile clinic in Thailand, respectively. Farmer and co-authors9 report on visual function and quality of life outcomes for cataract surgery cases in Bali. While good quality outcomes were noted in both Thailand and Indonesia, the findings from Lao PDR showed outcomes considerably below WHO outcome guidelines. The common theme is the importance of routinely measuring outcome and then using the findings to implement plans to improve quality of care. However, routine collection of cataract surgery-related data is challenging; the web-based reporting system for cataract surgery,10 established by the Chinese National Ministry of Health, has faced resistance by many hospitals and surgeons. Changing behaviors of surgeons and patients, as noted in the article by Dan and colleagues11 in this issue, will remain one of the greatest challenges to achieving the goals laid out by WHO and the eye care community.

While eye care professionals have an insatiable thirst to adopt new technologies, new tools, and new goals to advance ophthalmology and eye care service provision, the collection, reporting, and use of accurate data will remain equally important, whether for Vision 2020 or the GAP. We still need epidemiologic research to help us figure out what works, what doesn’t work, and why.

DECLARATION OF INTEREST

The authors report no conflict of interest. The authors alone are responsible for the content and writing of this article.