Kerala Journal of Ophthalmology

: 2022  |  Volume : 34  |  Issue : 2  |  Page : 92--93

Sustainable global vision care

Bindu Narayana Das 
 Department of Ophthalmology, Rustaq Regional Hospital, Sultanate of Oman

Correspondence Address:
Dr. Bindu Narayana Das
Department of Ophthalmology, Rustaq Regional Hospital
Sultanate of Oman

How to cite this article:
Das BN. Sustainable global vision care.Kerala J Ophthalmol 2022;34:92-93

How to cite this URL:
Das BN. Sustainable global vision care. Kerala J Ophthalmol [serial online] 2022 [cited 2022 Sep 29 ];34:92-93
Available from:

Full Text


Eye health and vision have widespread and profound implications on many aspects of life, health, development, and the economy. Poor access to high-quality, affordable eye care is causing vision impairment and blindness.

For the first time, United Nations General Assembly has recognized the need for vision care to eradicate poverty and promote development. A resolution “VISION FOR EVERYONE” was made in July 2021 by unanimous consent of the organization and its 193 members. There are 17 Sustainable Development Goals (SDGs) as proposed by United Nation. SDGs are target-driven goals for 2030, to achieve a better and sustainable future for all. Eye health care falls under SDG-3 which ensures good health and wellbeing for all.

By adding eye care, this resolution raises its visibility globally. Also, this calls for financial help to support developing countries in tackling preventable sight loss.

 Challenges to be met

The majority of people having avoidable blindness and moderate to severe vision impairment live in low-income and middle-income countries (LMIC). There is a high need for building cross-sectorial partnership, which includes various aspects of development. Different kinds of leadership skills and capabilities need to be developed to connect the whole system together.[1]

 Causes of Global Vision Impairment

Leading causes of vision impairment are cataracts, uncorrected refractive errors, glaucoma, age-related macular degeneration, and diabetic retinopathy. We also see changing epidemiology of eye diseases like global increase in myopia, increased blindness due to diabetic retinopathy, etc. As life expectancy is on the rise, blindness due to age-related macular degeneration is increasing.[2]

By adding two eye health indicators to outcomes reported for SDG-3, namely, the cataract surgery rate and the refractive error coverage rate, 80% of avoidable blindness and visual impairment are accounted for. This enables the countries to measure, report, and allocate resources in a pragmatic manner.

 How To Tackle the Problem?

Universal health coverage is central in delivering SDG-3. Without affordable, accessible, high-quality comprehensive eye care, universal eye care is not universal. There is a huge disparity between the number of ophthalmologists and allied health care professionals in an area or country and the number of patients needing ophthalmic care. Further, eye care prioritization should be done based on leading causes of visual impairment as well as non-vision impairing conditions.[3]

Ideally, a minimum package of eye care within universal health coverage would include primary care (promotion, prevention, and refractive services), eye care integrated within other services (neonatal care, school eye health, care of old people), specialist ophthalmic services (cataract surgery, management of glaucoma, diabetic retinopathy, and age-related macular degeneration), and rehabilitation.[4]

 Integrated People-Centered Eye Care

To deliver the integrated service, eye health needs to be included within national health plans, policies, and financing mechanisms. Providing services within or close to where people live and work, results in increased access and usage. Eye health education and promotion within communities can lead to improved service uptake.[5],[6] A good example is the school health service. Eye care delivery within the primary health care system must be strengthened, as it is the health care professionals at this level who form the basic pillar for assessment, treatment, and referral of patients with eye problems. In many countries, several large non-governmental organizations provide primary care services and are well integrated into networks of secondary and tertiary eye hospitals (spoke and hub model). Public–private partnerships are promising to cover the needs of a large population.

 Eye Care within Secondary and Tertiary Health Care

Secondary eye health services are important for diagnosing and managing the leading causes of vision impairment. Secondary and tertiary eye care systems need to be developed in terms of accessibility, affordability, and quality.[7],[8]

 Vision Rehabilitation Services

Rehabilitation services are a set of services that assist individuals who experience disability, to achieve and maintain optimal functioning. The staggering degree of morbidity due to low vision or blindness in developing countries has not received the attention it deserves, yet. Improving the integration of rehabilitation within health systems needs a lot of effort, not only from the side of the government but also from non-governmental organizations. District, state, and national level organizations of the eye care professionals can link with the corporates through their corporate social responsibility (CSR) schemes or private donors to enhance their societal services.[9],[10],[11]

 Strengthening Training to Build Quality

Our traditional way of ophthalmic education is focused on knowledge of diseases rather than competencies. We need to modify our curriculum to patient-centered, competency-focused learning which is tuned to meet the population's eye health needs.

Surgical training opportunities are insufficient worldwide. New training practices including the use of simulations and remote learning are essential to build the necessary capacity. While factors like cost and backlog from coronavirus disease 2019 (COVID-19) pandemic are significant, patient safety is the most important reason to use simulation training.[12],[13]

 Technology Support for Eye Health Delivery

Advancing eye health services within universal health coverage will require expansion of service capacity and innovative forms of delivery. Teleophthalmology, mobile health (mhealth), and artificial intelligence offer significant support to innovative eye care delivery through task sharing.[14]

Last but not the least, better health financing is crucial to make progress towards universal health coverage. Investing in universal eye health is a realistic, cost-effective way of improving health and well-being leading to improvement in education, work, and economy, thereby attaining sustainable developmental goals.[15]


1Available from: [Last accessed on 2022 Jun 12].
2Gilbert C, Murthy GV. The sustainable development goals and implications for eye health research. Ophthalmic Epidemiol 2015;22:359-60.
3Dean WH, Gichuhi S, Buchan JC, Makupa W, Mukome A, Otiti-Sengeri J, et al. Intense simulation-based surgical education for manual small-incision cataract surgery: The ophthalmic learning and improvement initiative in cataract surgery randomized clinical trial in Kenya, Tanzania, Uganda, and Zimbabwe. JAMA Ophthalmol 2021;139:9-15.
4Dean WH, Buchan J, Gichuhi S, Philippines H, Arunga S, Mukome A, et al. Br J Ophthalmol Epub ahead of print: Br J Ophthalmol: first published as 10.1136/bjophthalmol-2020-318049 on 25 January 2021 doi:10.1136/bjophthalmol-2020-318049.
5Hubley J, Gilbert C. Eye health promotion and the prevention of blindness in developing countries: critical issues. Br J Ophthalmol 2006;90:279-84.
6Sustainable development Goals. United nations. Available from:
7Gilbert C, Murthy GV. The sustainable development goals and implications for eye health research. Ophthalmic Epidemiol 2015;22:359-60.
8Matthew JB, Ramke J, Marques AP, Bourne RRA, Congdon N, Jones I, et al. The lancet global health commission on global eye health: Vision beyond 2020. Lancet Glob Health 2021;9:e489-551.
9Decker S, Sportsman S, Puetz L, Billings L. The evolution of simulation and its contribution to competency. J Contin Edu Nurs 2008;39:74-80.
10Naseri A, Chang DF. Assessing the value of simulator training on residency performance. J Cataract Refract Surg 2012;38:188-9.
11Universal eye health: A global action plan 2014-2019. WHO. Available from:
12IN FOCUS-Beyond 2020: What next for global eye health? By Peter Holland. Available from: [Last accessed on 2022 Mar].
13Flanagan JL, De Souza, N. Simulation in ophthalmic training. Asia Pac J Ophthalmol 2018;7:427-35.
14WHO World report on vision. Available from: on vision. 2019. [Last acessed on 2022 April 29].
15WHO –Framework on integrated people-centred health services. Available from: https://apps.whoint/gb/ebwha/pdf_files/WHA69/A69_39-en.pdf?ua=1&ua=1.2016. [Last accessed on 2022 April 29].