Two papers published today in The Lancet Global Health mark an important milestone in the World Health Organization and partners’ efforts to propose inclusion of two indicators of eye care coverage into those of Universal Health Coverage and ultimately the global indicator framework for the United Nations Sustainable Development Goals. Using data from population-based eye health surveys around the World, investigators have published baseline estimates for effective Cataract Surgical Coverage (eCSC)[i] and effective Refractive Error Coverage (eREC)[ii]. Cataract surgery and correction of refractive error remain two of the most cost-effective healthcare interventions ever. These two indicators serve as ideal proxy indicators not only to track changes in the uptake and quality of eye care services at the global level, but also contribute to monitoring progress towards UHC in general. In 2021, the World Health Assembly set ambitious global eyecare targets for 2030 of a 30% increase in eCSC and a 40% increase in eREC.
 
The paper on Effective Cataract Surgical Coverage shows it to vary widely between countries with higher coverage in those countries with greater income-level, with the highest at 70.3% and the lowest only 3.8%. Higher coverage was also seen among men. Leading the research into this indicator, Professor Matthew Burton (The International Centre for Eye Health at the London School of Hygiene & Tropical Medicine) said “This research identified a variable quality gap, with people in some contexts accessing services but not uniformly experiencing good vision, particularly after cataract surgery. This highlights the need in such settings for quality improvement before increasing access to surgery. There is also a major need to embed equity in efforts to improve access to surgery”.
 
The paper on effective Refractive Error Coverage estimated that less than half (43%) of people who need glasses for distance vision have had this need met. Leading the research into this indicator, Professor Rupert Bourne (Anglia Ruskin University, Cambridge, UK), who leads the Vision Loss Expert Group (the international ophthalmic epidemiology reference group), commented that “while the past 20 years has seen an increase in coverage by 19%, the WHO target will require substantial improvements in quantity and quality of refractive services, in particular for near vision impairment. The lower levels among women and among older people probably reflect differences in access to healthcare and take-up of services, which need to be addressed”.
 
Speaking on behalf of the WHO at the launch of the “Report of the 2030 targets on effective coverage of eye care”, at the United Nations New York building on 12th October, on the eve of World Sight Day, Dr Stuart Keel said: “These 2 papers set the baseline for what we want to achieve by 2030 and the international collaborative effort demonstrates how well-positioned the eye care sector is to contribute to the advancement of Universal Health Coverage within countries”.
 
The work for the eREC study was funded by the WHO, Sightsavers, The Fred Hollows Foundation, Fondation Thea, Brien Holden Vision Institute and Lions Clubs International Foundation. The work for the eCSC study was funded by the Indigo Trust, Peek Vision, and the Wellcome Trust.


[i] Effective cataract surgical coverage (eCSC) measures the number of people in a population that have been operated for cataract, and had a good outcome, as a proportion of all the people requiring or having received surgery in that population

[ii] Effective refractive error coverage (eREC) is defined as the proportion of people in need of services for poor eyesight such as spectacles or contact lenses who have received these interventions and have a resultant good-quality outcome
 
Link to a recording on UN Web TV at The United Nations, New York on 12th October 2022:
https://media.un.org/en/asset/k1k/k1kmexqe0y

A news release by the WHO:
https://www.who.int/news/item/12-10-2022-new-baseline-report-on-effective-coverage-of-eye-care

Publications
 
Effective refractive error coverage in adults aged 50 years and older: estimates from population-based surveys in 61 countries.
(link to become live post-embargo): https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00433-8/fulltext
 
Effective cataract surgical coverage in adults aged 50 years and older: estimates from population-based surveys in 55 countries.
(link to become live post-embargo): https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00419-3/fulltext

These two open access papers mark the culmination of a 5 year project to update the Global Vision Database with the recently published population-based surveys of eye disease.
 
Bourne RRA, Adelson JD, Flaxman S, et al. Trends in Prevalence of Blindness and Distance and Near Vision Impairment over 30 years and contribution to the Global Burden of Disease in 2020, Lancet Global Health 2020, In press.
 
Adelson JD, Bourne RRA, Briant PS et al. Causes of blindness and­­ vision impairment in 2020 and trends over 30 years: evaluating the prevalence of avoidable blindness in relation to “VISION 2020: the Right to Sight”. Lancet Global Health 2020, In press.
 
Please contact us if you would like to be emailed about these papers, with a press release and embargoed papers in advance of their release. All VLEG members and funders will automatically receive this information.

VLEG data has been used by the World Health Organization as their core data source for their World Report on Vision which was published in October 2019. This was the first time the WHO has produced a World Report on Vision. Using VLEG data, it sets a global framework for eye care for the next decade. VLEG data has informed the development of a resolution which will has been passed at this year’s World Health Assembly, and it is underpinning work that is now underway with WHO to establish a set of global measures and indicators.

Access the report here.

• To be published in Acta Ophthalmologica on World Sight Day, 8 October 2020
• To be presented at 16th World Congress on Public Health 2020

Professor Rupert Bourne was awarded a Marie Curie Fellowship grant from the European Commission in 2018, with which to support Professor Nicolas Leveziel (University of Poitiers) in a collaborative project entitled “EUROVISION: Self-reported vision status and associated risk factors in Europe: prevalence and temporal change”. This project involved the analysis of data from more than 300,000 participants of the European Health Interview Survey. Workingwith colleagues in Eurostat, and other VLEG members the project team calculated prevalence rates of self-reported vision impairment and hearing impairment among this population-based sample of 28 European Union countries, and Iceland and Norway. The unique richness of the survey dataset also allowed the team to investigate factors relating to physical and mental health, lifestyle and socioeconomic status that were associated with vision and hearing impairment but also dual sensory impairment. This study offers valuable insights into the status of sensory impairment in the European population and heterogeneity within and between countries. The project team have been closely supported by the European Coalition on Vision.

The new Vision Atlas will be launched on World Sight Day 12th October 2017 by the International Agency for Prevention of Blindness (IAPB) and will be available via http://atlas.iapb.org
​
Members of the VLEG have worked with the IAPB and several sponsors to create the Vision Atlas which features visualisations of the blindness and vision impairment data by country and cause data by region, prepared by the VLEG from analysis of the Global Vision Database. This is a great example of actionable data and this website offers the opportunity to disseminate these latest global and country-level findings to any internet user. As stated on the Vision Atlas website, this development gives us the opportunity to create a public conversation that helps persuade decision-makers in government and the private sector to tackle what is largely an avoidable problem. A briefing pack can be obtained from the IAPB by contacting communications@iapb.org

Published by Lancet Global Health on Aug 2 2017.*
 
Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis. To be published by Lancet Global Health on October 11 2017.
 
Both articles are open access.
*can be accessed by following this link: ​http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30293-0/fulltext

​Rupert Bourne, Konrad Pesudovs, Jost Jonas and Vinay Nangia attended this 4 day event with a Training Day in GBD methods and developments, followed by 2 days of lectures on the GBD collaboration and impact. Hosted by the Institute for Health Metrics and Evaluation at the University of Washington and the international medical journal, The Lancet, we attended a special event with Bill Gates, Co-Chairman of the Bill & Melinda Gates Foundation, and Dr. Jim Yong Kim, President of the World Bank that tracked the evolution of the GBD Study, the actionable data that it has produced and will continue to provide, and its importance in influencing policymakers at every level. It was a truly inspirational event and there was opportunity to discuss future strategy for vision loss analysis with the GBD core team at IHME.

In February 2016, the Vision Loss Expert Group convened a workshop of experienced ophthalmic epidemiologists at the World Ophthalmology Congress in Mexico. We agreed on the value of the generic “Strengthening The Reporting of Observational studies in Epidemiology” checklist. However, we also identified unresolved challenges. These included issues around the standardisation of vision impairment and eye disease definitions, study design and measurement protocols, analysis approaches, and how best to ascertain and report the risk of bias. We determined a need for consensus guidelines on the conduct and reporting of population-based eye and vision surveys.

An inclusive working group has been formed to move this forwards.  Our aim is twofold:

• To promote high quality eye and vision surveys in the future through sharing best practice insights.
  
• To develop a framework against which to grade future studies included in meta-analyses including, but not limited to, those undertaken for the Global Burden of Disease Study.

Over 50 colleagues with direct experience in the design, conduct and analysis of eye and vision surveys are involved in this. If you would like to contribute your expertise to this working group, please get in touch!

For further information please contact:
tasaneebraithwaite@gmail.com

The Vision Loss Expert Group works with NASA to display its work on global vision loss at the biggest eye research event, ARVO, USA

The Association for Research in Vision and Ophthalmology (ARVO) holds its annual global eye research conference in Baltimore, USA this year, (7-11 May 2017). The latest estimates for global blindness and vision impairment will be presented by The Vision Loss Expert Group (VLEG) in scientific sessions that includes a Special Interest Group entitled “Global Prevalence of Blindness and Vision Impairment: Magnitude, Temporal Trends, and Projections: are we on track to meet VISION 2020 and WHO Global Action Plan goals and beyond?” on 9 May.

A collaboration with NASA with sponsorship by Brien Holden Vision Institute, The Thea Foundation, Ocular Services on Demand, EyeKor, Anglia Ruskin University and support by the ARVO Foundation for Eye Research, will display an eight foot tall globe of the World onto which is projected global, regional and country blind and vision impairment data from the group, with special feature videos from core members of the VLEG.