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
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
- 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
- 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
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