By Mark Steedman, PhD. Research Manager, Centre for Health Solutions
This week’s blog is the third in our series focusing on eye health, which we developed in support of a global policy report that was launched this week at the World Innovation Summit for Health (WISH). Our first blog in the series focused on glaucoma, while our second examined new treatments for age-related macular degeneration (AMD). This latest blog focuses on the main findings and recommendations of the full report Bright future: A new vision for eye health.
Eye health continues to be an important and fascinating topic, as without my contacts in, I’m as ‘blind as a bat’ – figuratively speaking of course, as a simple search of the web will tell you that bats are not blind, and digging a little deeper you’ll find that some bats can see much better than humans.1 What it means to me is that it is a constant reminder that I have had to wear corrective lenses (either glasses or contacts) since the age of eight to correct my vision, and I consider myself lucky that my eyes are healthy other than a simple refractive error that is easily correctible.
Refractive errors – the term used to characterise common problems with the eye’s ability to focus correctly – include myopia (near-sightedness), hyperopia (farsightedness) and astigmatism (distorted vision resulting from an irregularly curved cornea). A fourth refractive error, known as presbyopia, results in difficulty reading or seeing at arm’s length and affects over one billion people worldwide, is not covered in the WISH report as it is linked to ageing and occurs almost universally.2
Instead, the report focuses on how to prevent, diagnose and treat the main causes of avoidable global visual impairment, and how to transform eye health so that the world is ready for tomorrow’s challenges. Sight is our dominant sensory input, and lost or impaired vision has an enormous impact on quality of life, economic productivity and life span. As part of our research for the report, we commissioned a survey from YouGov that asked 6,496 people across six countries (UK, Australia, US, China, India and Qatar) which of their five senses is most precious to them. Overwhelmingly, respondents answered ‘sight’ (see Figure 1), which corresponds to other research studies that have found that sight is the sense people fear losing most.3
Figure 1. YouGov poll question: Which one of your five senses is the most precious to you?
Source: YouGov, 2018
Luckily, my myopia only prevents me from seeing distant objects clearly, and it has always been corrected and does not affect my daily life beyond needing to put in my contacts or find my glasses. However, for much of the world’s population these types of simple eye health interventions are often unavailable. If left uncorrected, refractive errors can become so severe they can cause visual impairment, including blindness.
Overall, visual impairment due to uncorrected refractive error affects nearly 124 million people worldwide. Other leading causes of visual impairment include cataract, age-related macular degeneration, glaucoma, diabetic retinopathy and numerous others (see Figure 2).
Figure 2. Causes of visual impairment worldwide
Source: IAPB Vision Atlas, 2018
As of 2015, approximately 253 million people suffered from visual impairment, of which 36 million were blind. Eighty-nine per cent of the people suffering from visual impairment live in low and middle-income countries (see Figure 3). Importantly, 80 per cent of all global visual impairment is avoidable or curable.4
Figure 3. Global prevalence of visual impairment
Source: IAPB Vision Atlas, 2018
These numbers are expected to grow significantly in the next few decades. By 2020 the number of people suffering from visual impairment will increase to 276 million in 2020 and 703 million in 2050, driven mainly by the ageing of the global population (see Figure 4).
Figure 4. The estimated number of people suffering from visual impairment is increasing
Source: IAPB Vision Atlas and WHO, 2018
Evidence-based solutions to eye health challenges
The report provides examples of sustainable solutions to today’s most prevalent eye health diseases and health system challenges, including evidence-based case studies that demonstrate specific examples related to screening, education and training programmes, policy initiatives, social enterprises, new treatment approaches and technological advances from around the world. For example:
- NHS Diabetic Eye Screening Programme in England – the first national screening programme for diabetic retinopathy that oversees more than 80 local screening programmes covering over 2.5 million people over the age of 12 with diabetes
- Ghana National Health Insurance Scheme – the only government health system in the world that finances its health insurance scheme through value-added tax revenue and covers key eye health services such as refraction, visual fields, scans, keratometry, cataract removal and eyelid surgery
- Peek Vision –with programmes in Botswana, Indonesia, Kenya, Pakistan, Rwanda and Zimbabwe – is a social enterprise that uses technology, health intelligence and partnerships to create sustainable, evidence-based solutions for improving eye care
- The LV Prasad Eye Institute Pyramid of Eye Care – a model of holistic eye care that relies on the creation of permanent, sustainable facilities within local communities that has been adopted by the Government of India and is expected to be implemented in multiple Indian states
- Orbis Flying Eye Hospital – a modified cargo plane containing an operating room, classroom and recovery room that brings a team of eye specialists to low and middle-income countries to share skills and techniques with local medical teams and Cybersight – an Orbis International telemedicine platform that trained eye health professionals in 125 countries in 2017 and has supported more than 16,000 patients through telemedicine consultations
- DeepMind and Moorfields Eye Hospital NHS Foundation Trust – a partnership that has shown that artificial intelligence can diagnose more than 50 conditions with 96 per cent accuracy and determine the urgency of the condition to a similar level of accuracy
Universal eye health is an achievable goal. Indeed, if we fail to improve current eye health, visual impairment is predicted to increase to unprecedented levels in the next few decades. Consequently, the report highlights five policy recommendations that policymakers can implement to improve eye health in their countries and make inroads towards universal eye health.
- Prioritise the most precious sense
Raise the priority of eye health, and adopt policies that address inequalities by promoting early, equitable access to prevention, diagnosis and treatment services. Support these policies with evidence of the very high socioeconomic return on investment that can be achieved through improving eye health.
- Invest in sustainable, universal eye health
Ensure that all people have access to information on maintaining good eye health, and provide preventive, curative and rehabilitative eye health services. Monitor performance through agreed key activity and outcome indicators, while also ensuring that service users are not exposed to financial hardship.
- Embrace the power of partnership and collaboration
Utilize the skills and knowledge of key public, private and not-for-profit stakeholders in eye health through partnerships and collaborations to combine talent, expertise, technology and purpose to solve complex problems and work toward common goals.
- Promote excellence in education and training
Develop and deliver effective education programs for the healthcare workforce, and support new ways of working, including task-shifting (moving appropriate tasks to less specialized health workers). Develop self-management educational tools to enable people to understand the risk factors and become co-creators in managing their own eye health.
- Utilise technology and innovation
Invest in collaborative research and development, and use incentives and financial models to encourage the adoption of new technologies that can impact eye health worldwide.
The Deloitte Centre for Health Solutions was delighted to support the WISH conference and help draft the Bright future report, which was led by Professor Sir Peng Tee Khaw from Moorfields Eye Hospital and the UCL Institute of Ophthalmology. My colleague Karen Taylor, Director of the Centre for Health Solutions, and I were honoured to use our research knowledge and expertise to raise the profile of this incredibly important subject and help influence policymakers around the world to understand the what, why and how of eye health from a global context. It is our hope that this report, in conjunction with the many dedicated members of the global eye health community, can help increase the priority and funding provided to improving eye health around the world.