5 misconceptions preventing progress in eye health

BARCELONA — Myths about vision and eye health are preventing people from receiving care that could help improve their vision, according to eye health experts.

“There are many misconceptions and myths that are challenging in terms of getting the uptake of eye health services,” said Imran Khan, chief global technical lead at Sightsavers.

Of the 2.2 billion people currently living with vision impairments — most of which are cataracts and uncorrected refractive errors, or URE — the majority reside in low-income countries. One billion of these cases are considered avoidable.

As poor vision tends to happen gradually, people adjust and don’t seek help, even when services are available, said Jayanth Bhuvaraghan, chief mission officer of Essilor, adding that in addition to misconceptions, acceptance is also a barrier.

Devex asked experts which misapprehensions serve as the largest obstacles to reaching people with adequate eye health services. Here are the myths they felt to be the most significant — and how to counteract them.

1. Vision is just a health problem and doesn’t affect other development issues

For Khan, this is one of the biggest misconceptions preventing progress. “There’s a lack of awareness that a child who is unable to see in a classroom is not just a health issue, but an education problem too,” he said, adding that there are also links to workplace efficiency.

“If an adult is unable to see when they’re working, it will affect their productivity,” he said, which on a large scale can impact a country’s economy as a whole. Research has found that lost productivity among adults who need glasses amounts to an estimated $227 billion per year.

The interconnected nature of vision means the success of the Sustainable Development Goals requires improved access to eye care services — something the World Health Organization’s global action plan for universal eye health, rolled out in 2014, pushed for. Khan said that there is a continual need among the development community to look at vision as a cross-sectoral issue rather than in silos.

For example, in Cambodia, Ethiopia, Senegal, Liberia, and Ghana, Sightsavers and the Partnership for Child Development are working with ministries of education and health in a School Health Integrated Programming initiative, or SHIP. This involves training teachers to carry out simple physical eye examinations and be aware of major eye conditions affecting their region.

2. Vision impairment is a divine punishment

According to Dr. James Clarke, ophthalmologist and medical director of the Crystal Eye Clinic in Ghana and Unite For Sight Ghana, some religious and spiritual beliefs can stop people from seeking treatment.

“Vision loss is often considered to be a curse or punishment from the gods, and a belief is that the gods have to be contacted before treatment is effected,” Clarke said, adding that this is common in certain Ghanaian communities.

Some people may fear “incurring the wrath of the gods” and thus choose not to visit any available health care facilities, he said, while “others seek the intervention of the gods in their treatment” and attend prayer camps and spiritualist centers. He added that they also might look to traditional eye medications — such as herbs or human urine — which can cause extensive damage to the surface of the eye and could make the initial problem worse.

Medical treatment is then sought only when complications arise, by which time it may be too late to regain eyesight, Clarke said.

“Sometimes surgery can be provided, but vision can’t be fully restored due to the damage, and then the poor visual outcome is attributed to the surgery, which discourages others from accepting to undergo surgery,” he said.

3. Inherited retinal diseases can’t be prevented

While some communities don’t take action because of a belief in a divine will, others think that there is no treatment for inherited retinal diseases — and specifically those caused by intrafamily relations — such as congenital cataracts, glaucoma, and retinitis pigmentosa, also known as night blindness.

“For social, economic, and political reasons, people still marry within the same family, which increases dramatically the prevalence of inherited retinal diseases,” said Dr. Ala'a AlTalbishi, ophthalmic surgeon and lead researcher in ophthalmogenetics at the St John of Jerusalem Eye Hospital Group, a charitable provider of expert eye care in Gaza, the West Bank, and east Jerusalem. Within these areas, even among doctors, there is a belief that nothing can be done, he added.

In actuality, genetic testing can reduce the likelihood of a child being born with a retinal disease. But few people are aware of premarriage genetic counseling and testing, and even if they are, the number of facilities offering these is low, AlTalbishi said. St John Eye Hospital was previously the only organization providing genetic testing for eye diseases in the areas it serves, but this project has recently ended due to a lack of funding, he said.

He believes that if there were more awareness around genetic testing, the number of children born with vision impairment could be reduced significantly.

4. Glasses make eyesight worse

Despite this common misconception, Essilor’s Bhuvaraghan said the reality is that vision actually deteriorates from not wearing medically necessary glasses or contact lenses, as well as from changes in the shape of the eyeball as an individual grows.

Khan said this myth is especially prevalent among parents and teachers. “When we try to prescribe glasses for children, they feel that by the child wearing the glasses, the eyes won’t improve and will actually get worse,” he said. Children then don’t receive a pair, jeopardizing their ability to learn and reach their full potential.

Training eye health professionals and providing equipment and spectacles in low-income contexts — in other words, generating supply — is not enough on its own; you have to create the demand, Khan said, which means raising awareness that glasses work and do not make vision worse.

Bhuvaraghan added that compounding this problem is the idea that glasses are unattractive and “geeky.”

5. If an approach works in one place, it will work elsewhere

While the most common vision problem worldwide is URE, the type varies according to location, according to Dr. Bruce Moore, professor emeritus with the New England College of Optometry. As such, generalizing an approach to tackle URE — something that Moore said happens too often — won’t work.

Localized, fact-checked, duplicated, and verified data on the epidemiology of vision care problems in each place and the piloting of projects that collaborate with local systems are the best approaches to meeting the needs of a local population, Moore said. “That is not simple or fast, but generalizing across the world leads to mistakes in individual countries,” he said.

Varying levels of available resources — and the willingness to allocate those resources — further complicate the process of addressing poor vision in communities, Moore added.

According to Dr. Nathan Congdon, a professor and chair of global eye health at Queen’s University Belfast, people sometimes suggest that task-shifting is "inferior service" and are opposed to deploying it in areas where it is needed the most. "But to me, that is the same as saying that fairness and morality dictate that we impose rich-world solutions on the poor world," he said.

How to dispel the myths

One way to improve the vision of more people and dispel many of these myths is through continuous health education that explains the anatomy and function of the eye using pictures and models, according to Clarke, noting that community and spiritual leaders should play a role in this process.

“[This will] make the public understand the causes of eye diseases and the treatments available,” he said, adding that personal testimonies from people who have regained their eyesight after surgery could also help encourage others to undergo surgery if needed.

Congdon recommended the use of data — made up of careful observation and analysis — to counter some of the myths. “It can tell us what approaches work best in what setting and what cadre can safely deliver what service and to whom,” he said.

When it comes to tackling myths around spectacle use, Khan said reaching out to communities with information on the causes as well as the treatment for poor vision is key. By screening teachers, parents, and children as part of the SHIP initiative — and providing them with glasses when needed — children are able to see that they work.

“In one way, that makes teachers more engaged within the overall program, but it also raises their awareness around the benefit of wearing spectacles so they can pass that on to the children,” Khan said.

Creating awareness at an early stage of life will allow the right messaging to stay with people and help dispel some of the myths, Bhuvaraghan said.

Editor's note: This story has been updated to accurately reflect the opinion of Dr. Nathan Congdon.

Devex, with financial support from our partner Essilor, is exploring challenges, solutions, and innovations in eye care and vision. Visit the Focus on: Vision page for more.