Progress on ending leading cause of blindness at near standstill, report says

LONDON — The past 30 years have seen little to no reduction in the leading cause of blindness among people aged 50 and over in developing regions, data published Thursday in The Lancet reveals.

The research, conducted by the Vision Loss Expert Group, shows that the global level of blindness caused by cataracts in adults over age 50 has remained almost unchanged, declining only slightly from 36.7 percent in 1990 to 35.1 percent in 2015, with a further decline to 34.7 percent predicted by 2020. While it is the leading cause of blindness and visual impairment in developing countries, the disease is both preventable and curable.

The figures — released to coincide with World Sight Day on October 12 — shed new light on the steadily increasing levels of blindness worldwide. As the population aged 50-plus is set to rise dramatically, stalled progress on cataracts and other causes of blindness — and the progressive nature of those diseases — means the number of blind individuals is expected to triple by the year 2050, according to the data. A lack of access to eye health care in low- and middle-income countries, and paltry donor interest in efforts to combat the leading causes of blindness in those countries, are to blame for the stagnant progress, the report says.

While higher income countries are showing steady progress in tackling blindness, concerns among organizations such as Sightsavers that developing countries are lagging behind seem to be confirmed. The report indicates that 89 percent of visually impaired people live in low- or middle-income countries, and more than 4 percent of the population of sub-Saharan Africa is blind. That compares to just 0.09 percent of the population of the United Kingdom, for example.

Separate research highlighted this week shows that more than two-thirds of the world’s blind are women. The discrepancy is partly due to the fact that women live longer than men on average, but is also attributable to unequal access to eye health care in low- and middle-income countries.

In light of the research, Sightsavers, together with the U.K. government, announced on Thursday a “final push” in its Million Miracles campaign, an effort to raise funds from the British public for 1 million cataract treatments in low- and middle-income countries. The U.K. government announced on Wednesday it will match all funds donated by the public to the campaign until January 9, as part of its UK Aid Match scheme.

Sightsavers CEO Dr. Caroline Harper said in a statement: “I am very concerned to hear that the levels of avoidable blindness, which had been steadily declining, are now projected to increase significantly over the next few decades.”

“This means we must redouble our efforts, especially to treat cataracts, which are the biggest cause of blindness in developing countries. Our partnership with the U.K. government will put fresh impetus into our ‘A Million Miracles’ campaign.”

Harper said the campaign is currently about 80 percent funded. New funds will go to projects in Bangladesh and Pakistan, where high rates of poverty mean little access to health care and a high prevalence of blindness or moderate-to-severe visual impairment. About 4 percent of the population of Bangladesh, and 6 percent of Pakistan, has such an impairment.

Blindness more prevalent among women

More than two-thirds of the world’s blind are women, according to research from the International Agency for the Prevention of Blindness, highlighted in its new Vision Atlas. While the discrepancy globally is due in large part to differing life expectancies, the statistics suggest that in low- and middle-income countries it “is simply because women do not get to access services with the same frequency as men.”

“For example the cataract surgical coverage among women in sub-Saharan Africa and south Asia is nearly always lower, sometimes only half that in men,” the IAPD report states.

Social factors can prevent women from accessing treatment. Women often have less access to family financial resources to pay for eye care or for transportation to reach services, and may be less able to travel to a surgical facility because they have fewer options for travel, statistics from the IAPD show.

Women also perceive the value of surgery differently, due to social conditioning. For example, women view cataracts as an inevitable consequence of ageing and are less likely to have social support within the family to seek care. Finally, lower rates of literacy, especially among the elderly, mean that women are less likely to know about the possibility of treatment for eye disease.

Director for Sightsavers Pakistan Munazza Gillani said in an email to Devex: “As we move towards rural areas … the decisionmaker and breadwinner [tends to be] the male members of family so women and girls are often at the end of the priority list and miss out on the decisionmaking process about who in the family gets treatment and what the household can afford.”

“[Women] need transportation and often this isn’t provided free of cost; they also often have to bear other responsibilities with the family and in-laws,” she added.

Gillani said one promising, cross-cutting solution for Sightsavers’ work in Pakistan has been through encouraging young women to pursue careers in eye health.

“Ten years ago there were hardly any women in these [optometry] courses; now women account for more than 50 percent. It’s becoming really popular with female students.”

Gillani said Sightsavers’ work in Pakistan — part of the Million Miracles campaign funded with the help of UK Aid Match — is a “remarkable achievement,” which “makes female patients and their families feel a lot more comfortable and firmly places women in a position of authority to talk about eye health care within the country.”

There are 253 million blind and visually impaired people worldwide, but three-quarters of all causes of blindness are curable. At current rates, 115 million more people will be blind by 2050, due to the increase in the world’s ageing population.

Update, October 13: This story was updated to clarify that the UK government will match donations to the Million Miracles campaign until January 9.

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