Where are we in elimination of avoidable blindness after ten years of implementing 'VISION 2020 The Right to the sight' in Oman?

VISION 2020 The global initiative to eliminate avoidable blindness by the year 2020 was launched in Oman in 1999. After 12 years of implementing activities related to the prevention of blindness and strengthening ophthalmic services in Oman, much is achieved. The author has described different activities, impact, and challenges both due to unaddressed agenda and newer challenges we face in this rapidly developing country. While global efforts are to update the Action Plan for the prevention of avoidable blindness and visual impairment (2014-2019) and Oman's attempt to plan for 2050, the current status of eye health care in Oman will be useful both to decision makers and researchers for generating additional evidence based information.

Global initiative of “VISION 2020 - The Right to the Sight” was launched in 1999 with the aim of eliminating avoidable blindness by the year 2020.[1] Member countries of the World Health Organization (WHO) endorsed and reemphasized their commitments to achieve this goal.[23]

Ministry of Health (MOH) launched “VISION 2020 – Oman” in1999. The outcomes of the blindness survey that was held 1996 and subsequent situation analysis of the eye health care program in Oman were referred for evidence based planning of “VISION 2020 – Oman.”[4]

Following Activities Were Carried Out in Last Eleven Years

Inclusion of VISION 2020 Oman agenda within “Eye” Domain of 7th and 8th Five Year of Health Plan of Oman.[56]

Formation of national eye health care committee in 1992 and its revision in 2000. At least one meeting was held per year to discuss the policies of eye care in Oman.

A section of eye and ear health care within the department of Non communicable Disease Surveillance and Control was operational since 1998. Governorate eye health care teams implemented, supervised, and evaluated activities on annual basis.

Community based information on blindness and blinding eye diseases like cataract, trachoma, and glaucoma were generated periodically.

High quality of eye care was made accessible to citizen of Oman at affordable cost in all governorates.

Evaluation of eye health care program (internal by expert in MOH and external by WHO consultants).

Integration of eye health care within the Primary Health Care (PHC) since 1995 and its periodic strengthening at national and governorate levels.

Integration of eye health care in school health for screening and management of eye problems of students at four levels on annual basis since 1995.[7]

Standard operating procedures for eye care in eye health care manual – 1st edition (1995), 2nd Edition (2000), 3rd edition (2011),[8] and eye health care training manual (1995).

Inclusion of health matrix on eye care morbidity ad management at primary, secondary, and tertiary level of service delivery in 1998 and using the data to monitor the progress annually.

Building capacity of existing eye care personnel through workshops, training in subspecialty, international conferences, and seminars both at national and governorate levels.

More than 70 indexed publications on eye health care in Oman in last 10 years.

Eighteen health education pamphlets in Arabic language on common and blinding eye diseases, five posters were prepared and displayed at all PHCs. Talks were held periodically on TV and radio to increase the knowledge, improve attitude, and practice regarding eye care of the community.

Low vision rehabilitation was initiated in 2003 with the help of national NGO and international experts.

Organized “World Sight Day” activities both at national and governorate levels on 2nd week of October every year since 2003.

Launched website of the section. http://www.eyecareprogram.net/n8/index.php in 2008 details of VISION 2020 OMAN and program activities are given in this web page.

Impact of VISION 2020 Initiatives in Oman

The blindness rate in 40 years and older Omani population declined from 10.3% in 1996 to 8.25% in 2005 and 7.5% in 2010 (8 northern and central governorates of Oman).[9] The nutrition and communicable eye diseases related visual disability declined and proportion of blindness due to diseases of posterior segment of eye increased.

Prevalence of glaucoma was found to be 4.75% in 40 years and older Omani population.[10] The rate of diabetes was 12.2% in 20 years and older population and diabetic retinopathy among registered diabetics was 14.5%.[1112]

The ophthalmologist to population ratio improved from 1:30 000 in 2000 to 1:18 000 in 2010.

The eye unit with surgical and diagnostic facilities at present is available in 11 governorate hospitals of MOH and 9 other hospitals.

Ophthalmologists use modern diagnostic facilities in 20 policlinics of MOH and 15 eye clinics in private sector in all governorates of Oman.

Cataract surgery rate (CSR) 2400/ per million population in 2011. More than 95% of them was provided intraocular lens implants.[13]

Blinding Trachoma eliminated in 2008 and sentinel surveillance for next 3 years proved that there is no resurgence of trachoma and existing services are capable to address incident blinding trachoma. Trachoma was included Neglected Tropical Disease control in 2005.

Post graduate Ophthalmology residency program with two seats per year 2009. Training of 15 Omani ophthalmologists in subspecialty fellowship in international centers.

Provision of modern technologies to eye units; computerized case record system, diagnostic and operating microscopes, laser machines, optical and coherent tomography, electrophysiology unit, auto perimeters, digital fundus camera, etc.

Challenges

Oman will face following challenges in the field of prevention of blindness in coming years.

Epidemic of diabetes and increasing number patients with diabetic retinopathy in Oman.

Improve efficiency of eye care services for optimal utilization of resources.

Lack of eye bank and eye donation in Oman.

Sustaining high cost eye care services in Ministry of Health Institutions.

Childhood blindness due to birth defects and provision of rehabilitative services at early age.

Improve compliance of eye patients in following advices for eye care especially in chronic age related blinding eye diseases.

Develop mid level eye care personnel, provide them employment opportunities in exiting services.

Local manufacturing of low cost visual aids, ophthalmic disposables, and medications.

Institution based rehabilitation services for low vision disabled and providing them devices at affordable cost.

Operational research related to health economics in eye care, impact of eye care on quality of life, and patient satisfaction for eye care services.

Conclusion

Eye Health Care in Oman has made considerable progress in last 10 years and has experienced acceleration after VISION 2020 initiative was launched. Unmet challenges still remain but we are confident that goal of eliminating avoidable blindness by the year 2020 could be achieved.