Public Health Interventions to Reduce the Prevalence of Blindness in Developing Countries.

Sir,

Blindness has been defined as visual acuity of less than 3/60 in Snellen's chart or inability to count fingers in daylight at a distance of three meters.[1] In 2010 alone, 285 million people are found to be visually impaired worldwide, of whom close to 90% were from developing nations.[23] Visual impairment interferes with ordinary life as a disability, adversely affects quality of life, increases susceptibility to injuries or accidents, negatively impacts productivity and national progress, dramatically increases economic and social costs, and burdens the health care system.[24]

The epidemiological distribution of visual impairment is dependent on multiple parameters such as age groups, gender, literacy level, and geopolitical zone.[25] Approximately two-thirds of visually impaired individuals are aged 50 or over, whereas 19 million children under the age of 15 years have impaired vision.[25] Uncorrected refractive errors are the main reason for visual impairment worldwide; however, in middle/low-income countries, the leading cause of blindness is cataract.[6] In addition, conditions such as glaucoma, corneal opacity, childhood blindness, trachoma, and diabetic retinopathy have been identified as significant factors leading to visual impairment.[56] Over three fourth of all visual impairment can be prevented or cured provided appropriate prevention strategies like providing refractive services and cataract surgery.[23]

The number of visually impaired counteract avoidable blindness. visual impairment, integration of eye care services within distinct levels of primary health care, provision of services which are high quality, available and affordable, adoption of appropriate mass media to raise awareness, involvement of stakeholders via school-based education and constructing strong international corporations; however there is no reduction in the blind population because of population growth, increased life expectancy and the untenable feature of public health strategies.[13]

In order to reduce the magnitude of visual impairment worldwide, one of the most crucial elements is to develop a surveillance system so that accurate information regarding the prevalence and causes of visual impairment can be obtained, enabling program managers to prioritize and formulate rational policies to allow judicial utilization of scarce resources, especially in developing countries.[16] On the other hand, to ensure sustainability and provision of effective and easily accessible services, strategies like strengthening existing eye care services and completely integrating them into the health system have been universally recommended. In addition, a target-oriented approach for some major causes of blindness (such as, diabetes mellitus, rubella, or vitamin A deficiency) has been proposed to counter the menace of visual impairment.[6] In order to expand the scope of preventive services, some interventions including the incorporation of visual impairment prevention and rehabilitation agenda into wider health policies and strategies, involvement of multiple stakeholders, and adopting a multi-sectoral approach can be tried upon.[167]

To conclude, the need of the hour is to develop holistic policies, well supported with systematic monitoring and involvement of national and international welfare agencies to counteract avoidable blindness.