Four out of five people lose their sight unnecessarily, even in today’s world, where 80% of blindness can be treated, cured, and/or prevented. The sad reality is that blindness remains a disease of poverty with 90% of people with blindness living in developing countries, where all aspects of health care are often simply not a government funding priority. Although much of the global blindness prevention effort is geared towards the aging population, statistics prove that one child becomes blind every minute. [1] There are 6 million visually-impaired children in the world; 80% of whom live in developing countries. Most of these children will die from other causes within the first year. Improved access to affordable eye care is urgently needed across the globe to protect the millions each year who needlessly go blind. In a responsible global world, efforts need to be made to ensure a future of universal eye health coverage, which should be a fundamental human right. [2]

VISION 2020: The Right to Sight (V2020) is a global program that was established in partnership in 1999 by the International Agency for the Prevention of Blindness (IAPB) and the World Health Organization (WHO) with the joint goal to eliminate avoidable blindness by 2020. V2020 is supported worldwide by governments and health ministries, non-governmental organizations (NGOs), eye care professionals, program managers, and industry that together contribute to the planning, development, and implementation of sustainable national eye care programs. [3] These programs are based on the three core pillars of disease control, human resource development and infrastructure development, and the incorporation of the principles of primary health care. National committees for the prevention of blindness have been formed with members from both the private and public sectors in over 80 countries. [4]

Recent global data from the WHO show that blindness and visual impairment have been reduced globally by 9%, or 26 million people, since 2004. This is a remarkable achievement in spite of the fact that the age group most affected by visual impairment (>50 years) has increased by 14% in this time frame. [5] Yet, challenges remain in the fight against avoidable blindness, as the WHO estimates that 285 million people worldwide still have visual impairment, and 39 million people are blind. As of 2010, the WHO confirmed that the 3 leading global causes of blindness are cataracts, glaucoma, and AMD. However, diabetes is now a global public health crisis, and diabetic retinopathy, a complication of the disease that leads to blindness, is emerging as a priority of blindness prevention. Uncorrected refractive errors, although quickly solved with an eye examination and eye glasses, are the main cause for moderate to severe visual impairment. [6] 

Again, the reduction in the global cases of blindness and visual impairment is a significant achievement of V2020, which promotes advocacy, carries out relevant research on ophthalmology and public health, and promotes Community Eye Health (CEH) through workshops, training, and partnerships with international, regional, and local ophthalmologic societies. [7] CEH training is one of the most important V2020 activities and has demonstrated positive impact and results since program inception. CEH training, as a result of V2020 activity, has also been included in regional and national residency curricula and programs, including the Pan American Association of Ophthalmology curriculum and residency programs in Brazil, Chile, and Mexico. [8]

Prior to the launch of VISION 2020 global estimates, for the number of blind people put the figure at almost 38 million people and 110 million with low vision. The prediction was that, due to the aging and growing world population, this would rise to an estimated 76 million blind people by 2020. [9] These early figures excluded blindness due to uncorrected refractive error (URE). Later estimates [10] which included URE put the figure at 45 million blind people in 2004, plus another 269 million low vision thus a total of 314 million visually impaired people which represented some 5% of the global population at that time.

It is interesting to compare the most recent estimates of the total number of blind people of 39 million, against the original projected estimates made at the start of VISION 2020.[11] In terms of absolute numbers and as a percentage of the population the number of blind people does appear to be declining gradually and when one considers the increasingly aging nature of the global population (the numbers of people aged ≥ 50 years increased by 18% between 2004 and 2010) this may be deemed indicative of some progress. Assessing how much of any change can be attributed to VISION 2020, as opposed to general development, is much more difficult. However, there are some pleasing success stories which are indicative of considerable progress over the past few years and which give us a clear way forward for the future.

Cataract, which is responsible for half of the world's blindness and a third of visual impairment, has often been the initial focus of many programs designed to meet VISION 2020 goals. Considerable success has been achieved in some parts of the world–particularly in India and surrounding countries. [12] Not only has there been a 5-fold increase in absolute numbers but also has the use of intraocular lens (IOL) implants is now at levels in excess of 94%. The availability of low cost but high quality implants, which can now be purchased for as little as $2 [13] has been a major driver, as has the promulgation of the pioneering approaches to the development of financially sustainable cataract programs that are still capable of providing free services to the very poorest members of society.

The true extent of the magnitude of URE became apparent when definitions of visual impairment were changed to presenting vision rather than best corrected; this change was the result of prolonged advocacy work from stakeholders engaged with VISION 2020. The 120 million people visually impaired from URE refers to distance vision and one may add to this the estimated 410 million people that have near vision problems and whose quality of life and earning potential is decreased for want of a simple pair of reading spectacles.[14]

A key element in the successful delivery of refractive services to rural India has been the recent development of Vision Centers, a small facility with a trained Vision Technician able to deliver eye care to 50,000 people, including: primary eye care, refraction, dispensing of spectacles, detection and referral of sight-threatening conditions, as well as spectacle-making facilities to supply every five Vision Centers.

The promotion of training standards International Centre for Eye Education [15] for optometrists, optometric technicians and optical technicians, and the establishment of new schools of optometry is another notable success; as is the promotion of low cost quality spectacles, lenses and frames such as that supplied through the Hong Kong Low Vision and Durban resource centers. Interest in adjustable spectacles has grown, though the effectiveness of this as a solution to the problems of URE remains to be proven.[16] The acceptance of Optometry as a profession remains an issue in many countries and is an important advocacy issue for VISION 2020 going forward in many countries.

Though predating VISION 2020, control programs focusing upon both onchocerciasis and trachoma, are important aspects of the VISION 2020 global initiative.

The elimination of avoidable blindness can be achieved, but to achieve the aspiration of VISION 2020 a significant scaling up of current activity is required. We need more programs, better programs and we need faster progress toward our goal.

This will require programmatic approaches to be aligned more closely with health system development; new partnerships to be made and a renewed emphasis on gaining country level commitment. Some of this takes us out of our current professional comfort zone, but we have several assets that can embolden us as we advocate and forge new links. Through VISION 2020 we have identified not only the problem but also the solution. We have strong evidence to support our programmatic and advocacy approaches. We know what needs doing and how to do it and have much that other health movements could learn from.

The authors declare that they have no conflict of interest

No funding sources

The study was approved by the Department of Health and Family Welfare, Himachal Pradesh.

1. Uy, Harvey Siy, Pik Sha Chan, and Franz Marie Cruz. "Stem cell therapy: a novel approach for vision restoration in retinitis pigmentosa." Medical hypothesis, discovery and innovation in ophthalmology 2.2 (2013): 52. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3939754/

2. Ibrahim, Tarek A., and Osama Elmor. "Intracorneal rings (INTACS SK) might be beneficial in keratoconus; a prospective nonrandomized study." Medical Hypothesis, Discovery and Innovation in Ophthalmology 2.2 (2013): 35. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3939749/

3. Borrelli, Emma, and Velio Bocci. "Visual improvement following ozonetherapy in dry age related macular degeneration; a review." Medical Hypothesis, Discovery and Innovation in Ophthalmology 2.2 (2013): 47. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3939750/

4. Shahsuvaryan, Marianne L. "Glaucomatous optic neuropathy management: the role of neuroprotective agents." Medical hypothesis, discovery and innovation in ophthalmology 2.2 (2013): 41. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3939751/

5. Juarez, C. P., A. L. Gramajo, and J. D. Luna. "Combination of intravitreal bevacizumab and peripheral photocoagulation: an alternative treatment in eales disease." Medical Hypothesis, Discovery and Innovation in Ophthalmology 2.2 (2013): 30. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3939753/

6. Pascolini, Donatella, and Silvio Paolo Mariotti. "Global estimates of visual impairment: 2010." British Journal of Ophthalmology 96.5 (2012): 614-618. https://doi.org/10.1136/bjophthalmol-2011-300539

7. Ulldemolins, Anna Rius, et al. "Social inequalities in blindness and visual impairment: a review of social determinants." Indian journal of ophthalmology 60.5 (2012): 368.

8. Furtado, J.M., Lansingh, V.C., Winthrop, K.L., & Spivey, B. (2012). Training of an ophthalmologist in concepts and practice of community eye health. Indian J Ophthalmol.  60(5), 365–7. PMID:22944743. doi: 10.4103/0301-4738.100529

9. Thylefors, B., et al. "Global data on blindness." Bulletin of the world health organization 73.1 (1995): 115.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2486591/

10. Resnikoff, Serge, et al. "Global magnitude of visual impairment caused by uncorrected refractive errors in 2004." Bulletin of the World Health Organization 86.1 (2008): 63-70.https://www.scielosp.org/pdf/bwho/v86n1/17.pdf

11. World Health Organization. (2006). Global initiative for the elimination of avoidable blindness. WHO/PBL/97.61 Rev 2. 2006.

12. Rathore, A.S. (2010). Assistant director of the India NCPB. Presentation to VISION 2020 India meeting in 2010

13. International Agency for the Prevention of Blindness, Standard List. [Last accessed on 2012 Feb]. Available from: http://www.iapb.standardlist.org .

14. Holden, Brien A., et al. "Global vision impairment due to uncorrected presbyopia." Archives of ophthalmology 126.12 (2008): 1731-1739. https://jamanetwork.com/journals/jamaophthalmology/article-abstract/420914

15. International Centre for Eye Education. Refractive Error Training Package. Available from: http://www.icee.org/publications/research/pdfs/hr/A%20Comprehensive%20Refractive%20Error%20Training.pdf.

16. European Council of Optometry and Optics. ECOO European Diploma of Optometry. [Last accessed on 2012 Feb]. Available from: http://www.ecoo.info/mm/DiplERegulations.pdf .