Keynote session: Everybody from Washington to Ouagadougou deserves right to sight

May 4, 2009

It is tempting for many individuals in the United States and other countries with well-developed economies to think that global initiatives to improve eye health are meant for somebody else. With sophisticated technology and a multitude of medications for common eye diseases, things are going well here, you might say, so save your effort for somewhere out in the Third World. In reality, cataract, glaucoma, diabetic retinopathy, age-related macular degeneration, and uncorrected refractive errors are not things of the past in the developed countries, and everybody from Washington to Ouagadougou deserves the right to sight, said Hugh R. Taylor, MD, who gave the address Sunday evening at the ARVO/Alcon keynote session.

Fort Lauderdale, FL-It’s tempting for many individuals in the United States and other countries with well-developed economies to think that global initiatives to improve eye health are meant for “somebody else.” With sophisticated technology and a multitude of medications for common eye diseases, things are going well here, you might say, so save your effort for somewhere out in the “Third World.” In reality, cataract, glaucoma, diabetic retinopathy, age-related macular degeneration, and uncorrected refractive errors are not things of the past in the developed countries, and everybody from Washington to Ouagadougou deserves the right to sight, said Hugh R. Taylor, MD, who gave the address Sunday evening at the ARVO/Alcon keynote session.

Dr. Taylor is the Harold Mitchell Chair of Indigenous Eye Health at the Melbourne School of Population Health, University of Melbourne, Australia. He discussed VISION 2020, a global initiative of the World Health Organization and the International Agency for the Prevention of Blindness. The member organizations of the initiative are working together to eliminate avoidable blindness by the year 2020.

Goals include effective disease control, focusing on five conditions that can be addressed with a public health interventions: cataract, trachoma, onchocerciasis, childhood blindness, refractive error, and low vision. Other components include human resource and infrastructure development.

VISION 2020 is for everybody, Dr. Taylor emphasized. The world’s population is aging, not just in the developed countries but in those with developing economies, which means that the many age-related eye diseases will continue to afflict millions of people. Those in Washington, DC, often considered one of the wealthiest cities in the United States if not the world, will benefit from efforts to improve eye health, as will those in Ouagadougou, the capital of the African nation of Burkina Faso, one of the poorest countries in the world, Dr. Taylor said, and citizens of all points in between.

In response to the challenge of ensuring that everyone has the right to sight, three steps can be taken: prevent the things we can prevent, treat the things that we can treat, and solve the remaining problems, Dr. Taylor continued.

The prevention component is best addressed through regular eye exams in which diseases can be detected at an early stage and refractive errors can be corrected. Treating what we know how to treat includes providing therapy for common conditions such as cataract, and ensuring that therapy is widely accessible.

“Everybody will develop cataract if they live long enough, but cataract surgery is so extraordinarily effective and so cost effective that countries can’t afford to have people sitting around blind for years waiting for cataract surgery,” Dr. Taylor said. “It’s more cost effective for a country to go right ahead and offer it almost free.”

It is also important to provide low vision and rehabilitation services to help people lead fuller lives.

To tackle the as-yet unsolved questions, Dr. Taylor suggested additional research into diseases that are more difficult to treat, such as glaucoma and age-related macular degeneration. More work on genetics and an emphasis on slowing vision loss in the early stages of disease could be beneficial in treating AMD, while one simple yet effective step to lessening the impact of glaucoma would be to urge newly diagnosed patients to notify all of their relatives and ask them to be screened for this disease, as family history is a risk factor.

To close the gap between what is known about eye diseases and what is happening on the ground, Dr. Taylor offered several ideas along a spectrum ranging from being aware of the problem of blindness and vision loss to changing your research focus or making a life-changing move or, as he put it, becoming an Albert Schweitzer for vision. Advocacy is also critical.

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