December 2, 2017
Have you ever wondered how vision care around the world looked? The good news is that blindness decreased worldwide from 2004 to 2011, however, there was an increase in the number of visually impaired people. Of the 285 million visually impaired people across the globe, 39 million are blind. The leading causes of preventable vision impairment are uncorrected refractive errors (42%) and cataract (33%), while the leading causes of preventable blindness are untreated cataract (51%) and glaucoma (8%).
The World Health Organization (WHO) says 80% of vision impairment can be prevented or cured. This includes conditions that could have been prevented or controlled if available knowledge and interventions were administered (e.g. river blindness), or sight was restored (e.g. cataract). That’s why education and access to affordable vision care services are so important. A considerable challenge exists because 90% of the people who are visually impaired live in developing countries where education and access to services are lacking. Even in developed countries, politics, socioeconomic factors, and healthcare systems dictate access to affordable vision care.
WHO has launched several recent initiatives to curb global blindness in developing countries including VISION 2020 – The Right to Sight: A Global Initiative for the Elimination of Avoidable Blindness, and Universal Eye Health: A Global Action Plan 2014-2019. The last major WHO vision survey conducted in 2010 yielded the following vision impairment and blindness prevalence rates by WHO region. China had the highest rate of visual impairment at 5%, followed by India (4.6%). Prevalence rates for blindness were highest in the EMR region (0.8%), which includes many Middle Eastern countries, Afghanistan, Egypt, Morocco, Pakistan, Somalia, and Sudan. The rest of Africa and SEAR (parts of India, Indonesia, Sri Lanka, Thailand, Bangladesh, Bhutan, Democratic People’s Republic of Korea, Maldives, Myanmar, Nepal, and Timor Leste were at .07%.
A Global Perspective on Eye Health
South Africa: About 80% of people who are unable to afford expensive private medical
insurance rely on the state to provide affordable healthcare. The Brien Holden Vision Institute began collaborating with the Gauteng Department of Health (DOH) in 2010, initially focusing on school eye health. Later, they identified a lack of eye care for older people in Soweto, an area of socioeconomic deprivation. Older adults were subjected to long waits to see an optometrist, long lines at the university teaching hospital, and had no access to affordable eyeglasses. While DOH was hesitant to collaborate initially, the joint endeavor has resulted in improved access to eye care services.
United Kingdom: The National Health Service (NHS) is the publicly funded national
healthcare system for the U.K., and the largest and the oldest single-payer healthcare system in the world. Private healthcare is used by only 8% of the population, generally as an add-on to NHS services. Many people qualify for an NHS sight test or optical voucher. The NHS Low Income Scheme (LIS) provides partial funding for sight tests, glasses, or contact lenses for lower-income people who don’t qualify for complete coverage. Even so, chronic eye disease and an aging population have contributed to a growing number of people with vision impairment in the U.K. Of 2 million people with sight loss, 360,000 are registered with their local authority as blind or partially sighted.
Asia: Recent changes in environmental and lifestyle factors (e.g. air pollution, an aging
population, increasing obesity rates, and expanded use of phones and computers) have contributed to rising eye health problems and a need for vision services. In China, blindness is increasing at a rate of 6% each year, while glaucoma has become 10 times more prevalent in the past 30 years. In 1955, the rate of myopia among South Korean 20-year-olds was just 18%, whereas, in 2012, it was an astounding 95%. In Hong Kong, Taiwan, and Singapore, myopia impacts about 80% of the population. And in Malaysia, diabetes among adults is 17.9%, which is the 14th highest in the world.
In China, all three tiers of hospitals can provide routine eye care. Only class III hospitals have the infrastructure, ophthalmologists with international standard technical skills, and sophisticated equipment to deliver more advanced care. A lack of standardized protocols has led to discrepancies in diagnosing and treating patients with eye diseases.
United States: Eye disorders rank fifth among the top eight chronic conditions in terms
of direct medical costs. By 2050, it is estimated the prevalence of vision loss in the U.S. will grow by 135%, from 4.4 million to more than 10 million. By the same year, cataract, diabetic retinopathy, glaucoma, and advanced age-related macular degeneration together are expected to impact nearly 70 million adults. The overall annual cost of vision problems in the U.S. are currently estimated at $145 billion, however, without significant prevention and intervention, this could rise to $717 billion by 2050.
Vision care is one of those gray areas that differ greatly by state, employer, and insurance plan. For those who qualify for Medicaid, coverage for eye exams and corrective lenses are based on the state of residency and medical necessity. For those age 65 and older who qualify for Medicare, routine eye exams, eyeglasses, and contact lenses aren’t covered. Medicare Part B covers some preventive and diagnostic tests. If you have an eye disease, Medicare coverage varies by disease. Vision care for those ages 19 and older is not mandated by the Affordable Care Act, however, some health plans may include eye care coverage. In most plans, benefits to help defray the costs of eyeglasses or contact lenses is separate from services deemed medically necessary (cataract surgery, dry eye treatment, etc.).
Eyesight is central to a children’s success in school, adults’ employability, and sustained independence as people grow older. The American Academy of Ophthalmology recommends all adults with no signs or risk factors for eye disease receive an eye disease screening at age 40. If you cannot afford vision care, several organizations in the U.S. provide free eye exams and eyeglasses.