A third of the world’s population suffers from some form of vision impairment, and at least one billion people do so without current or prior medical attention that could have made a difference in outcomes and lives, according to the World Health Organization (WHO).

The organization today issued its first World Report on Vision, which gathers global information about the burden of eye conditions and the vision impaired. Aging populations, changing lifestyles and limited access to eye care are among the main drivers of the rising numbers of people living with vision impairment.

To better serve their citizens and strengthen their societies, low- and middle-income countries in particular need investments in medical facilities and caregiver workforce totaling at least $14.3 billion. High-income countries like the United States also face structural problems that allow eye care delivery to lag behind need, particularly in rural areas and among minority communities.

The WHO is hoping the report, released just prior to World Sight Day this Thursday, will give the organization and other stakeholders a platform from which to lobby for greater commitments to eye care worldwide.

Impairment by the Numbers

Globally, at least 2.2 billion people have vision impairment, the report states. Among the one billion of these individuals with an impairment that could have been prevented or has yet to be addressed, uncorrected presbyopia tops the list, affecting 826 million people. Next highest is unaddressed refractive error (123.7 million), followed by cataract (65.2 million), glaucoma (6.9 million), corneal opacities (4.2 million), diabetic retinopathy (three million) and trachoma (two million).

That one billion number is almost certainly an underestimation, the WHO report notes, as potentially preventable cases of age-related macular degeneration (AMD) are unknown and data on childhood visual impairment is hard to come by. The report does estimate a visually impaired AMD population of 10.4 million among the 2.2 billion overall cases.

Not Impaired, But at Risk The World Report on Vision discusses, in considerable detail, the extent of vision impairment globally, taking great pains to both quantify and contextualize it. But the report also presents estimates of people affected by various eye conditions with the potential to lead to vision impairment, including the following: 2.6 billion people with myopia in 2020 312 million younger than 19 with myopia in 2015 76 million people (ages 40 to 80) with glaucoma in 2020 2.5 million people with trachomatous trichiasis in 2019 1.8 billion people with presbyopia in 2015 146 million adults with diabetic retinopathy in 2014 195.6 million people with AMD in 2020

Regarding the combined 11.9 million people with vision impairment or blindness due to glaucoma, diabetic retinopathy and trachoma that could have been prevented, the report estimates the costs of preventive measures would have been $5.8 billion. “This represents a significant opportunity missed in preventing the substantial personal and societal burden associated with vision impairment and blindness,” according to the report.

The report also notes that the burden of eye conditions and vision impairment is often greater in people living in rural areas, those with low incomes, women, older people, people with disabilities, ethnic minorities and indigenous populations. 

In sum, the WHO concludes, “progress is not keeping pace with population eye care needs.”

Addressing the Challenges

The World Report on Vision sets out concrete proposals to address challenges in eye care. Its key proposal is to “make integrated people-centered eye care, embedded in health systems and based on strong primary health care, the care model of choice and scale it up widely.”  

“People who need eye care must be able to receive high-quality interventions without suffering financial hardship,” the report states. “Including eye care in national health plans and essential packages of care is an important part of every country’s journey towards universal health coverage.”

Policymakers should also direct attention to elevating the role of optometry, according to the report, which notes that “acceptance of optometry as a profession remains an issue in many countries and is an important advocacy issue going forward.” Eight of 24 countries the WHO recently surveyed “either did not recognize optometry as a profession or there was no established educational requirement for optometrists.” The report concludes that “in some countries, productivity may be diminished because a section of the health workforce, such as optometrists, are not accredited to carry out eye care services independently.”

The WHO estimates that to achieve the global eye health targets set for 2030, low- and middle-income countries need to invest in an additional 23 million health workers and build more than 415,000 new health facilities—which could cost upwards of $14.3 billion to address unmet cataract surgery and refractive error correction needs alone. According to the WHO, this financial investment is needed immediately, as these infrastructure and workforce investments require appropriate planning that cannot happen without the additional investment.

The WHO admits that major challenges lie ahead, particularly the fact that global eye care needs will rise sharply due to changing demographics and lifestyles—the prevalence of any near vision impairment is highest in regions with longer life expectancies, and environmental factors such as decreased time spent outdoors and increased near-work activities are largely driving projected increases in myopia. The WHO estimates that, by 2040, there will be a 50% increase in the number of people worldwide requiring access to routine (i.e. yearly or biennially, depending on setting) retinal examinations for diabetic retinopathy.

Given the stark estimates and the growing global need, the WHO says it is committed “to working with countries to improve the delivery of eye care, in particular through primary health care; to improving health information systems for eye care; and to strengthening the eye care workforce.” 

To Learn More

The World Health Organization’sWorld Report on Vision is available here for download.

Those planning to attend the American Academy of Optometry meeting in Orlando later this month can hear a presentation of the report’s findings, policy recommendations and implications for optometry during the Plenary Session on Wednesday, October 23. Attendees will learn more about the WHO’s efforts to tackle the extensive disease and blindness burdens on society throughout the world, and where optometry fits into this effort.