Chronic eye disease and the WHO Universal Eye Health Global Action Plan 2014-2019

The World Health Organization (WHO) has a new global agenda that aspires to significant improvements in eye health worldwide. The road map was presented at the 66th World Health Assembly, and Canada was one of 194 WHO Member States that unanimously endorsed “Universal Eye Health: A Global Action Plan 2014-2019.” This comprehensive action plan calls for immediate action of governments, international partners, and the WHO to work jointly in a coordinated manner. The vision is to prevent avoidable vision loss, and to help those with unavoidable vision loss to achieve their full potential, supported by universal access to comprehensive eye care services. Presenting a measurable target for this major global initiative, WHO Member States have agreed to reduce the prevalence of avoidable visual impairment by 25% from a 2010 baseline by 2019.1World Health Organization. Universal Eye Health: A Global Action Plan 2014-2019. Geneva, Switzerland: WHO; 2013. Available at: www.who.int/blindness/actionplan/en/.Google Scholar The WHO estimates that 285 million people are visually impaired worldwide, with 39 million blind. Globally, both cataract and refractive error are major causes of visual impairment. With this in mind, and given their known interventions, a major strategy for the new action plan is to tackle both cataract and refractive error, to help the greatest numbers recover sight.1World Health Organization. Universal Eye Health: A Global Action Plan 2014-2019. Geneva, Switzerland: WHO; 2013. Available at: www.who.int/blindness/actionplan/en/.Google Scholar In Canada, with its advanced economy and publicly funded universal health insurance system, cataract surgical services along with the provision of refractive services cover most of the population, although geographic and population inequities may exist. Given that Canadians are living longer, the share of other noncommunicable chronic eye conditions among causes of vision loss will grow substantially. Much more attention will have to be given to glaucoma, age-related macular degeneration, and diabetic retinopathy. Unlike cataract, these chronic eye diseases present many unique challenges. Damage from each is irreversible, which makes early detection and treatment critical. Once disease is detected, no single intervention represents a cure. In addition, each of these diseases has complex treatment protocols, with the additional need for continuous monitoring of disease over the life of the individual. It is evident that the prevention of vision loss associated with chronic eye disease will need comprehensive and active lifelong care. And while affordable health care is in place for Canada, critical inputs such as human resources and skill sets, specialized equipment, and access to care (among others) will need to be monitored very closely. In light of the increasing prevalence of chronic eye conditions, the new eye health action plan is timely and is a welcome guiding framework to tailor to Canada’s needs. To fully address the provision of eye care service in the future, what should we be measuring to assess adequacy of care in glaucoma, age-related macular degeneration, or diabetic retinopathy? One objective of the 2014-2019 WHO action plan calls for evidence-based advocacy. The collection of epidemiologic data at national and regional levels provides estimates of the prevalence and causes of visual impairment, both key indicators to measure the impact of interventions proposed. To understand trends, reliable epidemiologic data need to be periodically collected using internationally endorsed methodology in a representative population sample. This remains the most important tool to track progress and adjust eye care services according to identified needs. Data on the number of interventions to treat a given disease, such as cataract surgical rates, provide a surrogate measure of care. Although the number of people treated is helpful to identify geographic differences, gaps, and marginalized populations, to inform us of whether we are achieving our goals, our benchmark must be visual impairment prevalence. The new action plan also provides a much-needed roadmap for a comprehensive national set of evidence-based actions using a health system approach. The 6 areas embraced by this approach include service delivery, health workforce, health information, medical products and technologies, health care financing, and leadership and governance. In spite of its position globally as a developed and wealthy nation, Canada would benefit from a systematic critical evaluation of each of these components to ensure strength across all areas, in order to support robust, comprehensive eye care services. In addition to prevention and treatment, low-vision and rehabilitation services will also have to be strengthened for those who cannot be treated due to advanced stages of chronic eye disease. A third objective of the action plan is to encourage multi-sectoral comprehensive action. The engagement of non-health sectors, international and national partnerships, and alliances is critical to developing and implementing plans and policies that relate to eye health and prevention. Incorporating eye health into initiatives that encompass broad socioeconomic policies (such as poverty reduction and issues specific to aging) can serve to sensitize stakeholders not directly engaged in eye health, leading to strengthened comprehensive eye care and access. The 2014-2019 WHO Universal Eye Health Global Action Plan urges countries to take stock of eye care services and to identify gaps and needs. Canada is a high-income country, and although it has universal access to health care, it too has unmet eye care needs that will only grow with the aging population. It has a unique opportunity to actively participate in measures of eye health and disease, in areas of identified gaps including vulnerable groups and underserved communities. There is much to be done, and the new action plan outlines core components of important research opportunities. The action plan is both a tool and a reflection of collective international thinking on the best methods to analyze the consequences of eye care service. For decision makers at the federal and provincial levels to listen, and to adopt the right actions, the prevention of avoidable vision impairment from chronic eye disease in Canada will need to be rooted in evidence-based advocacy.