As the 2030 In Sight strategy points out, the vast majority of sight loss is preventable or readily treatable. In most cases, we have adequate knowledge of disease; effective optical and medical devices, equipment, and medication; and appropriate treatment protocols. Advancing medicine for eye care is important, but not enough on its own.
Many of today’s systems for preventing eye conditions and delivering care are no longer fit-for-purpose. This is especially true for the most vulnerable populations and those in low to middle-income countries. Even in high income countries, ageing populations are placing increasing pressure on the eye care system while, at the same time, lifestyle-related conditions are rising to become a significant driver of eye and vision conditions.
Ours is a shared belief that a world is possible where no-one needlessly lives with sight loss and those that do have the opportunity to reach their full potential. Achieving that vision is critical to realising the Sustainable Development Goals. The first, and most important step in achieving this future, is to reset our expectations for the results that the system, as it is now, will achieve. If we keep doing the same things, we will achieve the same results – and not the transformational results we need to achieve our goal by 2030.
As such, we need to set aside our attachments to current ways of working and more openly examine what needs to change. The 2030 In Sight strategy lays out several areas of the eye health systems in which this transformational change is needed. For each of these areas, we can identify the current state and the desired future state. Some of these areas are framed here.
Eye health and the Global Goals
2030 In Sight highlights how eye health is critical to achieving the Sustainable Development Goals and the 2030 Agenda. Progress on issues ranging from road safety to economic productivity are impossible without addressing eye health. This represents a significant change – from eye care seen as a separate issue – to being deeply interconnected to many aspects of not only an individual’s life, but also to progress at a national and global level.
Eye health in school and work
Employers have a role to play in taking ownership for eye health by ensuring that eye safety risks in the workplace are at an absolute minimum and for providing affordable eye health screenings and access to care. This will help more people receive the eye care services they need.
Schools and education departments have a role to play in taking ownership for the eye health of children as a part of school health. Schools can function in similar ways to workplaces while also educating children and their families about healthy eye behaviour. This will help more children receive the eye care services they need.
For many countries, eye care is largely provided in parallel to the mainstream healthcare system. In low-income countries, it is common for NGOs to fund and/or provide much of that care. 2030 In Sight envisions a future where national governments take ownership of eye care, leading the integration of systems that may include health systems, regulation, demand generation, and equitable provision of services and products. This leadership will exist in an environment where services will be delivered through a combination of government and non-governmental providers (both private and non-profit).
A Continuum of Care
Eye health is not independent from other areas of health. Attention to eye health from allied professionals has the potential to alert individuals to their eye health needs earlier, prompting them to seek out care that is timely and effective.
A large proportion of eye care needs can be provided at community and primary levels of care. However, in many settings, eye care is provided only by highly trained eye care professionals at secondary and tertiary health care settings. Many countries face both overall and local shortages of eye care professionals. Additionally, in many settings, community and primary health providers are not qualified or equipped to include eye care in their practice.
These challenges reflect the need to integrate eye care into a continuum of care, beginning in the community and primary care settings. This would improve access to services, better utilise the expertise of optometrists and enable ophthalmologists to increase the volume and quality of medical and surgical care they can deliver.
Developing such a continuum of care requires a strategy that combines appropriate human resource development (equipping each level of care with the appropriate training, technology, and licensing) with the development of integrated referral pathways that optimise the allocation of scarce resources and ensure individuals receive quality, appropriate, affordable, and timely care.
Cultural & Mindset Shifts
Many people face obstacles to good eye health before they encounter limitations in the availability of eye care services. We must help individuals and communities value vision and eye health, empower them to have routine eye tests, take action when they suspect there is a problem, and ensure that they have ready access to trustworthy products and care services.
In many high-income countries, the private sector is critical in providing many aspects of eye care such as vision screenings, eye health examinations, eyeglasses, contact lenses, surgery and low-vision aids. A strong eye care market can enable consumers to choose from products at a range of price points and be relatively confident that these products are of suitable quality.
Our vision of the future requires that all people have easy, reliable, and affordable access to eyeglasses, contact lenses and/or other appropriate options to treat refractive errors and restore their vision.
The development of sustainable business models in lower-income countries will require innovation, exploring approaches such as social enterprise and non-traditional distribution channels. These business models will require collective action in establishing new relationships among manufacturers, social entrepreneurs, governments, NGOs, investors, the private sector and philanthropic funders.