Positive action absolutely imperative

According to World Health Organization (WHO) data, four percent of the world's population– an estimated 314 million people – are blind or have significant visual impairment. That's not counting the estimated 517 million people whose quality of life and earning potential is adversely affected because they have no access to spectacles and their presbyopia remains uncorrected.

Ninety percent of people who are blind live in the lower income countries. Poverty causes blindness and blindness causes poverty – a spiralling relationship that plunges visually impaired people and their families into deprivation. That means living on less than a dollar per day and all that goes with it – lower life expectancy, higher levels of mortality and morbidity, decreased literacy and so on.

Against this background, and with the knowledge that 80% of global blindness could be prevented or cured, WHO and the International Agency for Prevention of Blindness (IAPB) jointly launched the global initiative VISION 2020: The Right to Sight in 1999. The aim was straightforward: to eliminate avoidable blindness by the year 2020.

However, there is no room for complacency. Only recently has the impact of uncorrected refractive error on overall levels of blindness and visual impairment been recognised.

Cataract, so easily treated, remains responsible for almost half the world's blindness – a major challenge in much of Africa. Services to treat retinopathy of prematurity are a growing need in the emerging metropolitan centres of India and China, whilst diabetic retinopathy will give rise to many more cases of blindness in future as the massive increase in the global prevalence of diabetes takes hold over the next two decades.

IAPB is the key partner working with WHO on the VISION 2020 global initiative. IAPB currently has 107 members including all major international NGOs involved in eye health, the global professional bodies for ophthalmology and optometry, universities, WHO collaborating centres and corporations that fund VISION 2020 programmes.

IAPB's work adds value and contributes to the achievement of VISION 2020 in the following specific areas: Advocacy - to influence policy change so that eye health will be integrated, and given greater priority within national health care services; Knowledge and technical expertise - to support the development of quality eye health programmes; Co-ordination - with so many different stakeholders, from private, public and not-for-profit sectors, good information exchange, co-ordination and ultimately collaboration are essential.

Finally, a word on gender and eye health. Two-thirds of blind people are women yet many fewer women access treatment than men in most developing countries. Despite this obvious discrepancy, many eye health programmes fail to target women. It is not enough to assume that women will seek treatment in equal numbers to men – in many parts of the world they do not, for a myriad of social and economic reasons. Affirmative action in favour of women patients is required in many communities – indeed it is an absolute imperative if VISION 2020 is to succeed.