Vision 2020

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objectives
Introduction
Current status
Constraints
Future plan of action
Strategies and outcome

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Vision 2020
’The Right to sight’ is a global initiative

launched by WHO in Geneva on feb 18 ,1999 in

a broad coalition with a ‘ Task Force of
International Non-Governmental Organization
(NGOs)” to combat the gigantic problem of
blindness in the world.

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India was the first country to launch the NPCB in

1976 with the goal of reducing the prevalence of

blindness.
Of the total estimated 45 million blind persons

VA < 3/60 in the world, 7 million are in India.

Blind particularly due to cataract.

India is committed to reduce the burden of

avoidable blindness by the year 2020 by

adopting strategies advocated for vision 2020:
The Right to Sight.
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Partners of vision 2020
1. WHO

2. Task force of International NGOs

which has following members
 International agencies for prevention

of blindness
 Christopher blindness mission

 Helen keller international

5 ORBIS International
 Sight Savers international
 Al Noor International Foundation

 International Federation of

Ophthalmological Societies
 Lions Club International Foundation

 Operation Eye Sight Universal

 The Carter Center

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objective
To eliminate avoidable blindness by the

year 2020
to reduce the global burden of blindness

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Current status
Extent of the problem

Achievements

Decentralized approach

Monitoring and evaluation

Quality of services

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Extent of problem
Three major surveys conducted to find out the

prevalence of blindness in the country.

 ICMR in 1974 (1.38% general population) VA <6/60

GOI/WHO 1986-1989 prevalence rate increased to

1.49%
VA < 6/60.
• Recent survey 1999-2001 in 15 districts of country

indicated that 8.5% of 50+ population is blind VA

<6/60.

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Disease
Disease included for vision 2020
prevention
and control in Diseases prevention
global in India
Cataract
Cataract
Childhood blindness
Childhood
refractive errors and
blindness low vision
Trachoma  corneal blindness

Refractive errors  diabetic retinopathy

Glaucoma
and low vision
 trachoma
onchocerciasis
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Vision 2020 achievements
 307 operation theatres and eye wards are constructed in district level
hospitals.
 Supply of ophthalmic instruments for diagnosis treatment and IOL
surgeries.
 800 eye surgeons trained in IOL.
 Cataract surgery increases since 1993, currently rate is 3700 per million
population
 The quantity and quality of cataract surgery has been improved ,
particularly since low cost intraocular lenses have been made available.
 Countries like India, Morocco, Nepal, Sri Lanka, Thailand, Gambia have
shown improvement in eye health.

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Approach (Implementation
unit)
Principles implementing vision 2020 at
district level:
‘I See’
Integrated
Sustainable
Equitable
Excellent
DBCS , health education and social welfare
departments, media, community leaders
and NGOs
Vision 2020 implemented
Through four 5 year plan

First one started in 2000

Second one in 2005

Third one in 2010

Fourth one in 2015

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Strategic approaches
Disease prevention and control

Training of eye health personnel

Strengthening of existing eye care infra

structure
Use of appropriate and affordable

technology
Mobilization of resources
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Evaluate
programme Quality of services
Communication IOL implantation at
needs assessment institutional level
Beneficiaries and not out door
assessment surgical camps
Evaluation of
trained eye
surgeons
Rapid assessment
for prevalence,
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coverage and
outcome
Constraints
Inequitable distribution of eye surgeons
Sub- optimal utilization of human resources
Inadequate number of paramedical eye
care personnel
Variation in quality
Sub optimal coverage
Over emphasis on cataract
Lack of public awarness

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Future plan of action
 Ophthalmology must be treated as a separate subject in
MBBS.
 During internship, two weeks of community eye care
programs
• Emphasis should be laid on training in fundus

examination and tonometry at UG level

• Uniform curriculum and assessment during MS / MD

courses including assessment of skills, maintenance of

log book ( minimum of 50 IOL microsurgical operations
during PG.
 Good eye surgeons in IOL technique , management of

glaucoma, pediatric ophthalmology, keratoplasty, vitreo

retinal surgery to develop skills in surgeons.
Uniform curriculum and assessment during MS

/ MD courses including assessment of skills,

maintenance of log book ( minimum of 50 IOL
microsurgical operations during PG.
Good eye surgeons in IOL technique ,

management of glaucoma, pediatric

ophthalmology, keratoplasty, vitreo retinal
surgery to develop skills in surgeons.
strategies
1. strengthening advocacy

2. reduction of disease burden

3. human resources development

4. Eye care infrastructure development

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Strengthening advocacy
Public awareness and information about eye

care and prevention of blindness

Introduction of topics on eye care in school

curricula
Involvement of professional organizations such

as All India Ophthalmological society (AIOS) ,

eye bank association of India (EBAI),

Indian medical association (IMA) in the national

program for control of blindness.
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To strengthen the functioning of district

blindness control society.(DBCS)

To enhance involvement of NGOs , local

community societies and community

leaders.
To strengthen hospital retrieval programs

for eye donation through effective grief

counseling by involving volunteers,
forensic department, police etc.
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Cataract

 Cataract remains the single largest cause of

blindness,estimated figure of 19 million people

are blind because of cataract
 They are not generally amenable to prevention ,

but currently available surgery can restore near

normal vision.
 In global terms it is necessary to increase annual

cataract surgery rate from 7 million ( in the year

2000) to 20 million by 2010, and 32 million by

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2020.
 Ultimately as recommended by the WHO, the highest

possible cataract surgical coverage 85% of eyes should

have 6/18 vision postoperatively.
 Primary screening- health worker to identify persons with

visual impairment ( finger counting < 6m in any eye.

 Case selection by eye surgeon at screening camps. IOL

surgery for all by 2010.

 YAG capsulotomy services at all district hospitals by 2010

 Support for free cataract surgery to be continued for

bilateral cases, underserved poor people especially

women.
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Aim

- ‘vision 2020 ‘ is to eliminate avoidable

blindness due to cataract

- to decrease the number of cataract blinds

in the world from 19 million to zero by the
year 2020

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Strategy

Year Global cataract Global number

surgical rate of cataract
operation(millio
n)

2000 2000 12

2010 3000 20

2020 4000 32

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Emphasis
High success rates in terms of restored

vision and quality-of-life outcome.

Affordable and accessible services

Measures to overcome barriers and

increased use of services.

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Childhood blindness
There are 1.5 million blind children

estimated in the world of whom 1 million

live in Asia and 3 lakhs in Africa.
There are 5 lakh children going blind

each year one per minute also.

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Childhood blindness
Prevalence of childhood blindness in India

has been projected to 0.8/1000 children by

using correlation between under 5
mortality rate and prevalence.
Currently there are 270,000 children who

are blind in in India

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causes

Childhood blindness vary from place to place and

change over time.

 vit A deficiency

Measles

Conjunctivitis

Ophthalmia neonatorum

Congenital cataract

29 Retinopathy of prematurity
Strategies and activities
 Detection of early childhood disorders,
refractive errors, squint, amblyopia and
corneal diseases.
 At the time of primary immunization
 At school entry

 Periodic check up every 3 years for normal

and every year for those with defects

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Preventable childhood blindness

 Prevention of xerophthalmia, trachoma,

refractive errors, childhood glaucomas, harmful
traditional practices, prevention of ROP by
proper screening and monitoring use of oxygen
in premature new born.
Curable childhood blindness

 due to cataract ROP, corneal opacity and

other causes to be taken care of by experts at
secondary and tertiary levels.
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Aim : Is to eliminate avoidable causes of

childhood blindness by the year 2020

Strategies and activities:

1. Elimination of preventable blindness by

measles immunization

vit A supplementation

monitoring use of oxygen in the

premature new born
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Avoidance of harmful traditional practices

Promoting school screening programs

for diagnosis and management of refractive

errors and trachoma in endemic areas
 Promoting eye health education in schools

2. Management of surgically avoidable

causes of childhood blindness such as
cataract , glaucoma , ROP

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Trachoma
It is a leading cause of preventable

blindness
Estimated 5.9 million persons blind or at

immediate risk because of trichiasis.

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Safe strategy
 surgery to correct lid deformity

and preventable blindness

Antibiotics for acute infections

and community control

Facial hygiene

Environmental change

including improved access to

water and sanitation and health
education

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Refractive errors and low vision.

 Vision 2020 will strive to make refractive services and

corrective spectacles affordable and available to the

majority of the population through primary health care

facilities

 There are estimated to be 153 million people with visual

impairment due to uncorrected refractive errors with

VA <6/18 in the better eye excluding presbyopia.

 vision screening in schools

 low cost production of spectacles

 Similar strategies for low vision services.

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strategies
Screening to identify individuals with poor vision which

can be improved by spectacles.

Refraction services to be made available to individuals

identified with significant refractive errors.

Ensure optical services to provide affordable spectacles

for individuals with significant refractive errors.

Low vision services and low vision aids to be provided

for all those in need.

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Onchocerciasis
River blindness is known to be endemic in

37 countries.
An estimated 17 million people are

infected with onchocerciasis.

Approximately 0.3 million-0.6 million

people are blind from the disease.

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About 95% of infected persons reside in

Africa, where the disease is most severe

along the major disease is most severe
along the major rivers in 30 countries.
Outside Africa the disease occurs in

Mexico, Guatemala, Ecuador, Columbia,

Venezula and brazil in the America, and in
Yemen in Asia.
Aim is to eliminate blindness due to
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onchocerciasis by the year 2020.
Target is to develop national onchocerciasis

control program with satisfactory coverage in all

the 37 countries where disease is endemic.

Strategy:
 Is to introduce community directed treatment

with annual doses of Mectizan ( ivermectin) .

 The disease in expected to be brought under

control by the year 2010, if present efforts in

endemic countries are successfully implemented.

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Glaucoma

WHO has estimated that 4.5 million are blind

due to glaucoma.
Published projections indicate that 4.5 million

people will be blind due to open angle glaucoma

3.9 million due to primary angle closure

glaucoma
2010 ( 44.7 million people with open angle and

15.7 with angle closure)

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Diabetic retinopathy
All known diabetes to be examined by

ophthalmologist.
Confirmation of diagnosis at tertiary level FFA

Treatment at tertiary level: laser treatment

Ensure that all ophthalmologist become familiar

with the use of indirect ophthalmoscope and lasers

for the diagnosis and treatment of DR to bring
down medical management of DR to secondary
level.
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Corneal blindness
A significant number of cases of visual

impairment and gross degree of loss of vision

occur due to disease of the cornea.
 There are about I million corneal blinds in India.

 Majority of these persons are affected in the

first and second decade of life.

 The major causes are corneal ulcers due to

infections trachoma, ocular injuries and

keratomalacia caused by nutritional deficiency .
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Objectives
 to reduce prevalence of preventable and

curable corneal blindness

To identify the infants at risk in cooperation

with RCH program

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Strategies
 Eye infections will reduce by health

education and improvement in personal

hygiene.
Eye injuries like ocular trauma should be

immediately referred to specialist for

effective management.
In India corneal blindness due to trachoma

is declined.
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Prevention of xerophthalmia will make a strong

dent in the number of corneal blinds

Industrial workers should be given goggles and

eye shades
There is a need of 1 lakh corneas per year for

transplantation to clear the backlog of corneal

blindness. Currently we are collecting 25000
per year.
More eye banks by government

 voluntary eye donations should be enhanced

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Human resources development

 ophthalmic nurses, technicians,

optometrists.
 community based mid level

ophthalmic personnel ( primary

eye care workers and
ophthalmic assistants)
 UG teaching refraction should

be taught.
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Eye care infrastructure
A flagship program of

IAPB and WHO

 Human resource

development as well
as infrastructure and
technology
development at
various levels of
health system.
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Primary : vision centre 20000
Refraction and prescription of glasses

Primary eye care

School eye screening program

Secondary : service centre 2000

Cataract surgery

Other common eye surgeries

Facilities for refraction

49Referral services
Tertiary : Training for 200
 Tertiary eye care including retinal surgery, corneal

transplantation, glaucoma surgery etc.

 Training and continued medical education

Centre of excellence 20
 Professional leadership

 Strategy development

 Continued medical education

 Laying of standards and quality assurance

 Research
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WORLD SIGHT DAY(WSD)
 World Sight Day (WSD) is an annual day of

awareness held on the second Thursday

of October, to focus global attention on
blindness and vision impairment.
 On World Sight Day, VISION 2020

members work together to:

 Raise public awareness of blindness

 Influence Governments/Ministers of

Health in developing countries

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 Educate target audiences
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 World Sight Day 2008 (WSD08) focuses on the

ageing eye, and vision impairment in older

people.
 The headline ”Eyes on the Future-fighting

vision impairment in later life” recognizes

that in a world where populations are aging,
and individuals are living longer, blindness
from chronic conditions is also rising.
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Targets of vision 2020
By 2011, established at least six global resource

centre.
Assess geographical needs and identify locations for

an additional 15 regional resource centre

In each country national vision 2020 plan, identify at

least one collaborating resource centre and one

training centre

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The right to sight today

Thanks to vision 2020 advocacy , all 193

WHO member states are formally

committed to investing in eye care.

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summary
 WHO blindness definition
best corrected visual acuity less than 3/60 or visual
field less than 10 degree in better eye.

Disease included for consideration under vision 2020

 Cataract

 Childhood blindness

 refractive errors and low vision

 corneal blindness

 diabetic retinopathy

 Glaucoma

 trachoma
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References
Parsons’ Diseases of the Eye. 21st ed.

Elsevier publishers;2011:393-5.
AK Khurana.2nd ed.Elsevier

publishers;2012:210-216.
Park K. Parks Textbook of preventive and

social medicine. Bhanot; 2013:401-410.

Thank you

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