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MODULE 1 – Why Eye Care Is Important

Decreased Quality of Life

Blindness and poor vision have a tremendous impact on quality of life, particularly for those living in poverty. The blind are heavily affected economically, as 90 percent of blind individuals cannot work.(1) Culturally, there are often negative stigmas associated with blindness, further alienating the afflicted from their communities.(2) Social disadvantages are also significant. Half of the blind people in impoverished countries report a loss of social standing and decision-making authority, and 80 percent of all women note a loss of authority within their families.(3) The social fabric of a community is also affected on a more practical level, as children become caretakers for blind adults, which prevents them from attending school. The impact of blindness on a family should not be underestimated:

“The physical and emotional toll impacts not just the individual and family but the social and economic fabric of the communities and everyone’s existence. Sudden blindness of one individual in a family can become the tipping point for survival when they are impoverished to begin with.”(4)

For these reasons and more, blindness is the most feared affliction after death and cancer.(5)

It is easy to mistakenly assume that the misfortune of the blind is confined to them and their families. Particularly in community-oriented cultures such as those found in the developing world, the ramifications of one person’s blindness are felt by the community at large. Ghanaian Ophthalmologist Dr. Seth Wanye explains:

“When we talk about healthcare needs in the government sector, it is all about killer diseases. The government's attention is on these diseases that actually cause immediate death. It is assumed that eye diseases do not kill, resulting in resources being channeled to other areas of healthcare. However, I have a different opinion. If you have someone who is blind, then someone else will have to forgo his or her activities in order to take care of this person. Oftentimes, you have a child who is supposed to go to school, but he is instead guiding a blind man around the house and directing him wherever he wants to go. This child could have gone to school, study, and become somebody in the future to help the family.

We often see very young people who are blind, many times younger than the age of 40. They become blind during their productive years; they could have been working and helping to contribute towards building wealth in the country. Instead, the blindness results in a financial loss to the nation because these people are not able to contribute to building the nation. We have therefore been trying to advocate to policy makers so that they understand that even though eye diseases do not kill, they do result in financial losses to the nation. We must see this as an emergency issue. I see eye care as a very important area, and I love to do what I am doing now, to try to help people who I think would benefit from the services that we provide.”(6)

 Increased Mortality

Although it is not typically recognized as a “killer disease,” blindness does in fact lead to increased mortality. Poverty and blindness are inextricably linked, and the blind are thus faced with the well-documented mortality risks associated with living below the poverty line. “To be poor sentences people to unfair, life-threatening challenges… Sadly, disability is both caused by poverty and causes poverty. Gooding, in an excellent review on poverty and its consequences, noted that although some individuals became disabled because of low income, a staggering 64 percent of those with disabilities were not in poverty prior to onset of the disability. Households affected by disability and which were not initially impoverished had three times the probability of entering income poverty within one year of onset of disability compared with unaffected households.”(7) Conversely, poverty can be the fundamental cause of some blinding eye diseases such as trachoma:  “People who do not live in poverty do not get trachoma.”(8)

Blindness has been linked directly to increased mortality as well.(9) Shockingly, “ the life expectancy of blind persons is one-third less than that of their sighted peers, and most of them die within 10 years of becoming blind. Two-thirds of the region’s 10 million blind persons, who have cataract, die without their sight being restored."(10) The data is even more discouraging for children affected by blindness:

“Poverty and blindness is a tragic, even lethal, combination. Gooding points out that a widely quoted but difficult to trace figure is that 50 to 60 per cent of children die within one to two years of becoming blind, largely from associated diseases, for example, measles, but also from neglect. She reports that longevity also suffers: the poor and blind in Africa have been found to live 15 to 20 years less than those who are only poor; while a study in Tanzania showed rates of mortality begin to increase when vision is worse than [20/20] and rise eight-fold in the group with worst vision.”(11)

The Feasibility of Successful Treatment

Preventable blindness is not a problem without a solution. In fact, the vast majority of visually impaired people throughout the developing world are suffering without reason. Eye infections that lead to blindness can usually be treated easily with antibiotic eye drops and ointments. Because such eye infections require immediate attention, eye care must always be accessible. For those already suffering from blindness, simple and lasting cures are often available. For many patients with cataracts and other visual impairments, vision correction surgeries are among the most cost-effective and highly successful medical interventions.

“In 1993, the World Bank reported cataract surgery as one of the most cost-effective health interventions in terms of cost per DALY [disability-adjusted life-years].* Cataract extraction in the developing world is an extremely cost-effective intervention, costing as little as US $5 per DALY in Nepal and 57 International dollars in Southeast Asia. In developed countries, such as the United States and Canada, where mortality rates are low and the cost of cataract surgery is high, the cost rises to approximately 800 International dollars per DALY. The DALY methodology may actually underestimate the economic and quality of life impact of cataract, as it does not account for the financial and social support provided by relatives and community members to visually impaired individuals.”(12)

“Eye care interventions are amongst the most cost-effective of all health care interventions, in terms of reducing the number of years people would otherwise have lived with a disability (this is quantified as disability-adjusted life-years or DALYs).  Economic arguments such as these are what governments and finance departments understand. For example, one can show that for each US dollar spent on eye care, there is a US $5 return to the community. Such an objective financial argument carries more weight than an emotional call for action to stop people losing their sight.”(13)

*Cost per DALY may be measured in US or International dollars. One International dollar is equivalent to the purchasing power of 1 US dollar within the United States at any one time, and allows a more accurate comparison of actual costs between countries.

Go To Module 2: Patient Barriers To Eye Care >>

Footnotes

Community Eye Health Online Course

• Table of Contents
• Module 1
• Module 2
• Module 3
• Module 4
• Module 5
• Module 6
• Module 7
• Module 8
• Module 9
• Module 10
• Module 11
• Module 12
• Module 13
• Guidelines For Evaluating Eye Care Work