“The eyes are the window to the soul.” This is a proverb often used that means that our eyes can be used to communicate deep emotions. The importance of people’s eyes and therefore eye health cannot be understated. Eyes are critical because they enable us to carry out and be productive in our daily responsibilities. The effect of poor eyesight or blindness can have a devastating impact on a family and pose an economic burden on the wider society. Ophthalmologists, the front-line medical doctors and eye surgeons caring for our eyes, have a large responsibility to maintain eye health.
Unfortunately, blindness and visual impairment in developing countries has remained a significant public health issue. According to the WHO Magnitude of Blindness and Visual Impairment Report (2002), childhood blindness remains a significant problem, with an estimated 1.4 million blind children below the age of 15. A 2007 Clinical and Epidemiologic Research on the Prevalence of Blindness and Visual Impairment in Nigeria, found that approximately 1.13 million Nigerians 40 years and above are blind. A further 2.7 million adults 40 years and above are estimated to have moderate visual impairment and an additional 400,000 adults are severely visually impaired. Research has also shown that cataract is the most common cause of blindness in Nigeria, and blindness imposes a substantial economic burden worldwide. As the population ages, even if the rate of age-specific blindness remains constant, the overall number of people blind or visually impaired will continue to increase. The result of this is that the burden of blindness will become a significant challenge in Nigeria, with economic consequences, as the individual’s productivity ultimately affects the nation.
The effects of poor eye health are aggravated because of poor access to affordable eye care and the lack of integrated eye care services. While emphasis has been placed on the need to address blindness and visual impairment in Nigeria, adequate action to support the drive remains to be seen. This has continued to be a source of concern for eye care professionals, international non-governmental development organisations, and other eye care workers. These were the sentiments echoed at the 43rd Annual General Meeting and Workshop of the Ophthalmological Society of Nigeria (OSN), held in Abuja in September 2018 with the theme, “Advancing Eye Care Beyond 2020: Recent advances in eye care”.
The 2006 population census of the Federal Republic of Nigeria revealed that there were approximately 500 ophthalmologists practicing in Nigeria with a population of 140 million. Research in 2012 on the practice of Nigerian ophthalmologists revealed that most ophthalmologists are based in tertiary eye health institutions, which are over-burdened with eye conditions that could have been appropriately addressed at the primary and secondary health care facilities if proper eye care resources were available. Apart from rendering clinical care, these ophthalmologists are routinely expected to teach, render diverse community services, and conduct research. Data on the prevalence, magnitude, and causes of blindness and severe visual impairment in vision-impaired persons is also needed for planning and evaluating preventive and curative services for such people.
Given the limited capacity for conducting eye research in many developing countries, the WHO noted that other fields that are developing robust national research systems such as HIV/AIDS, malaria, and tuberculosis should be utilized where appropriate, to develop and foster ophthalmic research. As noted during the 43rd OSN scientific conference, it is not all doom and gloom. Routine appraisals of ophthalmic research elsewhere, have been beneficial in gaining insights into the various challenges and prospects for the future of ophthalmic research in the region. Particularly relevant were the insights from Asia, where the burden of blinding eye diseases rivals that of Nigeria and appears to be stunting the development of ophthalmic research. Specialists who spoke at the conference opined that a conservative estimate of the global burden of blindness has shown that more than $100 billion in lost productivity could be avoided if interventions promoted by Vision 2020 was as successful as hoped. This figure would represent a relative substantial gain to sub-Saharan African economies.
‘Vision 2020’ has been described as Nigeria’s long-awaited panacea to blindness and visual impairment, founded on the World Health Organisation (WHO) and International Agency for Prevention of Blindness (IAPB). The vision seeks to eliminate avoidable blindness by creating awareness, increasing resources for eye care, and facilitating improvements in national eye care services.
The 43rd Annual General Meeting and Scientific Conference was however looking beyond 2020 to push for a Nigeria where everyone has a right to 20/20 vision. The conference presented a crucial platform to share experiences, best practices and new innovations in eye care, with the aim of improving the delivery of eye care services in Nigeria. Each year, in advance of the conference, a pre-congress eye camp is organised. This year, 94 cataract surgeries were carried out at Kubwa General Hospital and 143 cataract surgeries were carried out at the University of Abuja Teaching Hospital, Gwagwalada. Sight Savers International donated the consumables for the voluntary outreach.
At the opening ceremony, Vice President, Yemi Osinbajo represented by the Minister of State for Health, Dr Osagie Ehanire pledged the commitment of the Federal Government to scale up the implementation of Vision 2020 ‘Right to Sight’ to ensure universal access to healthy eyesight. He added that the project was aimed at ensuring that every citizen had a right to sight without financial hindrance by 2020. He stated that the government efforts were geared toward scaling up the implementation of Vision 2020, as improved access to eye health would be through the expansion of Universal Health Coverage.
The Minister of State for Health raised his concerns about the challenges in eye health in the country but disclosed that the government had procured modern machines for Phaco-emulsification surgery for the National Eye Centre, Kaduna, and other tertiary hospitals. According to him, these measures were aimed at upgrading the quality of eye care and scaling up the turnover of surgical interventions in the country, as well as helping to reduce the burden of cataracts in the country.
Dr Bade Ogundipe, OSN President, said the ‘Vision 2020 Right to Sight’ was to ensure that everyone had access to promotive, preventive, curative and rehabilitative eye healthcare at sufficient quality without suffering financial hardship. Ogundipe noted that the goal of the OSN was to attain a ‘Nigeria where nobody goes needlessly blind’. It is worthy to note that the Gambian Eye Care program (GECP) demonstrated a decrease in the prevalence of blindness from 0.70% to 0.42% between 1986 and 1996. The prevalence in 1986 was similar to the global prevalence of blindness. Although the prevalence in 1996 was somewhat higher than the levels anticipated from sub-Saharan Africa after Vision 2020 (0.33%), this was achieved after only eleven (11) years of implementation.
The goals of Vision 2020 and the government’s expressed commitment to meeting them are commendable. There has been a push to include eye health in the National Strategic Health Development Plan and significant progress has been made in this area with the process of developing a national eye health policy. However, beyond Vision 2020, there is need to strengthen eye care services via improving quality and equity of eye health services. It is critical for investments in eye health to be increased, and primary eye care should be included as part of the basic package of health services if we are to effectively tackle this challenge. It is essential that all Nigerians have access to good eye care, especially vulnerable populations and the elderly, if we are to become a nation with a healthy and productive people.