WHO in anction: most blindness is preventable

30 World Health • 47th Year, No.5, September-october 1994 WHO in a1tion Most blindness is preventable Young blind men making tea in Bangladesh. M ore than 35 million people worldwide are classed as "blind", and it has been gloomily predicted that- as demo- graphic growth outstrips the ability of health services to cope with blind- ing diseases- this number could double in 25 years. In every area of the world, someone becomes blind each day; yet some 80% of all vision loss is either preventable or curable. The most common causes are: • cataract (clouding of the lens of the eye); • trachoma (contagious infection, marked by scar formation and granulation within the eye); • xerophthalmia (vitamin A defi- ciency blindness, primarily found in children); • onchocerciasis (river blindness, a parasite transmitted by blackfly bites); • glaucoma (pressure within the eye which, if untreated, leads to blindness); • diabetic retinopathy (a complica- tion of diabetes); • physical injuries. Onchocerciasis is the target of a massive control programme in West Africa which began in 1974 and celebrated its twentieth anniversary this year. With WHO as the execut- ing agency in collaboration with several other UN agencies, the con- trol programme - through spraying of the vector blackflies breeding in West African rivers - has succeeded in almost eliminating the infection reservoir from the human population. As a result, communities which have settled in fertile lands beside the rivers are no longer at risk of onchocerciasis. Twenty million people are now safeguarded against the threat of blindness in West Africa. Since 1987, a new drug, iver- mectin, which is suitable for mass treatment, has been given out free by the manufacturer, Merck & Co. Inc. This drug has made it possible to treat many more millions of people in other African countries who have onchocerciasis and risk going blind. Over three million people in thirteen out of sixteen African countries have received treatment in 1994 with this drug, which is taken once a year. A group of nongovernmental develop- ment organizations, working closely with WHO, is assisting these coun- tries in setting up treatment pro- grammes, which need to be expanded urgently since so far only 20% of over 17.5 million people worldwide infected with onchocerciasis have been reached. Trachoma, provided it is diag- nosed in time, can easily be treated by applying eye ointment; the great problem is precisely in case-finding among widely scattered populations living in dusty areas of the world, and then treating each individual. The same difficulty arises in making vitamin A tablets available to remote communities - one tablet will protect a child from xerophthalmia for six months. Cataract can be removed in a comparatively simple operation, and many thousands have visited eye-camps in different countries where this operation is carried out in mass campaigns; the patient walks away, with the operated eye ban- daged, without needing to make an expensive stay in a hospital. WHO is playing a significant role in all these activities through its Programme for the Prevention of Blindness. Epidemiological data on eye diseases are collected in coun- tries in which urgent action is needed, and where there are good opportunities for disease control. WHO is also assisting countries in the planning of national programmes for the prevention of blindness; there is close collaboration with a network of international nongovernmental organizations supporting countries in need. The International Agency for the Prevention of Blindness coordi- nates much of the work between those nongovernmental organiza- tions; it works closely with the WHO Programme through a particular Consultative Group for joint project developments. Nevertheless, there is a chronic shortage of funds worldwide for dealing with all the causes of blind- ness, and the nongovernmental and charitable organizations play an important role in raising cash for this purpose. One example is Lions Clubs International, which in 1990 launched its global programme "SightFirst" with the target of raising US$ 130 million by the end of 1994; this target was reached early this year, and the final total will be more than US$ 150 million. SightFirst, which operates in collaboration with WHO, draws on the fundraising abilities and experi- ence of the 1.4 million members of Lions Clubs around the world. Besides training personnel in eye health management, it is using the mass media to educate the public in eye care awareness. A similar ap- proach forms part of a large project for strengthening the national blind- ness prevention programme in India, emphasizing community awareness and access to cataract surgery; that project is being supported through the World Bank to the amount of some US$ 120 million. It is hoped that these particular efforts, together with all other projects and develop- ments by national and international organizations and agencies, will provide at least the basic resources needed for effective blindness pre- vention up to the year 2000. •