Allied Health Professions: New policies and strategies addressing the global burden of eye diseases

Prof Rupert Bourne

ARU research on global changes in the burden, causes, and risk factors of eye disease over time has helped reduce the risk of preventable blindness and vision impairment for millions of people around the world.

The findings of Prof Bourne, from the Vision and Eye Research Institute (VERI), and national and international collaborators from the Vision Loss Expert Group (VLEG) have raised awareness of the prevalence of eye diseases globally.

As a result, international organisations and charities, and national governments have made eye health policies and/or investment decisions.

Headshot of Rupert Bourne. He has short, light brown hair and is wearing a dark blue suit jacket, white shirt, and light blue tie.

Prof Rupert Bourne

Rupert is Professor of Ophthalmology at ARU. He is also a Consultant Ophthalmic Surgeon at Cambridge University Hospitals and Director of Cambridge Eye Research Centre.

Find out more about Prof Rupert Bourne Explore ARU researchers' original work via our open access repository, ARRO

Research summary

The WHO has estimated that globally at least 2.2 billion people have vision impairment or blindness, causing a great deal of unnecessary suffering.

Prior to this research, however, there was a lack of comprehensive data on the burden of eye diseases, making it impossible to draw comparisons between countries and plan and allocate resources effectively.

Prof Bourne leads the VLEG, a global network of ophthalmic epidemiologists which was established in 2007. It advises and supports the Global Burden of Disease Study (GBED), and was developed to improve estimates for blindness and vision impairment worldwide.

Fifteen years on, the International Agency for the Prevention of Blindness (IAPB) – the principal global lobby group of eye health – and the WHO consider the VLEG to have the most comprehensive data on global blindness and vision impairment.

The study has made it possible to compare data across countries, taking into account years lived with disability (YLDs) and disability-adjusted life years (DALYs). It has also led the way in analysing change over time in the causes of the burden of blindness and vision impairment, and captured important risk factors such as gender inequality.

The VLEG initially prepared global estimates of the burden of eye diseases for 2010 and 2015 by analysing 288 existing studies, covering 4 million participants from 98 countries. It then extended the study to 2019, drawing in additional sources of microdata and covering a wider range of causes, severities and conditions.

The study found that the overall prevalence of vision loss has decreased over the last 25 years. However, the actual number of people living with blindness and vision impairment has increased, and the majority of vision loss occurs in women.

Furthermore, future projections for the next 30 years indicate that that the number of people affected by vision loss will rise dramatically. This is due to the global rise in ageing populations.

The study also found that over 80% of the burden of vision impairment is avoidable or treatable, and a billion people worldwide are affected by near vision impairment (presbyopia). This is principally due to cataracts, with other eye conditions such as glaucoma, age-related macular degeneration, and diabetic retinopathy also having a significant impact.

Human eye seen sideways on

Summary of the impact

  • Raised awareness of the prevalence of eye diseases globally
  • Influenced eye-health policies and/or investment decisions by the WHO, UN, governments of Australia, Sierra Leone, Nigeria and the UK, and international charities
  • Informed protocol for large population-based surveys on eye health
  • Benefitted millions of individuals at risk of preventable eye diseases

Impact

Influencing eye health policy at the global level

In 2016, Prof Bourne worked with the IAPB to develop the Vision Atlas, an open access online tool containing VLEG data on global eye diseases. As of 30 December 2020, it had received 243,000 unique visitors and 314,000 page views since its creation.

The IAPB, which has representatives of governments and NGOs on its boards, has reported that the data held in the Atlas has helped its policymakers to successfully advocate for policy changes.

The IAPB has used VLEG data to develop advice and strategies on managing and eradicating reversible causes of global vision impairment such as myopia and cataracts. One such strategy, implemented by the IAPB and the WHO in 2017, measured the unmet need for cataract operations in certain countries by comparing the need for operations with the number of actual operations carried out.

The IAPB and the WHO also used VLEG data to gauge the success of the WHO’s Global Action Plan (2014–19) for Universal Eye Health. The data heavily informed the WHO Director-General’s Report, as well as the proposed resolution on integrated people centred eye care that was approved by the WHO Executive Board in February 2020.

The Fred Hollows Foundation - a non-profit aid organisation for the prevention of blindness and other vision problems, operating across 25 countries – has used VLEG data to influence global eye health policy at the UN.

The Pan American Health Organization, in collaboration with WHO, used VLEG data to generate its plan for action for the prevention of blindness and visual impairment in September 2020. The plan offers concrete actions to address priorities for the prevention of blindness and improved eye care for different countries of America.

About more about influencing eye health policy at the global level.

Shaping strategies and practice at country level

Investigators have used VLEG data to plan large population-based studies.

For example, it has informed the sample size for the Australian National Eye Health Survey (NEHS). The NEHS’s significant impact has influenced the Australian government to commit to funding a second countrywide survey, though the implementation of this has been delayed due to COVID-19.

VLEG research also highlighted the need for up-to-date comprehensive data on eye health in the UK. This led to the development of the protocol for the UK National Eye and Hearing Study (UKNEHS), for which Prof Bourne is Chief Investigator.

This has received support from multiple public sector stakeholders, including the Four Nations Committee for Public Health, the House of Lords, and the House of Commons. The UKNEHS will examine 25,000 participants from across the UK.

Shaping the strategies and practice of charities and NGOs

Vision Aid Overseas (VAO), a UK charity operating in Africa, has used VLEG data and the Vision Atlas to successfully advocate for universal eye care.

VAO has used the data in programme proposals and presentations to donors and partners, and invited Prof Bourne as a keynote speaker at a 2018 event in the House of Commons that made the case for improved access to affordable eye care in developing countries.

In 2021, Prof Bourne was awarded the Vision Excellence Award for contribution to the WHO/IAPB VISION2020 program.

Other major charities have also used the VLEG’s outputs to campaign for change. For example, Sightsavers has used the Vision Atlas to successfully influence Sierra Leone’s national health policy, and Nigeria’s first National Eye Health Policy.

VLEG data has also informed Sightsavers’ own organisational policies for improvements. Most notably, in light of the VLEG’s finding that the majority of vision loss occurs in women, Sightsavers has disaggregated its data by gender in order to reach more women with eye health services.

The SEVA Foundation - an international NGO working in more than 20 countries – responded to the VLEG’s findings on the unmet need for cataract operations with a plan to fund an additional million surgeries in developing countries each year through its Global Sight Initiative.

About more about shaping the strategies and practice of charities and ngos.

United Nations Sustainable Development Goals

We have mapped our REF 2021 impact case studies against the United Nations' Sustainable Development Goals (SDGs).

The 17 SDGs, adopted by all UN Member States in 2015, are an urgent call for action. They recognise that ending poverty and other deprivations must go hand-in-hand with strategies that improve health and education, reduce inequality, and spur economic growth – all while tackling climate change and working to preserve our oceans and forests.

This case study is mapped to SDG 17: Strengthen the means of implementation and revitalize the global partnership for sustainable development, target 17.6.

See also

Read the full REF 2021 impact case study for UoA 03: New policies and strategies addressing the global burden of eye diseases (PDF)

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