VISION 2020: THE RIGHT TO SIGHT

I. INTRODUCTION

II. MAGNITUDE OF THE PROBLEM

• Globally, approximately 285 million people were visually impaired (at the time of launch)
• Of these, 39 million were blind and 246 million had low vision
• 80% of all blindness is avoidable (preventable or treatable)
• India alone accounts for nearly ~20% of global blindness burden (approximately 12 million blind)
• Developing nations bear 90% of the global burden

III. DEFINITION — BLINDNESS (WHO Criteria)

IV. GOALS OF VISION 2020

1. Eliminate avoidable blindness by year 2020
2. Develop sustainable, comprehensive eye care services
3. Build national capacity for eye care delivery
4. Reduce global blindness by 50% from 1990 levels (from 45 million to 22.5 million)
5. Ensure equitable eye care access — especially in developing countries

V. PRIORITY DISEASES TARGETED BY VISION 2020

1. Cataract (~47% of global blindness)

• Leading cause in developing countries including India
• Intervention: Cataract surgery with IOL implantation
• Target: Increase cataract surgical rate (CSR)
• India target CSR: >4000 per million population per year

2. Refractive Errors (~18%)

• Often uncorrected, especially in school-age children
• Intervention: Refraction services, affordable spectacle provision
• School eye health programmes, vision screening camps

3. Glaucoma (~12%)

• Causes irreversible but preventable blindness
• Intervention: Screening, early diagnosis, IOP reduction (medical/surgical)
• Focus on primary open-angle glaucoma (POAG) screening

4. Trachoma (~11%)

• Leading infectious cause of blindness
• WHO SAFE strategy:
  • S — Surgery (trichiasis correction)
  • A — Antibiotics (Azithromycin)
  • F — Facial cleanliness
  • E — Environmental improvement (sanitation, clean water)

5. Onchocerciasis (River Blindness) (~4%)

• Mainly sub-Saharan Africa
• Intervention: Mass drug administration with Ivermectin
• Vector control: Simulium blackfly elimination

In India specifically, diabetic retinopathy, corneal blindness, and childhood blindness are additional priority areas beyond the original 5.

VI. THREE CORE STRATEGIES OF VISION 2020

1. Disease Control

• Targeting above priority conditions with cost-effective interventions

2. Human Resource Development

• Training ophthalmologists, ophthalmic assistants, community health workers
• India target: 1 ophthalmologist per 50,000 population
• Mid-level ophthalmic personnel (MLOP) training

3. Infrastructure Development

• Upgrading district-level hospitals with eye care units
• Providing essential equipment, consumables, and medications
• Outreach services and community eye camps

VII. VISION 2020: INDIA (National Programme for Control of Blindness — NPCB)

• India launched its own National Programme for Control of Blindness (NPCB) in 1976 (later renamed NPCB & VI — Visual Impairment in 2017)
• Integrated with Vision 2020 framework
• Five-year plans target:
  • Cataract surgery (main thrust — backlog clearance)
  • School eye health
  • Low vision services
  • Diabetic retinopathy screening
  • Corneal transplantation programme
• Funding: Central sector scheme — 100% centrally funded
• District-level implementation through District Blindness Control Societies (DBCS)
• Mobile ophthalmic units for rural outreach

VIII. KEY COMPONENTS — "VISION 2020" FRAMEWORK

IX. ACHIEVEMENTS AND PROGRESS

• Global blindness prevalence reduced by 20% between 1990–2010 despite population growth
• India's CSR increased from ~1500 (1990s) to >6000 per million (by 2018–19)
• Trachoma eliminated from India (2017 — certified by WHO)
• Onchocerciasis near elimination in Africa
• Increased availability of low-cost IOLs and cataract surgical kits globally

X. CHALLENGES AND SHORTCOMINGS

1. Backlog of untreated cataract despite high CSR — poor quality of surgery and poor uptake due to:
   • Fear of surgery
   • Lack of awareness
   • Financial constraints
2. Unequal distribution of ophthalmologists (urban vs. rural disparity)
3. Emerging causes not adequately addressed: Diabetic Retinopathy, AMD, Glaucoma
4. Vision 2020 goal was not fully achieved by 2020 — global blindness figures still high
5. COVID-19 pandemic severely disrupted eye care delivery services globally

XI. POST-2020: "WORLD REPORT ON VISION" (WHO 2019)

• 2.2 billion people globally with vision impairment
• 1 billion have impairment that could have been prevented or has not yet been addressed
• New priorities: Myopia epidemic, aging populations, diabetic retinopathy
• "Universal Eye Health Coverage" — new framework replacing Vision 2020
• Goal: Integrate eye care into universal health coverage (UHC)

XII. ROLE OF OPHTHALMOLOGIST IN VISION 2020

1. Providing high-quality cataract surgery with good visual outcomes
2. Conducting outreach camps in underserved areas
3. Training paramedical eye care personnel
4. Participating in school vision screening programmes
5. Advocacy and community awareness generation
6. Telemedicine-based diabetic retinopathy screening
7. Contributing to national eye health data collection

XIII. SUMMARY TABLE

XIV. CONCLUSION

Key Examination Tips for PDU Medical College, Rajkot:

• Examiners typically expect: Definition → Magnitude → Goals → Priority diseases (with details) → SAFE strategy for trachoma → India's NPCB → Achievements → Challenges → Conclusion
• CSR target for India (>4000/million) is a frequently asked numerical fact
• The SAFE strategy is a high-yield short note within this topic
• Mention trachoma elimination from India in 2017 — this is a recent important fact
• Differentiate economic vs. social blindness criteria used in India