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A Research Agenda for Global Blindness Prevention |
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The global initiative known as ‘VISION 2020: the Right to Sight’ .The goal is eliminating avoidable blindness by the year 2020. ‘Blindness’ is defined as visual acuity of less than 3/60, or a corresponding visual field loss to less than 10, in the better eye with the best possible correction.‘Low vision’ is defined as visual acuity of less than 6/18 but equal to or better than 3/60, or a corresponding visual field loss to less than 20, in the better eye with the best possible correction. ‘Visual impairment’ includes both low vision and blindness |
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Global causes of blindness due to eye diseases and uncorrected refractive errors |
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Vision research to support Vision 20/20 and Vision for the Future |
Prevention:
cataractogenesis requires innovative epidemiologic studies seeking factors that
increase the risk of disease (short- to medium-term) and mechanistic studies of
lens biology (medium- to long-term).
Cataract Surgery:
Compare the cost-benefit of cataract surgery performed at different levels ofvisual acuity (adjusted for visual demands).Assess factors that determine local indications for cataract surgery, and theirappropriateness
Identify resources and incentives required to motivate/train existing cataract
surgical manpower to better meet quality standards and higher surgical volumes
Evaluate cataract surgical rate (cataract operations per million population per year).
2. Trachoma
Trichiasis Surgery(Research issues)
Improving surgical outcome of trichiasis surgery. At present, the relapse
rate, even for well-trained ophthalmic surgeons, is high. Identify factors that influence the recurrence of trichiasis following seemingly successful lid surgery? Develop improved surgical approaches (by employing the latest plastic surgery techniques), and test these in clinical trials.
Identify barriers to surgical uptake and ways to reduce cost and
increase access (e.g., minimal equipment and supplies; efficient and
effectives procedures and the training of lid surgeons; ways to increase
demand/compliance).
4. Xerophthalmia
control micronutrient malnutrition
UNICEF estimates these reach 80% of their target childhood populations in over 40 countries.
Develop better tools for population assessment of vitamin A status and the impact of Vit A deficiency on ocular structures and ocular immune system.
5. The Glaucomas
Research Opportunities (for various yype of glaucoma)
population-based intervention: screening techniques are needed that identify subgroups at particularly high risk of disease (genetic markers?) Epidemiologic studies may identify environmental/behavioral factors that contribute to (seemingly) societal variations in risk
Simplified and sensitive measures of progression of optic nerve damage would dramatically improve the ability to test alternative interventions and improve the benefits of intervention/management
New and novel treatment approaches, particularly neuroprotection (beyond medical and surgical approaches targeting IOP), would offer new options for control of blinding disease
6. Diabetic Retinopathy
Diabetic retinopathy is a rapidly growing problem. global epidemic of obesity is fueling a dramatic increase in the incidence of NIDDM.
Operations research may targeted to those at high risk because of genetic or nutritional factors.
Documenting population variations in risk of DRP may help elucidate genetic and environmental markers/pathogenetic mechanisms
The nature of angiogenesis and its relation to antioxidant intake may better be studied in micronutrient poor populations
Better tools are needed for defining risk, early disease, and tracking progression
7.Age-Related Macular Degeneration
The number affected is expected to double by the year 2020 as a result of the ageing of the world’s population
Aim: to prevent and reduce vision loss from age-related macular degeneration and improve functioning vision and quality of life of persons with functional low vision
Operations Research:
Effectiveness of different treatment methods
Epidemiologic Risk Profile:
Documenting population variations in risk
Environmental markers/pathogenetic mechanisms
Basic Biologic Research :
Genetic markers/pathogenetic mechanisms
Transplantation of retinal pigment epithelial and neural retinal cells
Drug delivery systems
8. Refractive Error
Refractive error is the most common ocular abnormality The two major refractive disorders impacting on employment and quality of life are myopia and presbyopia (aside from surgical aphakia).
Research Opportunities
Enroll high risk populations into epidemiologic studies and randomized clinical trials seeking environmental/behavioral etiologic factors and effective strategies for reducing the incidence/progression of refractive error
Investigate the value of social marketing of refraction/spectacles
Identify the origins of myopia
Investigate alternative interventions for reducing the incidence/progression of refractive error
Low vision is currently defined as ‘visual acuity of < 6/18 down to and including 3/60 in
The better eye’, from all causes. Enhance vision-related quality of life for people with functional low vision
9. Childhood blindness
Childrens’ eyes cannot, however, be considered smaller versions of adults’ eyes, and specific expertise and equipment are required
Unlike adults, children require longterm follow-up after surgery, to manage complications and to prevent amblyopia
The causes of the main avoidable childhood blindness are:
Corneal scarring
Cong cataract
Cong glaucoma
Retinopathy of prematurity
Refractive errors and low vision, which encompasses visual impairment and blindness from untreatable causes
10.Human resource development
Human resource development is the second component of the strategy for eliminating avoidable blindnessby 2020
The goal is to have in place a sustainable, equitable, comprehensive eye-care system
as an integral part of national health systems
Aim: to have in place an appropriately trained, functional, multidisciplinary workforce, that will focus on the coverage, quality and sustainability of eye health services
Train ophthalmologists in the required sub-specialities
11.Technology
Ensure an optimal supply of appropriate, high-quality, affordable equipment, instruments, consumables and resource materials essential for the delivery of eye-care services
Monitor new products to determine their suitability
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