EyeWorld Asia-Pacific December 2016 Issue

December 2016 66 EWAP NEWS & OPINION participants to become familiar with the Universal Eye Health GAP and most importantly to establish partnerships and form national committees for GAP implementation,” Dr. Németh said. GAP investigators used Rapid Assessment of Avoidable Blindness (RAAB) with diabetic retinopathy (DR) module surveys on the regional level, a rapid population- based survey of blindness, visual impairment, diabetic eye complications, and eyecare services among people aged 50 years and older, to acquire reliable European epidemiological data. The survey provides information on the prevalence of blindness and visual impairment, main causes, output and quality of eyecare services, barriers, cataract surgical coverage, and other indicators of eyecare services in a specific geographical area. The survey was completed in the Republic of Moldova and in Hungary. According to the results of the RAAB+DR in the Republic of Moldova, the prevalence of blindness was 1.4%. The major causes of blindness and severe visual impairment were: untreated cataract (58.2%), glaucoma (10.9%), and other posterior segment diseases (10.9%). 2 “The RAAB+DR survey in the Republic of Moldova established that untreated cataract is the major cause of avoidable blindness in rural areas. This needs to be tackled by expanding the geographic coverage of cataract surgical services,” Dr. Németh said. In Hungary, the survey involved 3,523 screenings of people aged 50 years and older in 105 districts around the country, and was completed in July 2015. The study was supported by the Lions Club International Foundation (LCIF) SightFirst research grant. Dr. Németh explained, “The Hungarian implementation involved 5 days of training carried out at the Department of Ophthalmology in Budapest. There were five survey teams, each including an ophthalmologist, an ophthalmic assistant for surveys, records, and visual acuity exams, a nurse who was responsible for blood sugar testing, a health worker for connecting participants with the teams, and a driver. The random selection of examination sites was performed by the Hungarian Central Statistical Office. The teams were issued standardized survey forms and used portable instruments to measure visual acuity, blood sugar, and for direct and indirect ophthalmoscope examinations.” The prevalence of blindness in Hungary was 0.9%, and the major causes of blindness were: AMD (27.3%), other posterior segment diseases (27.3%), untreated cataract (21.2%), glaucoma (12.1%), and diabetic retinopathy (6.1%). The major cause of severe visual impairment (SVI) and moderate visual impairment (MVI) was untreated cataract (SVI: 35.3%, MVI: 49.7%). The study showed that the causes of blindness and visual impairment were more frequent with advancing age. “Our investigation revealed that 45% of bilateral blindness is avoidable, meaning it is either preventable or treatable. However, 55% of people with blindness need vision rehabilitation. The Hungarian RAAB study showed that the prevalence of blindness was lower (0.9%) than earlier WHO estimates (2.5%). Visual rehabilitation must be offered to the high percentage of individuals with visual impairment, numbering 33,000 blind people and 218,000 people with low vision. Hungary’s high prevalence of avoidable blindness highlights the importance of establishing nationwide screening programs and telemedical screening systems,” Dr. Németh said. Funding LCIF provides funds to support public health research initiatives that evaluate and directly influence the operation of the SightFirst program, which is LCIF’s premier initiative to strengthen eyecare systems in underserved communities. SightFirst research grants of up to US$100,000 are available to support projects that investigate: (1) innovative approaches to reduce blindness from cataract; (2) innovative approaches to reduce blindness from trachoma; (3) innovative approaches to reduce and correct refractive errors in school-age children; or (4) epidemiological surveys in geographical areas where there is no recent data available or where repeated surveys may inform existing trends. “The Lions Ophthalmology Educational Center in Prague, an institution that serves many European countries through the provision of educational programs to eyecare professionals, public health research, and monitoring of eyecare services, offers a diabetic retinopathy teaching course, which is partially supported by IAPB. The implementation of DR telemedical screening programs and laser therapy is a highly recommended way of decreasing the prevalence of DR-related visual impairment,” Dr. Németh said. The next focus of IAPB-Europe is retinopathy of prematurity (ROP), for which it seeks to establish European national ROP screening programs and provide fundus laser therapy and workshops, which have already started. “For all of these tasks, joint forces are needed in European countries that include ophthalmologists from ophthalmologic societies, national ophthalmology boards, and university departments. We also need the involvement of medical specialists such as for DR and ROP, educational and rehabilitation institutes, civil organizations, and government,” Dr. Németh said. EWAP References 1. Pascolini D, et al. Global estimates of visual impairment: 2010. Br J Ophthalmol. 2012;96:614–8. 2. Zatic T, et al. Rapid assessment of avoidable blindness and diabetic retinopathy in Republic of Moldova. Br J Ophthalmol. 2015;99:832–836. Editors’ note: Dr. Németh has no financial interests related to his comments. Contact information Németh : nemeth.janos@med.semmelweis-univ.hu New plan - from page 65