Color & Control:

Tackling avoidable blindness

By Kevin Spurgaitis

In her primary school in the Doyogena District of Ethiopia, Ajebush had been struggling with her eyesight for a long time. However, her teachers—unaware of her deteriorating vision—were convinced she had no interest in her studies. Ajebush never participated in class and she barely made it to school every week. She ranked 53rd among the 54 students, and ended up repeating both the third and fourth grades, as a result of her lower performance.

Fortunately for Ajebush and her family, though, she was eventually screened by a teacher, who determined that she had low vision and referred her for further treatment. The teacher previously attended a school eye club, established by Orbis Canada, which teaches children about the importance of hygiene and good eye care, and trains educators to screen for refractive errors. In March 2016, Ajebush went to the Amacho Health center, whose Primary Eye Care Unit is supported by Orbis Canada also. She was quickly diagnosed with myopia—or shortsightedness—by an optometrist and given her first pair of glasses. Ajebush’s vision then vastly improved to the point that she ranked in the top of 10—out of 50 students—in the first semester of 2017. She can now see her surroundings clearly and is leading “a happy, more fulfilled life.”

“I used to struggle with my vision, and it was the reason for my low performance in school,” Ajebush told Orbis Canada. “My life was full of anger when I couldn’t see clearly, and I ended up breaking some things at home and when I couldn’t read a thing from the blackboard. No one ever understood me. … But now that I have gotten better, I want to improve my results.”

Missed opportunities
Losing sight in low- or middle-income countries—where skilled eye doctors or quality medical centres are few or non-existent—is challenging to the say the least. One’s chances of receiving the right kind of eye care are minimal. And as one’s sight becomes worse, their chances of receiving an education, earning a steady income, or caring for family are shockingly low. Today, this is the reality for the one in seven people—or a billion—who live with avoidable vision loss or blindness, according to the World Health Organization. Nearly 90 per cent of the world’s visually impaired live in low- or middle-income countries, particularly in Sub-Saharan Africa and Asia. And 55 per cent are women.

Moreover, the number of people who are blind globally is set to triple to 115 million by 2050, according to the Vision Loss Expert Group. In its 2017 paper published in the Lancet, it acknowledged that most visual impairment occurs in older age as a result of conditions like cataracts, the world’s leading cause of blindness. It goes on to explain that an aging and growing population means that access to eye health services is even more essential. 

Along with its 400 volunteers—more than 100 of whom are Canadian—in the eye health sector, and partners in governments, health ministries, NGOs and local hospitals, Orbis Canada is helping to fight blindness in 165 countries. In fact, it has played a significant role in efforts to decrease worldwide visual impairment. The prevalence of visual impairment has dropped from nearly 4.6 per cent in the 1990s to less than 3.4 per cent today, according to Orbis Canada.

“Canadians are generally very fortunate to be in a position to access the eye care they need,” says Lisa McKeen, CEO of Orbis Canada. “However, we too, have underserved communities, particularly in remote areas where access to eye care is difficult, and other marginalized populations that have various barriers to access.”

A ripple effect
In 1984, Orbis Canada became an affiliate of Orbis International, which trains health-care workers in regional hospitals, and leaders and teachers in remote areas. It builds capacity, so that eye care teams are able to continue to teach and mentor. It treats hundreds—and even thousands—of patients for every one eye professional it trains. “The ripple effect is absolute,” McKeen says. 

For starters, Orbis’ pioneering Human Resources for Eye Health Initiative has strengthened a network of African medical schools and affiliated teaching hospitals. It has provided quality training and infrastructure for better training and service delivery; built an African leadership network and advocated for eye health to “become an integral component of participating country’s health systems.”

Since establishing an office in Beijing in 1999, Orbis has supported quality, affordable and accessible eye care in China’s remote ethnic minority areas and other rural communities. In fact, it is considered to be one of the leading blindness prevention organizations in the country by the International Association for the Prevention of Blindness and other nongovernmental groups. China is said to have the largest number of blind people in the world—around 8.2 million, according to Orbis. Yet, although a majority of its blind people live in rural areas, most of its eye care professionals like surgically skilled ophthalmologists practice urban areas.

In India—which has more than 20 per cent of the world’s blind population and the largest number of blind children—Orbis has worked to prevent blindness and treat eye diseases, especially among children. In 2002, Orbis India launched the India Childhood Blindness Initiative, the organization’s flagship program, to help ensure that India’s children have access to quality eye care. It has been the largest network of Children’s Eye Centers in the world.

In addition to its long-term country programs, Orbis’ specialist training takes place through its Flying Eye Hospital and online mentoring platform, Cybersight.

The Flying Eye Hospital, which is a former MD-10 cargo plane, is a state-of-the-art teaching facility with a classroom, operating room and recovery room. The Orbis volunteers aboard this aircraft share their knowledge with—and help to develop skills in—communities around the world. They also serve as advocates and envoys in the worldwide effort to end avoidable blindness. Inside the Flying Eye Hospital’s, which has an advanced audio-visual system, professionals can observe surgeries in real time—and in 3D.

“We knew that the high costs of tuition, international travel and accommodations prevented most health care professionals in low-resource countries from participating in overseas training programs,” McKeen says. “Even when they could afford to study abroad, their opportunity for direct clinical experience was limited because strict licensing laws often prevented them from performing surgery.”

Through its award-winning global telemedicine initiative, Cybersight, Corbis’ expert volunteers use the latest in internet and mobile technologies to teach and support eye care teams. Cybersight has become especially important during the COVID-19 pandemic, when professionals’ physical presence has been near-impossible. “A record-breaking number of eye care professionals have turned to the platform to stay connected and learn amid lockdowns,” McKeen says. In 2020, alone, the number of registered eye care professionals on Cybersight more than doubled. Now, the platform now has more than 43,000 registered eye care professionals across over 200 countries and regions.

As Dr. Dan Neely, Professor of Ophthalmology at the University of Indiana and Medical Advisor for Orbis, explains on the organization’s website: “You can only send people and equipment to so many places, but you can go everywhere, an unlimited number of times, with technology. That is the power and force-multiplier that technology provides us.”

All with a pair of glasses
At the end of the day, creating “sustainable change” in communities around the world means leveraging advances in technology, according to Orbis Canada. This way, eye care professionals and frontline eye health workers—who would otherwise not have access—can be trained and avoidable blindness can be eliminated. 

This happens to be one of the most cost-effective ways of fighting poverty, too.

“When individuals become visually impaired or blind, often, girls remain home from school to act as caregivers, and that shuts off their future,” McKeen says. “When families are impacted, communities are impacted—and when communities are impacted, economies are impacted. … Also, as one’s sight becomes worse, their chances of getting an education, earning a steady income, or caring for their family decreases, if not disappears.”

However, their enhanced vision—“all with a pair of glasses”—translates to significant gains in output, and thus economic impact, though. Basically, “a $1-investment in vision care equals $4 in economic benefit,” McKeen says.

“So, we have a huge problem—with a clear solution. … We work with existing infrastructure within each country … to co-create what ultimately will work in the bigger picture for that country, while ensuring the end result is a meaningful eye care program that can be sustained.”

Kevin Spurgaitis is a Toronto-based writer interested in ethics and public health issues.

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