Vision 2020 – The Right to Sight
Introduction
Vision 2020: The Right to Sight is a global initiative launched in 1999 by the World Health Organization (WHO) in collaboration with the International Agency for the Prevention of Blindness (IAPB). The program aimed to eliminate avoidable blindness worldwide by the year 2020. It focused on strengthening eye care systems, increasing access to services, and developing sustainable solutions for vision health, especially in developing countries.
Background and Rationale
At the time of launch, over 45 million people were blind globally, and 80% of those cases were either preventable or curable. The burden of blindness was significantly higher in low-income countries, particularly among children and the elderly. Vision 2020 was launched to address these gaps through a coordinated international public health approach.
Objectives of Vision 2020
- Eliminate avoidable blindness by the year 2020
- Prevent the projected doubling of blindness cases between 2000 and 2020
- Focus on major causes of avoidable blindness such as cataract, refractive errors, childhood blindness, trachoma, and onchocerciasis
- Strengthen eye care infrastructure and human resources in developing countries
- Integrate eye care into national health systems
Major Causes Targeted by Vision 2020
- Cataract: Leading cause of blindness globally, especially in elderly populations
- Refractive Errors: Uncorrected myopia, hypermetropia, and astigmatism, particularly in school-age children
- Childhood Blindness: Due to Vitamin A deficiency, congenital cataracts, or retinopathy of prematurity
- Trachoma: A bacterial infection causing corneal scarring and blindness, endemic in poor sanitation areas
- Onchocerciasis (River Blindness): Parasitic infection prevalent in Africa and Latin America
The Three Pillars of Vision 2020
1. Disease Control
- Implement cost-effective and proven strategies for prevention and treatment
- Organize eye screening camps and mobile surgery units
- Promote vaccination (e.g., measles to prevent childhood blindness)
2. Human Resource Development
- Train eye care personnel including ophthalmologists, optometrists, vision technicians, nurses, and community health workers
- Encourage capacity-building programs at the district and community levels
- Foster academic and research institutions in eye care
3. Infrastructure and Technology
- Develop accessible and affordable eye care services in rural areas
- Establish Vision Centers and Secondary Eye Units
- Ensure availability of spectacles, surgical instruments, and diagnostic equipment
Implementation of Vision 2020 in India
India adopted the Vision 2020 initiative and integrated it into its existing National Programme for Control of Blindness and Visual Impairment (NPCBVI). The Ministry of Health and Family Welfare partnered with international NGOs, hospitals, and professional organizations to operationalize Vision 2020 goals.
Key Activities under Vision 2020 India
- Free cataract surgeries in high-volume centers
- Establishment of permanent Vision Centers in rural areas
- Distribution of free spectacles to school children and elderly
- Training of optometrists and paramedical ophthalmic assistants
- Eye screening for diabetic retinopathy and glaucoma
Achievements of Vision 2020
- Global blindness rates have declined despite population growth
- Over 20 million cataract surgeries performed annually worldwide
- Significant reduction in trachoma-related blindness
- Expansion of community-based rehabilitation and low vision programs
- Enhanced collaboration between governments, NGOs, and private sector
- Increased number of trained eye health professionals
Limitations and Challenges
- Inadequate infrastructure in remote and tribal regions
- Shortage of trained optometrists in rural India
- Low awareness about refractive errors and spectacle compliance
- Gender disparity – women have higher risk but lower access to services
- Limited financial sustainability of free eye care services
Transition Beyond 2020
Although the original timeline for Vision 2020 ended in the year 2020, the initiative’s mission continues through:
- WHO’s World Report on Vision (2019): Emphasizes "Integrated People-Centered Eye Care" (IPEC)
- IAPB 2030 In Sight Strategy: Focuses on building inclusive, equitable, and resilient eye care systems
- United Nations SDG Goal 3: “Ensure healthy lives and promote well-being for all at all ages” – includes universal eye care
Role of Optometrists in Vision 2020
- Conduct mass vision screening in schools, workplaces, and communities
- Identify and correct refractive errors with prescription glasses
- Support cataract identification and pre-surgical assessments
- Educate the public about eye health and preventive strategies
- Train community health workers in basic eye care and referrals
- Participate in low vision rehabilitation and community-based programs
Conclusion
Vision 2020 – The Right to Sight was a landmark initiative that revolutionized the approach to global eye health. Its focus on prevention, early intervention, and sustainable systems has significantly reduced the global burden of avoidable blindness. As we move forward beyond 2020, the lessons and frameworks established under this initiative continue to shape national and international strategies for universal eye health. Optometrists remain integral to delivering these services effectively at the grassroots level.
References
- World Health Organization & IAPB. Vision 2020: The Right to Sight – Global Initiative. [https://www.iapb.org/vision-2020]
- Ministry of Health and Family Welfare, Govt. of India. Vision 2020: India Guidelines. [https://npcbvi.gov.in]
- World Health Organization. World Report on Vision, 2019. [https://www.who.int/publications/i/item/9789241516570]
- International Agency for the Prevention of Blindness (IAPB). 2030 In Sight Strategy. [https://www.iapb.org/learn/vision-2030-in-sight]
- Park K. Preventive and Social Medicine. 25th Edition. Banarsidas Bhanot Publishers, 2019.
Screening for Eye Diseases
Introduction
Screening for eye diseases is a key preventive health strategy aimed at early detection and management of potentially sight-threatening conditions. It involves examining asymptomatic individuals to identify diseases in their early stages, before they cause irreversible visual damage. In public health optometry, mass screening helps reduce the burden of avoidable blindness and enhances access to timely eye care.
Definition
Eye screening is defined as the systematic application of a test or procedure to identify individuals at sufficient risk of a specific ocular condition to benefit from further diagnostic evaluation or intervention.
Objectives of Eye Screening
- To detect eye diseases early, especially in asymptomatic individuals
- To reduce the burden of visual impairment and blindness
- To ensure timely referral and treatment
- To increase awareness about ocular health in the population
- To collect epidemiological data for planning eye care programs
Types of Eye Screening
1. School Eye Screening
Targets school-aged children to identify refractive errors, squint, amblyopia, and congenital anomalies. Early correction of refractive errors improves academic performance and social development.
2. Workplace Screening
Conducted in offices, factories, and industrial settings. Focuses on computer vision syndrome, eye strain, and protective gear compliance in hazardous work environments.
3. Community-Based Screening Camps
Rural and urban slum communities are targeted to detect cataracts, refractive errors, glaucoma suspects, and diabetic retinopathy. Often organized by NGOs and public health departments.
4. Antenatal and Postnatal Screening
Screening of mothers and newborns helps detect congenital cataract, retinopathy of prematurity (ROP), and maternal infections that may affect the child’s vision.
5. Geriatric Vision Screening
Elderly populations are screened for cataracts, age-related macular degeneration (ARMD), glaucoma, and presbyopia. Regular check-ups ensure quality of life in aging populations.
6. Diabetic Retinopathy Screening
Annual fundus photography or dilated exams for diabetics helps detect early retinal damage and prevent permanent loss of vision.
Commonly Screened Eye Conditions
- Refractive Errors: Myopia, hypermetropia, astigmatism
- Squint (Strabismus)
- Amblyopia (Lazy Eye)
- Cataract
- Glaucoma
- Diabetic Retinopathy
- Age-related Macular Degeneration (ARMD)
- Vitamin A Deficiency (Bitot’s Spots, Xerophthalmia)
- Congenital Anomalies
Screening Methods and Tools
Visual Acuity Testing
- Snellen or LogMAR chart for distance vision
- Near vision chart (Jaeger) for presbyopia detection
Retinoscopy or Autorefraction
- To detect refractive errors quickly and accurately
Torchlight Examination
- Used in field conditions to examine the anterior segment, pupil reactions, and lens clarity
Direct and Indirect Ophthalmoscopy
- Fundus examination to identify retinal diseases
Tonometry
- Used to screen for raised intraocular pressure (IOP) indicative of glaucoma
Color Vision Testing
- Especially important in occupational screening (drivers, electricians, etc.)
Portable Diagnostic Devices
- Handheld autorefractors, non-mydriatic fundus cameras, smartphone-based screening tools
Criteria for a Good Screening Program (WHO)
- The condition should be a significant health problem
- There should be a recognizable early stage
- Acceptable, simple, and cost-effective test available
- Facilities for diagnosis and treatment must be accessible
- The program must reach the target population
Benefits of Eye Screening
- Early identification of sight-threatening conditions
- Prevents school dropouts due to undetected visual problems
- Improves workforce productivity by correcting visual stress
- Reduces burden on tertiary care centers by detecting issues early
- Empowers communities with knowledge and preventive strategies
Challenges in Eye Screening Programs
- Shortage of trained personnel for field screening
- Lack of follow-up after referral for treatment
- Poor awareness and stigma in rural populations
- Infrastructure gaps in remote or tribal areas
- Inconsistent funding or supplies (e.g., spectacles, equipment)
Integration with National Programs
Screening is a core component of the National Programme for Control of Blindness and Visual Impairment (NPCBVI). The program includes:
- School vision screening projects
- Free distribution of spectacles for children with refractive errors
- Annual screening of diabetic patients under NPCDCS
- Regular training of health workers in basic eye care screening
Role of Optometrists in Screening
- Conduct school and workplace screenings
- Identify and correct refractive errors
- Educate patients and families about eye health and hygiene
- Refer serious cases to ophthalmologists for further care
- Maintain records and help in research and data collection
- Train vision technicians and community health workers
Future Directions
- Use of artificial intelligence (AI) for automated image analysis in screening
- Tele-optometry for remote evaluation and diagnosis
- Smartphone apps and portable devices for rapid field screening
- Integrated health screening camps (eye, dental, hearing, etc.)
Conclusion
Screening for eye diseases is a cost-effective and impactful method to prevent avoidable blindness. It is essential for early detection and management, especially in vulnerable groups like children, diabetics, and the elderly. With trained optometrists and appropriate infrastructure, screening programs can greatly enhance public eye health and contribute to national development goals.
References
- World Health Organization. Screening Program Guidelines. [https://www.who.int]
- Ministry of Health & Family Welfare, Govt. of India. NPCBVI Implementation Guidelines. [https://npcbvi.gov.in]
- Park K. Preventive and Social Medicine. 25th Edition. Banarsidas Bhanot Publishers, 2019.
- Sundar G et al. Community Ophthalmology: Principles and Practice. 2002.
- LVPEI Eye Screening Tools. [https://www.lvpei.org]
National and International Health Agencies – NPCB, IAPB
Introduction
Effective eye care delivery and blindness prevention require the collaborative effort of national and international health organizations. Two key agencies that play a pivotal role in combating visual impairment are:
- NPCBVI – National Programme for Control of Blindness and Visual Impairment (India)
- IAPB – International Agency for the Prevention of Blindness (Global)
These organizations work at policy, program, and grassroots levels to reduce avoidable blindness and promote universal access to quality eye care services.
1. National Programme for Control of Blindness and Visual Impairment (NPCBVI)
Overview
Launched in 1976 by the Ministry of Health & Family Welfare, Government of India, NPCB is one of the oldest and largest national eye health programs in the world. It was renamed NPCBVI in 2017 to incorporate visual impairment into its focus, aligning with WHO’s strategies.
Vision and Objectives
- Reduce the prevalence of blindness to 0.3% in India by 2025
- Provide comprehensive eye care services at all levels of the health care system
- Promote awareness about blindness prevention and treatment
- Establish permanent infrastructure for eye care at the community level
- Collaborate with NGOs and private providers for mass eye care delivery
Key Strategies of NPCBVI
- High-volume cataract surgery at government and NGO hospitals
- School eye screening and free spectacles for underprivileged children
- Establishment of Vision Centers at the primary health care level
- Training of ophthalmic assistants, optometrists, and paramedics
- Integration of diabetic retinopathy and glaucoma screening
- Support to eye banks and corneal transplant programs
- Monitoring and evaluation through data reporting systems
Major Achievements of NPCBVI
- Reduction of blindness prevalence from 1.49% (1976) to ~0.36% (2019)
- Over 66 lakh cataract surgeries performed annually (pre-COVID)
- More than 1 crore school children screened every year
- Support to 1,200+ eye care NGOs and district hospitals
- Inclusion of ROP, glaucoma, and DR into program scope
Optometrist’s Role in NPCBVI
- Conduct refraction and school screening programs
- Support community-based vision centers
- Identify cataract, glaucoma suspects, and low vision cases
- Educate communities about eye diseases and prevention
- Maintain records and assist in program implementation
2. International Agency for the Prevention of Blindness (IAPB)
Overview
IAPB is a global alliance of over 150 organizations working together to eliminate avoidable blindness and promote equitable eye health. Founded in 1975 with support from the WHO, IAPB is headquartered in London and works across all continents through regional offices.
Vision and Mission
The IAPB envisions a world in which no one is needlessly blind and everyone has access to the best possible standard of eye health.
Core Activities
- Global advocacy for universal eye health policies
- Support implementation of WHO’s World Report on Vision
- Lead international campaigns like World Sight Day
- Promote eye health as part of universal health coverage (UHC)
- Mobilize resources and partnerships for Vision 2030
Key Programs and Initiatives
- Vision 2020: The Right to Sight – A joint initiative with WHO (1999–2020)
- 2030 In Sight Strategy – Building resilient, inclusive eye care systems
- World Report on Vision – Supporting WHO’s recommendations for integrated people-centered eye care (IPEC)
- Eye Health Hero Awards – Recognizing contributors in eye care globally
Partnerships and Reach
IAPB members include international NGOs (e.g., Sightsavers, Orbis, Fred Hollows Foundation), governments, academic institutions, private providers, and eye health professionals. It also coordinates regional efforts in South-East Asia, Africa, and Latin America.
IAPB and India
- Supports Vision 2020 India secretariat
- Facilitates funding and research through partner NGOs
- Collaborates with LVPEI, Aravind, and other Indian centers
- Contributes to World Sight Day and National Eye Donation Fortnight activities
Optometrist’s Role in IAPB Framework
- Actively participate in vision screening and awareness programs
- Promote IAPB campaigns like “Love Your Eyes” and World Sight Day
- Contribute to training, policy advocacy, and community eye care
- Collaborate in data collection, program monitoring, and reporting
- Serve as global eye health ambassadors in underserved regions
Collaboration Between NPCBVI and IAPB
Several national programs in India have been designed or enhanced with inputs from IAPB’s global strategies:
- Adoption of Vision 2020 principles by NPCB
- Inclusion of comprehensive eye care and IPEC in NPCB guidelines
- NGO funding partnerships through IAPB members
- Co-branded events for advocacy and public engagement
Conclusion
National and international health agencies like NPCBVI and IAPB are crucial to strengthening eye care delivery systems and reducing the global burden of avoidable blindness. Through coordinated strategies, funding, awareness campaigns, and capacity building, these agencies ensure access to equitable and affordable vision care. Optometrists, being the primary providers of refraction and vision care, are key stakeholders in implementing their vision and achieving universal eye health goals.
References
- Ministry of Health and Family Welfare, Govt. of India. NPCBVI Guidelines and Reports. [https://npcbvi.gov.in]
- IAPB Official Website. International Agency for the Prevention of Blindness. [https://www.iapb.org]
- World Health Organization. World Report on Vision, 2019. [https://www.who.int/publications/i/item/9789241516570]
- Park K. Preventive and Social Medicine. 25th Edition. Banarsidas Bhanot Publishers, 2019.
- Vision 2030 Strategy. IAPB. [https://www.iapb.org/learn/vision-2030-in-sight]
