According to the WHO globally about 220 million people have significant visual impairment or are blind (32 million alone). A similar number have notable hearing loss or are deaf. It is the poor that suffer the most, with the collective burden and sheer human misery being vast.
Many diseases are currently beyond medical science’s reach; yet up to 80% of blindness and 50% of deafness is avoidable – avoidable in that it can be treated or prevented by known cost-effective means. We aim to concentrate on but one formidable, overlooked hurdle: providing affordable, easy-to-use, clinical diagnostic tools, geared to the needs of the workers in the field. Only then can we begin to tackle these awful blights.
The international VISION 2020 plan holds that, for given resources, targeting certain diseases will have the fastest and greatest impact on sight loss worldwide. There is a certain quality in quantity, that relatively speaking, simple cheap products can bring. Like immunisation, sight and hearing interventions are one of public healths ‘best buys’ – generating a profound amplifying impact on health and poverty reduction.
Instruments such as ophthalmoscopes, otoscopes, and loupes that are taken for granted in the west or larger cities are usually only found locally in rural areas where most blindness and deafness occurs at great cost. And even where they do exist these complex devices are usually not readily available – being kept under ‘lock and key’. Few hospital-based doctors have these essential tools and almost none at the mid or community level.
With little equipment or training health workers try to identify and treat as best they can a host of unglamorous neglected tropical diseases (NTDs) such as: trachoma, onchocerciasis, xerophthalmia, as well as cataract and countless corneal problems. About 210 million people live in areas where trachoma is suspected to be endemic; with 7 million having an advanced stage, in which the eyelashes turn inward and scrape painfully.
Widespread adoption of Arclight™ together with focused ongoing training could help in achieving the 2020 aim, even ahead of schedule. Raising the profile of ‘eyes’ among health professionals and within governments could provide the springboard to improved care – all without external aid.
The best is the enemy of the good
The saying goes: “The best is the enemy of the good” – the poor will accept any safe and effective treatment, and it does not have to be the best. Any fair remedy is better than the current usual standard – nothing. Watson-Watt’s dictum was “Give them the third best to go on with; the second best comes too late, the best never comes.”
Take trachoma: a complex, cross generational problem interwoven with absolute poverty. Even if such an instrument and the basic training needed to use it became widely available – it would still only be a part of the way out. But, and we claim no more, it just might be enough to nudge things in the right direction.
Target diseases are:
- Refractive Error
- Childhood Blindness
- Diabetic Retinopathy
- Macular degeneration