Academic journal article Bulletin of the World Health Organization

Global Cost of Correcting Vision Impairment from Uncorrected Refractive Error/ Cout Global De Correction D'une Deficience Visuelle Induite Par Une Erreur De Refraction Non corrigee/El Coste Global De Corregir Las Discapacidades Visuales Causadas Por Errores De Refraccion No Corregidos

Academic journal article Bulletin of the World Health Organization

Global Cost of Correcting Vision Impairment from Uncorrected Refractive Error/ Cout Global De Correction D'une Deficience Visuelle Induite Par Une Erreur De Refraction Non corrigee/El Coste Global De Corregir Las Discapacidades Visuales Causadas Por Errores De Refraccion No Corregidos

Article excerpt

Introduction

Uncorrected refractive error (URE) is the most common cause of vision impairment worldwide and the second most common cause of blindness. (1,2) The aim of this paper was to estimate the global cost of establishing and operating health-delivery systems that are capable of providing refractive care to all individuals who currently have vision impairment resulting from URE. The estimated cost can be compared to a previously published estimate of the annual cost of the productivity lost due to refractive vision impairment worldwide, of 269 000 million international dollars, equivalent to 202 United States dollars (US$). (3) The comparison provides an indication of the economic return that society might expect from the investment required to make refractive care accessible to all. We present an idealized account of the actions needed to solve the problem of URE globally, which can serve as a guide and provide an incentive for action. In reality, uncontrollable socioeconomic, cultural and political factors complicate the process and make the cost of eliminating URE unpredictable.

Methods

For this analysis, we used the current World Health Organization (WHO) definition of distance vision impairment: a visual acuity worse than 6/18 in the better eye. (4) For near vision impairment, since WHO has not specified a standard, we used the definition suggested by the International Agency for the Prevention of Blindness: "vision at the individual's required working distance worse than N8 in the better eye". (5)

As it has been reported that URE cannot be dealt with by existing eye care workers, (5) we have estimated the extra staff needed. In doing so, we adhered as closely as possible to each country's expectations of the specific personnel required to provide the various elements of refractive care.

Given the large number of individuals with URE, it was logical to assume that refractive care should be delivered in primary-care settings. (6) Moreover, WHO noted that, when refractive care is provided in primary care, the opportunity should also be taken to identify those who need treatment for eye disease. (7) Consequently, we based our costing of the infrastructure needed on a vision centre model that provides both refractive care and screening for ocular disease at the primary-care level. (8,9)

We combined data from several sources. Population data were mostly based on estimates for the middle of 2007 obtained from the International Data Base, a computerized database established by the United States Census Bureau that contains statistical tables of demographic data for 228 countries and areas of the world. (10,11) In doing this, we used the same population data as Smith et al., (3) which enabled us to compare our findings with estimates of the cost of the productivity lost due to vision impairment made by those authors. Economic data included price level indices from the International Comparison Program of the World Bank (12) and the Asian Development Bank (13) and data on wage levels and resource use in health care were taken from WHO CHOICE databases. (14) Data on the prevalence of distance and near vision impairment due to URE in each country were obtained from the publications of Resnikoff et al. (1) and Holden et al., (2) respectively. The number of cases of vision impairment in each country was derived by combining prevalence data with population data. To simplify reporting, we give estimates for the 14 subregions of the world used in the WHO publication Global burden of disease 2002: data sources, methods and results. (15)

New practitioners required

The number of new practitioners needed to provide clinical refraction services was estimated for each country by calculating how many refractive care practitioners were required to reach the ratio of 1:50000 for the number of "functional clinical refractionists" to the population specified by WHO and the International Agency for the Prevention of Blindness (7) and by taking into account existing human resources. …

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