Rapid Assessment of Avoidable Blindness for Health Service Planning

By Mactaggart, Islay; Wallace, Sarah et al. | Bulletin of the World Health Organization, October 2018 | Go to article overview

Rapid Assessment of Avoidable Blindness for Health Service Planning


Mactaggart, Islay, Wallace, Sarah, Ramke, Jacqueline, Burton, Matthew, Bastawrous, Andrew, Limburg, Hans, Qureshi, Muhammad Babar, Foster, Allen, Kuper, Hannah, Bulletin of the World Health Organization


The World Health Organization (WHO) Universal eye health: a global action plan 2014-2019 calls for the generation of evidence on the magnitude and causes of visual impairment as well as on eye care services, to plan towards universal eye health. (1) The Rapid Assessment of Avoidable Blindness (commonly called RAAB) is cited in the document as a standard method for generating this epidemiological evidence.

Description of the assessment

The rapid assessment is a standardized population-based survey method to assess the prevalence and causes of visual impairment and blindness among the population older than 49 years. (2) This survey method also generates service indicators, including cataract surgical coverage and cataract surgical outcome; to date, it has been used in over 330 surveys across 70 countries worldwide, providing a substantial contribution of data used to calculate global blindness estimates. (2,3)

The rapid assessment of avoidable blindness was developed by the International Centre for Eye Health at the London School of Hygiene & Tropical Medicine, and evolved from the Rapid Assessment of Cataract Surgical Services. (4) The assessment provides a simple, low-cost, open-access and epidemiologically robust method to collect data to inform eye-care programmes and policies with the aim of reducing or eliminating avoidable blindness.

This assessment has several key strengths. First, it focuses on the population older than 49 years, where blindness prevalence is highest, thereby requiring a substantially smaller sample size than all-age population-based surveys. Second, it uses simple examination techniques and has low equipment needs, and is therefore low-cost and time-efficient, while providing comparable estimates to an all-age survey. (2,5) Third, it has an open-access data entry and analysis software that provides robust, autogenerated analysis reports of key eye health indicators disaggregated by sex and age. These data assist assessment users in eye health service planning. The standardized reports ensure that findings from these assessments worldwide and over time are comparable, and the collation of data and reports online in an open repository means that they are accessible. (6)

For quality assurance, the assessment includes a certified trainer scheme, and trainers are available throughout most of the world. To be certified as a trainer, candidates must attend a one-week, face-to-face training of trainer's workshop and then train a rapid assessment team under the supervision of a senior trainer. The new trainers are then available to train survey teams and support them to prepare for and undertake rapid assessments and interpret the generated data.

Updating the method

The International Centre for Eye Health is currently collaborating with Peek Vision (7) and CBM International, (8) with input from a wider technical and stakeholder group, to update several components of the overall method and develop the seventh version of the rapid assessment of avoidable blindness.

Digitalization and new technology

The seventh version of the assessment will use paperless mobile data entry connected to a cloud-hosted, web-based system available via browser. Users will have the option of using Peek Acuity, a validated smartphone-based visual acuity test. (9) Users will be able to access the system without needing to install software, maintain databases or use a particular operating system. Data will be held centrally, providing a higher degree of data quality assurance and potential for cross-survey analysis. All existing assessment indicators will be viewable and downloadable via websites, facilitating real-time views of the gathered data. Dashboard views of surveys in progress will also allow for real-time overview of survey progress and completeness. New interactive, web-based methods of visualizing the assessment's data will be provided via a configurable web application to support data interpretation by eye health decision-makers. …

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