Eliminating a disease requires collaborative determination, a proven set of health care policy and technology solutions, and resources. Yet, complexities abound. While a range of medical interventions and government policies have helped decrease the incidence and prevalence of corneal blindness in the United States, the near opposite is true in Asia and Africa, where the highest percentage of people who are corneal blind live. As nearly 80% of all corneal injury and disease is treatable and preventable, expanding access to appropriate and affordable care is key, but bridging gaps is far easier said than done.

The Challenge

Consider the experience of Meena, a 22-year-old mother in the remote village of Madhya Koluwa, Nepal. One day while harvesting rice, Meena unexpectedly injured her cornea. As long-term illness keeps her husband from working, Meena worried what her injury and rapidly progressive vision loss would do to her family, whose well-being depended on her as their sole provider. To get the care she needed, Meena would have to forgo two days of work and income to travel to the nearest eye hospital.

For individuals like Meena, such barriers to care are frequently insurmountable. They are also why corneal injury and disease remain one of the leading causes of blindness and visual impairment in low- and middle-income regions globally, and why corneal blindness continues to impact productivity and life expectancy, creating cycles of poverty and premature death worldwide.^1-3

The Opportunity

Despite the challenges, corneal blindness can still be eliminated. The requirement is partnerships, especially with local communities, that help ensure health systems, and moreover corneal health care providers have the resources and capabilities they need to save and restore the sight of all their patients. Key to this approach is innovative health policies that both catalyze and sustainably integrate prevention and treatment solutions into locally delivered primary health care. This is where SightLife comes in as a global health organization that collaborates with strategic partners in Asia and Africa to expand patient access to the corneal health services they need.

In our program sites in India and Nepal, local community health care workers (CHWs) trained in first aid eye care by SightLife have helped reduce new cases of corneal blindness via topical antibiotic ointment, resulting in a 97% resolution rate of corneal abrasions after four days of treatment. Such programs ensure people like Meena don’t have to choose between their livelihoods and their health. These CHWs have also helped increase the number of referrals to tertiary eye clinics for more severe cases.

To scale this low-cost, high-value approach to addressing eye trauma and infectious keratitis, the indications responsible for over 80% of moderate to severe cornea-related vision impairment and blindness in China and nearly 70% in India,¹ government officials and collaborating stakeholders need to develop local, regional, and national roll-out plans that not only leverage, but also bolster existing legal and health care financing frameworks.

For more advanced cases, SightLife and our global partners are working to expand capacity building for general ophthalmologists, optometrists, and other allied ophthalmic personnel, including ophthalmic nurses, to help improve corneal health outcomes across the full continuum of care.

This also includes increasing the number of corneal transplant surgeons in low-resource rural settings. Fortunately, and in direct partnership with leading local eye hospitals, organizations such as Himalayan Cataract Project, International Council of Ophthalmology, Orbis International, Seva Foundation, SightLife, and Visionaries International offer a range of fellowships and skills-transfer trainings to help in-country surgeons learn, leverage, and deploy the latest technologies and techniques.

More Support Needed

To optimize transplant outcomes, surgeons need access to quality corneal tissue. Furthermore, any curative approach to restoring sight cannot achieve impact at a sustainable scale without supportive and facilitative policies, such as mandatory death notifications and a national donor registry, that help create a robust eye banking system. In addition, as the COVID-19 pandemic threatens to erase years of progress, more work is needed to shore up existing eye banks, as well as scale the available range of proven and appropriate corneal health care solutions that patients need.

These steps will take time, but are a fundamental piece of the puzzle and should be prioritized for the more than 12 million people globally who await a corneal transplant, plus the additional millions of individuals, like Meena, who need protective eye wear, as well as just-in-time eye care to help prevent blindness altogether.

Fortunately for Meena, she lives in a region supported by SightLife. So, instead of traveling for several days to access corneal care during harvest season, she received prophylactic antibiotic ointment from a trained CHW and, after four days, the corneal abrasion cleared up. Her sight was saved.

Moving forward, how do we ensure that Meena’s corneal care experience is the norm across low-resource settings? More partners are needed on our journey. Here are just some of the ways you can get involved:

• Innovate for access. There is a need for affordable, appropriate corneal care solutions that empower local eye care providers to prevent corneal disease, as well as diagnose and treat patients more effectively. Help us overcome barriers to treatment and prevention through the practical application of research.
• Advocate for supportive policy. Join us in working with local associations, key opinion leaders, and ministry officials to ensure corneal disease is represented in national eye care plans, and policies are adopted that ensure access to care when and where people need it.
• Train the eye health workforce. Leverage your experience, and that of your ophthalmic team, to ensure that we can train care providers in the latest corneal care techniques. Partner with us in the development of curriculum, and volunteer to serve as a mentor or master trainer.
• Partner to scale. Work with SightLife and our other global collaborators to identify government, industry, health care, philanthropy and ophthalmology stakeholders with whom we can partner to sustainably scale innovative corneal health care solutions in the regions that need them most.

It Can Be Done

The elimination of corneal blindness is possible through partnership, and we challenge you to bring your time, talent, and treasure to the cause. Visit www.sightlife.org to get involved. CP

References:

1. Tran TM, Duong H, Bonnet C, Kashanchi A, Buckshey A, Aldave AJ. Corneal Blindness in Asia: a Systematic Review and Meta-Analysis to Identify Challenges and Opportunities. Cornea. 2020;39(9):1196-1205.
2. Access Economics. The Global Cost of Visual Impairment. Accessed January 15, 2021. www.icoph.org/dynamic/attachments/resources/globalcostofvi_finalreport.pdf
3. PricewaterhouseCoopers. The Value of Sight. The Fred Hollows Foundation. A quantification of the benefits associated with eliminating avoidable blindness and visual Impairment. Accessed January 15, 2021. www.hollows.org/Upload/FHFV3/Media/au/pdf/Other%20file%20downloads/PwC-3-Value-of-Sight-Final-Report-2013.pdf

MS. NOAH serves as SightLife’s chief global officer, where she oversees program strategy and implementation across Africa and Asia, and identifies philanthropy and partnerships to accelerate and scale the elimination of corneal blindness by 2040.