To the Editor:
We put forward the recommendation that more effort be made to align global vision-related research efforts with the causes of global blindness. With cataract accounting for more than one third of the burden of blindness, we think it reasonable that commensurate attention be paid to investigations into solutions to this situation.
Mr Lavin presents the argument that we do not need more research; the solutions are already known—they just need funding. Certainly, the very low prevalence of cataract blindness in high income countries [1], and the strong positive association between Gross National Income of a country, and the Cataract Surgical Rate (CSR) [2] clearly demonstrate that there are macro-economic solutions to cataract blindness. Cataract surgery in blind patients has been proven to alleviate poverty [3], hence a positive economic feedback loop would be created. It is possible in theory that rich people could fund the treatment of the majority of global cataract blindness, either directly or through taxation mediated public spending on health. However, this opportunity has been present for the past few decades [4] without being taken up.
The problem of cataract blindness is not the lack of an efficacious intervention that could eliminate cataract blindness if global economic circumstances and corrupt human behaviour were different. What we advocate is that efforts are expended to identify effective, scalable and sustainable strategies—be they macro-economic, micro-economic, technological or administrative—that produce a CSR high enough, and sufficiently equitably accessible, to deal with incident cases of blinding cataract. This will require implementation research and health systems research along with strategies that address the maldistribution of human resources for eye health [5], integrate eye health into public health policy and financing arrangements, eliminate inequity [6], and improve quality.
If any billionaire philanthropists wish to prove us wrong, we would be delighted. But in their absence, we feel that global research efforts—which will to a large extent be reflected in funding—be directed proportionately at finding effective solutions to the leading causes of global blindness.
References
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Wang W, Yan W, Fotis K, Prasad NM, Lansingh VC, Taylor HR, et al. Cataract surgical rate and socioeconomics: a global study. Invest Ophthalmol Vis Sci. 2016;57:5872–81.
Kuper H, Polack S, Mathenge W, Eusebio C, Wadud Z, Rashid M, et al. Does cataract surgery alleviate poverty? Evidence from a multi-centre intervention study conducted in Kenya, the Philippines and Bangladesh. PLoS ONE. 2010;5:e15431.
Frick KD, Foster A. The magnitude and cost of global blindness: an increasing problem that can be alleviated. Am J Ophthalmol. 2003;135:471–6.
Bastawrous A, Hennig BD. The global inverse care law: a distorted map of blindness. Br J Ophthalmol. 2012;96:1357–8.
Ramke J, Evans JR, Gilbert CE. Reducing inequity of cataract blindness and vision impairment is a global priority, but where is the evidence? Br J Ophthalmol. 2018;102:1179–81.
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Buchan, J.C., Dean, W.H., Ramke, J. et al. Response to: Comment on: ‘The inverse-research law of global eye health’. Eye 34, 2350 (2020). https://doi.org/10.1038/s41433-020-0808-1
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DOI: https://doi.org/10.1038/s41433-020-0808-1