Elimination of preventable blindness: can success in Nepal be replicated in Africa?

Abstract

Elimination of preventable blindness: can success in Nepal be replicated in Africa? Neda Nikpoor,1,2 Eric D Hansen,2,3 Matthew S Oliva,2,4 Geoffrey Tabin,1,2 Sanduk Ruit2,5 1Byers Eye Institute, Stanford University, Palo Alto, CA, USA; 2Himalayan Cataract Project, Waterbury, VT, USA; 3Moran Eye Center, University of Utah, Salt Lake City, UT, USA; 4Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA; 5Tilganga Institute of Ophthalmology, Kathmandu, Nepal Abstract: There are an estimated 36 million people who are blind worldwide: ~1 in every 200 people. A third of these are blind from cataracts and could have perfect vision restored with a simple operation costing less than US$25. Ninety percent of the blind and visually impaired live in the developing world, with particular concentrations seen in South Asia and sub-Saharan Africa (SSA). Innovations in surgical techniques, delivery systems, and material production, developed first in Nepal and India, have provided a viable blueprint to address treatable blindness in the developing world. In fact, Nepal was the first developing country to reverse its trajectory of blindness. This was largely possible because of a collective effort by many international nongovernmental organizations to support Sanduk Ruit and his colleagues as they developed a sustainable eye care–delivery model anchored at Tilganga Institute of ­Ophthalmology. This model is similar to that of LV Prasad Eye Institute and Aravind Eye Hospital in India, which is also being successfully utilized to combat the enormous burden of needless blindness in Africa. Over the last decade, there have been early successes in transferring the Nepali model of care to Ethiopia and Ghana, and there have been other models successfully implemented across Africa as well. Though there has been significant progress in restoring sight in SSA, the prevalence of avoidable blindness in Africa is higher than any other continent, with about 4.8 million people living blind. Keywords: blindness, cataract,visual impairment, Nepal, Africa, cataract surgery