COVID-19 is putting millions of people at risk of blindness

Our eyes are one of nature’s complex wonders. It's no wonder they are regarded as the window to the soul.

The COVID-19 pandemic and associated safety measures have prompted a change in the provision and delivery of eye health services. A large number of vision programmes have been temporarily suspended, including mobile eye-screening exercises and non-emergency surgeries, in an attempt to reduce the risk of exposure to COVID-19 for both patients and health workers.

While several concerns have been raised regarding the role of the eyes in the transmission of the virus, especially given the proximity of eye-care professional to patients during eye examinations, the pandemic surely has implications both for eye health and eyecare professionals.

This current situation is likely to have a huge impact on eye health in general because the VISION 2020 Right to Sight global initiative – a joint programme of the World Health Organisation (WHO) and the International Agency for the Prevention of Blindness (IAPB) that aims to eliminate avoidable blindness by the year 2020 – cannot now be attained as had been hoped, as people living in underserved regions who relied on outreach services are going to be the most affected.

In Nigeria, my country of birth and residence, it has been reported that utilization of eyecare services is as low as 25% compared to the optimum target of 90%. This is mainly due to high costs and poor access. With around 40% of the Nigerian population living below the international poverty line, the barrier to accessing eye care services is growing thanks to the COVID-19 pandemic. This is likely to cause a rebound effect with an increased demand for eye care services once restrictions are lifted at outreach camps and eye care facilities, thereby compelling eye care workers to double their workload in affected communities.

It is estimated globally that at least 2.2 billion people have a vision impairment or blindness, of whom at least 1 billion have a vision impairment that could have been avoided or has yet to be addressed. These are alarming statistics – but the good news is that 75% of all blindness and visual impairment is treatable or preventable. Avoidable vision loss due to uncorrected refractive errors (reversible with spectacle correction) and cataracts (reversible with surgery) continue to be the most common causes of moderate and severe forms of visual impairment and blindness. As the world’s population grows and ages, blindness and visual impairment globally are expected to triple over the next 30 years and this is why a large scale-up of eye care provision is now needed to address an increasing incidence of preventable vision loss.

It is disheartening to note that vision is often an overlooked area within global development. Optometrists in Ontario, Canada, are set to launch an urgent appeal to the Ontario government to end 30 years of neglect in funding eye care – because this, coupled with the devastating impact of COVID-19 on optometrists' ability to see patients, is threatening Ontarians' access to these essential health services. Due to strict COVID-19 protocols in Ontario, patient volumes for optometry practices will be reduced by as much as 50%, thereby posing a barrier to the delivery of comprehensive eye exams to nearly 2 million people over the next 12 months.

While the COVID-19 pandemic has the potential to improve eye health thanks to the increase in hand-washing and overall improvements in hygiene, other issues such as increases in the rate of short-sightedness (myopia), dry eye syndrome and computer vision syndrome, amongst other eye conditions, are bound to arise following prolonged screen time while learning or working from home.

The pandemic is not just a challenge for health systems; it is also a socio-economic burden, because the gap in eye care impacts everything from education and personal mobility to road safety and prospects for employment. This is why our current reality should not inhibit our ability to generate a new paradigm for infrastructure, distribution of eye care providers and eye care settings.

There is indeed so much to speculate as to what lies ahead. What is the future of eye health as the world adapts to the new pandemic landscape, and what will we learn from the pandemic and its lockdowns? Only time will tell if we acted wisely; what we do know, however, is that everyone deserves an equal right to sight, no matter where they live.