gms | German Medical Science

To review progress of blindness prevention activities in Africa and enumerate the main challenges remaining for the Vision 2020 programme.

When Vision 2020 was launched in February 1999 it was estimated that 50 million people were blind now it is 37 million. These estimates were calculated differently but there does seem to be a real decrease in blindness, probably most of it in Asia. Different programmes were reviewed to evaluate possible changes in Africa.

Progress has been made in the control of diseases targeted by Vision 2020. Cataract surgical rates (CSR) have been increasing in many areas as services are established and barriers to surgery are overcome but provision of surgical services particularly in rural areas remains one of the major challenges for Vision 2020 in Africa. The main blinding foci of Onchocerciasis are under treatment but the remaining ones are amongst the most difficult to reach. Trachoma programmes are developing but the poorest and most remote are still those who suffer most. Childhood blindness is diminishing with improving measles vaccination, Vitamin A distribution, better maternity services and refractive services are gradually developing for school children as well as for adults with presbyopia. In Africa as a whole glaucoma is the second most important cause of blindness. This will shortly become the major challenge for blindness prevention programmes. Community diagnostic methods must be elaborated and appropriate “one off” treatments must be perfected for those for whom the monthly bill for eye drops exceeds their monthly wage. Surgery for congenital cataract, and increasingly strabismus, which used to be completely ignored, are of increasing importance in paediatric ophthalmology as other causes become less important. In the cities there is a gradual life style change for the richer population. As a result problems of diabetes and hypertension are on the increase.

Over the next decade, delivery of cataract services to the remote rural poor will remain a challenge. Diabetes and glaucoma will increase in the cities and for those few surviving into older age macula degeneration will begin to be important. For children however much work will be needed to develop services for strabismus, but is it not time to look at prevention of cataract and other congenital abnormalities by introducing rubella vaccination, in spite of the associated problems?