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Reversible Visual Impairment in the Pacific Region

Callum Narita, Editorials and Publications Team PMSA

Visual impairment is a common health issue across the globe (1), and there is no exception within the Pacific region (2). It results in a substantially reduced quality of life and any level of visual impairment can hamper activities of daily living. The causes of visual impairment can be classified into irreversible and reversible categories. Those within the irreversible classification include the common age-related macular degeneration, diabetic retinopathy or glaucoma. These diseases can be challenging to manage, and often require longitudinal care.

Alternatively, the reversible causes of visual impairment and legal blindness can be simply and quickly addressed, often with a single interventional timepoint. Uncorrected refractive error is the leading cause of reversible vision loss across the globe, including the Pacific region. This includes myopia (short-sightedness), hyperopia (long-sightedness) and astigmatism (distorted vision due to abnormal curvature of the eyeball). These are all preventable with the use of glasses or contact lenses. WHO estimate 153 million people worldwide are affected with uncorrected refractive errors (3).

The second major cause of reversible vision loss is cataracts. This opacity of the lens of the eye causes clouding and blurring of the vision. These develop gradually, and whilst there are many risk factors, cataracts can occur in anyone, particularly as they age. To treat a cataract, surgery is required to remove the clouded lens and to replace with an artificial intraocular lens. This is a fast operation completed under mild sedation. This is also a common issue in developing nations. It is estimated that 33% of all visual impairment and 51% of legal blindness is caused by cataracts (1).

These two issues share the common feature of rapid treatment with excellent outcomes. Cataracts can be resolved with a single operation, and vision is rapidly restored. Uncorrected refractive error requires only the prescription of glasses to manage. Indeed, if both issues are present in the same patient, the inserted intraocular lens can assist with a refractive error and prevent the need for glasses.

The rates of visual impairment due to reversible causes tend to be lower in high income countries due to a higher availability of management. However, methods are being used to target those with reversible vision loss in developing nations. Namely, outreach clinics and aid work are common methods to assist with cataract surgery, particularly in the Pacific Island Countries and Territories (4). Often, local education is a key component of these programs, to ensure ongoing care is present in the at-risk areas.

However, given there are still many people living with reversible vision loss around the globe and in the Pacific, it appears these field trips are insufficient in managing this problem. Ultimately, further work is required to address the issue of reversible vision loss in the Pacific region.

1. Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. Br J Ophthalmol. 2012;96(5):614-8.

2. Garap JN, Sheeladevi S, Shamanna B, Nirmalan PK, Brian G, Williams C. Blindness and vision impairment in the elderly of Papua New Guinea. Clin Experiment Ophthalmol. 2006;34(4):335-41.

3. Resnikoff S, Pascolini D, Mariotti SP, Pokharel GP. Global magnitude of visual impairment caused by uncorrected refractive errors in 2004. Bull World Health Organ. 2008;86:63-70.

4. Lees J, McCool J, Woodward A. Eye health outreach services in the Pacific Islands region: an updated profile. The New Zealand Medical Journal (Online). 2015;128(1420):25.

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