Jan. 2, 2020
By Scott Mundle, OD
As a practicing optometrist for the past 36 years in Canada, it has been my duty, honor, and pleasure to take care of patients with all sorts of vision impairment. Practicing optometry in a developed world country with an expanded scope of practice allows me and my optometric colleagues to better assess, diagnose, manage and treat many types of eye disease and forms of refractive error, including the management of myopia.
As a maturing high myope myself, I can empathize with many other myopic patients. Thankfully, I was able to be treated for my ‘side effect’ of high myopia, specifically bilateral retinal tears, by a very competent local ophthalmologist in Canada before it had progressed to retinal detachments.
The Global Myopia Awareness Coalition (GMAC), which is housed within the World Council of Optometry (WCO), is a coalition of companies and health care associations committed to raising public awareness of childhood myopia, one of the significant public health challenges of our time. The WCO is proud to house GMAC within its organizational structure, and as Immediate Past President of the WCO, I am honored to be WCO’s representative on the GMAC Board.
With the recent release of the World Health Organization’s (WHO) World Report on Vision, the rest of the world will finally know what optometry has known for years – myopia is not just a ‘vision anomaly’ that is simply treated with glasses but a disease that can have devastating social, cultural, economic and health consequences, and also result in blindness. Globally, at least 2.2 billion people have a vision impairment or blindness, of which at least 1 billion have a vision impairment that could have been prevented or has yet to be addressed. Here are some of the pertinent issues raised in the World Report on Vision that will have a direct impact on strategies, including myopia management.
- The WHO is proposing integrated people-centered eye care (IPEC) as an approach to health systems that will contribute to achieving universal health coverage (UHC) and WHO’s Sustainable Development Goal 3 (SDG3): “Ensure healthy lives and promote well-being for all at all ages.”
- Significant challenges lie ahead. For example, eye care needs globally will rise sharply due to changes in demographics and lifestyle. Currently, vision care is often frequently poorly integrated into health systems, and the vision care sector workforce is poorly coordinated.
- The World Report on Vision recognizes and makes recommendations on some issues relevant to the GMAC’s mission, including making vison care an integral part of universal health coverage, promoting health systems research complementing existing evidence for effective eye care interventions and raise awareness and engage and empower people and communities about vision care needs.
With the burden of the disease of myopia now finally recognized by the WHO, the vision care sector will now be able to work with governments to implement a vision care strategy for their citizens. Included in this strategy will be an opportunity for the two main players in the sector, namely ophthalmology and optometry, to collaborate on a human resource structure for vision care that can be amended and implemented as necessary within regions and countries. Such structures and strategies will depend on the available human resources or cadres, the scope of practice of the cadres, and the availability of technology and treatment options and devices.
The infrastructure is well established in the developed world, where the recognition, regulation/legislation, and scope of practice of optometry is robust, and when optometry works in collaboration with ophthalmology, the care for the public is at its best. At the same time, some regions and countries are not as fortunate for several reasons. In these countries, where the need is the greatest, the infrastructure is less well established, and if the cadres work less collaboratively, the public suffers. The WHO has recognized that there are many other cadres and governmental and non-governmental organizations (NGOs) that also provide care throughout some parts of the world. While it will take time, ophthalmology and optometry have been tasked with working collaboratively to set up the best system in each country. WCO and the International Council of Ophthalmology (ICO) have already begun this process.
I envision a day when all peoples of the world have timely access to vision care, including assessment, diagnosis, treatment or management of all the various forms of vison care anomalies or disease. We owe it to the future generations to establish the platform where such care is equitable, affordable, and provided by the appropriate caregiver in the best way possible.
Scott Mundle, OD, is the immediate past president of the World Council of Optometry.