The Cost of Myopia: An Interview with Dr. Kovin Naidoo

Over the last couple of months we’ve been highlighting the myopia epidemic and have received valuable feedback through our social media channels. What stood out to me are the comments about personal experience with nearsightedness and the impact it has on individual lives. Multiply this impact to billions of people, and the cost to individuals and societies is vast. This month we invited VII Advisory Board Member, Optometrist and Public Health Leader, Kovin Naidoo, to give us his perspective on how myopia is affecting our societies in ways that go beyond purely vision. Here’s a summary of our interview:

We’re hearing more and more about the impact of myopia. How is the epidemic affecting the world from a cost perspective?

It should be noted that the numbers below are just one measure of the cost to society and more research needs to be done to determine the total cost. As the prevalence of myopia increases to 50 percent of the world’s population by 2050, the cost to correct myopia and provide services to deal with both correction and treating eye diseases (Myopia Macular Degeneration(MMD) and glaucoma, for example) will be astronomical and will place a huge burden on economies. Earlier this year, we presented a poster at The Association for Research in Ophthalmology Conference (ARVO) that contextualized this economic impact from a productivity perspective. The global potential productivity loss associated with the burden of Vision Impairment (VI) from Myopic Macular Degeneration (MMD) and uncorrected myopia in 2015 was estimated at US$250 billion including US$17 billion (US$3-49 billion) in care-associated productivity loss. This will increase significantly as the prevalence increases.

You’ve often said that this problem requires a consolidated effort. Why is that?

The projected prevalence of myopia is mind boggling and constitutes a future public health crisis of a magnitude seldom seen. Furthermore, studies show that access to spectacle correction is very low in some communities. At times less than 20 percent of those who need spectacles are able to access correction, and this magnifies the challenge we face.

It is very rare for a major public health issue to affect half of the world’s population. In order to reverse this trend we need to mobilize all players and consolidate efforts to achieve our goals.  We need to adopt a comprehensive approach that addresses service delivery, access to affordable correction, health promotion, advocacy and policy change at a national level. All players in eye care need to contribute. We need to scale up services like we’ve never done before. This means that government, civil society, academia/researchers (creating affordable myopia control products), and the private sector need to come together to make this happen.

As a global society how do we address myopia?

To implement the strategies I outlined above, we need to collaborate for change and not focus on competing with each other. We need more collaborative efforts like the International Myopia Institute (IMI) that is bringing about consensus on key issues such as definitions, clinical guidelines, clinical trials, and industry approach. Consensus will ensure that we speak with one unified voice and keep our eye on the key challenge rather than focus on disagreements between us. We need more coalitions around education, service delivery, health promotion, advocacy, and research. For far too long good efforts have focused on islands of success, while we have been surrounded by a sea of need. Coalitions and partnerships will allow us to scale up efforts and make the true impact that is needed. Failure to do so is tantamount to having self-serving organizations and institutions that keep us in jobs while society’s needs escalate.

It’s clear we need to work together in partnership. What role can government play?

Government is critical in the developing world in addressing the needs of the poor. Even without the myopia crisis, refractive services are in a crisis in many countries. This is going to only get worse with the increase in myopia prevalence. In particular, governments need to escalate child eye health services and, in particular, school eye health services, to reach our children as early as possible.

Both developing and developed country governments need to address policies that make eye exams compulsory for children at an early age, create policies that allow for easy access and import of myopia control products, accelerate the passing of regulatory approval of myopia control products, and push the national narrative around prevention with strategies and policies around time outdoors.

What steps can we take in our schools?

If myopia is the enemy, schools are our battleground. All over the world, schools create access points for children and parents that could be maximized for direct service delivery or health promotion activities that encourage parents to take children for eye exams and access the appropriate correction.

In the developing world, despite barriers of poverty and hunger, children are getting to school, but when they get there they can’t see the board. In that case their lack of clear vision is not helping them to break the continuum of poverty. We have a compelling argument to make schools the launch pad of a broader program to address myopia.

 How does the private sector play a role?

The private sector needs to support all components of a comprehensive approach, be it service delivery, human resource development, advocacy, policy change, research, and health promotion. However, industry should drive the agenda to create advanced, yet affordable, myopia control products, whether  contact lenses or spectacle lenses, and create access for children all over the world. The best technology in the world is worthless if it is not accessible to the majority of our children.

How can vision organizations play a role?

Vision organizations are key to supporting the comprehensive approach by prioritizing advocacy and policy change. Governments (public sector) and the private sector practitioners are the custodians of service delivery. Vision organizations must support the scaling up of these services rather than see themselves as a replacement for either government or the practitioners. They play a catalytic role and can adopt a more activist approach to effecting change. We need to get our agenda on the WHO, UNICEF, and other broader development agendas. We need to make the case that myopia has the potential to slow the education of our children and thus hamper efforts at achieving the Sustainable Development Goals (SDGs). If we continue operating within a narrow clinical paradigm, we will be sitting with a crisis in the future, and history is going to judge all of us –  public, private, academic, and civil society organizations –  very harshly.

We’ve seen the success of adopting a broader more collaborative approach. The Our Children’s Vision Campaign (OCV) in its short existence, has brought together more than 75 eye care and other organizations, to put child eye health on the broader development agenda of governments in both the developing and developed world. The collaboration also supports advocacy, policy change, and health promotion efforts. It is a matter of partner or perish.

Are there examples of countries that you’ve seen that have started to tackle myopia with some success?

I do believe that countries like Singapore, Taiwan, and China have recognized the crisis myopia poses, and there have been efforts at effecting policy change and pushing an agenda to address myopia. However, even in these countries there’s a lot to do to ensure a more comprehensive approach is adopted.

There are other countries like Cambodia, Liberia and individual states in the US that have started addressing the issue of school eye health through policies that can scale up access, and this is a good start. There is, however, still a lot to do. A great start will be increasing the time outdoors in preschools and schools across the world and effecting education policy to support this.

What will happen if we don’t do anything about myopia?

We will face a crisis in eye and health care. The impact of high myopia (worse than -5.00D) will be particularly devastating. Blindness and vision impairment prevalence will increase and reverse the gains we have made thus far through prevention efforts. The cost of managing glaucoma, MMD, early cataracts, and ocular disease associated with high myopia will put huge pressure on already burdened eye health services.

How can each of us play a role in being a catalyst for change?

Optometrists and ophthalmologists need to see themselves as managing patients and families and not merely treating myopia. This will demand a paradigm shift in the way we practice. Health promotion and education has to become a critical component of the patient management repertoire. Eyecare professionals will also need to support efforts at effecting policy change and use their connection in the community to become advocates. Every politician has either an optometrist or an ophthalmologist who takes care of his or her eye health.

The rest of society needs to effect change through civil society organizations and focus on advocacy and health promotion efforts. At the very least, we must start at effecting behavior change with our own kids.

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