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Guest editorial

VISION 2020: the meaning and the spirit of the right to sight
initiative

Prof Dr Murthy VS Gudlavalleti, MSc, MD
8 Bedord Square, Gower Street

London WC1B3RA, UK

VISION 2020: The Right to Sight, the global initiative for the elimination of avoidable blindness, has become the
fulcrum of all programs for control of blindness worldwide. Just like the five blind men who perceived an
elephant differently, policy makers, program planners, eye care professionals and the general population (the
main stake holder) have different interpretations for what VISION 2020 stands for. For many, it has replaced the
national programs for control of blindness that have been in existence for over two decades. For some, it is the
panacea of all that ails eye care services. For others it is the new mantra (formula) to get rid of unwanted
blindness. There are also those who presume that after 2020, there is no need of any focus on avoidable
blindness. With such a plethora of views, VISION 2020 unfortunately is being marketed by many as the new
strategy for eye care services. Instead of using VISION 2020 as a step to successfully climb the ladder for
prevention of blindness; many countries have fallen into the trap of using VISION 2020 as jargon. The laudable
effort of the global alliance between the countries of the world (represented by the WHO) and the international
eye NGOs (represented by IAPB) to use VISION 2020 as the plank to ‘demystify’ eye care and emphasize the
rights of all individuals to seek appropriate eye care and sound the bugle for those unnecessarily blind despite
available technology will stand defeated if the basic premise for the clarion call goes unheeded.

VISION 2020 became a reality because of the realization that problems abound while resources are limited. A
significant difference would be palpable if the available resources were to be used optimally. Therefore, it was
necessary to set priorities in both the relation to the diseases primarily responsible for blindness as well as to
populations which had remained marginalized and beyond the ‘service net’. At a global level, it was possible to
chart out a course of action with some benchmarks for individual countries to plan their strategies and activities.
For planning at country level, an evidence base was essential. There is a need for evidence on prevalence and
causes of blindness, availability and functionality of human resources and eye care infrastructure, integration of
eye care with general health services, community perceptions on eye care, utilization patterns of existing eye
care services, provider perceptions and needs and the political and administrative support to eye care before one
could embark on need-based and situation-dependant strategies for the elimination of avoidable blindness.
Unfortunately, even in countries where such evidence was available, policy makers and program planners chose
to ignore the same and instead devise plans based on ‘personal experience’, ‘anecdotal information’ and simple
jugglery of setting targets based on past outputs. In every country in the South Asia region, a VISION 2020
National Committee was formed, but in terms of functionality, most of the countries continued the same approach
to problem solving without paying heed to new evidence available from scientifically sound- research studies in
either their country or a neighboring country. Similarly, the planning for the future requirements for eye care
personnel has hardly been based on the availability and effectiveness of available human resources but has
depended on the numbers required by 2020 based on norms enunciated by the global VISION 2020. How the
gap between what was existing and what was required by 2020 was to be bridged has never been given
adequate attention. How personnel could be made to work in rural and remote area and what facilities they
would require to make them productive and happy are issues which need to be addressed. At the same time,
case studies need to be undertaken to see why some populations access services and why others do not.

Gudlavalleti MVS
Nep J Oph 2009;1(2):83-84
Right to sight initiative



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Gudlavalleti MVS
Nep J Oph 2009;1(2):83-84

Right to sight initiative

VISION 2020 is about making services accessible to all populations in a country. It therefore means that additional
efforts will be needed to increase access to populations that are not within easy reach compared to those
populations who are within reach. There has been a tendency to reach those within easy reach than make
efforts to reach the ‘unreached’. Very often one hears about a plethora of ‘eye camps’ at the same site year
after year while there are more needy areas where no eye care team ever ventures.

The need to work with communities cannot be under-emphasized. Identifying volunteers within communities
who act as facilitators and counselors through simple training can go a long way in sustaining eye care services
at no additional costs. However for maintaining their motivational levels, regular contact and due recognition for
their efforts are essential.

The most crucial aspect of VISION 2020 which is often overlooked is that the strategy is targeted towards those
‘already blind’ and redresses their problem. Most countries report on the number of cataract surgeries done in a
year and not on the number of surgeries done on blind persons where the presenting vision in the better eye is <
3/60. In India nearly 5 million cataract surgeries have been reported in 2008. How many of these were done on
blind persons is not known. Many people take the path of least resistance by stating that even if people are
operated before they go blind, they are being prevented from going blind in the future. What they forget is that
the recommended cataract surgical output for elimination of avoidable blindness is only tenable when that number
of surgeries is done ONLY on blind persons and not otherwise. If this principle is not followed, then it will not be
possible to eliminate avoidable blindness by 2020. Another argument used is that surgery is being done on a
‘blind’ eye and therefore it is acceptable. There is nothing like a ‘blind’ eye as blindness only refers to presenting
vision in the better eye and therefore connotes person vision.

Over the next 10 years, if professionals and program managers concentrate their efforts on identifying the most
needy groups through a situational analysis and needs-assessment exercise and ensure that blind persons in
these populations receive priority attention, it will go a long way in working towards the ethos and spirit of
VISION 2020, rather than using the laudable effort as marketable jargon.

Prof Dr Murthy VS Gudlavalleti, MSc, MD
8 Bedord Square, Gower Street

London WC1B3RA, UK

Source of support: nil. Conflict of interest: none