Nepal Achieves new Milestone in eye health: Blindness reduction

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From 1981 to 2021, Nepal has shown tremendous progress in eye health. With the support of IAPB members in the country another blindness survey was carried out in 2019, which showed reduction of prevalence of blindness as 1.05% among the age 50 years and older. The all-age extrapolation shows that prevalence of blindness as 0.26%. The recent RAAB survey also provides the eCSC data on operable cataract defined at <VA 6/60, post-operative outcome of ≥6/12 as 62.6%. The survey revealed that blindness reduction and improved in cataract surgical coverage and outcome compared to 2010 survey.

The province wise detail of prevalence of blindness of RAAB Survey 2020 is showed in table appended below.

	Female			Male			Total
Province	N	%	95% CI	N	%	95% CI	N	%	95% CI
1	3,488	0.94	0.58 – 1.53	2,904	0.78	0.48 – 1.24	7,136	0.96	0.61 – 1.19
2	5,420	1.49	1.02 – 2.17	4,170	1.05	0.68 – 1.63	9,511	1.25	0.94 – 1.68
Bagmati	3,495	0.86	0.62 – 1.20	1,912	0.45	0.28 – 0.73	5,403	0.65	0.50 – 0.84
Gandaki	2,576	1.22	0.84 – 1.78	1,128	0.60	0.35 – 1.04	3,791	0.95	0.70 – 1.30
Lumbini	6,801	2.07	1.59 – 2.69	4,681	1.43	0.99 – 2.05	11,479	1.75	1.40 – 2.20
Karnali	1,034	1.11	0.73 – 1.69	765	0.79	0.45 – 1.35	1,805	0.95	0.67 – 1.34
Sudur Paschim	888	0.71	0.45 – 1.10	629	0.50	0.30 – 0.84	1,506	0.60	0.42 – 0.86
National	23,360	1.23	1.06 – 1.42	16,811	0.87	0.72 – 1.05	40,230	1.05	0.93 – 1.18

This is a massive achievement, considering the first ever nation-wide blindness survey in 1981 showed that 0.84% of the population was blind, 80% of the blindness was avoidable and 92% of all the people with blindness resided in the rural area. Cataract alone accounted for two thirds of Nepal’s blindness.

The Rapid Assessment of Avoidable Blindness survey carried out in the country in 2010 showed there is blindness rate as 2.5% (among the age 50 years and older) and all age extrapolation was estimated as 0.35%. This was almost 60% reduction in blindness in three decades compare to prevalence rate of 1981.

So, how was progress achieved in Nepal from 1981 to now?

In 1981, eye Health services were in the rudimentary stage, few government hospitals had eye department, only 7 Ophthalmologists without any paramedic’s support in eye health were performing 700 to 1000 cataract surgery annually in the country. Only one dedicated eye hospital existed in the capital city of Kathmandu for tertiary level eye care. Considering limited capacity in eye health and other health priorities the Nepal Government initiated Public Private Partnership in eye health thus NGO and INGO were solicited to support the eye health services in the country. Many IAPB members such as SEVA Foundation, Eye Care Foundation, Norwegian Association for Blindness and Partially Sighted (NABP); Swiss Red Cross; CBM, Orbis International, Lions Club International, Fred Hollows Foundation, Himalayan Cataract Project, Operation Eyesight Universal, AOCA, Japan and many more supported eye care services in Nepal.

Following the survey, a Master Plan was developed in 1982 and various category of human resource was developed. Ophthalmic Assistant training was started in 1981 and in country training programme for Ophthalmologist and Optometrists was started in 1988 and 1998 respectively. At present there are more than 400 Ophthalmologist, 1250 Ophthalmic Assistants, and more than 400 Optometrist in the country provides service to more than 4 million people including 350,000 cataract surgeries annually.

Infrastructure of the eye hospitals in various parts of the country and primary eye care centers in different districts were established with the support of local, national, and international government and non-government organizations, agencies, trusts and the local families and individuals in their respective districts/areas.

All of this has contributed significantly to the change we see now in Nepal.