Eye Care Services in a Time of Covid-19

 By Olusegun Adeniyi

(Keynote speech at the 44th national conference and vision expo of the Nigerian Optometric Association in Lagos on 24th June, 2021)

Officials and members of the Nigerian Optometric Association (NOA), distinguished ladies and gentlemen, I am delighted to be here this morning for your 44th annual conference and vision expo. I consider it a privilege to be asked to speak at such a gathering of respected healthcare professionals as this.

While the human brain combines the neurons of seeing, hearing, smelling, tasting, and touching as an integrated whole, seeing, as the old saying goes, is believing. It has to be so. With about 80 percent of our impressions created by means of sight, it indeed goes without saying that the eyes represent the most important of these five sense organs. In fact, so critical is this sense organ to our general well-being that the word eye is mentioned 40 times in 38 verses of the Quran while there are 44 Biblical passages that speak to its significance. I crave the indulgence of this audience to read Matthew 26, verses 22 and 23: “The eye is the lamp of the body. If your eyes are healthy, your whole body will be full of light. But if your eyes are unhealthy, your whole body will be full of darkness. If then the light within you is darkness, how great is that darkness!” This same passage is more or less repeated in Luke 4, verses 34 to 36, perhaps for emphasis on the critical role that the eyes play in our lives.

From reading a book to driving a car to shopping in a mall to watching the news, life revolves around the gift of sight. But it is also perhaps the most challenged of the five sense organs and definitely the most sensitive, which then explains why your work as optometrists is very important.

Although more than three quarters of all blindness and visual impairment cases are either preventable or treatable, access to such care has shrunk considerably in the past one and a half years, due essentially to Covid-19 pandemic. But even if there were no pandemic, utilization of eye care services in Nigeria has always been very low. With more than half the population living below the poverty line, it is understandable. Yet, the lack of attention to optical health will have knock-on effects on the quality of life for our people. It is therefore time to innovate and scale up the provision of eye health services in Nigeria, starting from today. So, the theme for this conference ‘Quality Eye Care: Economic and Security Impact of COVID-19’ could not have been more apt.

The enormity of the health challenge we face as a nation can be glimpsed from the fact that while the World Council of Optometry (WCO) prescribes one to 10,000 as the appropriate ratio for optometrists to population, we are far from meeting that threshold. If the members of this association are 4,000 in a population of more than 200 million people, that means one Optometrist is serving about 50,000 persons. When it is further revealed that there is significant disparity between urban and rural dwellers in eye care services uptake and that majority of Nigerians live in the rural areas, we can see the challenge clearly. In the eye care services context, the rural areas remain highly underserved and even where access exist, there are fewer eye care facilities, personnel resources, etc.

With the restrictions imposed by COVID-19 pandemic, the few interventionist efforts (medical missions, outreaches, community eye health programmes, etc.) to bridge the gap to eye care access for rural communities have been severely hindered, invariably producing devastating consequences on eye health delivery for many of our people. This has in turn led to the proliferation of unwholesome actors who peddle blindness in the name of eye care.

In October 2019, the World Health Organisation (WHO) launched its first report on vision which established that changing lifestyles and limited access to eye care are among the main drivers of the rising numbers of people living with vision impairment, especially in Third World countries. “It is unacceptable that 65 million people are blind or have impaired sight when their vision could have been corrected overnight with a cataract operation, or that over 800 million struggle in everyday activities because they lack access to a pair of glasses,” says Dr Tedros Adhanom Ghebreyesus, WHO Director-General. Dr Alarcos Cieza, who heads WHO’s work to address blindness and vision impairment, could not have put it better when he said: “In a world built on the ability to see, eye care services, including rehabilitation, must be provided closer to communities for people to achieve their maximum potential.”

Findings in the report include the fact that the burden for vision impairment is often far greater in people living in rural areas, those with low incomes, people with disabilities, ethnic minorities and indigenous populations. The report concludes that sub-Saharan Africa and South Asia “have rates of blindness that are eight times higher than in all high-income countries.” Coming home, it is estimated that more than a million Nigerians are currently blind. About three million others are estimated to have moderate visual impairment and an additional half a million severely visually impaired. But there is also a class dimension to this challenge, even within the country. The more people are driven into poverty, the more difficult it becomes to afford the appropriate care for their eyes.

Unfortunately, there is less focus on optometry services in Nigeria, which in turn can be dangerous for people’s knowledge of what to do and where to go when they actually need medical attention. There is a role that we in the media can also play in this area. That will entail continuously raising awareness for people to care for their eyes – including outlining access to eye care in local communities. But the first responsibility is that of the health authorities who must create access to these services, thereby limiting the number of people going blind with dire implications for our national economic well-being. For example, if a parent goes blind due to lack of access or no money to afford appropriate eye care, that could throw the entire family into chaos and hardship. In a situation in which those without any disabilities find it difficult to be gainfully employed, one can then imagine the fate of the visually impaired. So, there is a way in which vision impairment reinforces poverty. The problem has been compounded by the COVID-19 pandemic.

As at 6am this morning when I last checked the WHO Dashboard, there were 178,837,204 confirmed cases of Covid-19 globally, resulting in the confirmed death of 3,880,450 people while 2,414,347,324 doses of vaccine have been administered. With the financial impact running into trillions of dollars, it has severely challenged all infrastructures and resources globally including eye care resources. Lockdowns, revised clinical protocols, loss of eye health personnel and resources, loss of funding for eye care, scaling down of numerous intervention efforts, etc. have brought about severe reduction in access to quality eye care. To worsen the situation, current projections put the estimated number of people with visual impairment to reach 50% of the world population by 2050 and we can all hazard a guess as to where the majority of them will be.

Covid-19 pandemic is not just a huge challenge for global health systems; especially for developing countries like Nigeria, it is also a socio-economic burden. Which is why if we do nothing to scale up eye care services, more and more people will be impacted negatively – with clear detriment to their mobility and quality of life. I am therefore calling on the Nigerian Optometric Association to step up their campaign in making both the people in authority and the society at large appreciate the role that eye care services play in the national economy.

For quality eye care to reach target population and produce the desired outcome, it must be available, affordable and accessible to all. With the advent of the pandemic, eye health resources and programmes have dwindled leading to a worsening of the already grim outlook of the blindness scourge. With reduced earnings, households tend to focus more on survival and providing primary needs such as food, shelter, clothing, etc. This lowered demand for quality eye care and uptake of eye care services has worsened the already bad situation, especially given the tendency to consume substandard eye care services which will worsen the blindness burden both in the short and long terms. I hope the health authorities in Nigeria are paying attention to this emerging problem.

On the positive side, some of the inconvenient protocols that go with Covid-19 preventive measures have helped to a certain extent in eye care services. Basic interventions such as handwashing, social distancing techniques, improved hygiene, etc. rub off on the delivery of quality eye care as transmissible diseases such as trachoma etc. naturally would reduce in spread rate. But on the negative side, several eye care professionals have either been thrown out of job or suffered underemployment as a result of the pandemic. Studies from most countries reveal that work hours have reduced for eye care professionals in order to minimize their exposure to unsuspected carriers. The same is true of Nigeria. There are reports of work/salaries being reduced or suspended entirely for some practitioners in order for their employer-institutions to remain financially viable. This situation has dragged some of those affected into poverty or, at best, reduced their economic capacities. It has also impacted negatively on the larger society.

With restriction in consultations for eye and health care services as several hospitals and clinics decline to receive patients due to Covid-19 pandemic, non-sight -threatening cases were not attended to, causing patients to result to alternative and most often unsafe methods of dealing with their eye health problems. The period of lockdowns and restricted movements spiraled many of our people into the blindness cage and by extension, pushed them below the poverty line.

Before I take my seat, let me say that Nigerian Optometrists must seek the appropriate skills, knowledge and facilities to manage the huge demand hat is out there. This will entail working more collaboratively with global partners to share knowledge and learn innovative and new ways of carrying out the duties of providing eye care services to patients. Perhaps this is the time for the establishment of a Covid-19 response efforts for urgent eye care services across the country. I am sure your members can reach out to the presidential task force on Covid-19 on how to leverage on your expertise and experience in that direction.

Finally, this association should take the lead on the establishment of a more innovative ways of providing care, including tele-optometry, as we have seen in several other countries. As of 2019, the telemedicine global market was valued at some $50 billion. The market was forecast to grow significantly with projection that by 2030, it would be valued at nearly $460 billion. Many factors have contributed to the growth of this market, including increased traditional health care costs, funding for telemedicine and an increase in digital health users. However, the most recent driver is the COVID-19 pandemic. There can be no better time than now for members of this association to key in.

As I take my seat, let me commend this great association for the efforts you are making to serve public good despite the hostile operating environment. I am for instance aware of your collaboration with the Federal Road Safety Corps (FRSC) on ‘Vision for the Road’, a radio programme which focuses on sensitising the motoring public on how to maintain excellent vision and some other initiatives.

Thank you for inviting me here this morning. I wish you a successful conference.