1976 is a landmark year for Global Blindness Prevention. After years of apathy, blindness prevention and control was on World Health Organisation (WHO) agenda. Only a year ago in 1975, World Health Assembly had adopted a resolution on problem of blindness. The assembly zeroed in on six leading causes of blindness at that time, namely trachoma, xerophthalmia, cataract, onchocerciasis, ocular trauma, and glaucoma. The next year’s theme for World health day and year was “Foresight prevents blindness.” Like all previous years, world health day theme is launched on 7th April, and it sets an agenda for current and subsequent years.
The year was indeed a landmark for Blindness Prevention in India. We launched National Programme for the Control of Blindness (NPCB), a first for any country in the world. However, given everything else that had occupied political landscape in India, this event must have gone unnoticed. We rather remember 1976, for a state of Emergency, political censorship, and forced vasectomies. Yet, the foundation of NPCB was all set to change the prevalent blindness scenario.
The strategies for prevention of blindness
Blindness prevention agenda was a need of the developing countries in Asia, Africa and Latin America. Three top priorities in 1976 were Xeropthalmia (due to deficiency of Vitamin A), trachoma (due to a bacterial infection) and River blindness or onchocerciasis (due to a neglected tropical parasitic infection). While the first two in the list were a global concern, River blindness was restricted to Africa.
Vitamin A Deficiency
India had already introduced Vitamin A supplementation as part of National Immunisation Program in 1970. The program provides nine doses of vitamin A till five years of age. Many other countries incorporated education and supplementation in their programs. Globally the prevalence of Vitamin A deficiency has substantially decreased.
River Blindness
Similarly, Today River blindness is eliminated from Latin America. It now has a restricted geography in Sub-saharan Africa, and is on the pathway for elimination soon.
Tracoma
Trachoma is a bacterial infection that affects the eyes, causing blindness and visual impairment. It is endemic in many remote and poor rural areas of Africa, Asia, Central and South America, Australia, and the Middle East. In 2024, it was declared eliminated from 18 tropical countries, and the global eradication target is set for the year 2030. Once a leading cause of preventable blindness in India, today this disease is practically eliminated. Trachoma elimination has four pillars, Socio-developmental markers and implementation of Surgery, Antibiotics, Facial cleanliness, Environmental improvement (SAFE) interventions.
Cataract
Cataract is a leading cause of blindness, and it affects elderly. India’s NPCB has traditionally been cataract surgery centric. Since 1976, the annual number of cataract surgeries in India have tremendously increased. Last year, in 2023 the program in India logged more than 83 Lakh surgeries.
Global blindness control programs
National Societies for blind, were set up in early 1900s in many countries of Europe. After first world war, countries launched blindness rehabilitation initiatives for the war wounded. Many international non-government agencies were also engaged in blindness prevention much before 1976. For instance, Lion’s club was established in 1917, and inspired by Helen Keller started blindness control activities in 1925. Sight-savers was established in the year 1950.
International Program for control of Blindness
WHO Programme for the Prevention of Blindness was officially established in Geneva in 1978. By 1987, WHO Task Force completed its analysis of blindness data, and estimated that there were between 27 and 35 million blind people in the world.
In 1999, WHO launched a Global Initiative for the Elimination of Avoidable Blindness by the year 2020. This initiative was called Vision-2020. This initiative placed preventable blindness on the worldwide agenda for public health. Many countries launched their National blindness control programs, as part of Vision-2020 initiative, for instance Bangladesh and Pakistan in 2005, and Sri Lanka in 2007.
Meanwhile, the International Agency for Prevention of Blindness (IABP) that was set up in 1978, began coordinating various efforts into one. One of the advocacy efforts was adopting “World Sight Day” in the year 2001. This day is observed on second Thursday of October, and this event was first initiated by Lions Club International Foundation as a part of their Sight First campaign. Many important initiatives of IAPB are launched on this day.
Blindness and Visual Impairment
In 2017 NPCB was renamed as NPCBVI. The words VI mean “Visual impairment”. While blindness is a condition with an extreme visual loss, visual impairment is less stringent. Blindness is defined as a visual acuity of less than 3/60. This means that an object that can normally be seen at 60 feet, can be seen by a person only from 3 feet or less. Cataract remains leading cause of blindness, followed by corneal damage, and ocular trauma. Visual impairment is defined as vision between 6/12 and 3/60.
In addition to Cataract, Myopia, Diabetic Retinopathy, Glaucoma and Age related Macular degeneration are now leading causes of Visual impairment today. The NPCBVI has now expanded to these areas as well. We have indeed come a long way from 1976.
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