New report helps to understand the impact of blindness and vision impairment in Vanuatu

A survey into the causes of blindness in Vanuatu has found that 92 per cent of blindness in the Pacific Island nation is avoidable. This means that nine out of 10 people who are blind don’t need to be.

The Rapid Assessment of Avoidable Blindness (RAAB) Survey, conducted between August and December 2023, examined the eyes of over 5,000 people across all six provinces of Vanuatu.

The cross-sectional population-based survey, for adults over 50 years of age, looks at the prevalence and causes of blindness and visual impairment, the quality of eye care services, barriers to receiving eye care, cataract surgical coverage and other indicators of eye care services in a given country.

The RAAB survey report, which was approved for public release on 19 November 2024, was conducted by the Ministry of Health of the Government of Vanuatu, with technical support and funding from The Fred Hollows Foundation NZ and The Fred Hollows Foundation Australia. The Foundation is also grateful for additional funding provided by New Zealand’s Ministry of Foreign Affairs and Trade (MFAT) and JN & HB Williams Foundation. This represents a significant effort to understand the prevalence and causes of blindness and vision impairment in Vanuatu.

The research evidence will inform Ministry of Health, provincial and national planning for Vanuatu eye health services. It will also enable the local eye care team, and its partners, to advocate for, and build national capacity to improve eye health access, responses and interventions, as well as monitor the effectiveness of eye care programmes.

Dr Audrey Aumua, Chief Executive Officer of The Foundation, says the survey forms part of a broader initiative aimed at enhancing eye health across the Pacific, driven by the belief that everyone has the right to good vision, irrespective of their geographic or economic circumstances.

“Addressing the impacts of avoidable blindness and vision impairment is a major challenge for Pacific Island countries because they have limited information on the scale, nature, and distribution of this important public health issue. As such, the true burden of vision loss on health and economic development is largely invisible, with many countries not having plans or policies that can target efforts and resources towards addressing this significant challenge.

“The goal of this research is to support Pacific governments in establishing affordable, effective, and equitable eye health systems,” she says.

In Vanuatu, the rate of blindness was found to be 1.7 per cent, with a further 19.4 per cent of people living with some form of vision impairment. This equates to just over 8,000 people aged 50 years and older living with some form of blindness or visual impairment.

Although the prevalence of blindness is lower in relation to other countries in the Pacific for which comparable data is available (Papua New Guinea, 5.6 per cent, and Fiji, 2.6 per cent), these findings underscore the significant burden of vision impairment in the population aged 50 years and older.

Untreated cataracts were identified as the leading cause of blindness and vision impairment, accounting for more than half (53 per cent) of cases in the survey. In terms of unmet need for cataract surgery, it was estimated that approximately 5,800 people have some degree of vision loss due to cataracts in both eyes, and a further 9,600 live with vision loss in one eye due to cataract.

The survey found that while almost 80 per cent (79.2 per cent) of people who were blinded by cataracts had received surgery, only just over half of these (54.6 per cent) could see better after the treatment.

Another significant cause of vision loss was uncorrected refractive error, which was the leading cause of early vision impairment, responsible for 76.9 per cent of cases.

Globally, uncorrected refractive error is the main cause of visual impairment, however, most people can see again with a correctly prescribed pair of glasses.

In Vanuatu, over 10 per cent (10.3 per cent) of all participants who needed glasses were found to not have them or had not been prescribed the correct lenses.

Dr Johnson Kasso, Vanuatu Ministry of Health RAAB Principal Investigator, says these findings highlight significant achievements and opportunities for improvement to eye care services in Vanuatu.

“The findings indicate a relatively low prevalence of blindness but highlight significant gaps in cataract surgical outcomes, as well as low refractive error coverage. These gaps point to the need for enhanced strategies to improve access to and quality of eye care services in Vanuatu,” he says.

Much of blindness and vision impairment discovered in survey participants is avoidable because it’s treatable and preventable with cost-effective interventions.

“In many cases a simple 20-minute operation can restore sight. Some people simply need glasses,” Dr Kasso says.

“However, data suggests that while many cataract surgeries were performed, the quality of surgery and visual outcomes in Vanuatu needs improvement, therefore priority should be given to improving the quality of cataract surgery, before focusing on actions to increase access or output.

“A significant proportion of people with refractive errors are also not receiving effective care, which highlights the need for strengthened refractive services in Vanuatu.”

Dr Aumua says investment in eye health goes beyond restoring eyesight. Globally, every USD$1 invested in tackling the world’s two leading causes of blindness, cataract and refractive error, delivers an economic return of USD$9.40.

“It is transformative, helping people to unlock human potential in education and employment which contributes to workforce productivity, economic development, prosperity, and stability.”

The RAAB survey also included a component that helps to assess the prevalence of diabetes and diabetic retinopathy (DR), which are increasing public health issues in the Pacific. Diabetic retinopathy is a complication of diabetes that damages the blood vessels in the back of the eye (retina), and which can lead to blindness if not adequately managed.

In this survey, 13.3 per cent of those who consented to a diabetes examination (which was 99 per cent of those surveyed) were identified with known or suspected diabetes. But more than eight in 10 people (85.9 per cent) of these had never undergone an eye examination for diabetic retinopathy. Within this group, among those who consented to a DR examination (which was 88.9 per cent of the group), 21.2 per cent had some degree of retinopathy and 8 per cent had sight threatening DR.

“This lack of regular screening increases the risk of vision loss among individuals with diabetes and underscores the need for further strengthening of DR screening and management services,” Dr Kasso says.

“Integrating diabetes care with eye health services is essential to provide comprehensive care. Early detection is the most important and cost-effective way to prevent blindness.”