Australia and other developed economies need to take vision loss seriously, as blindness and vision loss have huge and broad ranging impacts on our society. Even in a developed country like Australia, avoidable vision loss is a major problem now, and will increase with the changing demography. Although specific interventions may increase direct costs they should bring significant savings in both categories of indirect costs.
Blindness and cancer are the two most feared health conditions that people want to prevent.17
Australia has good tertiary and secondary eye care services. It also has some of the best data in the world, if not the best, on the distribution and impact of visual impairment.4
These data show the trebling of vision loss with each decade of life, with substantial impacts on independent living and the quality of life, and the issues presented by demographic ageing. The projected prevalence together with the cost and impact of vision loss presented in this report confirm the need to develop and utilise treatments and technologies to safeguard the eyesight of the increasing number of people who would otherwise lose vision.
Much can be done because so much blindness and vision loss can be prevented or treated with cost effective interventions. Half of visual impairment is correctable and one quarter is preventable.4
Well constructed strategies such as The Vision Initiative are available and should be implemented nationwide without delay.18
The real direct and indirect financial cost of vision loss represents A$252 for every Australian or 0.6% of GDP. Eye care has a range of proved, low risk, high success and cost effective interventions, as measured by cost utility and cost effectiveness analysis, normally expressed as A$/QALY (quality adjusted life year or one DALY avoided). For Australia, an intervention that costs between A$37
000 to A$112
000/QALY is regarded as being cost effective.7
If the cost is less than GDP per capita to avert one lost DALY, that is less than A$37
000, it is considered to be very cost effective.
First eye cataract surgery costs around A$2800 (US$2020) per QALY and second eye cataract surgery was almost as cost effective at A$3700 (US$2727), converted at purchasing power parity of 0.7281.19,20
The distribution of and access to eye care services need to be improved, especially the delivery models available in rural and remote Australia. Given the major impact of visual impairment, the 2 year long waiting lists for cost effective procedures like cataract surgery must seriously be reassessed.
Further research is necessary to address the questions of blindness and vision loss that currently are unable to be comprehensively treated, particularly conditions such as glaucoma and macular degeneration. Substantially increased public sector research funding through National Health and Medical Research Council and other bodies is needed. The funding in 2004 was A$36.4 million. The exceptional returns to investment in health research and development from Australian health research and development have been documented and show a return of up to 5:1 for every dollar spent from 1960 to 1999.21
Research needs to be viewed as an investment in health outcomes for ourselves and our children
There is a need for rehabilitation services for most people with vision loss; however, less than a quarter of people with vision loss access these services.22
Rehabilitation services have the potential to maintain quality of life and thus reduce the impact of visual impairment.
Further research is needed to develop models of effective services that can provide for greater numbers of people with impaired vision. The increase in numbers is not only from the ageing of the population but also from more effective referral services.
Even in a developed country vision loss imposes a tremendous cost. A country cannot afford avoidable vision loss and specific initiatives and health policies need to be developed to address this issue.