Although Asian economies such as India and China are widely acknowledged now as global powerhouses, it nonetheless remains a fact that more than 60% of the world’s blindness can be found in Asia. Asia has many advantages in combating blindness, including a high population density, generally good transportation infrastructure, and a relatively high ratio of eye care providers to the population compared with regions such as Africa. Asia has provided successful models for the delivery of high-volume, low-cost cataract surgery at facilities such as Aravind in India and Lumbini in Nepal. However, challenges remain. This article briefly reviews the state of screening and prevention efforts for major causes of vision disability in Asia, while outlining how resources may best be allocated to remedy these problems ( Table ).

In Asia, as in most other parts of the world, cataract remains the leading cause of blindness and impaired vision. Screening outreach efforts and low-cost, high-volume surgery are increasingly available in the region, and there are encouraging data suggesting that such outreach in fact can help to redress disparities in gender, income, and education with regard to surgical access. Nonetheless, problems with surgical quality remain, particularly in rural areas, and uptake of available services may be poor, with lack of knowledge remaining a crucial barrier. Skill transfer may be problematic in countries such as China, where the opportunities to learn surgery, particularly for younger doctors in rural areas, may be limited. Educational interventions are needed, aimed at informing patients about the treatability of cataract and at providing surgeons with the knowledge of how to screen, treat, and manage follow-up and complications. Further resources should be allocated for routine, organized screening outreach, either from hospital revenue, government funds, or communities themselves.

Asian countries have among the world’s highest prevalence of children’s refractive error, much of which may go uncorrected in rural areas. Although school-based vision screening and refraction programs are increasingly widespread in Asia, these interventions are encountering certain barriers to achieving their maximum impact. In China, for example, there is a widespread belief among children, their parents, and teachers that wearing glasses is harmful to the eyes. Research is needed to test the effectiveness of interventions to correct such beliefs and to promote spectacle wear.

Although some programs provide free spectacles to children with refractive error, others provide screening and prescriptions only, depending on locally available services to dispense glasses. Although this approach arguably may be more sustainable, it is dependent on the quality of locally produced spectacles. Recent studies in rural China suggest that as many as 50% of glasses currently worn by children are inaccurate by 1.0 diopter or more and that nearly 20% vary by 2.0 diopters or more. Although current therapies have some limitations, research into compounds that can retard axial elongation raises the possibility of primary prevention of myopia in parts of Asia such as Taiwan, Singapore, and Hong Kong, where prevalence is very high, provided that accurate strategies can be devised to screen for children at risk sufficiently early in life.

Diabetes is a growing problem in Asia, with significant increases in prevalence predicted for the large populations of India, China, and Indonesia. Studies in rural Asia have demonstrated that as few as 10% of persons with diabetic eye disease have been diagnosed and treated. Even in urban areas, as many as two thirds of diabetic patients in treatment may not be receiving optimal eye care, with lack of knowledge among both patients and physicians posing the major barrier. In a chronic disease such as diabetes, the challenge goes beyond simple screening and includes improving adherence with life-long care. Programs are needed using proven interventions such as intensive case management and novel ones such as financial incentives and lotteries to increase the proportion of diabetics in Asia regularly receiving sight-saving care. Better training, for internists about the need for diabetic eye care, and for ophthalmologists on how to provide such care, also is needed.

Glaucoma is a leading cause of blindness in Asia, as it is elsewhere in the world. This disease causes 10% of all blindness in India, for example, although only 10% of Indians with glaucoma have been diagnosed and treated. Glaucoma screening has posed a significant challenge to program planners, and even in the developed-world setting, such screening programs have not been considered cost effective. It seems that the most efficient strategy for glaucoma in Asia currently may be to optimize case finding among patients seeking treatment at clinics, potentially for other ailments such as cataract. This strategy will depend principally on improved training of physicians and other caregivers. As with diabetic eye disease, after the screening problem has been overcome, the challenges of promoting long-term adherence to therapy and short-term acceptance of surgery remain. Limited available evidence suggests that compliance with glaucoma treatments in Asia is equally as problematic in the developed world, if not more so. As noted above for diabetes, cost-effective strategies are needed to improve performance in this area.

Much progress has been made in combating unnecessary blindness in Asia since the inception, 10 years ago, of Global Vision 2020. As this program nears its midway point, we are challenged to increase our efforts as physicians, educators, and researchers. Sufficient knowledge about the prevalence, causes, and treatments of eye disease in Asia exists to reduce the burden of blindness there drastically. Disseminating this knowledge widely among patients and doctors will be a key step in moving from theory to practice. A more proactive stance toward screening outreach, committing resources, personnel, and organizational support, also is needed on the part of providers. Strong evidence indicates that patients in rural Asia are prepared to pay sufficient amounts for these services to make such efforts sustainable.