Eye health is essential to achieve the Sustainable Development Goals; vision needs to be reframed as a development issue There is extensive evidence showing that improving eye health contributes directly and indirectly to achieving many Sustainable Development Goals, including reducing poverty and improving work productivity, general and mental health, and education and equity. Improving eye health is a practical and cost-effective way of unlocking human potential. Eye health needs to be reframed as an enabling, cross-cutting issue within the sustainable development framework. Almost everyone will experience impaired vision or an eye condition during their lifetime and require eye care services; urgent action is necessary to meet the rapidly growing eye health need In 2020, 1•1 billion people had distance vision impairment or uncorrected presbyopia. By 2050, this figure is expected to rise to 1•8 billion. Most affected people live in low-income and middle-income countries (LMICs) with avoidable causes of vision impairment. During the life course, most people will experience vision impairment, even if just the need for reading glasses. Because of unmet needs and an ageing global population, eye health is a major public health and sustainable development concern which warrants urgent political action. Eye health is an essential component of universal health coverage; it must be included in planning, resourcing, and delivery of health care Universal health coverage is not universal without affordable, high quality, equitable eye care. In line with the WHO World report on vision, we urge countries to consider eye care as an essential service within universal health coverage. To deliver comprehensive services including promotion, prevention, treatment, and rehabilitation, eye care needs to be included in national strategic health plans and development policies, health financing structures, and health workforce planning. Coordinated intersectoral action is needed to systematically improve population eye health, also within healthy ageing initiatives, schools, and the workplace. Integration of eye health services with multiple relevant components of health service delivery and at all levels of the health system is of central importance.

To establish the prevalence and causes of low vision and blindness in children aged 0 to 15 years in Fiji using existing data and new surveys. Method: Childhood visual impairment data on both low visual acuity (Ͻ20/60-20/400) and blindness (Ͻ20/ 400) were obtained from existing records at hospital clinics, the school, an outreach service for visually impaired children, primary school screening records, and surveys in high schools and schools for children with multiple disabilities. Crude prevalence was derived and, using 5-year age range and age at onset of vision loss, the probable prevalence per 1000 children was calculated. Results: A total of 81 children were identified; causes were established for 70 children, showing that 69% had unavoidable causes of vision loss (retinal, 39.7% and corti-cal, 15.5%), with the avoidable cause of low vision and blindness mainly being cataract (15.5%). Probable prevalence was 1.134 per 1000 children (95% confidence interval [CI], 1.115-1.153), with low vision, 0.774 per 1000 children (95% CI, 0.758-0.790) and blindness, 0.36 per 1000 children (95% CI, 0.349-0.371). The rate of severe visual impairment (Ͻ20/ 200) was 0.522 per 1000 children (95% CI, 0.509-0.535), only half of the total vision loss. Conclusions: Both the low to moderate prevalence and mainly unavoidable causes of visual impairment indicated that Fiji, a developing country, has prevalence and causes of visual impairment similar to more resourced, industrialized countries.

Background In the Solomon Islands and Vanuatu, the sign trachomatous inflammation—follicular (TF) is common, but ocular infection with Chlamydia trachomatis is not. It is therefore debatable whether azithromycin mass drug administration (MDA), the recommended antibiotic treatment strategy for trachoma’s elimination as a public health problem, is necessary in this setting. We set out to estimate what proportion of adolescents were at risk of progression of trachomatous scarring. Methods A cross-sectional survey was undertaken of all children aged 10–14 years resident in communities identified as high-TF clusters during previous population-based mapping. Graders examined children for clinical evidence of trachomatous scarring, pannus and Herbert’s pits (HPs) or limbal follilcles in both eyes. A dried blood spot was collected from each child and tested for antibodies to C. trachomatis. Results A total of 492 children in 24 villages of the Solomon Islands and Vanuatu were examined. 35/492 (7%) of children had limbal signs (pannus and/or HPs) plus any conjunctival scarring. 9/492 (2%) had limbal signs and moderate or severe conjunctival scarring. 22% of children were anti-Pgp3 seropositve. Conclusions Few adolescents here are at risk of future complications from trachoma, supporting the conclusion that further antibiotic MDA is not currently required for trachoma elimination purposes in these settings.

. Yaws is a neglected tropical disease targeted for eradication by 2020. Kiribati, a Pacific Island nation, was previously endemic for yaws but lacks recent data from which its current endemicity status could be determined. This study tested antibody responses to Treponema pallidum to determine if transmission of yaws is taking place among children in Kiribati. Using a commercially available T. pallidum particle agglutination kit (Serodia ® , Fujirebio Inc., Tokyo, Japan), we tested dried blood spots, collected during population-based trachoma prevalence surveys on Tarawa Atoll and Kiritimati Island, for long-lived treponemal antibodies. Dried blood spots from 1,420 children aged 1–9 years were tested. Only two were positive, suggesting T. pallidum is not being widely transmitted among children in the settings sampled. These data require support from additional surveys to demonstrate the absence of clinical signs of disease and molecular evidence of infection, to confirm that yaws is no longer endemic in Kiribati.

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