From Science and Technology to Eye-Health Policy: A Review on Global and Asia–Pacific Strategies on the Prevention of Blindness from Retinal Diseases

Abstract

The World Health Organization (WHO) is making a concerted effort to enhance health, including eye health and overall well-being. This global effort has resulted in a reduced age-standardized prevalence of avoidable blindness and no increase in avoidable moderate and severe vision impairment. However, the absolute number of cases has increased for both avoidable blindness and moderate-to-severe vision impairment. Globally, the leading causes of visual impairment include uncorrected refractive errors and cataract, though many retinal conditions equally contribute. All causes of blindness and moderate-to-severe visual impairment are higher in low- and middle-income countries, including many in the Asia–Pacific region. This inequality could be reduced by harmonizing science and technology and translating them into regulatory policy to close the care loop.

This review aimed to provide a perspective on the disease burden of common retinal conditions such as diabetic retinopathy, age-related macular degeneration, myopia, and retinopathy of prematurity; the latest science and technology for diagnosing and treating these conditions; and recommendations to translate them into national policy. We also reviewed the WHO’s global policy and targets related to the United Nations Sustainable Development Goals, recommended to prevent global blindness by the year 2030. The national health and eye care systems, from primary to tertiary care, in an Asia–Pacific country, which align with “Integrated People-Centered Eye Care” proposed by WHO, are also reviewed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40123-026-01361-w.

Key Summary Points

As the year 2030 draws near—the targeted milestone for the prevention of global blindness proposed by the World Health Organization (WHO)—the gap in eye care should be identified, monitored, and closed to achieve this goal. Advancements in science and technology alone, without being translated into policy, cannot address these important tasks.

Although the WHO has issued global targets for the management of refractive error and cataract, and regional targets for the management of diabetic retinopathy, certain retinal diseases, such as age-related macular degeneration, myopia, and retinopathy of prematurity, are not accounted for in the global burden. The prevalence of these diseases in the Asia-Pacific region contributes a large proportion of the global burden.

The implementation of national policies, based on the latest science and technology, such as telemedicine and artificial intelligence, to prevent blindness from the leading retinal diseases may be conducted in parallel to the policies on refractive error, cataract, and diabetic retinopathy.

Introduction

In 2021, all the 193 member states of the United Nations (UN) unanimously agreed upon the resolution “Vision for Everyone”, the first UN General Assembly resolution on eye health, aiming to integrate eye health into the UN Sustainable Development Goals (SDGs) to accelerate actions to achieve the goals. This resolution was supported by World Health Assembly Resolution 73.4, adopted in 2020, urging member states to include people-centered eye care in universal health coverage. This call to action was to nudge the member states to implement scientific and technological advances into public policy to prevent blindness.

Science and technology have made significant contributions to the transition in health and healthcare delivery, providing clinicians, patients, policymakers, and the public with transparent information that has led to improved healthcare quality and access. There have been several examples of science contributing to important health policies, such as hand washing to reduce the spread of infection, mandatory vaccinations in childhood against certain infectious diseases, use of iodized salt to reduce goiter, stopping tobacco to reduce the incidence of cancer; and the most recent, the vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In ophthalmology, similar examples include universal neonatal screening to detect congenital eye disorders at birth, annual eye examinations for comprehensive eye health, dilated fundus examinations to detect diabetic retinopathy, the use of an intraocular lens in cataract surgery to improve vision quality, and the use of povidone-iodine in ophthalmic surgery to reduce postoperative infection.

Globally, at least 2.2 billion people have vision impairment. Unfortunately, about half of them have the impairment that should have been prevented or at least addressed [1]. The annual global cost of productivity loss due to burden on vision impairment is estimated at US $411 billion [1]. While uncorrected refractive errors and unoperated cataract remain as the global leading causes of vision impairment, retinal disorders, already the leading cause of vision impairment in some regions in the world, are emerging as a global burden. A recent nationwide registry study from China demonstrated that retinal diseases (diabetic retinopathy [DR] is the leading cause) resulted in a significant burden of vision impairment in the country [2]. A few other common retinal diseases, such as age-related macular degeneration (AMD), myopia, particularly pathologic myopia, and retinopathy of prematurity (ROP) in the Asia–Pacific region, share significant proportions of the global burden.

The objectives of this review are to measure the recent scientific knowledge and technology with respect to care for retinal diseases and their impact on eye care policy planning in the Asia–Pacific region. We selected retinal disease specifically because these are the emerging eye disorders after uncorrected refractive error and unoperated cataract. Program planning for eye care cannot be discussed separately from human health planning; we therefore briefly describe the region’s health status before elaborating on retinal disorders. We then explore how the new knowledge could be translated into a public health policy aligned with the UN’s aspirational goals for the 2030 SDGs. However, considering that there are both high- and low-income group countries and proportionately different resources in different countries in the region, the strategy for retinal disease care in people in different regions would be different. We have also cited the case study of Thailand, which has successfully implemented many of the stated goals and formulated an eye health policy. We hope this article helps inform policymakers in preventing visual impairment from retinal disorders and advancing the goal of “Vision for Everyone” by 2030.

Methods

In this article, we defined the Asia–Pacific region per the WHO regions, i.e., West Pacific (29 countries) and Southeast Asia (11 countries). We utilized World Bank data to present the country’s baseline information, such as population, economy, and two key health indicators: physician density and health expenditure per capita and obtained the recent healthcare consumption trends from the 2023 Bain & Company survey. We conducted a literature search on PubMed using search term: “prevention” AND “blindness” AND “retinal diseases”. We included articles related to the prevention of blindness from retinal diseases, including their epidemiology, disease burden, technology, and treatment. The articles were reviewed if they had full-text available and were published in English from January 2015 to December 2025. We focused on four common retinal disorders: DR, AMD, myopia, and ROP. We described each of these diseases under three main headings: the magnitude of the problem (disease burden), current knowledge (science), and possible large-scale solutions (science-to-policy). Additionally, before we describe the specific retinal diseases, we have outlined emerging technologies applicable to ophthalmology and the 2030 SDG targets. Disease burden was derived from global burden of disease data [3] and the population-adjusted disease burden was calculated by dividing each sub-region’s percentage share of global disease burden by its percentage share of the global population. This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors. It requires no ethical approval.

Results

The Asia–Pacific region is home to approximately 4.8 billion people (approximately 60% of the world population). India is the most populous country in this region, with 44.8% (14 of 32, data for seven were not available) of the countries are in low- and middle-income economies. At 4.1 per 1000 people, Australia has the highest physician density. At 10.8% of gross domestic product (GDP), health expenditure is highest in Japan among the larger countries that have a population of 100 million or more. Additionally, Bangladesh has the highest proportion of its population in out-of-pocket spending (OOPS) at 73.0% [4, 5] (Supplementary Table 1). The Asia–Pacific region shares a high global burden of the four common retinal disorders focused on in this review. The spectrum varies by the sub-region (Table 1 and Fig. 1).

Table 1.

Estimated percentage share of the global burden of selected retinal diseases, by Asia–Pacific sub-region in 2025.*

Asia–Pacific sub-region	Population. (millions)	Global population share (%)	Percentage share of global burden (population-adjusted risk ratio)
			DR	Myopia	AMD	ROP
East Asia	~ 1160	~ 20.1%	~ 20% (1.0)	~ 50–60% (2.7)	~ 15–18% (0.8)	~ 20–25% (1.1)
Southeast Asia	~ 700	~ 8.5%	~ 10% (1.2)	NA	~ 5–7% (0.7)	~ 10% (1.2)
South Asia	~ 2085	~ 25.4%	~ 25% (1.0)	~ 15% (0.6)	~ 8–10% (0.4)	~ 40% (1.6)
Oceania	~ 466	~ 0.6%	< 1% (0.8)	< 1% (0.8)	~ 1% (1.7)	< 1% (0.8)
Total Asia–Pacific region	~ 4851	~ 55%	~ 55–60% (1.1)	~ 60–70% (1.2)	~ 30–35% (0.6)	~ 65–70% (1.2)
Rest of the world	~ 3333	~ 100%	~ 45% (1.0)	~ 40% (0.9)	~ 65% (1.4)	~ 35% (0.8)

^*Author calculations using Global Burden of Disease Study 2021 data; values are approximate ranges. Population-based risk ratio shows higher diabetic retinopathy (DR) burden in Southeast Asia, myopia in East Asia, age-related macular degeneration (AMD) in Oceania, and retinopathy of prematurity (ROP) in South Asia

DR diabetic retinopathy, AMD age-related macular degeneration, NA not available, ROP retinopathy of prematurity. Major countries in East Asia: China, Japan, and Korea. Major countries in Southeast Asia: Indonesia, Thailand, the Philippines, Singapore, and Vietnam. Major countries in South Asia: India, Bangladesh, Pakistan, Nepal, and Sri Lanka. Major countries in Oceania: Australia, New Zealand, and Papa New Guinea

Fig. 1.

Forest plot showing population-adjusted burden ratios for major ocular diseases across Asia–Pacific sub-regions. Ratios were calculated as the percentage share of global disease burden divided by the percentage share of the global population. The vertical dashed line at 1.0 represents population-proportional burden. DR diabetic retinopathy, AMD age-related macular degeneration, ROP retinopathy of prematurity

Diabetic Retinopathy

Disease Burden

The 2020 global estimate of the number of people with diabetes was 537 million, and it is likely to increase to 643 million in 2030 [6]. Correspondingly, there would be an increase in the complications of diabetes, including DR, classified by the International Classification of DR [7]. In 2024, the prevalence of diabetic retinal disease in the Southeast Asia and Western Pacific region, respectively, was as follows: any DR- 20% (95% confidence interval [CI] 16–25) and 25% (95% CI 19–31); vision-threatening diabetic retinopathy, VTDR—11% (95% CI 6–15) and 10 (95% CI 6–15); proliferative diabetic retinopathy, PDR- 20% (95% CI 16–25) and 4% (95% CI 2–7), and diabetic macular edema, DME- 4% (95% CI 2–6) and 9% (95% CI 6–13) [6] (5). The higher prevalence of PDR in Southeast Asia, despite a near-similar prevalence of DR and VTDR in the West Pacific region, suggests a possible delay in screening and treatment of people with DR.

The Asia–Pacific region is home to a large proportion of people with diabetic eye disease: DR ~ 51% and VTDR ~ 56%. The burden is higher in South and East Asia (Table 1), but the age-adjusted burden is rather close to the rest of the world (Fig. 1). Systematic retinal screening for VTDR has been shown to successfully reduce the rate of vision impairment due to this condition in small, affluent countries [8]. However, screening every person with DR is not a feasible option for many health systems around the world due to resource constraints, capacity, and capability within the health system, patient and public awareness, and cost of screening [9].

Science

Fundus photography is the accepted method of detecting retinal changes in people with diabetes. Rapid advances have been made in fundus camera technology. These advances include the reduced size, the ability to obtain retinal images without dilating the pupil, and the development of artificial intelligence to differentiate treatable from non-treatable DR [10]. There is a clear benefit of segregating screening from treatment of DR and employing differently skilled personnel for these jobs. Telemedicine is another approved and accepted approach to patient care.

Science to Policy

The first approach is to leverage emerging fundus camera technology to identify DR, deploy artificial intelligence (AI) to detect treatable DR, and use teleophthalmology for last-mile care [11–13]. These efforts empower ophthalmic technicians to effectively screen and triage patients with diabetes, while freeing ophthalmologists to concentrate on treating patients.

The second approach is to develop and deploy risk-based predictive models to determine screening frequency and identify those at risk of VTDR. These models must align with the country’s available resources [14, 15]. Broadly, the first approach is feasible in higher-income and resource countries, and the second approach is feasible in lower-income and resource countries.

Age-Related Macular Degeneration

Disease Burden

Age-related macular degeneration (AMD) is one of the leading causes of visual impairment among older individuals. A meta-analysis of 39 studies suggested that the projected number of people with AMD worldwide in 2040 will be approximately 288 million [16]. The Asia–Pacific region shares ~ 35% of the global burden. Within the region, there is a higher prevalence in East Asia (Table 1). In Asian populations, geographic atrophy is less prevalent than neovascular AMD, and it is higher in East Asian ethnicities [17]. The age-adjusted disease burden is higher in Oceania than other regions of the Asia–Pacific region.

Science

Given the overall low prevalence in the general population, targeted screening rather than systematic screening for AMD is the current practice. Targeted screening refers to active case finding among predefined high-risk groups, such as screening all people 65 years or older attending a cataract screening program (very prevalent in low-resource countries) rather than organizing a systemic screening irrespective of individual risk. In parallel, recent advancements in AI applications for image screening and genetic risk scores are reshaping detection and treatment [18, 19]. Fundus photography and optical coherence tomography (OCT) identify early pathological markers of AMD, including retinal fluid, drusen, and pigmentary alterations. Simple, self-administered tools, such as the Amsler grid, or the advanced tools, such as Home OCT, help monitor central vision distortion; as adjuncts to clinical screening, they prompt patients to seek further evaluation.

Science to Policy

In settings where the overall prevalence of AMD is low, widespread screening can lead to an unacceptably high rate of false positives, thereby straining healthcare resources and, more importantly, causing undue patient anxiety [20]. A more focused approach is required—one that prioritizes individuals who exhibit known risk factors, such as advanced age, a history of smoking, or a familial predisposition to AMD. In resource-limited or remote settings, AI-powered teleophthalmology platforms enable expedited and reliable diagnosis [21]. Additionally, in clinical practice, targeted genetic testing can be offered to individuals with a strong family background of AMD or early signs of the disease.

Myopia

Disease Burden

Myopia is a major contributor to the global burden of eye disorders and is projected to affect nearly half of the world’s population by 2050 [22]. The Asia–Pacific region shares ~ 35% of the global burden of myopia, and East Asia has a larger share in the sub-region (Table 1, Fig. 1).

Science

While both genetic and environmental factors contribute to the development of myopia, the rising prevalence is largely due to environmental influences, notably increased near work and insufficient outdoor time [22].

Science to Policy

Efforts to modify environmental behavior by reducing near work and increasing outdoor time include patient education by eye care practitioners and initiatives by preschools, schools, and after-school programs [23]. For children with myopia and a high risk of developing high myopia later in life, referrals to ophthalmologists for treatment (such as low-dose atropine eye drops, special spectacles or contact lenses, or orthokeratology) would be beneficial. In a low-resource setting, low-dose atropine is a more scalable intervention. Children at high risk include those children with early-onset myopia, fast progression, and more severe myopia at the first visit. AI tools analyzing fundus images have been used to predict the risk of myopia in children [24].

Retinopathy of Prematurity

Disease Burden

In 2019, an estimated 2.17 million children and adolescents worldwide were living with blindness or visual impairment due to ROP, corresponding to an age-standardized prevalence of 86.4 per 100,000 population under 20 years (23). The Asia–Pacific region shares ~ 70% of global ROP-related visual impairment. South Asia has the highest age-standardized ROP-related disability burden globally [25] (Table 1, Fig. 1).

Science

ROP is diagnosed by dilated fundus examination. Of the three studied treatments, cryopexy, laser, and anti-vascular endothelial growth factor (VEGF) therapy, the latter two are the standard of care [26–28]. Currently, universal fundoscopy is not advocated due to the lack of an appropriate and readily available tool. The deployment of AI imaging technologies and retinal cameras will likely improve the situation.

Science to Policy

Gaps in operational implementation include a lack of robust policy and strong advocacy. These gaps can be bridged through universal newborn eye screening that includes all newborns, not just premature babies. It is estimated that 1.14 billion children under 15 have severe visual impairment or blindness: South Asia and Western sub-Saharan Africa account for 45.6% of all blind children in the world [29]. The WHO South-East Asia Region (SEARO) newborn health screening guidelines [30] mandate the screening of all babies for eye abnormalities. Programmatically, this means training nurses and physicians in all birth facilities and providing them with essential equipment. It also implies setting up diagnostic facilities for referral and management. In low-resource settings, universal eye screening that aims to detect all congenital abnormalities at birth might be difficult. In these situations, a targeted ROP risk-based screening of pre-term and low birth weight babies would be useful.

A Model of Eye Care from an Asia–Pacific Country

In Thailand, the current public health system began to take shape in the 1960s, with the implementation of the Royal Thai Government’s first National Economic and Social Development Plan (NESDP) [31]. In the fourth NESDP in 1977, which focused on primary health care, the government established at least one community hospital in each district throughout Thailand; this was completed in the 90s [32]. This national plan also included training and deployment of appropriately trained and adequate workforce in the community hospitals [33], and reducing financial burden for marginalized people [34]. The secondary and tertiary health care systems in Thailand have been based on specialist-oriented provincial and regional hospitals (n = 77 and 13, respectively). Each region, where a large tertiary care regional hospital is located, covers a population of 4 to 5 million people and 4–8 provinces. There is at least one smaller secondary care provincial hospital in each province. Patients who require secondary or tertiary care identified at district hospitals are referred to regional hospitals. This aligns with the WHO’s proposed structure for IPEC (Integrated People-Centered Eye Care) (Fig. 2). Groups of specialist doctors in each region form the “Regional Service Plan Committee” for the medical specialties. These Regional Committees form the “National Service Plan Committee” for the specialties. For example, there are Heart Service Plan, Kidney Service Plan, and Eye Service Plan. The National Committee establishes, implements, and monitors health indicators for each specialty. The Eye Service Plan Committee has indicators such as the proportion of patients with blinding cataract who underwent surgery, or the proportion of patients with diabetes who were screened for DR, etc. To complement this structural description, we summarize key Thai Eye Service Plan indicators in Table 2, including screening coverage, performance targets, and service outcomes across major eye health problems.

Fig. 2.

Comparison of the integrated people-centered eye care (IPEC) proposed by the World Health Organization and Thailand eye care structure

Table 2.

Summary of the Thai Eye Health program performance indicators and outcomes

Focus area	Key initiatives	Target key performance indicators	Outcomes
Cataract	Vision screening for older adults Cataract surgery campaign in district hospitals	Adults aged ≥ 60 received vision screening: 75% Patients with blinding cataract received surgery within 30 days: 85% Patients with low vision cataract received surgery within 90 days: 80% Total cataract surgeries: 150,000 eyes	Adults aged ≥ 60 screened: 74.9% Patients with blinding cataract received surgery within 30 days: 84.6% Patients with low vision cataract received surgery within 90 days: 92.1% Total cataract surgeries: 205,993 eyes
Retinal diseases	Increase screening for diabetic retinopathy (DR)	Patients with diabetes received DR screening: 65%	Number of patients with diabetes: 3,812,917 Eye exams using ophthalmoscope or fundus camera: 1,723,330 cases (45.2%)
Thai children’s vision screening program	Increase vision screening and proactive eyeglass prescription for Grade 1–6 students	Prescription of eyeglasses to students (Grades 1–6) with refractive errors: 50,000 students	Eyeglasses given to students (Grade 1–6) with refractive errors: 65,110 students
Corneal transplantation	Scale up corneal transplantation across all health regions	Corneal transplants: 1800 patients	Corneal transplants performed: 2154 patients Waiting list: 12,948 patients

Data are according to reports in the fiscal year of 2025 (October 1, 2024–September 30, 2025) and acquired from the minutes of the Meeting of Thai Eye Service Plan Committee, January 29, 2026

Discussion

Health Transition and Health Matrices

The health transition is a dynamic process where a society’s health and disease patterns evolve in response to broader demographic, socioeconomic, technological, political, cultural, and biological changes [35]. Demographic transition and epidemiologic transition are two components of health transition. The demographic transition describes the shift from the high fertility-high mortality rates characteristic of less developed societies to the low fertility-low mortality rates typical of developed societies. The epidemiologic transition describes the changes in mortality and morbidity patterns (from infectious to chronic diseases) as a society’s demographic, economic, and social structures change [36]. The health outcomes also result from changes in the cultural, social, and behavioral determinants of health [37]. Many countries in the Asia–Pacific region are undergoing a transition from less developed to more developed nations (Supplementary Table 2).

Healthcare Consumption Trends

In 2023, Bain & Company surveyed 2300 consumers across nine Asia–Pacific geographies (Australia, China, Hong Kong, India, Indonesia, Malaysia, the Philippines, Singapore, and Vietnam) to understand trends in healthcare consumption in the region [38]. The population of these countries is 3.6 billion, or 83.7% of the Asia–Pacific population. Four salient survey findings were: (1) Health care is no longer a passive experience. People are willing to pay for their health, demand a better experience, and are willing to invest in wellness (highest for nutrition- 45%); (2) The people expect seamless, omnichannel care experiences beyond traditional hospital settings (highest for preventive routine checkups- 74%); (3) Integrated care is the new standard, i.e., a single touchpoint to manage their health (mean: 37%; highest in China- 62% and lowest in Malaysia- 33%); and (4) AI and emerging health technology are curated to personalized care and new modes of healthcare delivery (mean: 47%; highest in China- 70% and lowest in the Philippines- 30%).

Burden of Eye Diseases and SDG Targets

In 2019, the Global Burden of Disease (GBD) has reported that the crude prevalence of visual impairment was higher in South Asia (Nepal: 21.3%, India: 19.3%, Sri Lanka: 17.7%, Bangladesh: 16.5%) and a few West- and East-Pacific countries (Thailand 20.4%, China: 19.2%, DPR Korea: 15.5%, Taiwan: 16.0%, Vietnam 14.2%) than in Oceania (Australia and New Zealand: 5.3%) (37). Five major causes of visual impairment were refractive error (671 million people), cataract (100 million people), AMD (8.1 million people), glaucoma (7.8 million people), and DR (4.4 million people). Also, 56 million people had visual impairment due to other causes, including ROP, trachoma, xerophthalmia, corneal diseases, and ocular trauma [39].

Emerging Technology in Eye Care

Emerging technologies in medicine (and eye care) include the convergence of AI, big data, cloud computing, and the Internet of Things (IoT). These have accelerated digital transformation, enabling more efficient and accessible healthcare delivery [40, 41]. In eye care, these technological innovations can potentially bridge gaps in service delivery, particularly for remote and underserved populations. One can enhance screening efficiency and address workforce shortages by leveraging digital health solutions, such as telemedicine, AI-driven diagnostics, and intelligent medical devices. As healthcare systems worldwide struggle with rising demand and limited resources, digital transformation offers a pathway to more equitable and effective care.

Heterogeneity Demands Tailored Strategies

The Asia–Pacific region is highly heterogeneous with respect to population demographics (from densely populated India, China and Bangladesh to sparsely population Pacific islands), economic and health workforce resources (from well-resourced Japan, Australia and South Korea to Afghanistan, and Timor Leste), climate (tropical to cold), and dietary practices (rice-based in East and Southeast Asia to sea-food based food in costal nations, and processed food in urbanized regions). This substantial heterogeneity has important implications for disease patterns, risk factors, and the feasibility and effectiveness of uniform public health and clinical strategies. Policy recommendations should be stratified by health system capacity, prioritizing high-impact and scalable measures. We offer a loosely framed resource-dived implementation strategy for the four retinal conditions analyzed in this communication; (Table 3) these suggestions should be further tailored to country-level capacity and resources.

Table 3.

Suggested strategies for care of common retinal disorders

Disorder	Category	Low-resource	High-resource
Diabetic retinopathy	Specific	Opportunistic screening AI-based low-cost fundus camera Tele ophthalmology	Annual screening
	General	Anti-VEGF intravitreal injections, when required	Anti-VEGF intravitreal injections, when required
Age-related macular degeneration	Specific	Screening people with known high risk AI-based low-cost fundus camera	Annual screening Genetic testing
	General	Anti-VEGF intravitreal injections, when required	Anti-VEGF intravitreal injections, when required
Myopia	Specific	Increase outdoor activities	Environmental changes Contact lens Orthokeratology
	General	Low-dose atropine	Low-dose atropine
Retinopathy of prematurity	Specific	At-risk baby screening	Universal baby screening
	General	Retina laser Anti-VEGF intravitreal injections, when required	Retina laser Anti-VEGF intravitreal injections, when required

Anti-VEGF anti-vascular endothelial growth factors

For DR, given the larger global burden of diabetes every country should work for adult population annual screening and national registry. Opportunistic screening may serve as an interim strategy in limited-resource health systems.

For AMD, currently, targeted genetic testing offers incremental value primarily in risk stratification and diagnostic clarification, not in direct therapeutic decision-making. It is less likely to be cost effective in resource-limited countries. Hence, priority should be given to scalable interventions with proven impact such as early detection, smoking cessation, and access to anti-VEGF therapy in low-resource countries.

For myopia, the strategies differ substantially in scalability. Increasing outdoor exposure and, low-dose atropine can be implemented with modest infrastructure. But other interventions, such as orthokeratology and specialized contact lenses require higher financial and human resources. Policy recommendations should therefore be stratified by health system capacity, prioritizing high-impact, scalable measures before expanding precision optical interventions.

For ROP, the proven way to prevent ROP-related blindness is screening to detect followed by early and appropriate treatment. Universal new born eye screening is ideal because a host of other congenital abnormalities could be detected early, but targeted screening of at-risk premature infants provides substantially higher yield and is cost-effective than universal newborn retinal imaging. However, universal red reflex screening for congenital anomalies may be feasible across resource levels.

WHO Recommendations

The WHO’s 2019 World Report on Vision (WRV) [42] called for action to make eye care equitable and universal in delivery and integrated within the general health system. One of the important recommendations of the WRV was to deliver care through IPEC [43]. The IPEC is designed to deliver universal (eye) health coverage (UHC) and primary (eye) care. The UHC advocates equity, quality, and protection from financial risk. The WHO has set global targets for two key causes of blindness and visual impairment: refractive error and cataract. The Southeast Asia Action Plan 2022–2030 added two additional targets, DR and trachoma, specific to the region, to meet the 2030 SDG [44]. These four targets, the first two global and the latter two regional, are:

Target 1. A 40-percentage-point increase in effective coverage of refractive error by 2030.

Target 2. A 30-percentage-point increase in effective coverage of cataract surgery by 2030.

Target 3. At least 80% of people with diabetes are screened regularly for retinopathy and.

80% of those identified with sight-threatening diabetic retinopathy are treated by 2030.

Target 4. Eliminate trachoma in the region by 2025.

Globally, the WHO did not include other retinal diseases due to several confounding factors related to screening for retinal disorders. The practical value of any screening procedure is significantly influenced by two key parameters: the specificity of the diagnostic method and the prevalence of the disease. Any procedure with relatively low specificity will result in a high number of false-positive individuals, who will overwhelm the healthcare system and may prevent truly affected patients from receiving a correct diagnosis and treatment. The lower the prevalence, the lower the screening procedure’s efficacy, unless one focuses on subgroups of individuals at increased risk of the disease. DR was included in the WHO South-East Asia action plan because of its high prevalence. On the other hand, ROP is a fit case for obligatory screening, though it is not one of the target diseases, because the prevalence of the disease is relatively high, the target population is premature and underweight children, and effective therapies are available. The preterm babies with ROP are expected to have long life expectancy with correspondingly high disability-adjusted life years (DALYs).

Technological development in camera technology and AI has democratized the screening and detection of retinal diseases. Their widespread adoption will reduce costs and improve equity and accessibility for people. Several challenges exist, including AI bias, legal considerations, and implementation costs. Despite these challenges, improved digital accessibility, regulatory frameworks, and global health collaborations will allow AI-driven solutions to be a key enabler of the WHO’s vision for people-centered, equitable health care.

The adoption of the World Health Assembly Resolution 73.4 in 2020 requires all countries to strengthen eye care within and across their health systems [45]. This is possible if the current science of diagnosing and treating common retinal disorders is translated into robust regulatory policies. It would close the care pathway loop. Retinal disorders are generally more challenging to treat than cataract surgery or correcting refractive error, but they must not be ignored for policymakers and a healthier society.

The strengths of this review are its focus on both science and technology development and policy making. While the adoption of science and technology is usually at the clinical level to treat patients with eye or retinal diseases individually, adoption at the policy level enables treating patients at scale. Communications on health policy are relatively rare. The limitations are the fast-changing science and technology and policy decisions, and the focus on only retinal diseases from only one part of the world. In addition, this review focuses on short-term targets for 2030, as defined by the WHO, not the long-term targets.

Conclusions

In conclusion, this review presents an approach to integrating scientific and technological advancements into eye care policy development, focusing on preventing vision impairment from retinal diseases. While the WHO 2030 targets do not include AMD, myopia, or ROP, national policies can be tailored to address these major causes of vision impairment globally. The implementation of IPEC is recommended as an effective strategy for successful policy execution.

Supplementary Information

Below is the link to the electronic supplementary material.

Author Contributions

Taraprasad Das, Subhadra Jalali, Jost Jonas, Ryo Kawasaki, Seang Mei Saw, Sobha Sivaprasad, Anna CS Tan, and Paisan Ruamviboonsuk contributed to the contents of this article, including literature review and drafting of the manuscript. Taraprasad Das proposed the concept and design, and conducted statistical analysis, of this article. Taraprasad Das and Paisan Ruamviboonsuk finalized the manuscript with approval by all the authors.

Funding

No funding or sponsorship was received for this study or the publication of this article.

Data Availability

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

Declarations

Conflict of Interest

Taraprasad Das, Subhadra Jalali, Jost Jonas, Ryo Kawasaki, Seang Mei Saw, Sobha Sivaprasad, Anna CS Tan, and Paisan Ruamviboonsuk declare that they have no conflicts of interest which is related to this article. Seang Mei Saw and Paisan Ruamviboonsuk are Editorial Board members of Ophthalmology and Therapy. Seang Mei Saw and Paisan Ruamviboonsuk were not involved in the selection of peer reviewers for this manuscript nor any of the subsequent editorial decisions.

Medical Writing/Editorial Assistance

There is no professional medical writer for this article. There is no assistance by artificial intelligence. The authors thank Nathorn Piyawannarat, MD for administrative support, manuscript preparation, and assistance in the manuscript submission process.

Ethical Approval

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors. It requires no ethical approval.