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Published in final edited form as: Lancet Planet Health. 2022 Feb 25;6(3):e270–e280. doi: 10.1016/S2542-5196(21)00351-X

Advancing the Sustainable Development Goals through improving eye health: a scoping review

Justine H Zhang 1,✉, Jacqueline Ramke 2, Catherine Jan 3, Covadonga Bascaran 4, Nyawira Mwangi 5, João M Furtado 6, Sumrana Yasmin 7, Cynthia Ogundo 8, Miho Yoshizaki 9, Ana Patricia Marques 10, John Buchan 11, Peter Holland 12, Brandon A M Ah Tong 13, Jennifer R Evans 14, Nathan Congdon 15, Aubrey Webson 16, Matthew J Burton 17
PMCID: PMC7618288  EMSID: EMS209640  PMID: 35219448

Abstract

UN member states have committed to achieving the Sustainable Development Goals (SDGs) by 2030. This Review examines the published evidence on how improving eye health can contribute to advancing the SDGs (beyond SDG 3). We identified 29 studies that showed direct benefits from providing eye health services on SDGs related to one or more of poverty (SDGs 1, 2, and 8), education (SDG 4), equality (SDGs 5 and 10), and sustainable cities (SDG 11). The eye health services included cataract surgery, free cataract screening, provision of spectacles, trichiasis surgery, rehabilitation services, and rural community eye health volunteers. These findings provide a comprehensive perspective on the direct links between eye health services and advancing the SDGs. In addition, eye health services likely have indirect effects on multiple SDGs, mediated through one of the direct effects. Finally, there are additional plausible links to other SDGs, for which evidence has not yet been established.

Introduction

In 2015, all UN member states committed to work towards achieving the Sustainable Development Goals (SDGs) by 2030.1 The 17 SDGs have broad objectives (panel), that include 169 targets and 232 indicators. They address many aspects of development, including poverty, hunger, health, education, gender equality, economic development, and environmental issues.

Panel. Summary of the Sustainable Development Goals (SDG).

  • SDG 1: end poverty in all its forms everywhere

  • SDG 2: end hunger, achieve food security and improved nutrition, and promote sustainable agriculture

  • SDG 3: ensure healthy lives and promote wellbeing for all at all ages

  • SDG 4: ensure inclusive and equitable quality education and promote lifelong learning opportunities for all

  • SDG 5: achieve gender equality and empower all women and girls

  • SDG 6: ensure availability and sustainable management of water and sanitation for all

  • SDG 7: ensure access to affordable, reliable, sustainable, and modern energy for all

  • SDG 8: promote sustained, inclusive, and sustainable economic growth, full and productive employment, and decent work for all

  • SDG 9: build resilient infrastructure, promote inclusive and sustainable industrialisation, and foster innovation

  • SDG 10: reduce inequality within and among countries

  • SDG 11: make cities and human settlements inclusive, safe, resilient, and sustainable

  • SDG 12: ensure sustainable consumption and production patterns

  • SDG 13: take urgent action to combat climate change and its impacts

  • SDG 14: conserve and sustainably use the oceans, seas, and marine resources for sustainable development

  • SDG 15: protect, restore, and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, halt and reverse land degradation, and halt biodiversity loss

  • SDG 16: promote peaceful and inclusive societies for sustainable development, provide access to justice for all, and build effective, accountable, and inclusive institutions at all levels

  • SDG 17: strengthen the means of implementation and revitalise the global partnership for sustainable development

The latest global estimates for 2020, show that about 596 million people have distance vision impairment, of whom 43 million are blind.2 Most of this vision impairment could have been prevented or can be treated. A further 510 million people have unaddressed near vision impairment.2 Around 83% of vision impairment is found in low-income and middle-income countries. It is often concentrated in under-served groups within countries.3 Impaired eye health affects people across the full life course, represents a major public health challenge, and is a substantial barrier to sustainable development.

This Review forms part of the Lancet Global Health Commission4 on Global Eye Health, which defined eye health as the state when vision, ocular health, and functional ability are maximised, thereby contributing to overall health and wellbeing, social inclusion, and quality of life.5

We hypothesised that eye health services that improve vision and functional ability can, in turn, lead to the advancement of multiple SDGs. We consider eye health services to include all types of interventions that improve eye health, encompassing the spectrum of promotion, prevention, treatment, and rehabilitation.6 Potentially, there is a two-way relationship between eye health and the SDGs; however, here we are primarily concerned with the impact that improved eye health services could have on the SDGs, rather than the impact that improvements in SDG-related areas can have on eye health. We summarise the nature and extent of published evidence that services improving eye health contribute to advancing specific SDGs and identify the main pathways by which such services lead to advancement of the SDGs.

Methods

We anticipated the literature on the relationship between the SDGs and eye health to be broad, complex, and very heterogeneous in nature. Therefore, a scoping review method was selected as the most appropriate approach to identify and map the available evidence.7 We report the Review in accordance with the PRISMA Extension for Scoping Reviews (appendix, pp 2–3).8

To guide the review, we initially asked Commissioners of the Lancet Global Health Commission4 on Global Eye Health to review all 169 SDG targets and outline possible links between eye health services and specific SDG targets.1 After reviewing the suggested links, a logic model was developed and iteratively refined by the authorship group, and is published in the protocol.9,10 This model was used to inform our search strategy.

A protocol for this scoping review was registered prospectively with Open Science Framework (gu4z6) on Nov 15, 2019, and published.10 As this study only included published data, ethics approval was not sought.

Search strategy and selection criteria

On Oct 31, 2019, we searched MEDLINE, Embase, and Global Health using a search strategy developed by an experienced information specialist from Cochrane Eyes and Vision (the MEDLINE search strategy is included in the appendix; pp 4–6). To identify further potentially relevant studies, we examined reference lists of all included articles. We also provided a list of the included studies to relevant Commissioners and requested they identify further potentially relevant studies for consideration in the review.

All primary research studies or meta-analyses were included if they reported the relationship between an eye health service and either an outcome related to one of the SDGs, or an element on a pathway between eye health and an SDG. A list of indicative pathway elements agreed on by the authorship group of this Review can be found in the appendix (p 7). Systematic reviews without meta-analyses were excluded.

We recognise that impaired eye health has many consequences for other health and wellbeing outcomes in SDG 3. Therefore, the Lancet Global Health Commission on Global Eye Health4 has also undertaken complementary reviews (published separately) investigating links between eye health and other health and wellbeing outcomes.11–14 Therefore, for the purposes of this Review, we excluded studies with SDG 3-related health and wellbeing outcomes.

Further criteria were established during the review process. Studies were excluded if there was no comparison group, or the study only compared different types of eye treatments against each other (eg, eye drop A vs eye drop B). We excluded these studies because without a comparison group, identifying whether the study findings were due to the effects of the eye health intervention or due to some other factor would not be possible, and studies comparing different treatments were unlikely to answer the question of whether any particular eye health intervention affected an SDG-related outcome. Studies were also excluded if simulation was used in the exposure group (eg, using goggles to simulate the effects of an eye condition) or the outcome (eg, virtual reality driving simulators), since this method was deemed to be insufficient for assessing the real-life effect of eye health services on the SDGs. Excluded studies also included those with a sample size of less than 100 participants. We excluded studies with small sample sizes post-hoc, as such studies would be unlikely to contribute to the aims of this scoping review. These studies are summarised in the appendix (pp 10–11).

Studies from all time periods were eligible for inclusion. We included studies from any world region (classified according to the seven Global Burden of Disease super-regions). No language restrictions were used. All potentially relevant publications in languages other than English were translated into English or screened and extracted by someone with at least professional working proficiency in that language. We included published peer-reviewed manuscripts only. As this scoping review was concerned with identifying the extent of evidence in published literature, grey literature was not searched.

Selection of sources of evidence

Titles and abstracts were independently screened by two investigators with web-based review management software (Covidence). Full texts were then independently screened by two investigators to establish eligibility for inclusion. Any conflicts were resolved with a third reviewer.

Data charting and data items

Data charting forms were developed with Google Forms and were pilot-tested by nine investigators (JHZ, JR, CJ, CB, NM, JMF, SY, CO, and MY) on two studies. A copy of the Google Form used for data extraction, which lists the data items that were collected, can be found in the appendix (pp 8–9). Two investigators charted the data of included studies, working independently, for all data items except for the type of study (eg, randomised controlled trial and prospective cohort study), which was charted by a single epidemiologically-trained investigator for consistency and verified by another investigator. Randomised controlled trials were explicitly indicated in the results tables. Countries of study were mapped to Global Burden of Disease super-regions (hereafter referred to as regions) by a single investigator. In the case of unclear information during data charting, we planned to contact authors directly, but this step was not required. We did not plan to formally appraise the quality of individual sources of evidence.

Synthesis of results

Following data charting, results were synthesised by mapping the retrieved evidence to our eye health–SDG logic model (appendix p 9).10 Closely linked SDGs (eg, SDG 1 no poverty, SDG 2 zero hunger, and SDG 8 decent work and economic growth) were grouped together, and evidence for SDG-related outcomes (eg, household income) were synthesised under these umbrella SDG groups.

Each pathway from exposure to outcome and the effect of the eye care service (which resulted in a change in eye health) on the SDG-related outcome was examined separately. Relevant evidence for each pathway was collated and summarised, including effect estimates when available. The directionality and extent of evidence supporting each pathway in the summary figure was indicated by differing arrow widths and colours. We planned to develop separate protocols for meta-analysis if sufficient homogenous studies were found for individual exposure–outcome pathways; however, this synthesis was not possible for any pathway.

Results

The search returned 17 332 unique publications. Titles and abstracts were assessed for eligibility, and 226 were selected for full-text assessment (including ten studies identified through reference list searches and expert recommendations); four full texts were not in English and were assessed by someone with at least a professional working proficiency in the language. 29 studies met the inclusion criteria and are considered in this Review in detail (figure 1). There were a further 13 studies that met all criteria except having a sample size of at least 100 participants. We provide summaries of these 13 studies in the appendix (pp 10–11).

Figure 1. Study selection.

Figure 1

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All included studies were in English. Study size ranged from 185 participants to 559 546 participants (median 1200, IQR 440–4067). The majority of studies were observational in design, and only six studies (21%) were randomised controlled trials (table 1).

Table 1. Characteristics of the 29 included studies.

Studies, n (%)
SDG *
Poverty-related (SDGs 1, 2, and 8) 12(41%)
Education (SDG 4)   9 (31%)
Equality (SDGs 5 and 10)   4 (14%)
Sustainable cities (SDG 11)   6 (21%)
Environment (SDGs 7 and 12-15)   0
Peace and partnership (SDGs 16 and 17)   0
Water and sanitation (SDG 6)   0
Innovation and industry (SDG 9)   0
Year of publication
1998–2004   5 (17%)
2005–09   2 (7%)
2010–14 11 (38%)
2015–19 11 (38%)
Study design
Meta-analysis   2 (7%)
Randomised controlled trial   6 (21%)
Prospective cohort study   9 (31%)
Retrospective cohort study   5 (17%)
Pair or series of cross-sectional studies   2 (7%)
Exposure cross-over study   1 (3%)
Economics study   4 (14%)
Global Burden of Disease super-region †
High-income country 19 (66%)
Southeast Asia, east Asia, and Oceania   9 (31%)
South Asia   9 (31%)
Sub-Saharan Africa   9 (31%)
North Africa and the Middle East   1 (3%)
Latin America and the Caribbean   0
Central Europe, eastern Europe, and central Asia   0
Funding
Public   7 (24%)
Private, charity, or industry-sponsored 10 (34%)
Mixed (public and private)   4 (14%)
Not reported   8 (28%)
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SDG=Sustainable Development Goal.

*

We excluded studies reporting outcomes related to SDG 3; includes two studies that are linked to two different SDG groups.

†

Several studies are linked to >1 Global Burden of Disease super-region. The percentages are based on a denominator of 29.

Several studies were conducted in more than one region (table 1). Most studies were done in the high-income region (19 studies, 66%). The regions of (1) sub-Saharan Africa, (2) south Asia, and (3) southeast Asia, east Asia, and Oceania each had nine included studies (31%). Only one study was done in the north Africa and Middle East region. Two regions had no included studies (one region being Latin America and the Caribbean and the second being central Europe, eastern Europe, and central Asia).

We mapped the studies to individual SDGs or umbrella SDG groups. The largest proportion of included studies (12 studies, 41%) were mapped to poverty-related SDGs (1, 2, and 8), followed by education (SDG 4; nine studies, 31%), sustainable cities (SDG 11; six studies, 21%), and equality (SDGs 5 and 10; four studies, 14%).

For the poverty-related SDGs (1, 2, and 8), studies show that the main pathways by which eye health services contribute to the advancement of these SDGs are through improvement in one or more of: workplace productivity, household per capita expenditure, household income, employment rates, and economic productivity. For education (SDG 4), eye health services were found to contribute to improved academic test scores. For equality (SDGs 5 and 10), eye health services eliminated gaps in per capita expenditure. For sustainable cities (SDG 11), eye health services were found to reduce driving-related difficulties and motor vehicle crashes.

We did not identify any eligible studies that mapped directly to outcomes related to the environment and energy (SDGs 7 and 12–15), peace and partnership (SDGs 16 and 17), water and sanitation (SDG 6), or innovation (SDG 9).

The key findings of the 29 included studies are briefly summarised in table 2. A more detailed synopsis of methods and findings for each study is provided in the appendix (pp 12–16). 27 studies reported that eye health services had a positive effect on advancing one or more SDG targets. Two studies reported a negative effect on SDG-related outcomes, though their findings were mixed or inconclusive. One of these studies showed that eye health improved at the aggregate level but inequality increased,37 whereas the other study showed that legally blind adults who attended specialised schools, for people with vision impairment, had a lower salary compared to legally blind adults who attended public schools.21

Table 2. Summary of the influence that interventions to improve eye health have on the advancement of SDGs, by SDG groups of poverty, education, equality, and sustainable cities.

Summary of study findings
Poverty-related: SDG 1 no poverty; SDG 2 zero hunger; and SDG 8 decent work and economic growth
Workplace relative productivity (one study) A randomised controlled trial showed that provision of free spectacles to tea workers with presbyopia in India improved workplace relative productivity by 22% (p<0·0001)15
Household per capita expenditure (two studies) Prospective cohort studies showed increases in household per capita expenditure in people with vision impairment who underwent cataract surgery;16,17 for example, in the Philippines, household per capita expenditure increased by 88% over 1 year in people who underwent cataract surgery (p<0·0001)
Household income (four studies) Several prospective cohort studies showed that household income increased after cataract surgery;18–20 for example, 1 year after provision of cataract surgery in marginalised communities in rural India, the proportion of households with a monthly income <1000 rupees decreased from 51% to 21% (p=0·05)
•• One retrospective cohort study showed that, in people who became legally blind by the age of 6 years in the USA, those who attended specialised schools for people with vision impairment had a lower salary than those who attended public schools, although this difference could have been confounded by other determinants21
Employment rates (one study) A retrospective cohort study showed that some vocational rehabilitation services for people with vision impairment in the USA were positively associated with paid employment; for example, training and support services were associated with increased odds of obtaining paid employment (odds ratio 1·10; p=0·001)22
Economic productivity (four studies) Cost-effectiveness and cost-evaluation studies showed benefits to economic productivity from cataract surgery23,24 and trichiasis surgery;25,26 for example, one study showed that there was a net 13 year US$123·4 billion return on investment from a 1 year cohort of patients who had had cataract surgery, which included an increase in US national productivity of $25·4 billion23
SDG 4 quality education
Academic test scores (seven studies) Five randomised controlled trials showed that provision of spectacles to children improved academic test scores,27–31 and this finding was also seen in prospective cohort studies;32,33 for example, a study in China showed that vision correction with spectacles reduced the odds of failing a class by 44% (p<0·01)28
Reading ability (two studies) Cohort studies found improved letter identification scores with spectacle wear34 and improved reading ability with attendance at specialised schools21
Equality: SDG 5 gender equality and SDG 10 reduced inequalities
Gender inequality (two studies) A systematic review and meta-analysis found reduced gender inequality in all-cause blindness, clinic attendance, cataract surgery coverage, and trachoma treatment coverage as a result of interventions to promote eye service use supported by trained rural community eye health volunteers in lower-income and middle-income countries35
•• A pair of cross-sectional surveys showed that free cataract screening and low-cost, high-quality cataract surgery in China resulted in a reduction in gender disparity in willingness to pay when comparing 5 year follow-up (88% willingness to pay in men and 91% in women) to baseline (67% in men and 50% in women)36
Equity, as measured by per capita expenditure (one study) A cohort study showed that people who had cataract surgery in Kenya, the Philippines, and Bangladesh were poorer than non-visually impaired people before they had their surgery (p≤0·02) but after surgery, there was no longer a difference in per capita expenditure between the cataract group and the non-visually impaired group (p≥0·20), showing that equity as measured by per capita expenditure improved17
Inequalities in use of eye care services (one study) A series of annual cross-sectional surveys showed that free eye examinations in Scotland increased use of eye care services at the aggregate level, but widened inequalities by income (p<0·001) and education (p<0·001)37
SDG 11 sustainable cities and communities
Driving-related difficulties (one study) A meta-analysis showed reduced driving-related difficulties after cataract surgery (pooled odds ratio 0·12; 95% CI 0·10–0·16)38
Motor vehicle crashes (five studies) Several observational studies showed that cataract surgery reduced motor vehicle crashes (with all studies reaching significance)39–43
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The relationship between eye health and SDG 3 is discussed elsewhere in complementary reviews.11–14 The table includes two studies that are linked to two different SDG groups. The full list summarising all included studies can be found in the appendix (pp 12–16). SDGs=Sustainable Development Goals.

However, the authors of this study acknowledged that this association could have been confounded by other determinants (eg, the public school group had more usable residual vision than the specialised school group); further, braille literacy was better in the specialised school group than the public school group.

We mapped out the reported direct connections or pathways between specific eye health services and the relevant SDG for the 29 included studies (figure 2; appendix p 17). The range of eye health services considered was broad, and included cataract surgery, free cataract screening, provision of spectacles, trichiasis surgery, rehabilitation services, and rural community eye health volunteers. Cataract surgery and spectacles were the interventions with the largest number of reported beneficial effects on an SDG.

Figure 2. Summary of evidence linking specific services to improve eye health and specific Sustainable Development Goals.

Figure 2

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Green arrows indicate a direct positive benefit (n=27); grey arrows indicate a negative relationship (n=2). The width of the arrows represents the number of studies.

Discussion

We identified 29 studies that reported direct links between eye health services or interventions and their largely beneficial effects on SDGs related to poverty (SDGs 1, 2, and 8), education (SDG 4), equality (SDGs 5 and 10), and sustainable cities (SDG 11). Our findings expand on the known associations between vision impairment and SDG-related outcomes, through providing a comprehensive perspective on the links between eye health services and advancing several of the SDGs. In addition to the direct links we identified, eye health plausibly has several indirect effects on the same and additional SDGs; for example, improved eye health promotes educational outcomes in girls and boys alike, thus improving gender equality (an indirect effect on SDG 5). Finally, there are additional hypothetical links to other SDGs, for which evidence is currently absent. We have represented all three types of relationship in figure 3 and go on to discuss each in turn.

Figure 3. Improving eye health.

Figure 3

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Solid green arrows indicate relationships with direct evidence of a beneficial effect, black arrows represent likely indirect effects, and dashed green arrows represent hypothesised beneficial effects.

Zero poverty and hunger; decent work and economic growth (SDGs 1, 2, and 8)

A strong association between poverty and vision impairment has been reported in many settings.44–46 This relationship is likely to be a bidirectional relationship, with poverty both a cause and a consequence of poor eye health. Poverty and low socioeconomic status can result in reduced access to quality eye health services, delayed diagnosis, and limited access to treatment.47 Poverty is also strongly associated with worse general health, which might adversely affect eye health. For example, poor nutrition leading to vitamin A deficiency results in a progressive eye disease called xerophthalmia.48

Conversely, poor eye health and social exclusion of people living with vision impairment might lead to poverty. Several studies, including the World Health Survey, have found that people with vision impairment were less likely to be employed49 and have lower salaries if employed than those without vision impairment,50 reducing household income. Moreover, there can be additional lost income for household members who need to stay home to care for someone with vision impairment.51 Other highly symptomatic eye conditions, which might not reduce visual acuity (eg, some cases of dry eyes), could also affect employment.52,53 The Commission4 estimated annual global economic productivity losses were equal to US$411 billion in purchasing power parity in 2018. Finally, some eye problems can lead to stigma. For example, a study in the USA found that digitally altered photographs of the same person from typical eye alignment to misalignment (squint or strabismus) reduced job hiring scores in women.54

We found evidence that interventions to improve vision and functional ability reduce poverty and improve economic prospects (table 2).15–26 For example, provision of free spectacles to tea workers with presbyopia in India improved workplace relative productivity.15 Prospective cohort studies showed increases in household per capita expenditure in people with vision impairment who underwent cataract surgery.16,17 Implementing effective eye health services would be a way to break the negative cycle of poor eye health, which leads to poverty, leading to worse eye health, and thus more poverty.55 The effects of improved eye health cascades beyond poverty reduction, to achieve wider benefits, such as improved health and wellbeing (SDG 3),56,57 and education (SDG 4).58

Improving health and wellbeing (SDG 3)

In this Review we specifically excluded links between eye health and health and wellbeing (SDG 3). Complementary reviews undertaken by the Lancet Global Health Commission on Global Eye Health4 explore the inter-section between eye health and other health and wellbeing outcomes, including the associations between vision impairment and mortality,11 vision impairment and falls,12 vision impairment and quality of life,13 and vision impairment and dementia, mental health, cardiovascular disease, respiratory disease, and cancer. A complementary scoping review investigating the prevalence and impact of dual sensory impairment has also been done.14

Improving education outcomes (SDG 4)

Good vision is associated with improved educational outcomes.59,60 A study of almost 1 million children across 30 low-income and middle-income countries found that children with vision impairment were two to five times less likely to be included in formal education compared with children without a disability.61 In high-income countries, although school attendance is generally mandatory, educational scores tend to be poorer in children with vision impairment than children without.62

We examined this relationship by investigating which eye health services are important for improving educational outcomes, and identified five randomised controlled trials, which were all related to the provision of spectacles to children.21,27–34 This inexpensive, simple intervention has been shown to improve academic test scores and literacy skills, which in turn can improve future opportunities for decent work and paid employment.

Reducing inequality (SDGs 5 and 10)

Poor eye health disproportionately affects low resourced countries and disadvantaged groups within countries. We found a few studies showing that eye health services reduce inequity by gender,35,36 and improve socioeconomic status (measured as increased household per capita expenditure).17 These findings are a promising start and there is scope for further research in this area.

One study in Scotland showed that offering free eye examinations actually widened inequalities across income and education groups.37 This example of an intervention-generated inequality is not uncommon with universal interventions designed to be accessed by everyone in the same way, as more advantaged (low-risk) groups are more able to access and benefit from the intervention.63 The Scottish study highlights the need to avoid intervention-generated inequalities, so that no one is left behind in the pursuit of the SDGs. Targeting services to those with the most to gain is one way to reduce inequalities. An example would be increasing the cataract surgical rate in rural areas, where a higher proportion of people tend to have vision impairment from cataract compared with people in urban areas.64 Another promising strategy to promote equity in the pursuit of the SDGs is proportionate universalism, which combines universal and targeted approaches, and aims to improve health for everyone while targeting underserved groups so that the degree of health improvement is proportionate to the level of disadvantage.65 We are unaware of any documented examples of proportionate universalism in eye health, although we anticipate this lack of evidence will change in the universal health coverage and SDG era.

Sustainable cities and communities (SDG 11)

Vision impairment can reduce driving safety and increase motor vehicle collisions,66 thereby affecting SDG target 11.2, which aims to provide access to safe, affordable, accessible, and sustainable transport systems for all. Vision impairment is not simply limited to visual acuity, but also includes visual field and colour vision problems. A complementary review undertaken by the Lancet Global Health Commission on Global Eye Health4 further explores the intersection between eye health and driving safety.67 The review determined that some causes of vision impairment, such as glaucoma and cataract, are associated with motor vehicle collisions and unsafe driving practices. Cataract has been found to be associated with approximately 2·5-fold increased odds of motor vehicle collisions,68 and glaucoma, which causes visual field loss, has been found to be associated with 1·65 times greater rates of motor vehicle collisions than in people without glaucoma.69

Several studies included in this Review show cataract surgery reduced driving-related difficulties and motor vehicle collisions.38–43 Most countries have a legal threshold of visual acuity that must be achieved in order to drive;70 eye health services helping to achieve this visual acuity threshold would be anticipated to contribute to improving road safety.

The remaining SDGs

Although the evidence identified for direct links between eye health services and the SDGs was limited to SDGs 1–5, 10, and 11, there are plausible indirect links between providing eye health services and the advancing of other SDGs. These indirect links, mediated through other SDGs, are harder to assess and attribute to improvements in eye health compared to direct links (figure 3).

Clean water and sanitation (SDG 6)

Eye health services could have an indirect effect on clean water and sanitation, through reducing poverty, which in turn is linked to improved infrastructure for water, sanitation, and hygiene.71 Conversely, improvements in the provision of clean water and sanitation are important in trachoma control, the most common infectious cause of blindness.72

Planetary health (SDGs 7 and 12–15)

Globally, health care is estimated to contribute about 5% of the world’s total greenhouse gas emissions.73,74 Ophthalmology is a major component of these emissions. For example, cataract surgery is one of the most common surgical procedures globally, and in the UK, ophthalmology has more outpatient attendances than any other hospital speciality.75 Clinical activity is forecast to rise by 50% over the next 20 years due to growing and ageing populations.76 SDG 13 requires urgent action to combat climate change and its impacts. The evidence on the effects of eye care on this SDG is notable by its absence.

The eye health sector has a responsibility towards environmental sustainability, as does any other sector in society. There are environmental impacts from the manufacturing, running, and disposal of eye health equipment, disposables, and drug treatments. Eye care services in high-income countries generate large amounts of waste products from clinics and surgeries, such as plastic single use containers for eye drops, or cataract surgical packs containing equipment and pharmaceuticals that are partly or totally unused and subsequently discarded; once sterile products are opened, local protocols might prevent the contents being resterilised and reused for other patients.77 Moreover, the comparison with services in lower-income and middle-income country settings has shown that the carbon footprint of one phacoemulsification cataract operation in an Indian institution is just 5% of that of the same procedure in the UK.78

There is minimal published research regarding how eye health affects planetary health. During abstract screening for this scoping review, we found three studies (not meeting our eligibility criteria) that discussed the carbon footprint of cataract surgery; these studies concluded that there is a need for further study in this area,79,80 and that phacoemulsification cataract surgery has a larger carbon footprint than modified small incision cataract surgery at two Scottish centres.81 Eye health services inevitably have effects on the environment, but how and what we can do to minimise the negative impact on the environment is an area that urgently needs to be addressed. The Lancet Global Health Commission on Global Eye Health4 has also conducted a scoping review82 on the environmental sustainability of eye health-care delivery.

The association between eye health and planetary health is probably bidirectional. As the focus of this Review is on how eye health services affect the SDGs, we did not search for evidence in the opposite direction regarding how planetary health interventions could improve eye health (eg, housing improvements might reduce risk of infectious eye conditions). However, these effects are important areas to consider for future work.

Industry, innovation, and infrastructure (SDG 9)

Our Review did not identify any studies with a direct link between eye health and SDG 9. However, given that improved eye health promotes educational outcomes (SDG 4), and a highly skilled workforce contributes to industry and innovation, indirect links between eye health and SDG 9 are conceivable.

Peace and partnership (SDGs 16 and 17)

This Review did not identify any studies with a direct link between eye health and SDGs 16 or 17. The global eye health community has developed some excellent examples of international partnership, including the International Trachoma Initiative,83 and the African Programme for Onchocerciasis Control.84 These partnerships both led to substantial reductions in the global burden of major eye diseases whose spread across borders could not have been addressed in any other way. Partnerships between public and private organisations have also been valuable, for example, in Timor-Leste a public–private partnership was successful in setting up a national spectacle programme.85 In 1987, Merck & Co made a groundbreaking donation of ivermectin for the onchocerciasis control programme, which arguably stimulated other public–private partnerships in later years.86

Strengths and limitations

To our knowledge, this paper is the first scoping review to explore how eye health services contribute to the advancement of the SDGs. Published peer-reviewed manuscripts were comprehensively assessed with no language, time period, or geographical restrictions. We included studies that described the links between eye health services and the SDGs, and not those that reported vision impairment without mention of eye health services. This pragmatic choice made abstract screening feasible given the broad search strategy we applied.

Our review method might have omitted some research relevant to eye health and the SDGs. Studies in which the SDG-related outcome of interest to this Review was not reported in the abstract were not included. We also omitted evidence from grey literature, in which indexing of primary studies is poor: this approach could have led to the exclusion of some reports from governmental and non-governmental organisations. Finally, as this Review was a scoping review, we did not perform a formal quality assessment of studies, nor did we do an overall assessment of the strength of the evidence for each observed association. We anticipated that the studies would be heterogenous and set out to identify and map the available evidence.

Recommendations for future research

We believe that improving understanding among the global community of how and in what ways eye health services affect wide-ranging societal issues across all SDGs is important. We found only 29 studies meeting inclusion criteria, indicating that relatively little research has been done on exploring the effect of eye health services on broad societal concerns such as poverty. Although direct effects do not exist between eye health and all SDGs, there is a disconnect between what the global community should know, and what we do know, about the effect of different eye health services on relevant SDGs. This gap should be addressed in future eye health research, including high-quality observational studies, quasi-experiments, and randomised controlled trials as appropriate. In addition, quantifying and comparing the relative impact of different interventions would be useful.

We found only one other systematic or scoping review looking at connections between improvement in a specific area of health and the SDGs: physical activity promotion strategies and their effect on the SDGs.87 The authors of that scoping review found that physical activity promotion had wide-ranging effects on the SDGs beyond SDG 3, but also concluded that “not all plausible links… are currently supported by scientific evidence, highlighting important research gaps”.87

Promoting equity should be a central pillar to all interventions, and we recommend that all future studies investigating the effect of an intervention should inspect equality dimensions across gender, socioeconomic status, and place of residence as a minimum. Embedding equity in this way is even more pertinent to studies investigating preventive interventions, as discussed earlier. For the global community to risk introducing interventions that widen inequalities in society would be a step backwards.

Recommendations for policy

Eye health does not currently feature within the 169 targets and 232 indicators of the SDG monitoring framework. This Review has highlighted direct and indirect effects of improving eye health on advancing multiple SDGs. As such we think that there is a strong case that improving eye health is a powerful enabling tool for sustainable development and should receive political prioritisation and financial support commensurate with its broad relevance. There is a need for embedded policies and interventions to improve eye health in multiple sectors including education, workplaces, and social services. Eye health needs to be included in the health mainstream as part of universal health coverage.

Conclusions

We have reviewed the evidence showing that eye health services aimed at maximising vision, ocular health, and functional ability have broad benefits and potentially promote the advancement of multiple SDGs, in particular, reducing poverty, supporting economic opportunities, and improving educational outcomes. This evidence supports the case for investing in eye health services, leading to cascading beneficial effects to widespread societal needs embodied by the SDGs.

Supplementary Material

Supplementary Material

Acknowledgments

We acknowledge Iris Gordon who constructed our search. We acknowledge colleagues and Commissioners of the Lancet Global Health Commission on Global Eye Health who provided suggested links between eye health and the SDGs during the model development process (Andrew Bastawrous, Hannah Faal, Clare Gilbert, Jost Jonas, Hannah Kuper, Fatima Kyari, Van Charles Lansingh, Wanjiku Mathenge, GVS Murthy, Thulasiraj Ravilla, Juan Carlos Silva, Anthony Solomon, Bonnielin Swenor, Hugh Taylor, and Renee du Toit). MJB is supported by Wellcome Trust (207472/Z/17/Z). JR’s appointment at the University of Auckland is funded by the Buchanan Charitable Foundation, Auckland, New Zealand. The Lancet Global Health Commission on Global Eye Health is supported by the Queen Elizabeth Diamond Jubilee Trust, Wellcome Trust, Moorfields Eye Charity (GR001061), Sightsavers, the Fred Hollows Foundation, the SEVA Foundation, the British Council for the Prevention of Blindness, and the Christian Blind Mission.

Footnotes

Contributors

MJB conceived the idea for the study. JHZ, JR, BAMAT, JRE, NC, and MJB developed and refined the study concepts and eligibility criteria. All authors reviewed and approved of the study protocol. JHZ and JR coordinated the study members. JHZ, JR, CJ, CB, NM, JMF, SY, CO, and MY did title, abstract, and full text screening, and data extraction. Data charting of the type of study was done by JHZ and verified by JR. APM reviewed potential economics papers for inclusion. JHZ, JR, and MJB synthesised the results with assistance from JRE. JHZ wrote the first draft of the manuscript, and JR, JB, PH, BAMAT, JRE, NC, AW, and MJB revised the manuscript. All authors reviewed and approved the final manuscript.

Declaration of interests

NC is Director of Research for Orbis International, an organisation performing global eye health work in low-income and middle-income countries. JMF receives consulting fees from the Lions Club International Foundation in his role as technical advisor of Lions Club International Foundation for Latin America. All other authors declare no competing interests.

Contributor Information

Justine H Zhang, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK; Manchester Royal Eye Hospital, Manchester, UK.

Jacqueline Ramke, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK; School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand.

Catherine Jan, Lost Child’s Vision Project, Taree, NSW, Australia.

Covadonga Bascaran, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.

Nyawira Mwangi, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK; Department of Clinical Medicine, Kenya Medical Training College, Nairobi, Kenya.

João M Furtado, Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.

Sumrana Yasmin, Sightsavers, Islamabad, Pakistan.

Cynthia Ogundo, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK; Department of Ophthalmology, Mbagathi Hospital, Nairobi, Kenya.

Miho Yoshizaki, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.

Ana Patricia Marques, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.

John Buchan, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.

Peter Holland, International Agency for the Prevention of Blindness, London, UK.

Brandon A M Ah Tong, The Fred Hollows Foundation, Melbourne, VIC, Australia.

Jennifer R Evans, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK; Centre for Public Health, Queen’s University, Belfast, UK.

Nathan Congdon, Centre for Public Health, Queen’s University, Belfast, UK; Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

Aubrey Webson, Permanent Mission of Antigua and Barbuda to the United Nations, New York, NY, USA.

Matthew J Burton, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK; National Institute for Health Research Biomedical Research Centre; Moorfields Eye Hospital NHS Foundation Trust and UCLInstitute of Ophthalmology, London, UK.

Data sharing

Data generated from this Review will be available upon reasonable request from Justine H Zhang (justine.zhang@lshtm.ac.uk).

References

  • 1.UN General Assembly. Transforming our world: the 2030 agenda for sustainable development. Resolution adopted by the general assembly on 25 September 2015. UN General Assembly; New York, NY: 2015. [Google Scholar]
  • 2.GBD 2019 Blindness and Vision Impairment Collaborators on behalf of the Vision Loss Expert Group of the Global Burden of Disease Study. Trends in prevalence of blindness and distance and near vision impairment over 30 years: an analysis for the Global Burden of Disease Study. Lancet Glob Health. 2021;9:e130–43. [Google Scholar]
  • 3.Ulldemolins AR, Lansingh VC, Valencia LG, Carter MJ, Eckert KA. Social inequalities in blindness and visual impairment: a review of social determinants. Indian J Ophthalmol. 2012;60:368–75. doi: 10.4103/0301-4738.100529. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Burton MJ, Ramke J, Marques AP, et al. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. Lancet Glob Health. 2021;9:e489–551. doi: 10.1016/S2214-109X(20)30488-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Ramke J, Tong Ah, Stern J, Swenor B, Faal HB, Burton MJ. Defining eye health for everyone. Ophthalmic Physiol Opt. 2022;42:1–3. doi: 10.1111/opo.12922. [DOI] [PubMed] [Google Scholar]
  • 6.WHO. World report on vision. WHO; Geneva: 2019. [Google Scholar]
  • 7.Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18:143. doi: 10.1186/s12874-018-0611-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMAScR): checklist and explanation. Ann Intern Med. 2018;169:467–73. doi: 10.7326/M18-0850. [DOI] [PubMed] [Google Scholar]
  • 9.Kneale D, Thomas J, Harris K. Developing and optimising the use of logic models in systematic reviews: exploring practice and good practice in the use of programme theory in reviews. PLoS One. 2015;10:e0142187. doi: 10.1371/journal.pone.0142187. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Zhang JH, Ramke J, Mwangi N, et al. Global eye health and the sustainable development goals: protocol for a scoping review. BMJ Open. 2020;10:e035789. doi: 10.1136/bmjopen-2019-035789. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Ehrlich JR, Ramke J, Macleod D, et al. Association between vision impairment and mortality: a systematic review and metaanalysis. Lancet Glob Health. 2021;9:e418–30. doi: 10.1016/S2214-109X(20)30549-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Chandra A, Keay L, Dillon L, Huang J, Gordon I. Vision impairment and eyerelated interventions to reduce falls risk: a systematic review. [accessed July 9, 2020];PROSPERO 2020 CRD42020187617. 2020 https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020187617 . [Google Scholar]
  • 13.Assi L, Chamseddine F, Ibrahim P, et al. A global assessment of eye health and quality of life: a systematic review of systematic reviews. JAMA Ophthalmol. 2021;139:526–41. doi: 10.1001/jamaophthalmol.2021.0146. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Bright T. Protocol for a scoping review on the prevalence and impact of combined vision and hearing (dual sensory) impairment. 2020. [accessed July 9, 2020]. https://osf.io/mgyfv/ [DOI] [PMC free article] [PubMed]
  • 15.Reddy PA, Congdon N, MacKenzie G, et al. Effect of providing near glasses on productivity among rural Indian tea workers with presbyopia (PROSPER): a randomised trial. Lancet Glob Health. 2018;6:e1019–27. doi: 10.1016/S2214-109X(18)30329-2. [DOI] [PubMed] [Google Scholar]
  • 16.Danquah L, Kuper H, Eusebio C, et al. The long term impact of cataract surgery on quality of life, activities and poverty: results from a six year longitudinal study in Bangladesh and the Philippines. PLoS One. 2014;9:e94140. doi: 10.1371/journal.pone.0094140. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Kuper H, Polack S, Mathenge W, et al. Does cataract surgery alleviate poverty? Evidence from a multicentre intervention study conducted in Kenya, the Philippines and Bangladesh. PLoS One. 2010;5:e15431. doi: 10.1371/journal.pone.0015431. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Finger RP, Kupitz DG, Fenwick E, et al. The impact of successful cataract surgery on quality of life, household income and social status in South India. PLoS One. 2012;7:e44268. doi: 10.1371/journal.pone.0044268. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Essue BM, Li Q, Hackett ML, et al. A multicenter prospective cohort study of quality of life and economic outcomes after cataract surgery in Vietnam: the VISIONARY study. Ophthalmology. 2014;121:2138–46. doi: 10.1016/j.ophtha.2014.05.014. [DOI] [PubMed] [Google Scholar]
  • 20.Glick P, Luoto J, Orrs MS, et al. The individual and household impacts of cataract surgery on older blind adults in Ethiopia. Ophthalmic Epidemiol. 2019;26:7–18. doi: 10.1080/09286586.2018.1504310. [DOI] [PubMed] [Google Scholar]
  • 21.Fireison CK, Moore JE. Employment outcomes and educational backgrounds of legally blind adults employed in sheltered industrial settings. J Vis Impair Blind. 1998;92:740–47. [Google Scholar]
  • 22.Giesen JM, Hierholzer A. Vocational rehabilitation services and employment for SSDI beneficiaries with visual impairments. J Vocat Rehabil. 2016;44:175–89. [Google Scholar]
  • 23.Brown GC, Brown MM, Menezes A, Busbee BG, Lieske HB, Lieske PA. Cataract surgery cost utility revisited in 2012: a new economic paradigm. Ophthalmology. 2013;120:2367–76. doi: 10.1016/j.ophtha.2013.04.030. [DOI] [PubMed] [Google Scholar]
  • 24.Haynes R, Gale S, Mugford M, Davies P. Cataract surgery in a community hospital outreach clinic: patients’ costs and satisfaction. Soc Sci Med. 2001;53:1631–40. doi: 10.1016/s0277-9536(00)00448-2. [DOI] [PubMed] [Google Scholar]
  • 25.Frick KD, Hanson CL, Jacobson GA. Global burden of trachoma and economics of the disease. Am J Trop Med Hyg. 2003;69(Suppl):1–10. doi: 10.4269/ajtmh.2003.69.5_suppl_1.0690001. [DOI] [PubMed] [Google Scholar]
  • 26.Frick KD, Keuffel EL, Bowman RJ. Epidemiological, demographic, and economic analyses: measurement of the value of trichiasis surgery in The Gambia. Ophthalmic Epidemiol. 2001;8:191–201. doi: 10.1076/opep.8.2.191.4163. [DOI] [PubMed] [Google Scholar]
  • 27.Glewwe P, West KL, Lee J. The impact of providing vision screening and free eyeglasses on academic outcomes: evidence from a randomized trial in title I elementary schools in Florida. J Policy Anal Manage. 2018;37:265–300. doi: 10.1002/pam.22043. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Hannum E, Zhang Y. Poverty and proximate barriers to learning: vision deficiencies, vision correction and educational outcomes in rural northwest China. World Dev. 2012;40:1921–31. doi: 10.1016/j.worlddev.2012.04.029. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Ma X, Zhou Z, Yi H, et al. Effect of providing free glasses on children’s educational outcomes in China: cluster randomized controlled trial. BMJ. 2014;349:g5740. doi: 10.1136/bmj.g5740. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Ma Y, Congdon N, Shi Y, et al. Effect of a local vision care center on eyeglasses use and school performance in rural China: a cluster randomized clinical trial. JAMA Ophthalmol. 2018;136:731–37. doi: 10.1001/jamaophthalmol.2018.1329. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Glewwe P, Park A, Zhao M. A better vision for development: eyeglasses and academic performance in rural primary schools in China. J Dev Econ. 2016;122:170–82. [Google Scholar]
  • 32.Hark LA, Thau A, Nutaitis A, et al. Impact of eyeglasses on academic performance in primary school children. Can J Ophthalmol. 2020;55:52–57. doi: 10.1016/j.jcjo.2019.07.011. [DOI] [PubMed] [Google Scholar]
  • 33.Joseph L. Refractive errors and academic achievements of primary school children. Nurs J India. 2014;105:269–71. [PubMed] [Google Scholar]
  • 34.Bruce A, Kelly B, Chambers B, et al. The effect of adherence to spectacle wear on early developing literacy: a longitudinal study based in a large multiethnic city, Bradford, UK. BMJ Open. 2018;8:e021277. doi: 10.1136/bmjopen-2017-021277. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Mercer GD, Lyons P, Bassett K. Interventions to improve gender equity in eye care in lowmiddle income countries: a systematic review. Ophthalmic Epidemiol. 2019;26:189–99. doi: 10.1080/09286586.2019.1574839. [DOI] [PubMed] [Google Scholar]
  • 36.Baruwa E, Tzu J, Congdon N, He M, Frick KD. Reversal in gender valuations of cataract surgery after the implementation of free screening and lowpriced highquality surgery in a rural population of southern China. Ophthalmic Epidemiol. 2008;15:99–104. doi: 10.1080/09286580801999118. [DOI] [PubMed] [Google Scholar]
  • 37.Dickey H, Ikenwilo D, Norwood P, Watson V, Zangelidis A. Utilisation of eyecare services: the effect of Scotland’s free eye examination policy. Health Policy. 2012;108:286–93. doi: 10.1016/j.healthpol.2012.09.006. [DOI] [PubMed] [Google Scholar]
  • 38.Subzwari S, Desapriya E, Scime G, Babul S, Jivani K, Pike I. Effectiveness of cataract surgery in reducing drivingrelated difficulties: a systematic review and metaanalysis. Inj Prev. 2008;14:324–28. doi: 10.1136/ip.2007.017830. [DOI] [PubMed] [Google Scholar]
  • 39.Owsley C, McGwin G, Jr, Sloane M, Wells J, Stalvey BT, Gauthreaux S. Impact of cataract surgery on motor vehicle crash involvement by older adults. JAMA. 2002;288:841–49. doi: 10.1001/jama.288.7.841. [DOI] [PubMed] [Google Scholar]
  • 40.Meuleners LB, Brameld K, Fraser ML, Chow K. The impact of first- and secondeye cataract surgery on motor vehicle crashes and associated costs. Age Ageing. 2019;48:128–33. doi: 10.1093/ageing/afy156. [DOI] [PubMed] [Google Scholar]
  • 41.Meuleners LB, Hendrie D, Lee AH, Ng JQ, Morlet N. The effectiveness of cataract surgery in reducing motor vehicle crashes: a whole population study using linked data. Ophthalmic Epidemiol. 2012;19:23–28. doi: 10.3109/09286586.2011.628776. [DOI] [PubMed] [Google Scholar]
  • 42.Meuleners LB, Ng JQ, Fraser M, Hendrie D, Morlet N. Impact of gender on first eye cataract surgery and motor vehicle crash risk for older drivers. Clin Exp Ophthalmol. 2012;40:591–96. doi: 10.1111/j.1442-9071.2011.02751.x. [DOI] [PubMed] [Google Scholar]
  • 43.Schlenker MB, Thiruchelvam D, Redelmeier DA. Association of cataract surgery with traffic crashes. JAMA Ophthalmol. 2018;136:998–1007. doi: 10.1001/jamaophthalmol.2018.2510. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44.Kuper H, Polack S, Eusebio C, Mathenge W, Wadud Z, Foster A. A casecontrol study to assess the relationship between poverty and visual impairment from cataract in Kenya, the Philippines, and Bangladesh. PLoS Med. 2008;5:e244. doi: 10.1371/journal.pmed.0050244. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 45.Jaggernath J, Øverland L, Ramson P, Kovai V, Chan VF, Naidoo KS. Poverty and eye health. Health (Irvine Calif) 2014;6:1849–60. [Google Scholar]
  • 46.Gilbert CE, Shah SP, Jadoon MZ, et al. Poverty and blindness in Pakistan: results from the Pakistan national blindness and visual impairment survey. BMJ. 2008;336:29–32. doi: 10.1136/bmj.39395.500046.AE. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47.Cockburn N, Steven D, Lecuona K, et al. Prevalence, causes and socioeconomic determinants of vision loss in Cape Town, South Africa. PLoS One. 2012;7:e30718. doi: 10.1371/journal.pone.0030718. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 48.Sherwin JC, Reacher MH, Dean WH, Ngondi J. Epidemiology of vitamin A deficiency and xerophthalmia in atrisk populations. Trans R Soc Trop Med Hyg. 2012;106:205–14. doi: 10.1016/j.trstmh.2012.01.004. [DOI] [PubMed] [Google Scholar]
  • 49.Harrabi H, Aubin MJ, Zunzunegui MV, Haddad S, Freeman EE. Visual difficulty and employment status in the world. PLoS One. 2014;9:e88306. doi: 10.1371/journal.pone.0088306. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 50.MojonAzzi SM, SousaPoza A, Mojon DS. Impact of low vision on employment. Ophthalmologica. 2010;224:381–88. doi: 10.1159/000316688. [DOI] [PubMed] [Google Scholar]
  • 51.Schmier JK, Halpern MT, Covert D, Delgado J, Sharma S. Impact of visual impairment on use of caregiving by individuals with agerelated macular degeneration. Retina. 2006;26:1056–62. doi: 10.1097/01.iae.0000254890.48272.5a. [DOI] [PubMed] [Google Scholar]
  • 52.Yamada M, Mizuno Y, Shigeyasu C. Impact of dry eye on work productivity. Clinicoecon Outcomes Res. 2012;4:307–12. doi: 10.2147/CEOR.S36352. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 53.Meijer JM, Meiners PM, Huddleston Slater JJ, et al. Healthrelated quality of life, employment and disability in patients with Sjogren’s syndrome. Rheumatology (Oxford) 2009;48:1077–82. doi: 10.1093/rheumatology/kep141. [DOI] [PubMed] [Google Scholar]
  • 54.Coats DK, Paysse EA, Towler AJ, Dipboye RL. Impact of large angle horizontal strabismus on ability to obtain employment. Ophthalmology. 2000;107:402–05. doi: 10.1016/s0161-6420(99)00035-4. [DOI] [PubMed] [Google Scholar]
  • 55.Marques AP, Ramke J, Cairns J, et al. Estimating the global cost of vision impairment and its major causes: protocol for a systematic review. BMJ Open. 2020;10:e036689. doi: 10.1136/bmjopen-2019-036689. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 56.Wickham S, Anwar E, Barr B, Law C, TaylorRobinson D. Poverty and child health in the UK: using evidence for action. Arch Dis Child. 2016;101:759–66. doi: 10.1136/archdischild-2014-306746. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 57.Tampubolon G, Hanandita W. Poverty and mental health in Indonesia. Soc Sci Med. 2014;106:20–27. doi: 10.1016/j.socscimed.2014.01.012. [DOI] [PubMed] [Google Scholar]
  • 58.Engle PL, Black MM. The effect of poverty on child development and educational outcomes. Ann N Y Acad Sci. 2008;1136:243–56. doi: 10.1196/annals.1425.023. [DOI] [PubMed] [Google Scholar]
  • 59.Toledo CC, Paiva APG, Camilo GB, Maior MRS, Leite ICG, Guerra MR. Early detection of visual impairment and its relation to academic performance. Rev Assoc Med Bras (1992) 2010;56:415–19. doi: 10.1590/s0104-42302010000400013. [DOI] [PubMed] [Google Scholar]
  • 60.Jan C, Li SM, Kang MT, et al. Association of visual acuity with educational outcomes: a prospective cohort study. Br J Ophthalmol. 2019;103:1666–71. doi: 10.1136/bjophthalmol-2018-313294. [DOI] [PubMed] [Google Scholar]
  • 61.Kuper H, Monteathvan Dok A, Wing K, et al. The impact of disability on the lives of children; crosssectional data including 8,900 children with disabilities and 898,834 children without disabilities across 30 countries. PLoS One. 2014;9:e107300. doi: 10.1371/journal.pone.0107300. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 62.Royal National Institute of Blind People. Key statistics on pupils with vision impairment. 2017. [accessed July 5, 2020]. https://www.rnib.org.uk/insight_online/statisticspupilsvisionimpairment .
  • 63.Lorenc T, Petticrew M, Welch V, Tugwell P. What types of interventions generate inequalities? Evidence from systematic reviews. J Epidemiol Community Health. 2013;67:190–93. doi: 10.1136/jech-2012-201257. [DOI] [PubMed] [Google Scholar]
  • 64.Zhao J, Ellwein LB, Cui H, et al. Prevalence and outcomes of cataract surgery in rural China the China nineprovince survey. Ophthalmology. 2010;117:2120–28. doi: 10.1016/j.ophtha.2010.03.005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 65.Gwatkin DR, Ergo A. Universal health coverage: friend or foe of health equity? Lancet. 2011;377:2160–61. doi: 10.1016/S0140-6736(10)62058-2. [DOI] [PubMed] [Google Scholar]
  • 66.Tanabe S, Yuki K, Ozeki N, et al. The association between primary openangle glaucoma and motor vehicle collisions. Invest Ophthalmol Vis Sci. 2011;52:4177–81. doi: 10.1167/iovs.10-6264. [DOI] [PubMed] [Google Scholar]
  • 67.Nguyen H, Di Tanna GL, Coxon K, et al. Associations between vision impairment and driving and the effectiveness of visionrelated interventions: protocol for a systematic review and metaanalysis. BMJ Open. 2020;10:e040881. doi: 10.1136/bmjopen-2020-040881. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 68.Owsley C, Stalvey BT, Wells J, Sloane ME, McGwin G., Jr Visual risk factors for crash involvement in older drivers with cataract. Arch Ophthalmol. 2001;119:881–87. doi: 10.1001/archopht.119.6.881. [DOI] [PubMed] [Google Scholar]
  • 69.Kwon M, Huisingh C, Rhodes LA, McGwin G, Jr, Wood JM, Owsley C. Association between glaucoma and atfault motor vehicle collision involvement among older drivers: a populationbased study. Ophthalmology. 2016;123:109–16. doi: 10.1016/j.ophtha.2015.08.043. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 70.Bohensky M, Charlton J, Odell M, Keeffe J. Implications of vision testing for older driver licensing. Traffic Inj Prev. 2008;9:304–13. doi: 10.1080/15389580801895277. [DOI] [PubMed] [Google Scholar]
  • 71.Jose TK. Micro enterprise initiative in water sector and poverty reduction. Water Sci Technol. 2003;47:119–28. [PubMed] [Google Scholar]
  • 72.Stocks ME, Ogden S, Haddad D, Addiss DG, McGuire C, Freeman MC. Effect of water, sanitation, and hygiene on the prevention of trachoma: a systematic review and metaanalysis. PLoS Med. 2014;11:e1001605. doi: 10.1371/journal.pmed.1001605. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 73.Pichler PP, Jaccard IS, Weisz U, Weisz H. International comparison of health care carbon footprints. Environ Res Lett. 2019;14:064004 [Google Scholar]
  • 74.Karliner J, Slotterback S, Boyd R, Ashby B, Steele K. Health care’s climate footprint: how the health sector contributes to the global climate crisis and opportunities for action. 2019. [accessed July 6, 2020]. https://www.arup.com/-/media/arup/files/publications/h/health-cares-climate-footprint.pdf .
  • 75.NHS Digital. Hospital outpatient activity 2018–19. 2019. Oct 10, [accessed July 3, 2020]. https://digital.nhs.uk/dataandinformation/publications/statistical/hospitaloutpatientactivity/2018–19 .
  • 76.Buchan JC, Norman P, Shickle D, CasselsBrown A, MacEwen C. Failing to plan and planning to fail. Can we predict the future growth of demand on UK eye care services? Eye (Lond) 2019;33:1029–31. doi: 10.1038/s41433-019-0383-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 77.Tauber J, Chinwuba I, Kleyn D, Rothschild M, Kahn J, Thiel CL. Quantification of the cost and potential environmental effects of unused pharmaceutical products in cataract surgery. JAMA Ophthalmol. 2019;137:1156–63. doi: 10.1001/jamaophthalmol.2019.2901. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 78.Thiel CL, Schehlein E, Ravilla T, et al. Cataract surgery and environmental sustainability: waste and lifecycle assessment of phacoemulsification at a private healthcare facility. J Cataract Refract Surg. 2017;43:1391–98. doi: 10.1016/j.jcrs.2017.08.017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 79.Venkatesh R, van Landingham SW, Khodifad AM, et al. Carbon footprint and costeffectiveness of cataract surgery. Curr Opin Ophthalmol. 2016;27:82–88. doi: 10.1097/ICU.0000000000000228. [DOI] [PubMed] [Google Scholar]
  • 80.Morris DS, Wright T, Somner JE, Connor A. The carbon footprint of cataract surgery. Eye (Lond) 2013;27:495–501. doi: 10.1038/eye.2013.9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 81.Somner J, Scott K, Morris D, Gaskell A, Shepherd I. Ophthalmology carbon footprint: something to be considered? J Cataract Refract Surg. 2009;35:202–03. doi: 10.1016/j.jcrs.2008.09.026. [DOI] [PubMed] [Google Scholar]
  • 82.Buchan J, Thiel C, Steyn A, et al. Addressing the environmental sustainability of eye health care delivery: a scoping review. 2020. [accessed June 4, 2020]. https://osf.io/cn5wp/ [DOI] [PMC free article] [PubMed]
  • 83.Bartlett S, Haslam D, Bush S, Haddad D. Elimination through collaboration: success factors in a global consortium. Int Health. 2019;11:24–29. doi: 10.1093/inthealth/ihy054. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 84.Tekle AH, Zouré HG, Noma M, et al. Progress towards onchocerciasis elimination in the participating countries of the African Programme for Onchocerciasis Control: epidemiological evaluation results. Infect Dis Poverty. 2016;5:66. doi: 10.1186/s40249-016-0160-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 85.Ramke J, Williams C, Ximenes J, et al. A public–private partnership to provide spectacles for TimorLeste. Community Eye Health. 2007;20:54. [PMC free article] [PubMed] [Google Scholar]
  • 86.Molyneux DH, Nantulya V. Public–private partnerships in blindness prevention: reaching beyond the eye. Eye (Lond) 2005;19:1050–56. doi: 10.1038/sj.eye.6701961. [DOI] [PubMed] [Google Scholar]
  • 87.Salvo D, Garcia L, Reis RS, et al. Physical activity promotion and the United Nations sustainable development goals: building synergies to maximize impact. J Phys Act Health. 2021;18:1163–80. doi: 10.1123/jpah.2021-0413. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplementary Material
EMS209640-supplement-Supplementary_Material.pdf (641.5KB, pdf)

Data Availability Statement

Data generated from this Review will be available upon reasonable request from Justine H Zhang (justine.zhang@lshtm.ac.uk).

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