Table 2.
Top 16 Grand Challenges in global eye health, prioritised via the Delphi method
| Round 2 rank | Round 3 rank | |
|---|---|---|
| Detection and treatment of conditions | ||
| Develop models to encourage population demand and ensure access to accurate refraction and affordable, good quality spectacles* | 15 | 1 |
| Identify and implement strategies to improve the quality, productivity, equity, and access of cataract services* | 27 | 2 |
| Improve child eye health: integrate evidence-based primary eye-care services for children into general children's health services and ensure strong connections to secondary eye-care services; develop and implement sustainable school eye health programmes, including screening and management for refractive error and amblyopia, that are well integrated within education services* | 2 | 3 |
| Develop and implement one-stop services for people with diabetes, through integrating diabetic retinopathy screening services with general diabetes care and developing robust systems to ensure ongoing follow-up and referral for assessment and treatment | 37 | 8† |
| Develop and implement evidence-based, effective, sustainable, and context-relevant screening and early detection strategies for eye conditions | 11 | 10 |
| Develop and implement effective, accessible, and inexpensive pathway approaches for screening, diagnosing, monitoring, and managing glaucoma | 10 | 21 |
| Health services and policy | ||
| Develop and implement evidence-based strategies for the effective integration of eye health services between primary level and secondary and tertiary levels, improving referral pathways; ensuring that there is recognition of those who need secondary level care and that there is a timely, reliable, accessible, and affordable mechanism connecting people to the care they need | 4 | 7 |
| Develop and implement evidence-based strategies for the effective integration of eye care at the primary care level and with other medical services (eg, child health, diabetes, and non-communicable diseases services); ensuring that services are widely accessible, affordable, and of high quality, meeting the primary eye care needs of the population | 7 | 8† |
| Ensure financing for eye health exists within national budgets and financing structures, and increase the investment | 3 | 13 |
| Encourage governments to prioritise delivering integrated people-centred eye health care services for Universal Health Coverage | 1 | 16 |
| Strengthen the health information system for eye health within health facilities, integrating them into national systems | 9 | 34 |
| Access and equity | ||
| Develop and implement services that are designed to prioritise reaching marginalised or vulnerable groups (eg, women, poor communities, Indigenous people, ethnic minorities, people with disabilities, people in aged care, and people in prisons and refugee camps) and people living in rural communities with quality, affordable eye services* | 5 | 4 |
| Develop and implement strategies that reduce out-of-pocket costs for those requiring eye care who are unable to afford full-cost services (eg, subsidy, tiered pricing, and insurance)* | 25 | 5 |
| Develop and implement appropriately responsive programmes to increase the access to and use of eye health services and treatment (eg, reduce barriers to accessing services and increase demand through greater awareness of need and confidence in health care provision) | 8 | 11 |
| Human resource capacity | ||
| Increased support to geographical regions with particularly severe shortages in eye health resources, by international bodies, professional bodies and colleges, and non-governmental organisations | 38 | 6 |
| Strengthen leadership and public health expertise across all levels of eye health care and ensure national level leadership has the ability to influence policy and resource allocation (including strengthening regional and national professional bodies for eye health practitioners) | 6 | 28 |
The rank from round 2 is from 85 challenges presented to all participants; the rank from round 3 is from 41–48 challenges presented to participants according to region.
*
The top five challenges ranked by disease-burden reduction, impact on equity, immediacy of impact, and feasibility.
†
Tied score.