National strategy

VISION 2020 NORWAY

A. Vision 2020, global background

Vision 2020 The Right to Sight is a global initiative for the elimination of avoidable blindness by 2020. According to the World Health Organization (WHO), approx 314 million people worldwide are blind or seriously visually impaired. 45 million of these are blind and 269 million are visually impaired, including 145 million people who are visually impaired due to lack of low vision aids. Most of these would obtain normal vision with spectacles or contact lenses. In addition to this it is estimated that more than 500 million people are visually impaired because of uncorrected nearsightedness, and normal vision could be restored with spectacles.

80% of all blindness can be treated or prevented.

90% of the blind worldwide live in low income countries.

2/3 of the blind and visually impaired worldwide are women and girls.

Longevity and/or negative lifestyle changes have resulted in more people experiencing blindness and low vision due to age-related macular degeneration or diabetes. Improved medical treatment in premature babies, head injuries, and neurological diseases has increased survival rates, however, with brain damage as result. More than half of these patients have brain related visual impairments. Without additional measures, it has been estimated that the number of blind people worldwide will increase to 76 million by 2020.

Definitions

The World Health Organization (WHO) has prepared two classification systems, ICD-10 and ICF.

1.ICD-10, International Classification of Diseases, classifies blindness and low vision according to the following criteria

When visual impairment is categorized, quality of vision is measured on each eye withthe patient’s usual means of correction. Taking into account size of vision field, the patients with a vision field no greater than a 10 degree radius around the central fixation on the better eye are considered category 3 patients.

Category / Visual acuity
Less than / Equal to or better than
0 – Mild or no visual impairment / 6/18
3/10 (0,3)
20/70
1 – Moderate Visual impairment / 8/18
3/10 (0,3)
20/70 / 6/60
1/10 (0,1)
20/200
2 – Serious Visual impairment / 6/60
1/10 (0,1)
20/200 / 3/60
1/20 (0,05)
20/400
3 – Blindness / 3/60
1/20 (0,05)
20/400 / 1/60(finger counting 1m)
1/50 (0,02)
5/300 (20/1200)
4 – Blindness / 1/60 (finger counting 1m)
1/50 (0,02)
5/300 (20/1200 / Light perception
5 – Blindness / No light perception
  1. ICF, International Classification of Functioning, Disability and Health, evaluates health and abilities in relation to social aspects and circumstantial influences.

In addition to reduction in visual acuity and visual field, WHO also considers all aspects which influence quality of vision (including: light sensitivity, paralysis of muscles in the eye, nystagmus, colour vision, contrast vision, visual depth perception,difficulties with half sided visual defects, small spots on visual field, night blindness, visual attention and visual orientation ability) as they influence each persons level of activity and participation. ICF offers a wider and more complete picture of personal and general health issues, as a basis to take action, both individually and by society.

Both classification systems are currently being used in Norway.

B. Vision 2020; Norway and national conditions.

A motion carried by the general assembly of The World Health Organization, makes a strong request to all its members to establish Vision 2020 committees, and to

prepare national Vision 2020 plans. The Norwegian Association of Optometry has initiated a Norwegian Vision 2020 committee.

Current members of the committee are: The Norwegian Association of Optometry, The Norwegian Ophthalmological Society, The Norwegian Glaucoma Society, The Norwegian Association of the Blind and Partially Sighted, The Norwegian Visual Educators Association and the Department of Optometry and Visual Science at BuskerudUniversityCollege. In addition to this the committee also consists of an observer from the Ministry of Health and Care Services.

Demographic conditions in Norway

The population is small (4.7 mill inhabitants), well-defined and stationary. First cousin marriages are rare(0.4%). Child mortality is among the lowest in the world and life expectancy is more than 70 years.

All children have free, mandatory 10 years of schooling, and the number of functional illiterates is low. Both sexes have equal opportunity to education and the same school training.

Health care services are organized by the authorities, and hospitalization is free. Norway has 17,000 medical doctors including 460 ophthalmologists. There are 1,700 opticians, 35 orthoptists, 200 vision- and mobility educators and 2,000 regional nurses.

Each county has an aid central organized through The Norwegian Labour and Welfare Service (NAV), which is responsible for distributing technical visual aids.

Children are examined at birth, when they are 6 weeks and 4 years old, in order to detect visual impairment or eye disease. Schoolchildren are examined when they have visual problems. Following brain damage, vision is not routinely examined, and recommendations made to routinely examine persons with multiple handicaps, are not automatically followed up. All premature babies must be specifically followed up with regards to findings and the development of variousvision functions.

Many organizations and public authorities have made large efforts in preparing information as pamphlets, vision tests, DVDs and internet sites, concerning vision and eye health. The result of this is that,a large part of the population is active regarding routine vision tests when they suspect complications of diabetes, glaucoma or macular degeneration. New medications and methods of treatment have simplified and improved treatment of glaucoma, cataract, diabetic retinopathy and age-related macular degeneration. Intensive and continuous information is considered the best preventive measure.

Social security reimbursement rules are applicable for children/young persons under the age of 18 with visual impairment and who need technical aids and spectacles.

The visually impaired in Norway

It is estimatedthat there are more than 100 children between 0-17 years of age with visual impairment per 100,000 children within the same age group. There is a small predominance of boys with visual impairment compared to girls. Challenges in relation to children with visual impairment imply monitoring changes in needs through all stages of development. The most frequent cause of visual impairment in children is damageto visual pathways and visual centres in the brain. Among these children we find some without additionalimpairments, while others have additional motor, sensory and/or mental impairments. Visual impairment, which occurs after brain damage, is not adequately registered. Studies show that some of the extreme premature babies have various types of visual impairments with neurological causes. These are often revealed later. Atrophy of the optic nerve is the second most leading cause of visual impairment in children, followed by various retinal disorders and congenital malformations in the eye’s anterior and posterior segment.

In a population of 100,000 it is estimated that at least 300 adults over the age of 19 are visually impaired or blind. After the age of 65, visual impairment increases. There are no records of the number of people with functional visual impairment according to ICF`s standards. In adults between 20-65 years old, various disorders of the retina and the optic nerve, which very often are hereditary, are the leading causes of visual impairment. Then follows visual impairment caused by diabetes, cataract and not so common glaucoma and macular degeneration. In the age group over 65, age related macular degeneration and cataract are dominant, followed by retinal disorders, damage to the optic pathways and complications to diabetes. Blindness caused by glaucoma is not so common.

In all age groups, the number of people with visual impairment increases following a stroke, tumours, head injuries or neurological disease. These visual impairments are classified according to ICF standards when they are followed by loss of function even though vision might be close to normal. Examples include; reduced peripheral vision, impaired perception of contrasts, disturbed motor function of the eye, and/or visual neglect (inattention to visual stimuli). Particularly in older people these problems can be added to an eye related visual impairment.

There is great uncertainty regarding frequency of visual impairment among the intellectually challenged of all age groups, but there are indications that visual impairment is quite common. The reason for this can be both lack of spectacles, eye diseases and/or neurological vision related impairments.Persons with Down syndrome more often have refractive errors, squinting and cataract as compared to the rest of the population. Immigrant women are a particularly vulnerable group. Due to lack of language skills, they have greater difficulties in explaining their visual problems.

We expect an increasing number of visually impaired people in Norway as the number of elderly increases.

Non-governmental organizations for the visually impaired in Norway: / Norwegian Association of the Blind and Partially Sighted.
Norwegian RP(Retinis Pigmentosa) Association
Laurence-Moon Bardet-Biedl Syndrom Association
Norwegian Glaucoma Society
Assistance – Association for visual impaired children
Norwegian Spielmeyer-Vogt Association
Norwegian Association for Albinism (NFFA)
Aniridi Norway
Norwegian Association of the Deaf Blind
Norwegian Association for people with low vision

C. Vision 2020 Norway`s national strategy and goals

Vision 2020 Norway is preparing a national strategy which includes fighting, preventing and treating visual impairment in Norway. One goal is increased interaction and cooperation at all levels, also between users and professionals. Our intention is to create a unifying frame for action in all vision-related issues before 2020.

Vision 2020 Norway has developed this strategy as a response to the World Health Assembly VISION 2020 resolution, which calls for as much elimination of blindness as possible within 2020 while encouraging improvement of support and services for the blind and visually impaired. Vision 2020 Norway refers to the lack of services within eye health, visual rehabilitation and other necessary services for the blind and visually impaired. Attention is focused on the exclusion of the visually impaired in various social arenas. Visual problems in general are often met with much ignorance and indifference.

Norway`s Vision 2020 strategy is based on the following values:

-Everyone, regardless of cause (medical or neurological), age or area of residence, shall have equal access to serviceswhich can detect visual impairments.

-Everyone has a right to rehabilitation services when a visual problem interferes with the functioning level or has a negative impact on learning and development.

-Services for visually impaired shall be individually designed and provided by professionals.

-The blind and visually impaired shall be respected in accordance with applicable law, and have the opportunity for participation in work and leisure on an equal basis.

Vision 2020 Norway’splans can only be achieved through clear goals. The objectives must be monitored continuously to ensure necessary progress. This should involve a regular review of the status through a wider consultation and review of strategy, for example, every four years.

Primary objectives

1Best possible vision for all

Improve services related to the detection, identification and treatment of eye disease and visual problems, in order to achieve best possible vision for all.

1.1 Five-year goal: Best possible vision for all

  • Prevent eye disease and loss of vision by educating and informing the population
  • Ensuring early identification of eye disease and other visual impairments.
  • Offer treatment that helps minimize vision loss.
  • Increase population awareness on how lifestyle, diseases and injuries may impair vision.
  • Increase the competence on vision related issues among professionals, within areas such as health, education, work and culture.

1.2Measures to achieve best possible vision for all

Ensure that routine examination of children is prioritized by offering eye examinations:

- at birth

- at the age of 4

- when the child starts school

- when transferring to junior high school/middle school

  • Ensure regular eye examinations of the intellectually challenged, who have high incidences of visual defects and eye diseases, but who have difficulties communicating their visual problems.

Establishment of a vision register of the visually impaired as soon as possible (based on informed consent) in order to ensure:

-that children with visual impairments are monitored to ensure necessary and proper training, health care in addition to social and financial support.

-an overview of persons with hereditary eye diseases to ensure increased research which will enable better treatment.

- information on new causes of visual impairments in the population, for example caused by lifestyle or other changes

- required adaption of training and rehabilitation services

- in addition, in the long term a national register of visual impairment covering the entire population is also desirable.

  • Information campaigns concerning treatable visual impairment (refractive errors), the most common eye diseases in the elderly (cataract, glaucoma, age-related macular degeneration) and visual impairment following brain damage and diabetes.
  • Promote optometrists as frontline eye health workers
  • Increase availability of practicing ophthalmologists.
  • Ensure a sufficient number of ophthalmologists in hospitals, where broad expertise is most easily built, including complicated and time consuming issues.
  • Ensure increased competence within the field of neuroophtalmology in hospitals, as an increasing number of people have visual impairments due to neurological symptoms, following brain damage or neurological disease.
  • Focus on vision/eye health for patients in nursing homes and in home care, by, among other things, increasing eye care expertise in nurses and nursing assistants to ensure the patient’s right to proper eye health and expertise.

2 Eye care expertise at all levels

Establish adequate and competent eye care expertise for everyone with visual impairments or with visual problems that impair level of function.

2.1Five-year goal: Eye care expertise at all levels

  • better coordination of services for the visually impaired
  • better services that promote the participation of the visually impaired
  • available and efficient vision and eye health services
  • increased competence within neuroophtalomolgy and greater availability of such services
  • better availability and capacity within vision educational training and rehabilitation
  • eye care expertise at all levels of society and within all services
  • increased research to improve services for the visually impaired
  • ensure eye educational follow-up for visually impaired students

2.2 Measures to achieve eye care expertise at all levels

Ensure eye care expertise by distributing technical aids through the various aid centrals organized through the Norwegian Labour and Welfare Service (NAV). Optimum utilization of the remaining vision, appropriate choice of eye technical aids and necessary training can best be achieved by combining the services from both optometrists and vision educators. In addition, regular visits to an ophthalmologist are recommended.

  • Improved follow-up of children with visual impairments. Eye educational training, follow-up and training within the municipality through the Educational Psychological Service (PPT) and the state training and special education services, to ensure all children with disabilities necessary help from a vision educator.
  • Increase knowledge about visions significance for reading and learning. Ensure ophthalmological diagnostics, follow-up by optometrist and education by vision educator for children with reading and writing difficulties.
  • Increased vision skills when implementing rehabilitation measures for children, adults and elderly with acquired brain damage followed by visual impairment.
  • Increased vision expertise within the Employment Agency to ensure necessary and correct qualification and preparation so that the visually impaired are able to find work and stay employed.
  • Increased research within ophthalmology, optometry and eye care education to find better means of prevention, treatment, rehabilitation and training methodology.
  • Increase capacity in eye care educational programs in order to ensure competence in rehabilitation and training.

3 Full participation for the visually impaired

Promote inclusion and participation for the visually impaired in all areas of society.

3.1 Five-year goal: Full participation for the visually impaired

  • Work to improve attitudes of service providers, employers and the general public towards the visually impaired
  • Improve awareness and insight into the needs of visually impaired in order to implement individual measures.
  • Remove barriers to inclusion, enabling blind and visually impaired to achieve independence, control and options.
  • Comply with laws prohibiting discrimination both in private and in public life.
  • Improve the procedures, laws and regulations which act as barriers and obstacles

3.2Measures to achieve full participation for visually impaired.

  • Campaigns, conferences and general information for the public regarding visual impairments with subsequent needs and possibilities.
  • Contact with legislative authorities
  • Cooperation with various suppliers of services

4 Contribute to the international Vision 2020 campaign

Five-year goal: Contribute to the international Vision 2020 campaign

  1. Contribute to the authorities, Norwegian specialist groups and Norwegian non governmental organizations (NGO`s) to ensure increased efforts for improved eye health, obtaining information about eye function, and eye rehabilitation.
  2. Contribute to increased international rights for visually impaired
  3. Contribute so that other states, international organizations and foreign specialist groups, are able to increase eye health efforts, the obtaining of eye function information, and eye rehabilitation.

4.2

Measures that can contribute to the international Vision 2020 campaign;

  1. Influence Norwegian authorities, Norwegianspecialist groups and Norwegian non-governmental organizations through cooperation and information, in order to increase efforts within eye health, the obtaining of eye function information, eye rehabilitation, education and international rights for visually impaired.
  2. Influence authorities in other states, international organizations, specialist groups and organizations through cooperation and information in order to increase efforts within eye health, the obtaining of eye function information, eye rehabilitation, education and rights for visually impaired.

References