Eye testing in the Third World countries. The paradox of access to health care and to the Internet.

The paradox of access to health care and to the Internet.

According to the 2019 report by WHO, at least 2.2 billion people worldwide have vision problems, of which at least 1 billion have yet to be detected. Among these problems, about 124 million are refractive errors, which we correct every day by wearing glasses or contact lenses.

Many eye diseases are unevenly distributed around the world. For example, glaucoma is most common in Africa (4.8%), Latin America and the Caribbean (4.5%). In the case of refractive errors, there is a significant correlation in distribution of these disturbances and the income level in the country. It is estimated that the prevalence in many low- and middle-income regions is four times higher than in high-income regions. Only three Asian regions (representing 51% of the world's population) represent 62% of the estimated 216.6 million people in the world with moderate to severe bilateral distance vision impairment. The prevalence of bilateral blindness in the low- and middle-income regions is eight times higher than in all high-income countries (<0.5%). Many of the countries belonging to the above-mentioned regions are so-called Third World. Currently, this concept is used in countries with a low level of socio-economic development, where poverty and economic backwardness remain the main problem.

Despite alarming statistics on Third World countries, the availability of diagnostics of eye diseases and disorders is extremely low. In rural areas where the demand for specialist ophthalmic services is the highest, there is a significant shortage of medical personnel. The fact that the vast majority of ophthalmic services are provided in hospitals, which are mainly located in urban areas, further increases the inequality of access. The shortage of trained human resources is one of the greatest challenges in increasing the availability of ophthalmic services and reducing the incidence of visual impairment and blindness. A recent (2019) survey of the ophthalmic workforce covering 198 countries (i.e. 94% of the world's population) found that while the number of practicing ophthalmologists is increasing in most countries, the distribution remains uneven. Critical human resource shortages have also been identified for optometrists and other related ophthalmic personnel such as optometrists and eye nurses who are involved in the care of an ophthalmic patient alongside doctors.

Even in the locations where healthcare professionals are available, the necessary ophthalmic equipment to treat eye conditions is often not accessible. A recent country-wide study of patterns of glaucoma management and treatment in Nigeria found that only about 30% of ophthalmologists had access to laser equipment, while basic diagnostic equipment was not available even in 20% of clinics. Despite invaluable help from many sides and from many individuals, the scale of needs is still huge and difficult to control.

In this case, the paradox of the economic and social situation is the availability of telephones and the Internet. For example, at the end of 2020, there were 495 million people in sub-Saharan Africa (46% of the population living in this area) registered to the mobile network. This is an increase of almost 20 million compared to 2019, while by 2025 the estimated number of people is to increase to 615 million (covering 50% of the population). By the end of 2020, 303 million people in sub-Saharan African countries were connected to the mobile Internet, corresponding to 28% of the population, and by 2025 this number is expected to rise to 474 million (39%). Looking at the Asian countries with a low level of economic development, the situation is similar. In Bangladesh, 41% of the population had access to smartphones in 2020, and by 2025 this figure is estimated to increase to 62%. At the same time, 28% of the population had a connection to the mobile Internet, and within 5 years this number is expected to increase to 38%.

Although compared to the statistics of highly developed countries, these values may seem incomparably low, they still paradoxically constitute greater technological availability compared to possibilities and availability of ophthalmic care. This proves the extremely difficult health situation of people in those countries.

The collected data and the possibility to support the ophthalmic healthcare system through technology was an inspiration behind FEYENALLY to start working on an online vision testing and monitoring application. By using the equipment already available to the public - smartphones with access to the Internet - we will introduce a solution that would allow diagnosing eye problems - self-control and self-examination. A properly developed and adapted platform will be an excellent database of existing defects and diseases, as well as information about the real need for ophthalmic care, which could be provided faster in cases of e.g. refractive errors using the network. Thanks to the Internet connection, part of the work will be performed and coordinated remotely from another country. This would make it possible to increase the efficiency of aid in Third World countries, giving the widest possible access among the population. The compactness and mobility of devices such as smartphones, which can be passed from hand to hand, provide self-examination of the problem with a specialist. The technology developed by FEYENALLY has a chance to change the approach and method of conducting diagnostics, dramatically increasing the chance of saving eyesight, and thus the life and functioning of many people in society.



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