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CERA and World Health Organization working together to prevent blindness

Dr Andreas Muller

Dr Andreas Mueller

On World Sight Day 2017, the Centre for Eye Research Australia (CERA) spoke to Dr Andreas Mueller, Deputy Director of the World Health Organization (WHO) Collaborating Centre for Prevention of Blindness. Dr Mueller has recently been reappointed as a consultant to the WHO.

The following is a part of a discussion with Andreas about his ongoing work with the WHO and at CERA.

Q: What is the role of the WHO in tackling eye disease in the Asia-Pacific?
Visual impairment is more common among poor people, with an estimated 90% of affected people living in low and middle-income countries. The main causes are chronic eye diseases, affecting mostly older people. Importantly though, over 80% of visual impairment can be treated or prevented, hence is entirely avoidable.

The WHO is a Specialised Agency of the United Nations. A key role of the WHO is to provide leadership on matters critical to health, including on visual impairment as a public health problem. The type of support the WHO provides to governments depends on the need of a country. Activities may include evidence gathering to inform the development of guidelines and policies around eye care. Another example is technical support towards disease elimination programmes. In October 2017, for instance, the WHO announced that Cambodia and Lao PDR have eliminated trachoma, which is the most common infectious cause of blindness in the world. The WHO supports various aspects of such elimination programmes, including surveys, distribution of antibiotics and health promotion.

Q: If so much of eye disease is avoidable, why is it so prevalent?
The lack of access to eye care services has varying causes. Some countries lack the capacity to provide trained eye-care personnel, making services available only in urban centres, beyond the reach of people unable to travel far. Other countries may have sufficient personnel and infrastructure but services may be privatized and unaffordable for those most in need. Consequently, WHO and government approaches to improve access to quality eye-care services differ among countries. However, some priority interventions such as reducing the backlog of unoperated cataract and increasing availability of optical services are relevant to most countries in our region.

Q: What are the biggest challenges to vision in the Asia-Pacific?
Despite all efforts to reduce the prevalence of visual impairment, recent data predicts a steep increase in the number people affected, particularly in Asia. This will be due to growing and ageing populations. In Asia, we face the additional challenge of ever increasing levels of myopia (short-sightedness). It is predicted that one-third of the world’s population (or 2.5 billion people) could be affected by myopia by the end of this decade.

Due to changes in lifestyles and diet, diabetes rates are fast increasing in the Asia-Pacific region. As a result, vision loss from diabetes represents a further growing challenge. Better systems to screen and treat diabetic eye disease are crucial to avoid blindness in millions of people.

An issue that is commonly neglected is the lack of support for people with irreversible visual impairment. Few low-vision and rehabilitation services are available, especially in low- and middle-income countries.

Q: Please describe the WHO organisation and what you like most about working there.
The WHO headquarters is in Geneva, Switzerland. There are six regional offices, supporting 149 in-country field offices. Between 2011 and 2016, I was based at the WHO Office for the Western Pacific Region in Manila, leading the programme for blindness prevention and control. The Western Pacific Region, of which Australia is part, spans from Mongolia in the north to Samoa in the South Pacific. I very much enjoyed the variety of my work, which ranged from high-level talks with government, for instance about national budgets for eye health programs, all the way to walking from hut to hut in a village on a small Pacific island, screening children for signs of infectious trachoma.

Q: What do you think of working at CERA?
Last year, my family and I returned to Melbourne, where I joined the WHO Collaborating Centre for Blindness Prevention at CERA. We are a small team, focusing on research that can effectively lead to public health solutions for eye disease screening and treatment in remote and poor settings.

I believe that, at CERA, we have a lot to offer regarding research solutions that can be applied to the parts of the world that have lower resources available, yet have the highest number of people with unnecessary visual impairment and blindness. Taking research findings into the real world and helping others to translate them into policy solutions is just as important as starting the research in the first place.

Q: What are your priorities for your work with WHO in the coming year?
Two months ago, I re-joined the team at the WHO Regional Office, this time as a consultant and based in Melbourne. While remaining at CERA, I will be able to provide technical support to governments and advocate for eye care services that are of high quality and available to all. A key priority will be improving access to eye care outside major hospitals, i.e. to better integrate eye care into services at health centres and smaller facilities, closer to where people live and work. Too often, health services fund and support large hospitals to deliver services that could be delivered at health centres and smaller clinics much more effectively and cheaper.

I very much look forward to working with colleagues in many countries across the region and it is important to point out that the success of this work relies on the continuous support from strong partners such as Australia’s own The Fred Hollows Foundation and the International Agency for the Prevention of Blindness.