VISION 2020 Deutschland

German text

Planned action

Network VISION 2020 Germany

Contact address:
Central Coordinating Committee VISION 2020 Germany
c/o BVA
Tersteegenstraße 12, 40474 Düsseldorf /
P.O. Box 30 01 55, 40401 Düsseldorf
phone: 0049 211 43037-0,
fax: 0049 211 43037-20
Internet: www.vision2020deutschland.de ,
E-Mail: info@vision2020deutschland.de

No one values vision more than one who lost it.
No one cherishes sight more than one who lost and regained it.

VISION 2020 Germany is part of the global initiative “VISION 2020 – The Right to Sight“, which was initiated by the WHO. This campaign explicitly deals with the right to eyesight. VISION 2020 aims at overcoming avoidable blindness by the year 2020.
VISION 2020 Germany seeks to promote this objective at the national and international level. We also want to broaden it by including the area of rehabilitation of the blind and visually impaired in VISION 2020 Germany.
VISION 2020 Germany is a consortium of eight German associations and organisations, which are all active in the areas of “vision” and “blindness”. At present these are:

Prevention of blindness in Germany: list of action plans

In its policy framework “Health 21 – Health for all” the WHO declares the prevention of avoidable blindness to be one of its main objectives until the year 2020. According to the World Health Report 2003, eye diseases hold the 10th place regarding their impact on world health, particularly in the group of over 60-year-olds. Furthermore, ophthalmology is considered one of the disciplines that, in future, will be particularly affected by the increase of diseases through demographic change. A patient’s eyesight is fundamental for his/her development, autonomy and the quality of life. That is why VISION 2020 Germany is launching this appeal to the public.

In Germany, blindness is defined as a maximum visual acuity of 0.02 (1/50th of normal visual acuity) on the better eye even with the aid of optimally correcting glasses. According to law, people with equivalent limitations of their visual fields are also considered blind.
Visual impairment is defined as a visual acuity of 0.3 or worse. For instance, such people cannot drive a motor vehicle or cannot read without the use of specific magnifying visual aids (magnifying glasses, electronic reading devices and the like).

All data regarding the absolute number of blind and visually impaired people as well as the frequency of severe eye diseases in Germany is currently based on estimates and projections. While the number of blind people in this country totals around 150,000, the information on the number of visually impaired is greatly divergent: it lies between 500,000 (projection based on figures from the former GDR) and 1.1 million (projection based on WHO figures for Central Europe). According to estimates of ophthalmological organisations, the most frequent causes of legal blindness in Germany are age-related macular degeneration (50%), glaucoma (18%) and diabetic retinopathy (17%). Less frequent, but significant due to their duration, are loss of eyesight and reduced vision that developed during childhood (amblyopia).

In order to be targeted and resource-efficient, action programmes for the prevention of blindness and visual impairment require distinct data including statistics on the development and frequency of blindness-related diseases.

VISION 2020 Germany appeals to the Federal Ministry to compile a national register of all blind and visually impaired people in Germany. The basis for this survey should be the collection of statistics by pension offices in the federal states and data collation at a federal level. Furthermore, the causes of diseases and the age distribution among those affected should be listed and evaluated for at least one representative federal state.
In addition, VISION 2020 Germany advocates the conducting of a study that describes the life situation of visually impaired senior citizens. So far no survey exists for this largest group of people affected by visual impairment in Germany regarding the effects of the impairment and possible and necessary aids.

There is no coherent general policy in Germany for the comprehensive treatment and rehabilitation of diseases that may lead to visual impairment or blindness. VISION 2020 Deutschland calls for a general policy to be developed and implemented with the involvement of ophthalmologists and patient organisations. It should be based on the following criteria:

In recent years, certain political measures undertaken by health care services resulted in a decline of blindness prevention. Thus, for instance, the exclusion of glasses or other visual aids for adults with vision > 0.3 from the benefits list of the statutory health insurance bodies resulted in a lack of visual aids for socially disadvantaged persons and a decrease in contacts to ophthalmologists. These are crucial for prevention in the early stages of eye diseases.

VISION 2020 Deutschland therefore challenges policy-makers to reverse the removal of visual aids from the benefits list of the statutory health insurance bodies or at least to make suitable arrangements in cases of hardship, e.g. for major visual impairments, or frames for children’s glasses.
The statutory health insurance should offer and finance suitable technical aids for the visually impaired (e.g. with voice output) and training that also covers additional sensory impairment.

The following suggestions are important aspects of the general policy that we call for. They concern five significant eye diseases and seek to fully exploit all possibilities of blindness prevention.

1. Age-Related Macular Degeneration (AMD):

Public awareness of the signs and symptoms of AMD need to be substantially increased so that affected people can detect initial – more easily treatable – forms of the disease and proceed to an appropriate ophthalmologic examination or treatment, if needed. So far, effective treatments (photodynamic therapy, injections of blood vessel inhibitors) have only become available for a few forms of AMD. These therapies are expensive and since they were introduced only recently, their refunding is only partially guaranteed. Thus, concerning indications with proven effectiveness, intravitreal injections need to be covered by health insurance immediately. Since macular degeneration will increase in future due to longer life expectancy, intensive research needs to be promoted in order to further investigate and develop therapies for non-etiological and treatable forms of macular degeneration.
As long as therapies for all forms of AMD are unavailable, aids such as magnifying visual aids are the only chance for affected patients to avoid serious life restrictions due to their loss of sight. Therefore, magnifying visual aids and their adjustment have to be appropriately covered by health insurance. The funding of training to develop everyday life skills needs to be guaranteed.

2. Glaucoma diseases

Glaucoma is still one of the most frequent causes of irreversible and complete blindness affecting the entire field of vision as well as the visual acuity. Nowadays, this form of blindness is almost always avoidable with an effective early screening and appropriate treatment. However, in countries such as Germany, which otherwise provide good medical services, 50% of all glaucoma diseases remain undetected. An extensive education of the population is necessary, as the disease does not cause symptoms in most cases, even in the later stages of the disease, and which can only be found if searched for appropriately with a combination of an examination of the papilla and a measurement of the intraocular pressure. The screening for glaucoma diseases needs to be covered by health insurance and should be performed in ophthalmologic eye checks (e.g. for presbyopic glasses) in adults over the age of 40 and in those at risk (e.g. family history).
A treatment to lower the intraocular pressure is successful regarding the most frequent and significant forms of glaucoma. In addition, existing approaches regarding the research of the disease genesis (autoimmune mechanisms with glaucoma, disturbances of blood supply, programmed apoptosis) should be further investigated and be used to derive new and more effective treatment strategies.

3. Diabetic Retinopathy

Almost 6000 ophthalmologists in Germany offer sufficient opportunities for the diagnosis and treatment (especially laser therapy) of diabetic retinopathy. Deficits particularly exist in the insufficient number of tests for the presence of diabetic retinopathy. The reasons lie in an insufficient knowledge on the part of diabetic patients about the necessity of eye examinations, even if they do not suffer any symptoms. Others are terrified of blindness as a consequence of diabetes. Furthermore, improvement is necessary regarding the cooperation of general practitioners with diabetologists and ophthalmologists. Ophthalmologists need to be included in the existing disease management programme (DMP) “Diabetes mellitus” as well-trained partners, along with a description of their quality services and an adequate compensation.
Despite all efforts, a worsening of retinopathy and vision can still be observed, in part because of poor compatibility with diabetes, or hypertension, or because the affected people smoke. Diabetics need to be made more aware of these implications. Training courses and awareness programmes should alert diabetics to possible eye problems and should demonstrate the role of preventive measures to preserve their vision.
Improved operative and medicinal options need to be researched for the therapy.

4. Amblyopia

Without any suitable measures, 6% of all children of primary-school age suffer from irreversible amblyopia in at least one eye. Previous measures involving tests within the paediatric medical checkups are not efficient enough. Therefore, VISION 2020 Germany and the Association of Paediatricians demand a preventive ophthalmologic examination of all children between the ages of 30 and 42 months at the expense of the statutory health insurance. Furthermore, parents need to be more alerted to the problem of amblyopia, which often goes undetected by them despite a good observation of their children. Ophthalmologists do have effective methods of amblyopia treatment; however, research needs to be intensified concerning the improvement of diagnostic and therapeutic options.

5. Hereditary diseases of the retina and optical nerve

The diseases of the retina or the optical nerve such as Retinitis Pigmentosa, which already appear during adolescence, are so far etiologically untreatable and hard to influence in their unrelenting course. Since this concerns hereditary diseases, intensive fundamental research (e.g. molecular genetics, cytology) needs to be pursued in order to develop treatments, which in turn prevent blindness. In addition to more basic research and treatment development, we call for appropriate, comprehensive care in specialised centres.

This page was last modified on April 29, 2008

Planned action on Vision 2020 Germany’s international projects

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Mitglieder des Netzwerks:
Berufsverband der Augenärzte Christoffel-Blindenmission Deutscher Blinden- und Sehbehindertenverband e.V. Deutsche Ophthalmologische Gesellschaft Deutscher Verein der Blinden und Sehbehinderten in Studium und Beruf e.V. Deutsches Komitee zur Verhütung von Blindheit e.V. Hilfswerk der deutschen Lions (HDL e.V.) Pro Retina Deutschland e.V.