WAC 2 – Solving the Blind Spot

We have to open our eyes to the problem of blindness in the Philippines. In the following pages, you
will see the extent of the problem, as described in the Philippine Star (pages 2-4) , followed by
information from the Department of Health’s website (pages 5 -13). You will also see current rates
for cataract surgery offered by a premium hospital (pages 14-16).
You will see that the article appeared in 2017, and that the data from the DOH website goes back
quite a number of years. On the other hand, the rates for cataract surgery are for 2019-2020.
Currently, PhilHealth covers cataract surgeries for P16,000 for one eye. If the cost is over this
amount, the PhilHealth member will have to pay the difference.
You have decided that you want to use your new-found talent of problem identification and creative
problem solving by focusing on the problem of blindness caused by cataracts. Specifically, you want
to choose an area of the Philippines which you can test your ideas on.
So, after going through the items below, submit your WAC to me as if it were a grant proposal,
following this template https://lac.org/wp-content/uploads/2014/07/Grant_Proposal_Template.pdf

1. Which region do you want to focus on, and why?

2. What would you need to be able to accomplish your objectives in the region you chose?
3. If you are asking for a grant to accomplish your objectives of curing the blind in the region
you chose, how much money will you need? How will you spend that money?
4. Think through how you can cure more with less money. What would you have to do?
5. Is it even possible to develop a program to cure blindness amongst the people in the region,
where they would pay nothing? Be realistic – if it is not possible, explain why. If you think it
is possible, then say how it can happen.

Submit through Turnitin no later than 4 pm of Feb 14, Friday. Please submit a World file entitled as
LastNameFirstNameWAC2.doc

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As of this year, the DOH said an estimated 332,150 people in the country are bilaterally
blind while the current number of persons with bilateral low vision has already reached
2,179,733. File

Over 2 million Pinoys blind, sight-

impaired
Mayen Jaymalin (The Philippine Star) - August 6, 2017 - 4:00pm
MANILA, Philippines - Over two million people nationwide are blind or
suffering from poor vision, the Department of Health (DOH) reported
yesterday.

As of this year, the DOH said an estimated 332,150 people in the country are
bilaterally blind while the current number of persons with bilateral low vision
has already reached 2,179,733.

Of the total number of bilaterally blind, 33 percent or about 109,609 cases

were due to cataract while 25 percent was caused by error in refraction
(EOR). Fourteen percent was due to glaucoma.

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About 937, 285 or 43 percent of those suffering from bilateral low vision was
due to EOR, 34 percent or 741,109 was caused by cataract while the rest was
attributed to glaucoma and other eye diseases.

According to the World Health Organization (WHO), approximately 285 million

people worldwide are visually impaired, with 39 million blind and 246 million
with low vision.

Cataracts remain the leading cause of blindness globally followed by

glaucoma and age-related macular degeneration as the secondary causes.

Health experts said blindness or severe visual impairment results in reduced

functional ability and loss of self-esteem and contributes toward the reduction
of quality of life.

The disability from visual impairment has considerable economic implications

with loss of productivity and income and can lead to poverty and social
dependency, experts said.

To address the problem, the government drafted a new National Policy on the
Prevention Program on Blindness that is more responsive to changing trends
in the prevalence of eye diseases.

The DOH also spearheaded yesterday the annual observance of the Sight
Saving Month with the theme “Universal Eye Health: No More Avoidable
Blindness.”

Health Secretary Paulyn Ubial said this year’s theme is aimed at

strengthening public awareness on the importance of proper eye care
and promote the prevention of avoidable blindness, which is now considered
a serious public health issue of global magnitude.

Ubial said early detection and preventive care can help keep the eyes healthy
and avoid common causes of blindness.

Thus, the DOH’s current thrust is to integrate eye care into public health
programs at the local government unit level for continued advocacy and
promotion of comprehensive eye care with focus on avoidable blindness.

She said the development of the Community Eye Health Program (CEHP),
particularly at the primary level, district and provincial settings will be able to

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make most of the shared referral and service delivery network from barangay
health stations, rural health units up to tertiary hospitals.

Aside from several provinces in the regions that have adopted the CEHP, the
model is being expanded to the poorest provinces like Eastern Samar, Leyte
and Surigao.

Population and individual eye care services focusing on the prevention and
management of avoidable blindness (cataract, EOR, childhood blindness,
other emerging eye diseases) at each stage of the life cycle shall be provided
through the functional service delivery network (SDN).

Through the SDN, families especially the poor and marginalized are profiled,
navigated, referred and arrangements made with health providers at the
different levels of care.

“I would like to assure the public that DOH is serious in its mandate and
commitment to ensure that every Filipino, particularly the poor, indigent and
marginalized has access to affordable and quality eye care,” Ubial stressed.

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FROM THE DEPARTMENT OF HEALTH

PREVENTION OF BLINDNESS PROGRAM

Government Mandates and Policies :

• Administrative Order No. 179 s.2004: Guidelines for the Implementation of the
National Prevention of Blindness Program
• Department Personnel Order No. 2005-0547: Creation of Program Management
Committee for the National Prevention of Blindness Program

Subcommittees: Refractive Error/Low Vision, Childhood Blindness, Cataract

• Proclamation No. 40 declaring the month of August every year as “Sight Saving
Month”

Vision:

All Filipinos enjoy the right to sight by year 2020

Mission:

The DOH, Local Health Unit (LGU) partners and stakeholders commit to:

1. Strengthen partnership among and with stakeholder to eliminate avoidable

blindness in the Philippines;
2. Empower communities to take proactive roles in the promotion of eye health and
prevention of blindness;
3. Provide access to quality eye care services for all; and
4. Work towards poverty alleviation through preservation and restoration of sight to
indigent Filipinos.

Goal:

Reduce the prevalence of avoidable blindness in the Philippines through the provision of
quality eye care.

The program has the following objectives:

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 General Objective No. 1: Increase Cataract Surgical Rate from 730 to 2,500 by the
year 2010

Specific:

1. Conduct 74,000 good outcome cataract surgeries by 2010;

2. Ensure that all health centers are actively linked to a cataract referral center by
2008;
3. Advocate for the full coverage of cataract surgeries by Philhealth;
4. Establish provincial sight preservation committees in at least 80% of provinces
by 2010;
5. Mobilize and train at least one primary eye care worker per barangay by 2010;
6. Mobilize and train at least one mid-level eye care health personnel per
municipality by 2010;
7. Improve capabilities of at least 500 ophthalmologists in appropriate techniques
and technology for cataract surgery;
8. Develop quality assurance system for all ophthalmology service facilities by
2008; and
9. Ensure that 76 provincial,16 regional and 56 DOH retained hospitals are
equipped for appropriate technology for cataract surgery.

General objective no 2: Reduce visual impairment due to refractive errors by 10%

by the year 2010

1. Institutionalize visual acuity screening for all sectors by 2010;

2. Ensure that all health centers are actively linked to a referral center by 2008;
3. Distribute 125,000 eye glasses by 2010;
4. Ensure that the hospitals and of health centers have professional eye health care
providers by 2010
5. Ensure establishment of equipped refraction centers in municipalities by 2008;
and
6. Establish and maintain an eyeglass bank by 2007.

General objective no 3: Reduce the prevalence of visual disability in children from

0.3% to 0.20% by the 2010

1. Identify children with visual disability in the community for timely intervention
2. Improve capability of 90% of health worker to identify and treat visual
disability in children by 2010; and
3. Establish a completely equipped primary eye care facility in municipalities by
2008.

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Burden of Blindness and Visual Impairment : Global Facts

The Philippines is a signatory in the Global Elimination of Avoidable Blindness: Vision

2020 – The Right to Sight. The Vision 2020 was initiated by the International Agency for
Prevention of Blindness (IAPB), World Health Organization (WHO), and the Christian Blind
Mission (CBM), Vision 2020 aims to develop sustainable comprehensive health care system
to ensure the nest possible vision for all people and thereby improve the quality of life.

According to WHO estimates :

• Approximately 314 million people worldwide live with low vision and blindness
• Of these, 45 million people are blind and 269 million have low vision
• 145 million people's low vision is due to uncorrected refractive errors (near-
sightedness, far-sightedness or astigmatism). In most cases, normal vision could
be restored with eyeglasses
• Yet 80% of blindness is avoidable - i.e. readily treatable and/or preventable
• 90% of blind people live in low-income countries
• Restorations of sight, and blindness prevention strategies are among the most
cost-effective interventions in health care
• Infectious causes of blindness are decreasing as a result of public health
interventions and socio-economic development. Blinding trachoma now affects
fewer than 80 million people, compared to 360 million in 1985
• Aging populations and lifestyle changes mean that chronic blinding conditions
such as diabetic retinopathy are projected to rise exponentially
• Women face a significantly greater risk of vision loss than men
• Without effective, major intervention, the number of blind people worldwide has
been projected to increase to 76 million by 2020

Burden of Blindness and Visual Impairment : Local Facts

• Number of blind people: 592,000 (based on 2011 estimated population of 102M &
2002 blindness prevalence of 0.58%)
• Number of persons with moderate or severe visual impairment: 2 million (2011
popn. & 2002 prevalence of 2.04%)
• Number of blind due to cataract: 367,000 (62%)
• Number of blind due to EOR: 59,000 (10%)
• Number of blind from cataract below poverty line: 92,000 (25%, NSCB 2009
figures]; figure est. doubled to include first & second quintiles

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RP Prevalence of Blindness (%), 2002

Caraga 0.16
National Capital Region 0.19
Cordillera Autonomous Region 0.2
Central Mindanao 0.4
Ilocos Region 0.5
Western Visayas 0.51
Eastern Visayas 0.53
Southern Luzon 0.56

National Figure 0.58

Northern Mindanao 0.61

Central Visayas 0.62
Bicol Region 0.71
Western Mindanao 0.74
Central Luzon 0.79
Autonomous Region of Mislim Mindanao 0.8
Cagayan Valley 0.87
Southern Mindanao 1.08

RP Prevalence of Low Vision (%), 2002

Caraga 0.6
National Capital Region 0.81
Cordillera Autonomous Region 0.87
Central Luzon 1.21
Central Mindanao 1.53
Western Mindanao 1.59
Southern Mindanao 1.71
Central Visayas 1.76
Western Visayas 1.91

National Figure 1.98

Northern Mindanao 2.17

Ilocos Region 2.43
Autonomous Region of Muslim Mindanao 2.43
Bicol Region 2.52
Eastern Visayas 2.56
Southern Luzon 3.71
Cagayan Valley 4.07

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RP Prevalence of Visual Impairment (%) , 2002

Caraga 0.76
National Capital Region 1
Cordillera Autonomous Region 1.07
Central Mindanao 1.93
Central Luzon 2
Western Mindanao 2.33
Central Visayas 2.38
Western Visayas 2.42

National Figure 2.56

Northern Mindanao 2.78

Southern Mindanao (blindness) 2.79
Ilocos Region (Low Vision) 2.93
Eastern Visayas (Low Vision) 3.18
Autonomous Region of Muslim Mindanao 3.23
Bicol Region 3.23
Southern Luzon (Low Vision) 4.27
Cagayan Valley 4.94

Interventions/Strategies employed or Implementation by the DOH

1. Advocacy and Health Education

This includes patient information and education, public information and education and
intersectoral collaboration on eye health promotion and the nature and extent of visual
impairments particularly its risk factors and complications and the need/urgency of early
diagnosis and management.

2. Capability Building

This component shall focus on ensuring the capability of national and local government
health facilities in delivering the appropriate eye health care services especially to the
indigent sector of the population. Program shall provide training for coordinators at regional
and provincial levels; will ensure the availability of and access to training programs by
program implementers. It shall include strengthening treatment/management capabilities
of existing personnel and operating capabilities of facilities conducting cataract operations
etc., taking into outmost consideration basic quality assurance and standardization of
procedures and techniques appropriate to each facility/locality.

3. Information Management

The program shall develop an information management system for purposes of reporting
and recording. As far as practicable, this system shall consider and will build on any existing
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mechanism. The system shall be national in scope, although the mechanism shall consider
the regional and local needs and capabilities.

4. Networking, Partnership Building and Resource Mobilization

An important component of the program is networking and partnership building to

ensure that services are available at the local level. This shall include public-private and
public-public partnership aimed at building coalition and networks for the delivery of
appropriate eye health care services at affordable cost especially to the indigent sector. This
component shall also focus on ensuring that the highest appropriate quality services are
made available and accessible to the people.

5. Supervision, Monitoring and Evaluation

The Program shall be coordinated by a national program coordinator from the

Degenerative Disease Office of the National Center for Disease Prevention and Control,
Department of Health. The national program coordinator shall oversee the implementation
of program plans and activities with the assistance of the regional coordinators from the
Centers for Health Development.

A system of monitoring program plans and activities shall be developed and implemented
taking into consideration the provision of the local government code as well as the organic
act of Muslim Mindanao, and any similar issuances/laws that will be passed in the future.

A program review shall be conducted as needed. Result of program evaluation shall be

used in formulating policies, program objectives and action plans.

6. Research and Development

The program shall encourage the conduct of researches for purposes of developing local
competence in eye health care and for other purposes that may be necessary. The
development and dissemination of clinical practice guidelines for eye health shall form part
of the research agenda of the program.

The program shall support researches/studies in the clinical behavior (KAP) and
epidemiological (trends) areas. It also aims to acquire information that is utilized for
continuing public health information and education, policy formulation, planning and
implementation.

7. Service Delivery

Service delivery for the prevention of Blindness Program shall be covered by the principle
of best practice. In collaboration with the local government units and stakeholders, the
program shall develop systems and procedures for the integration and provision of services
at the community level. This means primary eye prevention concentrating on health
education, advocacy and primary eye interventions; Secondary prevention; screening/early

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detection/basic management/ counseling, referral and/or definitive care and tertiary
prevention: management of complications, continuing care and follow up including
rehabilitation. The following areas will be the priority areas for services to be provided by
the National Prevention of Blindness Program:

a. Cataract Surgeries

b. Errors of Refraction

c. Childhood Blindness

Activities for the Vitamin A Deficiency Disorder, for practical purposes, shall be led by the
Family Health Office also of the NCDPC.

A Referral System shall form part of services delivered by the program. This is to ensure
that all patients receive quality eye health care at appropriate levels of health care delivery
system. All rural health units should be linked to an eye care referral center.

Cataract

Cataract, the opacification of the normally clear lens of the eye, is the most common cause of
blindness worldwide. It is the cause in 62% of all blindness in the Philippines and is found
mostly in the older age groups. The only cure for cataract blindness is surgery. This is
available in almost all provinces of the country; however there are barriers in accessing such
services. Interventions will therefore consist of increasing awareness about cataract and
cataract surgery; as well as improving the delivery of cataract services. The parameter used
worldwide to monitor cataract service delivery is the Cataract Surgical Rate.

Errors of Refraction

Errors of refraction is the most common cause of visual impairment in the country
(prevalence is 2.06% in the population). Errors of refraction are corrected either with
spectacle glasses, contact lenses or surgery. The services to address the problem of EOR are
provided mainly by optometrists. However, the provision of the eyeglasses or lenses (who
should provide, how is it provided, etc.) has to be addressed.

Childhood Blindness

The prevalence of blindness among children (up to age 19) is 0.06% while the prevalence
of visual impairment in the same age group is 0.43%. The problem of childhood blindness
is the highly specialized services that are needed to diagnose and treat it. However,
screening of children for any sign of visual impairment can be done by pediatricians, school
clinics and health workers.

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Future Plan/Action:

• Development of Service Package for Prevention Blindness Program

• Development of Clinical Practice Guidelines for Prevention Blindness
Program
• Development of Strategic Framework and a Five Year Strategic Plan for
Prevention Blindness Program (2012-2016)
• Continue conduct of promotion and advocacy activities and partnership with
National Committee for Sight Preservation, Specialty Societies and other
stakeholders on PBP
• Creation of PBP Registry System
• Ensure the implementation of the National Prevention of Blindness Program

Status of Implementation/Accomplishment:

• Department of Health supports prevention of blindness and vision

impairment
o Signatory of all World Health Assembly resolution on Vision 2020 and
blindness prevention.
o National Prevention on Blindness Program under Non-Communicable
Disease Cluster.
o Funded 3 national surveys of blindness 1987, 1955 and 2002.
o Planning workshop 2004 crafted 5 year development plan for eye care
2005-2010 assisted by IAPB / ICEH.
o AO 179 issued on Nov. 2004 by Sec. Dayrit creating “Guidelines for
Implementation of the National Prevention Blindness Program (NPBP)” which set-
up the Program Management Committee (PMC)
o Blindness prevention and rehabilitation of persons with irreversible
blindness are incorporated in the health program for persons with disability of
DOH

The following programs/projects are included in the Maternal and Child Care Program
of DOH:

o Expanded Program for Immunization (includes vaccination for diseases

that causes blindness)
o Vitamin A provision for pregnant mothers and children to prevent vitamin
A deficiency
o Comprehensive newborn care includes prophylaxis for ophthalmia
neonatorum
o Newborn screening includes screening for galactosemia which cause
congenital cataract

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• Several activities in the PBP

o Consultative and Planning Workshop on PBP, October 2011

o National Eye Summit, Manila Grand Opera Hotel, Manila last October 2009
o Strategic Planning Workshop on the National Sight Preservation and
Blindness Program 2008
o Training of Trainors of Primary Eye Care conducted 2007

Other Significant information:

• Available Human Resources:

Ophthalmologists - 1,573 registered PAO members as of January 27, 2011
- 95% is in private practice
Optometrists - 10,266 registered with Philippine Board of Optometry
as of July 2010
Financial Resources
o DOH provides funds largely for technical assistance for training, capacity building
activities, and augmentation of funds for local program implementation.
o Philippine Health Insurance Corporation covering personal eye care services (hospital
based)
Partner Organizations:

Aside from the collaborating divisions in the DOH, the following institutions partake in the
program:

• Local Government Units (LGUs)

• National Committee for Sight Preservation (NCSP)
• Philippine Academy of Ophthalmology
• Philippine Information Agency
• Optometric Association of the Philippines
• Rotary International
• Integrated Philippine Association of Optometrists
• Foundation for Sight
• Helen Keller International
• Lions Club International
• Tanggal Katarata Foundation
• UP - Institute of Ophthalmology
• Christian Blind Mission
• Resources for the Blind
• SentroOfthalmologico Jose Rizal
• World Health Organization

https://www.doh.gov.ph/national-prevention-of-blindness-program

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LEGEND
• IOL. Intraocular Lens implant. Implanted to improve vision after cataract surgery.
• PHILHEALTH. Philippine Health Insurance Corporation. First Payor. If cataract surgery
is pre-approved, Philhealth provides coverage of 16,000 pesos.
• HMO. Health Maintenance Organization. Second Payor. Provides coverage, after
Philhealth, for the rest of the hospital bill, and professional fees. If Philhealth is not
available, the HMO usually requires the individual to shoulder the Philhealth coverage
of 16,000 pesos. An IOL is usually not covered, and is paid out of pocket.
• MONOFOCAL. An intraocular lens which provides a correction for a single point of
focus, usually far. It does not correct for astigmatism. If used for far correction, the
individual must use reading glasses all the time
• TORIC. An intraocular lens used to correct for astigmatism. Astigmatism is a type of
refractive error in which the eye does not focus light evenly on the retina, resulting in
distorted or blurred vision at all distances.
• MULTIFOCAL. An intraocular lens which provides correction for all distances (far,
intermediate, near). Provides around 90% spectacle independence in the real world

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 setting. One may need to use prescription glasses for 10% of the time (small print, low
light conditions, bright light conditions).
• PRESBYOPIA. Presbyopia is a condition associated with age. As people age, the lens
becomes harder and less elastic, making it more difficult for the eye to focus on close
objects. Presbyopia correcting IOLs, e.g. multifocal IOLs, provide correction for all
distances. See MULTIFOCAL.
• ADDON. A second intraocular lens implant inserted in an anatomic space called the
sulcus, in front of an existing intraocular lens placed in the capsular bag. It may correct
for post-operative spherical refractive errors, astigmatism, and presbyopia. The SML,
Scharioth Macula Lens, is a Low Vision implant useful for patients with age -related
macular degeneration or other maculopathy (central vision problems).
• NON-ASPHERIC (SPHERICAL). A spherical intraocular lens can induce minor optical
imperfections called higher-order aberrations (HOAs), which can affect quality of vision,
particularly in low-light conditions such as driving at night.
• ASPHERIC. Premium aspheric IOLs approximate the shape and optical quality of the
eye's natural lens, and provide sharper vision, especially in low light conditions and for
people with large pupils.

HOW TO USE THE TABLE

COLUMN
• Choose the CASH column if you have no insurance and are paying 100% out of
pocket.
• Choose the CASH + PHILHEALTH column if you have PHILHEALTH. This is your total
bill minus 16,000 pesos paid by Philhealth.
• Choose the CASH + PHILHEALTH + HMO column if you have both PHILHEALTH and
HMO/Insurance. The amount shown here is basically the cost of the intraocular lens
implant, which is paid out of pocket.

ROW
• Choose the MONOFOCAL row if you would like far correction only. You are willing to
wear reading glasses all the time.
• Choose NON-ASPHERIC if your astigmatism is less than -0.75D and you don't
require excellent quality of vision at night.
• Choose ASPHERIC if your astigmatism is less than -0.75D and you require
excellent quality of vision at night.
• Choose TORIC if you have astigmatism greater than -0.75D.
• Choose the PRESBYOPIA row if you would like to have correction for all distances (far,
intermediate, near) in order to be less dependent on glasses. You understand that you

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 will be spectacle free for 90% of the time in the real world setting. You are willing to
wear prescription glasses for small print, low light conditions, and bright conditions.
• Choose MULTIFOCAL if your pre-operative astigmatism is less than -0.75D.
• Choose TORIC if your pre-operative astigmatism is greater than -0.75D.
• Choose the ADDON row, if you had previous cataract surgery, and have an
unacceptable post-operative refraction.
• Choose SPHERICAL if you have a significant spherical error and would like to
have clearer distance vision.
• Choose TORIC if you have significant astigmatism and would like to have clearer
distance vision.
• Choose MULTIFOCAL if you have acceptable distance vision, but would like to say
goodbye to reading glasses.
• Choose SML if you have low vision due to age-related macular degeneration, and
would like to have magnification for your your near vision requirements in your
non-dominant eye.

COLUMN + ROW
The intersection of the COLUMN and the ROW that you have chosen is the amount that
you have to settle for your cataract surgery.

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