By Avigayil Kadesh
Dr. Michael Belkin wanted to investigate whether there was any change in the rate of blindness from glaucoma in the world over the last 100 years.
But when he and fellow researchers looked specifically at Israeli statistics over the last 12 years, they discovered something extraordinary: Although rates of untreatable genetic causes of blindness remained steady over that time period, rates of preventable blindness were reduced by more than 56 percent. This was not true of any other country.
“There is nothing anywhere else remotely like what we have here in Israel,” says Belkin, a leading Israeli ophthalmologist and director of the Ophthalmic Technologies Laboratory at the Goldschleger Eye Research Institute at Tel Aviv University's Sackler Faculty of Medicine and Sheba Medical Center.
Israel’s success applies to all four main causes of preventable blindness — age-related macular degeneration, glaucoma, diabetes and cataract.
The study, published in the American Journal of Ophthalmology, shows that rates of preventable blindness in Israel dropped from 33.8 cases per 100,000 residents in 1999 to 14.8 in 2010.
What accounts for this singular achievement?
Prevention, policy, compliance
There are a few factors, say Belkin and co-authors Alon Skaat, Angela Chetrit and Ofra Kalter-Leibovici.
Community-based programs in Israel, such as dedicated diabetes clinics, promote early prevention and timely treatment for diabetes-related complications that can lead to blindness.
Belkin points out that these diabetes clinics have high startup costs but pay for themselves in about two years' time when you consider the much higher costs of treating blindness as it develops rather than preventing it from the start.
Another factor, says Belkin, appears to be cultural. Israelis tend to adhere to recommended treatment regimens more closely than patients in other countries. This phenomenon has been shown in relation to other diseases but hasn’t yet been proven in ophthalmology.
Glaucoma is one of four preventable causes of blindness.
However, Belkin says this may account for why, in the same issue of the American Journal of Ophthalmology, a report from Denmark showed a decline only in age-related macular degeneration. Denmark, like Israel, has socialized medicine and high standards of care, so compliance may be the key difference.
Public policy is also important. For example, since the 1990s, Israeli patients have been able to choose their doctors privately for cataract surgery. This practically eliminates wait times for surgery and prevents the condition from growing worse over the long term.
In light of World Health Organization data suggesting that blindness remains a severe health concern even in industrialized countries, Belkin believes other countries could see similar results by emulating Israel’s approach. An estimated 80% of blindness is preventable or treatable.