Correspondence
Barriers to eye care for
older people in the
Philippines
We read with interest the Article by
Jacqueline Ramke and colleagues
regarding global eye health.1 In low-
income and middle-income countries in
the Western Pacific region, population
ageing has contributed greatly to a
surge in non-communicable diseases
(NCDs),2 of which blindness and visual
impairment are serious consequences.
In the Philippines, a lower-middle
income country in southeast Asia,
blindness and visual impairment are
growing public health concerns, with a
prevalence rate of 1·98%.3 Despite this,
an estimated 4 million Filipinos with
eye problems remain undiagnosed,3 as
socioeconomic hurdles preclude access
to sight-saving care.
Geographical disparities in
accessibility and availability of health
resources remain obstacles to eye care
for many Filipinos. Many community-
based health centres lack the necessary
equipment for comprehensive eye
examinations, and regional hospitals
face similar resource limitations. 4
Mobilising human resources for
health in communities has also
proven challenging, as the majority of
ophthalmologists practise in capital
cities, such as Metro Manila.4
Although the existing Philippine
Plan of Action for Senior Citizens aims
to provide community-based services
and health promotion activities for
older people, this effort is blunted
by challenges in implementation,
including the lack of technical
assistance and wavering compliance of
participating agencies.4 Furthermore,
these activities are limited to only the
most common NCDs, with little to no
attention given to ocular morbidities.4
Prohibitive out-of-pocket costs
negatively impact health-seeking
behaviour and leave older people
dependent on donors and sponsors,
such as those that engage in medical
missions, for management of ocular
www.thelancet.com/healthy-longevity Vol 3 March 2022 e130
conditions.4 Although Filipino senior 3 Department of Health, Republic of the
Philippines. Eye health services part of
citizens are entitled to discounts and
tax exemptions for goods and services,
Universal Health Care – DOH. 2019.
https://doh.gov.ph/press-release/eye-health-
most provincial private clinics do not services-part-of-universal-health-care-DOH
(accessed Jan 14, 2022)
recognise these privileges.4 Poor health 4 WHO Regional Office for the Western Pacific.
literacy also contributes to the low Older people’s visual impairment: situational
analysis of programmes and services in the
uptake of eye care services, as many Philippines. 2016. https://iris.wpro.who.int/
Filipinos harbour misconceptions bitstream/handle/10665.1/13487/
about vision problems and view 9789290617846-eng.pdf (accessed Jan 14,
2022)
visual impairment as a natural part of 5 Syed A, Polack S, Eusebio C, et al. Predictors of
ageing.4,5 attendance and barriers to cataract surgery in
Kenya, Bangladesh and the Philippines.
We agree with Ramke and colleagues Disabil Rehabil 2013; 35: 1660–67.
that there is an urgent need to
improve access and promote equity
in eye care. 1 For the Philippines,
this entails lowering out-of-pocket
costs, strengthening eye care
services at the primary care level, and
ensuring proper implementation
of government programmes. The
recently passed Universal Healthcare
Act is a promising start, as it aims to
provide more comprehensive eye care
services, integrate eye care within local
health systems, and confront common
eye diseases that cause reversible
and irreversible visual impairment.3
Future eye health promotion activities
must target older Filipinos and their
families through culturally sensitive
approaches that dispel conventional
notions about ageing and promote
the view that older people are valuable
assets to their communities.
We declare no competing interests.
Copyright © 2022 The Author(s). Published by
Elsevier Ltd. This is an Open Access article under the
CC BY-NC-ND 4.0 license.
Frances Dominique V Ho,
Nicole Rose I Alberto, Gabrielle P Flores,
Michelle Ann B Eala,
*Bryan Vincent Q Mesina
bqmesina@up.edu.ph
College of Medicine, University of the Philippines,
Manila, Philippines (FDVH, NRIA, GPF, MABE);
Divisions of Neuro-Ophthalmology and Uveitis,
Department of Ophthalmology and Visual Sciences,
Philippine General Hospital, 1000 Manila,
Philippines (BVQM)
1 Ramke J, Evans JR, Habtamu E, et al.
Grand Challenges in global eye health: a global
prioritisation process using Delphi method.
Lancet Healthy Longev 2022; 3: e31–41.
2 Kasai T. Preparing for population ageing in the
Western Pacific Region.
Lancet Reg Health West Pac 2021; 6: 100069.