Your Excellencies, International President Mehta, members of the Lions Clubs International, ladies and gentlemen.

I would like to thank the Lions Clubs International for the invitation to talk at the United Nations' headquarters during this "Lions Day with the United Nations". It is a great honor to be asked to describe my vision for future work in our fight for sight.

In all special fields of medicine there are three main areas: prevention, treatment and rehabilitation. Usually doctors become specialists in one of these three areas, but I have worked in all three simultaneously during the last 25 years, both in clinical practice and in basic research. Within preventive ophthalmology my role has been to developed vision tests for the early diagnosis of vision problems, especially in children. In curative ophthalmology, my regular office work, I see patients of all kinds but have a special interest in diabetes, retinal degenerations and occupational problems. The last 20 years have meant a tremendous improvement in the treatment of diabetic eye disease. Yet it is the most common cause of new visual impairment in young adult population. We can treat only a few rare retinal degenerations whose metabolism is known. Most retinal degenerations are slowly progressive leading to visual impairment.

Since many diseases and accidents cannot be prevented or treated, they cause visual impairment and disability. In many teaching programs we have witnessed a rapid improvement and growth in services for the visually impaired after rather short intensive courses. In my experience, the least expensive and most effective low vision service is service as an integral part of the routine clinical examination, supported with a special low vision unit and courses.

If after this introduction, we make a short summary of our present problems, it is this:

PREVENTION
In the area of prevention there are numerous projects that are supported by local Lions clubs, the Lions Clubs International Foundation, the different UN agencies, and hundreds of smaller organizations which fight trachoma, river blindness and vitamin A deficiency in developing countries. The UNICEF report "State of the World's Children 1993" highlights the vitamin A issue, not only as the cause of blinding eye disease but also as a significant factor in terms of childhood growth, morbidity and mortality.

The prevention of blindness due to accidents has acquired a strange new area: the demining of previous battle fields in Afghanistan, Cambodia and other civil war areas where people are now moving back from refugee camps. Children are especially at great risk of being injured by exploding mines which will remain dangerous for years.

TREATMENT
The cure of treatable diseases has had great support from both Lions clubs and the United Nations. Eye camps will be needed for a number of years until the local medical services can cover the needs. Basic research in the treatment and prevention of these curable diseases needs support too, and significant resources have been allocated for research into new treatments.

REHABILITATION
The goal of the SightFirst campaign is the conquest of preventable and reversible blindness. Even if that goal is reached some day, there will still be millions who are visually impaired due to inherited diseases and age-related macular degeneration, for which there is no prevention or cure for all patients in a foreseeable future. These people will need special services at both ends of the age spectrum in particular and also in their working life.

Lions have served as "Knights of the Blind" for almost seventy years. United Nations agencies and national organizations support services for the visually impaired. These activities are important but so far they are insufficient. There is also a delay in getting the services in most places. A more lasting improvement in rehabilitation would be attained by educating ophthalmologists and their operating teams. If ophthalmologists knew more about rehabilitation, they would recognize their patients' low vision needs without delay and much needless suffering would be avoided.

It is not only the visually impaired individual who suffers, society also loses the benefit of the input of a valuable group of people who may have years of experience behind them. Today it is sad to see a loss of personal independence and it is sad to see worthwhile contributions to society being lost.

Let me quote an American eye doctor who examined a 77 year old executive, who had been a prominent community leader. A year ago this visually impaired man was living a very narrow life with no reading and little community involvement. After short course of rehabilitation he had his life changed: he bought a close circuit television reading aid (CCTV) and now reads a lot. He served as a campaign manager for a candidate in the last November election and was given significant credit for the most successful showing that his party had ever had in that district. - Each of us who works with the visually impaired could tell you similar success stories from different countries. Visual impairment is a problem, especially in information access and transfer, but it can be compensated, often by simple techniques, other times by technically advanced devices and, most importantly, the person must learn to live with his or her problem.

Children with congenital or early onset visual impairment and their families need early intervention so that the family becomes able to help the child to develop optimally. More than half of these children have additional impairments that makes the situation more difficult for the parents to cope with. If early intervention is well planned, a blind or severely visually impaired infant can have a better, sometimes a normal motor, social and cognitive development .

In occupational life small wonders can be done and severely visually impaired persons, even with double sensory impairment, deaf-blindness, may work in such demanding occupations as university teachers.

Compared with prevention and treatment, rehabilitation is in a very different position in ophthalmology: whereas there are thousands of lecturers in curative ophthalmology, at least one full professor in each medical school, and hundreds of academic teachers in prevention, there is only a handful of ophthalmologists teaching about vision rehabilitation as a part-time activity and there is only one chair in vision rehabilitation, at the University of Trondheim, in Norway. Since we cannot prevent or cure so many illnesses, the development of rehabilitation is important. With the very small number of lecturers available, we have to find new ways of spreading the information. We could consider the use of television and radio and support "distance education" by these means. For this new type of teaching, plenty of teaching material must be created, some parts of it different for different cultural backgrounds and different life situations. This is an enormous task, possible only with the support of one or more ophthalmologic institutes and with help from the private donors like the Lions Clubs International Foundation.

United Nations agencies and national organizations, National TV and radio networks are beginning to understand the value of distance learning, so we can count on support from them. In countries where there is some activity in rehabilitation, we could also use the tactics that have worked well in Brazil. According to the Brazilian model, we help an existing small rehabilitation unit to become a teaching center that can activate other hospitals to create rehabilitation services as part of their routine work. In Brazil they had a four day course for ophthalmologists, special educators and therapists in May 1990. In spring 1991 the center arranged a three month intensive training for nine rehabilitation teams that then started new low vision centers. By the end of this year there will be six more centers.

In other areas the first center has to be built and then supported in its task of passing on the information. My own experience in Tallinn, Estonia where I have helped to start up the low-vision clinic, is that the total costs can be kept rather low when all the available voluntary activity is used. At this point I would like to draw your attention to the situation in Eastern Europe where there is now an acute need of help in several areas, in vision rehabilitation as well. By supporting a teaching center there we could help the huge area that uses the Russian language in education.

Rehabilitation has a great need of further research, both basic and clinical, because numerous decisions are today made without good foundation. In such important legal issues as classification of visual impairment, defining who is visually impaired, what is the degree of impairment, or who gets e.g. driver's license the decision is often based on inadequate information.

Every worker in the field of visual impairment acknowledges with gratitude the great help you have given. The SightFirst campaign will, without doubt, alleviate the life of millions of people all around the world by supporting the prevention and treatment of blinding diseases. However, there will be millions of people, whom the prevention did not reach in time or the treatment was only partially successful. Most of these people have useful vision!

We can fight blindness after the treatment failed by helping the person to get optical devices and teaching him or her how to live using compensating techniques. Therefore, may I make a plea that rehabilitation would be chosen as one of the next goals whereby to help those whose visual impairment could not be prevented or cured. Helping the visually impaired to get better rehabilitation is not a charitable gift, it is an important investment for a better future.

As an additional motivating cause we might keep in mind that, despite the good medical care that we get, - most of us will also, if we live long enough, need vision rehabilitation.

With President Mehta

Listening to the interpreter