Visual function rather than visual acuity – Authors' reply

We would like to thank Ian Murdoch and David Crabb for their important letter pointing out the tendency underestimate global burden of glaucoma when focusing solely on central vision loss. Glaucoma is leading cause irreversible loss globally, whose share overall blindness prevalence has been growing steadily as investments have begun pay off in fight against diseases such cataract trachoma.1Burton MJ Ramke J Marques AP et al.The Lancet Global Health Commission Eye Health: beyond 2020.Lancet Glob Health. 2021; 9: e489-e551Summary Full Text PDF PubMed Scopus (50) Google Scholar, 2Bourne R Steinmetz JD Flaxman S al.Trends distance near impairment over 30 years: an analysis Burden Disease Study.Lancet e130-e143Summary (56) Scholar fully agree that reliance only index disease severity particularly poorly suited accurately estimating burden.3Tham YC Li X Wong TY Quigley HA Aung T Cheng CY projections through 2040: a systematic review meta-analysis.Ophthalmology. 2014; 121: 2081-2090Summary (2499) already done substantial harm eye visual function by time affected. Activities safe driving might become impossible because peripheral from glaucoma, long before affected.4Blane A Through looking glass: literature investigating impact crash risk, performance, driver self-regulation older drivers.J Glaucoma. 2016; 25: 113-121Crossref (16) Other underestimates also result this approach. As pointed Commission, many individuals with early need timely treatment avoid later certain high-risk groups, adults aged 40 years people African descent, require screening care same reason.1Burton All these demands health-care system are missed we account magnitude using measure. Besides more inclusive sensitive measures disease's implications, highlight again following pressing needs response outlined Commission: (1) low-cost outreach models low-income middle-income countries—eg, leveraging existing efforts eye-screening programmes patients diabetes; (2) trials cost-effective, scalable, locally acceptable treatments appropriate low-resource settings, laser trabeculoplasty; (3) rigorous studies inexpensive interventions improve knowledge about demand underserved areas; (4) capacity strengthening among eye-care professionals, sub-Saharan Africa east Asia, where especially high, skills detection management resourcing ongoing chronic stratified risk loss; (5) evidence-based advocacy governments include national health planning. reduce depend heavily accurate accounting its precise extent. cannot what do not know. NC reports professional fees Belkin Laser. other authors declare no competing interests. The 2020Eye widespread profound implications aspects life, health, sustainable development, economy. Yet nowadays, people, families, populations continue suffer consequences poor access high-quality, affordable care, blindness. Full-Text Open AccessVisual rather than acuityWe express our gratitude Matthew Burton colleagues (April, 2021),1 which highlights challenge. plea mention glaucomas. feel preventable insufficiently represented group understated use acuity alone measure disability. Access