OBJECTIVES: There is a global call for action for addressing eye health as a public health problem in the World report on vision, prepared by WHO and The United Nations General Assembly resolution on vision. The strategic pillars are the inclusion of eye care in national health plans to achievement of "vision for everyone" by 2030. The aim of the study is to assess the clinical, economic environment of neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME), and access to therapy.

METHODS: We conducted two step research. First, we made a desktop analysis on the current strategic policy on regional and national level. Second, we conducted cost of illness (COI) analysis from societal perspective related to nAMD and DME and assessed the value of medical, non-medical resources and the losses in productivity.

RESULTS: Vision health remains neglected at European level as most of the countries do not have approved national plans. In some countries, like UK for example, there is an active campaign for national strategies. In Bulgaria, visual impairments and eye diseases are not part of the National Health Strategy 2030. Political forces and society have insufficient awareness about the burden of eye diseases, confirmed by the fact that some chronic, progressive diseases, are 75% reimbursed. Two medicinal products are approved for the treatment of nAMD and DME – aflibercept and brolucizumab. The availability index is 0.5. The COI analysis shows that the overall mean costs in nAMD are between 56,000 and BGN 63,000 and in DME between 47,000 and BGN 54,000 (24-year-horizon).

CONCLUSIONS: Despite all strategic documents, guides, and publications, eye care and vision health often do not receive adequate attention from policymakers, health systems, and even individual health care providers. Vision outcomes are influenced by the availability and affordability of the best therapies.