Abstract
BackgroundRapid assessment of avoidable blindness provides valid estimates in a short period of time to assess the magnitude and causes of avoidable blindness. The study determined magnitude and causes of avoidable blindness in India in 2007 among the 50+ population.Methods and FindingsSixteen randomly selected districts where blindness surveys were undertaken 7 to 10 years earlier were identified for a follow up survey. Stratified cluster sampling was used and 25 clusters (20 rural and 5 urban) were randomly picked in each district.. After a random start, 100 individuals aged 50+ were enumerated and examined sequentially in each cluster. All those with presenting vision <6/18 were dilated and examined by an ophthalmologist. 42722 individuals aged > = 50 years were enumerated, and 94.7% examined. Based on presenting vision,, 4.4% (95% Confidence Interval[CI]: 4.1,4.8) were severely visually impaired (vision<6/60 to 3/60 in the better eye) and 3.6% (95% CI: 3.3,3.9) were blind (vision<3/60 in the better eye). Prevalence of low vision (<6/18 to 6/60 in the better eye) was 16.8% (95% CI: 16.0,17.5). Prevalence of blindness and severe visual impairment (<6/60 in the better eye) was higher among rural residents (8.2%; 95% CI: 7.9,8.6) compared to urban (7.1%; 95% CI: 5.0, 9.2), among females (9.2%; 95% CI: 8.6,9.8) compared to males (6.5%; 95% CI: 6.0,7.1) and people above 70 years (20.6%; 95% CI: 19.1,22.0) compared to people aged 50–54 years (1.3%; 95% CI: 1.1,1.6). Of all blindness, 88.2% was avoidable. of which 81.9% was due to cataract and 7.1% to uncorrected refractive errors/uncorrected aphakia.ConclusionsCataract and refractive errors are major causes of blindness and low vision and control strategies should prioritize them. Most blindness and low vision burden is avoidable.
Highlights
India was the first country in the world to initiate a public funded program for the control of blindness as a national priority health problem [1]
Based on presenting vision, 4.4% (95% Confidence Interval[CI]: 4.1,4.8) were severely visually impaired and 3.6% were blind
Prevalence of blindness and severe visual impairment (,6/60 in the better eye) was higher among rural residents (8.2%; 95% CI: 7.9,8.6) compared to urban (7.1%; 95% CI: 5.0, 9.2), among females (9.2%; 95% CI: 8.6,9.8) compared to males (6.5%; 95% CI: 6.0,7.1) and people above 70 years (20.6%; 95% CI: 19.1,22.0) compared to people aged 50–54 years (1.3%; 95% CI: 1.1,1.6)
Summary
India was the first country in the world to initiate a public funded program for the control of blindness as a national priority health problem [1]. Population based surveys have been the main source for providing information on whether the program was progressing in the right direction [2,3,4] These surveys have been undertaken at periodic intervals over the past two decades [2,3,4]. Rapid assessment of cataract blindness has been accepted as a robust tool to help planners in developing countries including India [5,6,7,8] These techniques were limited to ascertaining cataract blindness, visual outcomes after cataract surgery, cataract surgical coverage and barriers to cataract surgery [9,10,11,12,13,14]. The study determined magnitude and causes of avoidable blindness in India in 2007 among the 50+ population
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