Community Eye Health Research: Journal Article Database

This is a database of research articles for the field of eye health in developing countries. While this database may not be all-inclusive, it includes most all community eye health research articles published during the past 30 years.

This database is provided for the general public as well as for Unite For Sight's Global Impact Fellows participating in our Global Impact Lab.

Table of Contents: Research Article Topics

Database sorted by year of publication: http://www.uniteforsight.org/global-impact-lab/community-eye-health-research-by-date

Barriers to Uptake of Eye Services

A two-site, population-based study of barriers to cataract surgery in rural china.
Yin Q et al. Invest Ophthalmol Vis Sci. 2009 Mar;50(3):1069-75.
This study was conducted to identify barriers to cataract surgery in rural China. Lack of knowledge about cataract and concerns about the quality of local services appear to be the primary barriers to cataract surgery in rural China.

Increasing access to cataract surgery in a rural area--a support strategy .
Malhotra R et al. Indian J Public Health. 2005 Apr-Jun;49(2):63-7.
The objectives of the study were to elicit the reasons for not undergoing cataract surgery from those having cataract, aged 50 years and above, in a village community and, develop, implement and assess a support strategy for getting cataract surgery done. The leading reasons identified were monetary constraints (18.8%), transport difficulty (17.4%), lack of awareness about cataract in the eyes (17.4%) and lack of escort (14.5%).

Delay in presentation to hospital for surgery for congenital and developmental cataract in Tanzania.
Mwende J et al. Br J Ophthalmol. 2005 Nov;89(11):1478-82.
High quality surgical services have been established at a few tertiary facilities in the region; however, there appears to be delay in presentation to hospital. The mean delay between recognition by the caregiver and presentation to hospital was 34 months, almost 3 years. Long delay in presentation was associated with having developmental cataract, living far from the hospital, and low socio-educational status of the mother.

Social determinants of cataract surgery utilization in south India. The Operations Research Group.
Brilliant GE, Lepkowski JM, Zurita B, Thulasiraj RD. Arch Ophthalmol. 1991 Apr;109(4):584-9.
A field trial was conducted to compare the effects of eight health education and economic incentive interventions on the awareness and acceptance of cataract surgery. A multiple logistic regression analysis revealed that individuals who were aware of surgery tended to be male, literate, and more affluent than those who were unaware of that option. Interventions that covered the complete costs of surgery had higher surgery acceptance rates.

Use of cataract services in eastern Africa--a study from Tanzania.
Jefferis JM, Bowman RJ, Hassan HG, Hall AB, Lewallen S. Ophthalmic Epidemiol. 2008 Jan-Feb;15(1):62-5.
The goal of this research was to establish the proportion of patients who are blind or have low vision prior to undergoing cataract surgery at tertiary referral centers in Tanzania and to assess which patient groups presenting for cataract surgery are more likely to be blind or visually impaired. Predictors of blindness at presentation were: female sex; referral from a rural outreach program and older age.

Low uptake of eye services in rural India: a challenge for programs of blindness prevention.
Fletcher AE et al. Arch Ophthalmol. 1999 Oct;117(10):1393-9.
This study investigated service uptake in a rural Indian population served by outreach eye camps and identified barriers to uptake. A high proportion of people who could have benefited from eye treatment were not using available services. Poor visual outcomes were observed in surgically treated persons.

The social and family dynamics behind the uptake of cataract surgery: findings from Kilimanjaro region, Tanzania.
Geneau R, Lewallen S, Bronsard A, Paul I, Courtright P.Br J Ophthalmol. 2005 Nov;89(11):1399-402.
This study sought to describe and understand better the barriers that elderly cataract patients in Kilimanjaro region (Tanzania) experience at the family level in order to access surgery. The perceived need for sight and for surgery appears partly socially constructed at the family level. It was found that women were less likely to express a need for sight for fear of being seen as a burden. Furthermore, young heads of family are more inclined to support old men than old women.

Where do persons with blindness caused by cataracts in rural areas of India seek treatment and why?
Gupta SK, Murthy GV. Arch Ophthalmol. 1995 Oct;113(10):1337-40.
The utilization of eye care facilities by patients with a cataract was evaluated among 240 patients selected from eye care camps that were conducted by the center. Of the patients, 52.9% had visited previous eye care camps, while 19.2% consulted private ophthalmologists. Easy accessibility, reputation of a facility, competence of its staff, free service, and nearby facilities were the major reasons that were cited by patients for utilization of service facilities.

Eye care utilisation patterns in a rural county in Ireland: implications for service delivery.
Clendenin C, Coffey M, Marsh M, West S. Br J Ophthalmol. 1997 Nov;81(11):972-5.
A third of the visits were to optometrists, and all but 21 visits were for normal eye examinations or glasses. The majority of children aged less than 16 years, and people older than 60 years were seen by the ophthalmologist. Among children, 81% of all visits were to the ophthalmologist and 92% were classified as a normal examination.

Reasons for poor cataract surgery uptake - a qualitative study in rural South Africa.
Rotchford AP, Rotchford KM, Mthethwa LP, Johnson GJ. Trop Med Int Health. 2002 Mar;7(3):288-92.
The goal of this study was to understand the reasons for poor cataract surgery uptake in people with blindness or severe visual impairment in rural South Africa. Fear of surgery and a fatalistic attitude to the inevitability and irreversibility of blindness in old age were the main reasons for failure to attend for surgery.

Utilization of eye care services in rural south India: the Aravind Comprehensive Eye Survey.
Nirmalan PK et al. Br J Ophthalmol. 2004 Oct;88(10):1237-41
5150 randomly selected subjects underwent ocular examinations and previous use of eye care services was collected via questionnaire in order to determine utilization of eye care services in a rural population of Southern India. 3476 (72.7%) of 5150 subjects examined required eye care examinations. 1827 (35.5%) people gave a history of previous eye examinations, primarily from a general hospital (n = 1073, 58.7%).

Indirect costs associated with accessing eye care services as a barrier to service use in Ethiopia.
Melese M, Alemayehu W, Friedlander E, Courtright P. Trop Med Int Health. 2004 Mar;9(3):426-31.
A population-based survey of the magnitude and causes of blindness and visual impairment in adults 40 years and older in the Gurage Zone, central Ethiopia was conducted. The majority of the causes of visual impairment and blindness are treatable (cataract) or preventable (trachomatous trichiasis). The main barrier for seeking service is related to the indirect medical costs of the service.

Willingness to pay for cataract surgery in Kathmandu valley.
Shrestha MK, Thakur J, Gurung CK, Joshi AB, Pokhrel S, Ruit S. Br J Ophthalmol. 2004 Mar;88(3):319-20.
This cross sectional study was carried out on 78 screened cataract patients of two screening camps in Kathmandu valley, Nepal, to assess the willingness to pay for cataract surgery. This study clearly indicates that although there was awareness of the availability of treatment and services provided within the reach, people are not willing to pay for the surgery and use the facility primarily because of poverty. Hence, to change patients' attitudes, a more holistic approach is needed, keeping in view the cultural, social, and economic background of the society.

Willingness to pay for cataract surgery in two regions of Tanzania.
Lewallen S et al. Br J Ophthalmol. 2006 Jan;90(1):11-3.
Patients desiring cataract surgery were interviewed in Kilimanjaro Region and Iringa Region of Tanzania to learn how much they and their families were willing to pay for surgery and how "wealthy" (using ownership of several household objects as a proxy for wealth) the household was. The average expressed willingness to pay was 2457Tsh or approximately $US2.30, which is far below the actual cost of providing the service. There were significant differences in the expressed willingness to pay between Iringa and Kilimanjaro patients, which may reflect differences in the services provided in the regions.

Poverty as a barrier to accessing cataract surgery: a study from Tanzania
Kessy JP, Lewallen S. Br J Ophthalmol. 2007 Sep;91(9):1114-6.
Researchers investigated what happens to patients who reported being too poor to pay for cataract surgery.   Of patients who reported being too poor to pay for cataract surgery, 20% accessed funds after counseling. A significant proportion of those who did not return supplied other reasons for not accepting surgery when interviewed later at home, and did not use a free waiver granted at that time. Access to health care is a complex issue; however, this study does not support the notion that charging small fees for cataract surgery in this setting creates a major barrier to access.

Willingness to pay for cataract surgery in rural Southern China.
He M, Chan V, Baruwa E, Gilbert D, Frick KD, Congdon N. Ophthalmology. 2007 Mar;114(3):411-6.
This research studied the willingness to pay for cataract surgery, and its associations, in Southern China.
Older subjects were willing to pay less, blind subjects were significantly more likely to pay anything for surgery, but would pay on average 255 renminbi (US 32 dollars) less.

Using qualitative methods to understand the determinants of patients' willingness to pay for cataract surgery: a study in Tanzania.
Geneau R, Massae P, Courtright P, Lewallen S. Soc Sci Med. 2008 Feb;66(3):558-68.
This study attempted to formulate a grounded theory study in order to understand better cataract patients' willingness to pay for surgery in Tanzania. The study reveals that the main factors behind patients' WTP for cataract surgery are (1) the level of perceived need for sight and cataract surgery; (2) the decision-making processes at the family level and (3) the characteristics of local eye care programs.

Cataract surgery in Andhra Pradesh state, India: an investigation into uptake following outreach screening camps.
Finger RP, Ali M, Earnest J, Nirmalan PK. Ophthalmic Epidemiol. 2007 Nov-Dec;14(6):327-32.
Lack of access to personal funds limited and delayed the utilization of offered services by patients who had been advised of surgery at outreach screening camps or eye hospitals. Stigma, fatalism and ageism were other limiting factors. The majority of patients did not make the decision regarding uptake of services themselves.

Why are children brought late for cataract surgery? Qualitative findings from Tanzania.
Bronsard A et al. Ophthalmic Epidemiol. 2008 Nov-Dec;15(6):383-8.
The main objective of this qualitative study was to provide a better understanding of surgical delay in the care of children with congenital or developmental cataract. We identified several factors influencing the treatment-seeking behaviors of parents and guardians, including gender relations within the household, local health beliefs about cataract and cataract surgery and the ability of health care professionals in primary and secondary care settings to adequately inform parents and guardians about cataract and cataract surgery.

Cataract in leprosy patients: cataract surgical coverage, barriers to acceptance of surgery, and outcome of surgery in a population based survey in Korea.
Courtright P et al. Br J Ophthalmol. 2001 Jun;85(6):643-7.
This study sought to determine measures of cataract programme effectiveness in a cured leprosy population in South Korea. Barriers reported by patients included being told by the doctor that the cataract was not mature and a perception by the patient that there was no need for surgery.

Cataract blindness and barriers to uptake of cataract surgery in a rural community of northern Nigeria.
Rabiu MM. Br J Ophthalmol. 2001 Jul;85(7):776-80.
A population based cross sectional survey was conducted to determine the magnitude of cataract blindness and the barriers to uptake of cataract services in a rural community of northern Nigeria. A blindness prevalence of 8.2% (95% CI 5.8%-10.5%) was found among the sampled population. Cataract was responsible for 44.2% of the blindness. Thus, a cataract blindness prevalence of 3.6% was found. The cataract surgical coverage (people) was 4.0% and the couching coverage (people) was 18%. The main barrier to seeking cataract surgery was cost of the service (61%).

Cataract blindness and barriers to cataract surgical intervention in three rural communities of Oyo State, Nigeria.
Oluleye TS. Niger J Med. 2004 Apr-Jun;13(2):156-60.
The purpose of the study was to determine the prevalence of cataract blindness and barriers to cataract surgical intervention in an area served by a health facility managed by a tertiary institution. The prevalence of blindness in persons aged 50 years and above was 1.47% and that of cataract blindness in the same age group in the villages was 0.84% constituting 57.14% of blindness. The main barriers to hospital presentation were cost of surgery (52.8%) and distance to hospital (33.8%).

Barriers to the uptake of cataract surgery in patients presenting to a hospital.
Dhaliwal U, Gupta SK. Indian J Ophthalmol. 2007 Mar-Apr;55(2):133-6.
This study sought to assess the barriers for the acceptance of surgery among patients with cataract and visual disability. Attitudinal barriers were reported more often, rather than issues of accessibility or cost. Eye care providers should address the identified barriers for increasing acceptance of surgery in the study area.

Cataract surgical coverage and barriers to uptake of cataract surgery in leprosy villages of north eastern Nigeria.
Mpyet C, Dineen BP, Solomon AW. Br J Ophthalmol. 2005 Aug;89(8):936-8.
The goal of this study was to determine the coverage, outcome, and barriers to uptake of cataract surgery in leprosy villages of north eastern Nigeria.  From a sample of 480 people, cataract was the commonest cause of blindness. The cataract surgical coverage (people) was 39.2% for orthodox surgery and 29.7% for couching. After surgery, visual acuity > or =3/60 had been restored to 82.1% of eyes that had had orthodox surgery, but only 58.6% of eyes that had been couched. Cost was the commonest reason given for not seeking treatment for cataract.

Coverage, utilization and barriers to cataract surgical services in rural South India: results from a population-based study.
Chandrashekhar TS, Bhat HV, Pai RP, Nair SK. Public Health. 2007 Feb;121(2):130-6.
This study sought to determine the cataract surgical coverage, utilization and barriers to cataract surgery in a rural taluk of south India. Inability to afford the operation (22.9%) and fear of the operation (19.2%) were the main barriers to cataract surgery.

Barriers to accessing eye care services among visually impaired populations in rural Andhra Pradesh, South India.
Kovai V, Krishnaiah S et al. Indian J Ophthalmol. 2007 Sep-Oct;55(5):365-71.
This study sought to understand the reasons why people in rural south India with visual impairment arising from various ocular diseases do not seek eye care. Barriers to seeking treatment among those who had not sought treatment despite noticing a decrease in vision over the past five years were personal in 52% of the respondents, economic in 37% and social in 21%.

The cost effectiveness of strategies to reduce barriers to cataract surgery. The Operations Research Group.
Ellwein LB, Lepkowski JM, Thulasiraj RD, Brilliant GE. Int Ophthalmol. 1991 May;15(3):175-83.
The cost and effectiveness of eight approaches to reducing barriers to cataract surgery were evaluated in a rural area of South India during 1987-1989. Analyses suggest that the SV and AM interventions, both with full economic incentive, offer the greatest advantage. The AM intervention is the more effective of the two, but also the more costly. 

Barriers to acceptance of cataract surgery among patients presenting to district hospitals in rural Malawi.
Courtright P, Kanjaloti S, Lewallen S. Trop Geogr Med. 1995;47(1):15-8.
The objective of this research was to assess the barriers to cataract surgical acceptance by blind rural Malawians recognized and referred for surgical correction at district hospitals. Men and women who either talked to someone about cataract surgery or knew another aphakic patients were more likely to accept surgery.

Barriers to the uptake of cataract surgery.
Johnson JG, Goode Sen V, Faal H. Trop Doct. 1998 Oct;28(4):218-20.
The aim of this study was to investigate the reasons for non-attendance. The most frequently identified barrier by all three methods was cost, closely followed by lack of information about services, fear, transport difficulties, and the lack of an escort.

Socioeconomic barriers to cataract surgery in Nepal: the South Asian cataract management study.
Snellingen T et al. Br J Ophthalmol. 1998 Dec;82(12):1424-8.
The aim of this study was to determine the utilization of cataract surgery and the level of physical and psychosocial impairment and the socioeconomic barriers to surgery in a group of non-acceptors of surgery. It was found that in this population with a majority of patients with severe vision loss and blind, even when offered transport and free surgery the utilization of cataract surgery is below 60%.

Changing trends in barriers to cataract surgery in India.
Vaidyanathan K, Limburg H, Foster A, Pandey RM. Bull World Health Organ. 1999;77(2):104-9.
Earlier studies identified the major barriers to cataract surgery as poverty, lack of transportation or felt need, or sex related; and the critical barriers in rural areas as lack of awareness, difficult access, and cost. Compared with these earlier data, the results of the present study in Karnataka State indicate a shift in the character of the barriers. They now appear to be more related to case selection and service provision.

A study on the awareness of cataract disease and treatment options in patients who need surgery in a rural area of Eastern China.
Zhou JB, Guan HJ, Qu J, Yang XJ, Peng D, Gu HY. Eur J Ophthalmol. 2008 Jul-Aug;18(4):544-50.
This study investigated the awareness of cataract disease and treatment and to determine the major barriers for patients who need cataract treatment in a rural area of eastern China. A total of 89.6% of patients had been aware of their condition for more than 1 year. Only 49.8% of all patients had known for more than 1 year that their eye disease could be treated.

Barriers to spectacle use in Tanzanian secondary school students.
Odedra N et al. 2008 Nov-Dec;15(6):410-7.
Barriers to spectacle use were investigated using questionnaires and focus group discussions and a three months follow-up questionnaire explored satisfaction with spectacles and the attitudes of trial participants. Peer pressure and parental concerns about safety of spectacle use, cost of purchasing spectacles and difficulties in accessing good local optical services were identified as the main barriers.

Can a public health intervention improve awareness and health-seeking behaviour for glaucoma?
Baker H, Murdoch IE. Br J Ophthalmol. 2008 Dec;92(12):1671-5.
The aim of this study was to investigate whether a public education campaign can increase awareness and change help-seeking behaviour with respect to ocular health in an Indian population. This study has shown a significant increase in awareness from using different kinds of media and has shown radio to be the most effective in our target community.

Spectacles in Fiji: need, acquisition, use and willingness to pay.
du Toit R, Ramke J, Palagyi A, Brian G. Clin Exp Optom. 2008 Nov;91(6):538-44.
Problems with distance and/or near vision comprised 85.8 per cent of reported eye problems and started between the ages of 40 and 64 years for 54.8 per cent of people surveyed.
Using a rapid appraisal technique, semi-structured interviews were conducted with 174 urban and rural households in Fiji's Central Province to assist in planning eye-care services.

Cataract surgical coverage and self-reported barriers to cataract surgery in a rural Myanmar population.
Athanasiov PA et al. Clin Experiment Ophthalmol. 2008 Aug;36(6):521-5.
The aim of this study is to determine the cataract surgical coverage and investigate the barriers to cataract surgery as reported by those with cataract-induced visual impairment in rural Myanmar.  Cataract surgical coverage was higher for men than women, but gender was not associated with refusal of services.

Sources of patient knowledge and financing of cataract surgery in rural China: the Sanrao Study of Cataract Outcomes and Up-Take of Services (SCOUTS), report 6.
Congdon N et al. Br J Ophthalmol. 2008 May;92(5):604-8.
This study looked at patient sources of knowledge about cataract surgical services, and strategies for financing surgery in rural China. Strategies to increase uptake of cataract surgery in rural China may benefit from enhancing word-of-mouth advertising, using television advertising where affordable, and micro-credit or other programs to enable patients to pay their own fees, thus increasing uptake of second-eye surgery.

Childhood Visual Impairment and Blindness

Status of pediatric eye care in India.
Murthy G., John N., Gupta S.K., Vashist P., Rao G.V. Indian J Ophthalmol 2008;56:481-8.
A questionnaire on eye care services was sent to all known eye care institutions in the country in order to document the status of pediatric eye care in India. Out of 1204 institutions contacted, 668 (55.5%) responded to the questionnaire. Of these, 192 (28.7%) reported that they provided pediatric eye care services.  Authors conclude that pediatric eye care services are not adequate in India.

Causes of childhood blindness in the northeastern states of India
Bhattacharjee H et al. Indian J Ophthalmol 2008;56:495-9.
258 children underwent examination to determine the causes of severe visual impairment and blindness amongst children from schools for the blind in the four states of NER of India. The major anatomical causes of visual loss amongst the 258 were congenital anomalies (anophthalmos, microphthalmos) 93 (36.1%); corneal conditions (scarring, vitamin A deficiency) 94 (36.7%); cataract or aphakia 28 (10.9%), retinal disorders 15 (5.8%) and optic atrophy 14 (5.3%).

Childhood blindness in a rural population of southern India: prevalence and etiology.
Dorairaj SK et al. Ophthalmic Epidemiol. 2008 May-Jun;15(3):176-82.
The aim of this study was to determine the prevalence and etiology of childhood blindness in a rural population in southern India through a population based study. More than half of the blindness detected was potentially avoidable.

Prevalence and causes of functional low vision in school-age children: results from standardized population surveys in Asia, Africa, and Latin America.
Gilbert, C. E., Ellwein, L. B. Invest Ophthalmol Vis Sci. 2008 Mar;49(3):877-81.
This study was conducted to determine the prevalence and causes of Functional Low Vision among children recruited in eight population-based prevalence surveys of visual impairment and refractive error from six countries. The overall prevalence was 1.52 in 1000 children. Retinal lesions and amblyopia were the commonest causes.

Pediatric ophthalmology in the developing world.
Maida JM, Mathers K, Alley CL. Curr Opin Ophthalmol. 2008 Sep;19(5):403-8.
The focus of this paper is to discuss the status of pediatric ophthalmology in developing countries and the progress that has been made in the areas of avoidable childhood blindness and visual impairment, particularly corneal scarring as a result of vitamin A deficiency, congenital cataract and retinopathy of prematurity. Childhood blindness and visual impairment in developing countries remains a significant public health issue, but recent initiatives have shown promise of future improvements.

Causes of childhood blindness: results from schools for the blind in south eastern Nigeria.
Ezegwui IR, Umeh RE, Ezepue UF. Br J Ophthalmol. 2003 Jan;87(1):20-3.
This cross sectional study was undertaken to identify the major causes of childhood severe visual impairment/blindness (SVI/BL) among students in schools for the blind in south eastern Nigeria with a view to offering treatment to those with remediable blindness. the major causes of SVI/BL identified in the children (aged 15 years or less) were lesions of the lens (30.4%), corneal lesions (21.7%), whole globe lesions (mainly phthisis bulbi) (17.4%), and glaucoma/buphthalmos (10.9%).

Prevalence of myopia in urban and rural children in mainland China.
He M, Zheng Y, Xiang F. Optom Vis Sci. 2009 Jan;86(1):40-4.
A higher prevalence of myopia in urban settings, compared with rural settings, has been consistently suggested in several studies. This article reviews the available data on the prevalence of myopia in Chinese children living in China; particular consideration is given to the evidence of urban-rural differences and their implications.

Pseudophakia in children: precautions, technique, and feasibility.
Dahan E, Salmenson BD. J Cataract Refract Surg. 1990 Jan;16(1):75-82.
Intraocular lens implantation in young children can yield satisfactory results when the surgical techniques are modified and adapted to the child's eye.

Main causes of child blindness in People Republic of Congo (author's transl)
Menez B. Med Trop (Mars). 1981 Sep-Oct;41(5):527-30. French.
This is a report from 18 months of practice in the "Hôpital Général" of Brazzaville.

Screening of pre-school and school children for ocular anomalies in Lesotho.
Gordon YJ, Mokete M. J Trop Med Hyg. 1982 Aug;85(4):135-7.
One hundred and eighteen children (8.9%) were found to have significant ocular anomalies requiring treatment. The most common anomalies included refractive errors, squint, convergence insufficiency, amblyopia, vernalis, lid abnormalities, leukoma cornea, and cataract.

Causes of childhood blindness: results from west Africa, south India and Chile.
Gilbert CE, Canovas R, Hagan M, Rao S, Foster A. Eye. 1993;7 ( Pt 1):184-8.
Using World Health Organization definitions of visual loss and a standardised methodology, 905 children were examined in Chile, West Africa and South India. Of these 806 (89%) suffered from blindness (BL) or severe visual impairment (SVI).

Causes of blindness in Tunisian children                       
Ayed S et al. Rev Int Trach Pathol Ocul Trop Subtrop Sante Publique. 1991;68:123-8. French.
Among 214 children living at Blindness Institute of Bir El Kassaa the causes of blindness were determined. Main causes were: congenital glaucoma, tapeto retinal degeneration and congenital cataract because of high prevalence of consanguinity.

Causes of blindness in children in the blind schools of Ethiopia.
Wolde-Gebriel Z, Gebru H, West CE. Trop Geogr Med. 1992 Jan;44(1-2):135-41.
A total of 721 children in the six schools for the blind in Ethiopia were studied. Ninety-five per cent of those examined had bilateral blindness, 12% did not know how they had become blind and, of those who provided information on how they became blind, 21% knew that they were born blind, 30% implicated measles as being responsible, and 13% implicated 'mitch'.

Causes of blindness in children attending four schools for the blind in Thailand and the Philippines. A comparison between urban and rural blind school populations.
Gilbert C, Foster A. Int Ophthalmol. 1993 Aug;17(4):229-34.
256 children were examined in schools for the blind in Thailand (1 school) and the Philippines (3 schools). 244 (95%) were blind (BL) or severely visually impaired (SVI). Causes of SVI and blindness were classified anatomically and aetiologically, and avoidable causes identified.

Causes of childhood blindness in east Africa: results in 491 pupils attending 17 schools for the blind in Malawi, Kenya and Uganda.
Gilbert CE, Wood M, Waddel K, Foster A. Ophthalmic Epidemiol. 1995 Jun;2(2):77-84.
Pupils attending 12 schools for the blind in Malawi, 3 schools in Kenya and 2 schools in Uganda were examined to determine the causes of severe visual impairment or blindness. Of the 491 students included in the study 309 (62.9%) were blind (BL) and 69 (14.1%) were severely visually impaired (SVI).

Childhood eye diseases in Ibadan.
Ajaiyeoba A. Afr J Med Med Sci. 1994 Sep;23(3):227-31.
Eye diseases in 1028 children below 15 years of age, seen at the Eye clinic of the University College Hospital, Ibadan, Nigeria were studied. Refractive error, vernal conjunctivitis, measles keratitis associated with malnutrition and those referrable to injuries were leading causes of eye problems amongst children.

Hereditary disease as a cause of childhood blindness: regional variation. Results of blind school studies undertaken in countries of Latin America, Asia and Africa.
Gilbert C, Rahi J, Eckstein M, Foster A. Ophthalmic Genet. 1995 Mar;16(1):1-10.
Children in schools for the blind in 13 countries of Africa, Latin America and Asia were examined between 1990 and 1994 using a standardised method The anatomical site of abnormality and underlying aetiology were analysed for children with a corrected acuity in the better eye of less than 6/60 (severe visual impairment and blindness, svi/BL). In these countries II-39% of svi/BL was attributed to genetic disease.

Childhood blindness in India: causes in 1318 blind school students in nine states.
Rahi JS, Sripathi S, Gilbert CE, Foster A. Eye. 1995;9 ( Pt 5):545-50.
This is the first multi-state study to be undertaken in India using the Record for Children with Blindness and Low Vision from the World Health Organization/PBL Programme. The major causes of SVI/BL in this study were: (1) corneal staphyloma, scar and phthisis bulbi (mainly attributable to vitamin A deficiency) in 26.4%; (2) microphthalmos, anophthalmos and coloboma in 20.7%; (3) retinal dystrophies and albinism in 19.3%; and (4) cataract, uncorrected aphakia and amblyopia in 12.3%.

Aetiology of childhood cataract in south India.
Eckstein M, Vijayalakshmi P, Killedar M, Gilbert C, Foster A. Br J Ophthalmol. 1996 Jul;80(7):628-32.
This study sought to identify the causes of childhood cataract in south India with emphasis on factors that might be potentially preventable. Nearly half of non-traumatic cataract in south India is due to potentially preventable causes (CRS and autosomal dominant disease).

The importance of prenatal factors in childhood blindness in India.
Rahi JS, Sripathi S, Gilbert CE, Foster A. Dev Med Child Neurol. 1997 Jul;39(7):449-55.
A cross-sectional study of 1411 children 3-15 years of age attending schools for the blind in 9 states of India in 1993 investigated the causes of visual impairment. 113 of these children (8%) were severely visually impaired and 1205 (85%) were blind. Severe visual impairment or blindness was hereditary in 23% of cases, attributable to intrauterine factors in 2%, related to perinatal factors in 1%, acquired postnatally in 28%, and of undetermined etiology in 46%. 

Childhood blindness and low vision in Uganda.
Waddell KM. Eye. 1998;12 ( Pt 2):184-92
This study sought to examine the causes and outcome of subnormal vision starting in childhood in Uganda, to aid in planning for its avoidance and for rehabilitation. Cataract and corneal damage cause half of all subnormal vision, which is avoidable for both.

A survey on refractive error and strabismus among children in a school at Aligarh.
Gupta M, Gupta Y. Indian J Public Health. 2000 Jul-Sep;44(3):90-3.
An ophthalmic survey of 310 school children was conducted, revealing that 41 children (13.2%) had a vision of less than 6/6 in one or both eyes. Myopia of 0.5 D or more and hyperopia of +2 D or more or astigmatism of 1 D or more in one or both eyes were seen in 74 children (22.9%). There was a tendency for a decrease in hyperopia and an increase in myopia with advancing age.

Intraocular lens implantation for traumatic cataract in children in East Africa.
Gradin D, Yorston D. J Cataract Refract Surg. 2001 Dec;27(12):2017-25.
This study reviews the visual outcomes and complications after intraocular lens (IOL) implantation in children with traumatic cataract in sub-Saharan Africa, where contact lenses for unilateral aphakia are impractical in most patients. The results indicate that posterior chamber IOLs can be safely implanted by experienced surgeons in most children older than 2 years with traumatic cataract and should be the standard of care throughout the world.

Causes of low vision and blindness in children in a blind school in Lagos, Nigeria.
Akinsola FB, Ajaiyeoba AI.West Afr J Med. 2002 Jan-Mar;21(1):63-5.
This was a descriptive study to determine the causes of low vision and blindness in children attending the Pacelli School for the Blind in Lagos State, Nigeria. The anatomical sites of diseases leading to low vision and blindness in these children were retina (30.8%), lens (23.1%), glaucoma (19.2%), cornea (11.5%) and optic nerve (7.7%).

Causes of severe visual impairment and blindness in children in schools for the blind in Ethiopia.
Kello AB, Gilbert C. Br J Ophthalmol. 2003 May;87(5):526-30.
To aim of this study was to determine the causes of severe visual impairment and blindness in children in schools for the blind in Ethiopia, to aid in planning for the prevention and management of avoidable causes. 295 (94.5%) were blind or severely visually impaired. The major anatomical site of visual loss was cornea/phthisis (62.4%), followed by optic nerve lesions (9.8%), cataract/aphakia (9.2%), and lesions of the uvea (8.8%). The major aetiology was childhood factors (49.8%).

Childhood blindness in India: a population based perspective.
Dandona R, Dandona L. Br J Ophthalmol. 2003 Mar;87(3):263-5.
This research estimated the prevalence and causes of blindness in children in the southern Indian state of Andhra Pradesh. The prevalence of childhood blindness was 0.17% (95% confidence interval 0.09 to 0.30). Treatable refractive error caused 33.3% of the blindness, followed by 16.6% due to preventable causes (8.3% each due to vitamin A deficiency and amblyopia after cataract surgery).

Patterns of uveitis in children presenting at a tertiary eye care centre in south India.
Narayana KM, Bora A, Biswas J.n Indian J Ophthalmol. 2003 Jun;51(2):129-32.
This study examined the patterns of uveitis in the pediatric age group in a referral eye care centre in south India. Uveitis in children comprises approximately 6% of uveitis cases in a referral practice in south India. Anterior, intermediate and posterior uveitis were seen in equal numbers.

Pattern of childhood blindness at a referral center in Saudi Arabia.
Tabbara FK, El-Sheikh HF, Shawaf SS. Ann Saudi Med. 2005 Jan-Feb;25(1):18-21.
This retrospective review seeks to determine the causes of childhood blindness at an eye referral center. Genetically determined disorders continue to play an important role in the causation of childhood blindness among patients attending our referral center in Saudi Arabia.

Predictors of poor follow-up in children that had cataract surgery.
Eriksen JR et al. Ophthalmic Epidemiol. 2006 Aug;13(4):237-43.
This study aimed to measure routine follow-up and to determine the factors associated with good or poor follow-up. Found that significant investment in surgical interventions may not lead to improved visual rehabilitation or quality of life, if investments in follow-up are not increased. Linking individual children, their families, and the hospital needs to be approached systematically, if follow-up is to be improved.

Epidemiology based etiological study of pediatric cataract in western India.
Johar SR, Savalia NK, Vasavada AR, Gupta PD. Indian J Med Sci. 2004 Mar;58(3):115-21.
This study was performed to survey the causes of childhood cataracts and to identify the preventable factors in four western states of India. Our study shows that nearly 12% of non-traumatic cataract is due to potentially preventable causes. Health education of women to childbearing age and school children can decrease incidence of pediatric cataracts. 

Prevalence and causes of blindness and visual impairment among school children in south-western Nigeria.
Ajaiyeoba AI, Isawumi MA, Adeoye AO, Oluleye TS. Int Ophthalmol. 2005 Aug-Oct;26(4-5):121-5.
The aim of the study was to assess the prevalence and identify the causes of blindness and visual impairment in school children of Ilesa-East Local Government Area of Osun State, Nigeria. 11 (0.96%) children who were visually impaired and 4 (0.3%) who were severely visually impaired. Only 2 (0.15%) school children were blind. The causes of visual impairment were refractive error 10 (0.87%) and immature cataract 1 (0.08%), causes of severe visual impairment included corneal opacities 2 (0.2%), amblyopia leading to squint 1 (0.08%) and 1 cataract 1 (0.08%).

Refractive error and visual impairment in school children in rural southern China.
He M, Huang W, Zheng Y, Huang L, Ellwein LB. Ophthalmology. 2007 Feb;114(2):374-82
The aim of this study was to assess the prevalence of refractive error and visual impairment in school children in a rural area of southern China. Reduced vision because of uncorrected myopia is a public health problem among school-age children in rural China. Effective VA screening strategies are needed to eliminate this easily treated cause of visual impairment.

Pattern of childhood-onset uveitis in a referral center in Tunisia, North Africa.
Khairallah M et al. Ocul Immunol Inflamm. 2006 Aug;14(4):225-31.
The goal of this study was to analyze the pattern of childhood uveitis in a referral center in Tunisia, North Africa. The specific cause of uveitis in children was found in half the patients. Idiopathic intermediate uveitis was the leading cause of uveitis, followed by idiopathic anterior uveitis and toxoplasmosis.

Prevalence and causes of childhood blindness in camps for displaced persons in Khartoum: results of a household survey
Zeidan Z, Hashim K, Muhit MA, Gilbert C. East Mediterr Health J. 2007 May-Jun;13(3):580-5
The prevalence and causes of visual impairment and blindness were determined in 29 048 children < 16 years in all households of 5 camps for internally displaced people in Khartoum State, Sudan. After house-to-house visits by trained health care workers, 916 children received further assessment, 2.7% of whom were found to be blind, 1.6% to be severely visually impaired and 5.5% to be visually impaired.

Outcomes of bilateral cataract surgery in Tanzanian children
Bowman RJ, Kabiru J, Negretti G, Wood ML. Ophthalmology. 2007 Dec;114(12):2287-92.
The purpose of this study was to investigate outcomes of bilateral pediatric cataract surgery in east Africa. Fifty-eight (62%) of 94 patients with final follow-up acuities recorded in both eyes achieved 20/60 or better in their better eye and 13 (13%) of 94 patients were blind. Preoperative blindness was the strongest predictor of poor postoperative visual outcome.

Pattern of eye diseases and visual impairment among students in southwestern Nigeria.
Ajaiyeoba AI, Isawumi MA, Adeoye AO, Oluleye TS. Int Ophthalmol. 2007 Oct;27(5):287-92. Jun 22
The aim of the study was to determine the prevalence and causes of eye diseases and visual impairment in students in the Ilesa East local government area of Osun state, Nigeria. A total of 177 (15.5%) of the school children were found to have eye diseases. The major ocular disorders were in the following order: conjunctiva 91 (51.4%), refractive error 66 (37.3%), lid 7 (4.0%), corneal, including staphyloma and keratoconus 5 (2.8%) and then others.

Causes and temporal trends of childhood blindness in Indonesia: study at schools for the blind in Java.
Sitorus RS, Abidin MS, Prihartono J. Br J Ophthalmol. 2007 Sep;91(9):1109-13.
The aims of this study were to ascertain the causes of blindness and severe visual impairment (BL/SVI) in schools for the blind in Java, and to identify preventable and treatable causes and to evaluate temporal trends in the major causes. More than half of the BL/SVI causes are potentially avoidable. Cataract and corneal disorders related to measles or vitamin A deficiency were the major treatable and preventable causes.

Causes of severe visual impairment and blindness in Bangladesh: a study of 1935 children.
Muhit MA, Shah SP, Gilbert CE, Foster A. Br J Ophthalmol. 2007 Aug;91(8):1000-4.
The purpose of this study was to identify the anatomical site and underlying aetiology of severe visual impairment and blindness (SVI/BL) in children in Bangladesh. The main site of abnormality was lens (32.5%), mainly unoperated cataract, followed by corneal pathology (26.6%) and disorders of the whole eye (13.1%).

Pediatric cataract and surgery outcomes in Central India: a hospital based study.
Khandekar R, Sudhan A, Jain BK, Shrivastav K, Sachan R. Indian J Med Sci. 2007 Jan;61(1):15-22.
The aim of the study was to present the profile of cataract cases in children <or=18 years and postoperative visual status in the eyes operated. Congenital cataracts were in 88 (17.5%) eyes. Traumatic cataracts were noted in 170 (33.9%) eyes. The proportion of cataract was higher in males than in females.

Prevalence and determinants of xerophthalmia in preschool children in urban slums, Pune, India--a preliminary assessment.
Dole K, Gilbert C, Deshpande M, Khandekar R.Ophthalmic Epidemiol. 2009 Jan-Feb;16(1):8-14.
The purpose of the study was to estimate the prevalence of and identify risk factors for xerophthalmia in a sample of 1,589 children aged 6-71 months living in slums in Pune, India in 2003. Independent risk factors for xerophthalmia were having an illiterate mother and lack of a safe water supply.

The association between refractive cutoffs for spectacle provision and visual improvement among school-aged children in South Africa.
Congdon NG et al. Br J Ophthalmol. 2008 Jan;92(1):13-8.
This study evaluated different refractive cutoffs for spectacle provision with regards to their impact on visual improvement and spectacle compliance.  No association was found between spectacle retention and either refractive error or vision.

Inappropriate enrollment of children in schools for the visually impaired in east Africa.
Tumwesigye C et al. Ann Trop Paediatr. 2009 Jun;29(2):135-9 Review.
Many visually impaired children can learn to read print with appropriate training and simple visual aids. This may allow them to attend normal schools and to be integrated into society, which has lifelong benefits. The purpose of this analysis was to document the extent of inappropriate enrollment of visually impaired children in special schools and annexes for the blind in four African countries. Of 1062 children examined in special schools and annexes for the blind, 361 had visual acuity; the most common cause of visual impairment was retinal disease.

Cataract in children attending schools for the blind and resource centers in eastern Africa.
Msukwa G et al. Ophthalmology. 2009 May;116(5):1009-12.
The aim of this study was to describe results of a representative sample of children who have undergone cataract surgery in schools for the blind in 4 African countries. Of 1062 children examined, 196 (18%) had undergone cataract surgery or had cataract as the major cause of visual impairment; 140 (71%) had bilateral surgery, 24 (12%) had unilateral surgery, and 32 (16%) had not had surgery.

A study to explore the risk factors for the early onset of cataract in India.
Praveen MR, Shah GD, Vasavada AR, Mehta PG, Gilbert C, Bhagat G. Eye. 2009 Jun 12.
The aim of this study was to identify risk factors for the development of cataract in young patients. The major risk factors were atopy (25.6%), idiopathic (19.1%), high myopia (12.4%), atopy with steroid intake (10.9%), steroid usage (7.4%), sunlight exposure (3.8%), and diabetes mellitus (3.2%).

A population-based study of visual impairment among pre-school children in Beijing: the Beijing study of visual impairment in children.
Lu Q, Zheng Y, Sun B, Cui T, Congdon N, Hu A, Chen J, Shi J. Am J Ophthalmol. 2009 Jun;147(6):1075-81.
This study seeks to evaluate the prevalence and causes of visual impairment among Chinese children aged 3 to 6 years in Beijing. The leading causes of visual impairment among Chinese preschool-aged children are refractive error and hereditary eye diseases. A higher prevalence of refractive error is already present among urban as compared with rural children in this preschool population.

Traditional Medicine and Couching

Couching for cataract and Sino-Indian medical exchange from the sixth to the twelfth century AD.
Fan KW. Clin Experiment Ophthalmol. 2005 Apr;33(2):188-90.
This paper investigates the processes of interpretation and integration of the Indian ophthalmic technique known as 'couching for cataract' into Chinese medicine from the sixth to the twelfth century ad. The Indian medical knowledge of this procedure was eventually accepted because it could be reconstructed following Chinese medical concepts.

Cataract in Burkina Faso: factors of choice between modern and traditional surgical procedures
Meda N, Bognounou V, Seni E, Daboue A, Sanfo O. Med Trop (Mars). 2005 Nov;65(5):473-6. French.
The purpose of this study was to investigate the factors leading to the choice of lens couching for cataract treatment. Most patients (56%) did not understand the etiology of cataracts and attributed the disease to fate. Nor did they know of any other cataract treatment than lens couching. Only 13 patients (38.2%) would recommend modern cataract treatment and 52% suggested that health workers should come out into the villages and operate as traditional healers do.

Complications of traditional couching in a Nigerian local population.
Omoti AE. West Afr J Med. 2005 Jan-Mar;24(1):7-9.
The aim of this research was to evaluate the complications of traditional couching in a local population. Ten patients (71.42%) were initially satisfied but later became unsatisfied because of the complications and 2 (14.29%) were unsatisfied with the procedure. The main reasons for opting for couching were ignorance and fear of surgery. The main complications were secondary glaucoma (61.54%), hyphaema (15.38%) and optic atrophy (15.38%).

Traditional couching for cataract treatment: a cause of visual impairment.
Ademola-Popoola DS, Owoeye JF. West Afr J Med. 2004 Jul-Sep;23(3):208-10.
Couching as an ancient method of treatment usually practiced by traditional healer is discouraged and has been abandoned as a result of the attendant complications and also because of the availability of better techniques in the treatment of cataract. Records of 9 eyes of 6 patients (4 males, 2 females) who presented at the eye clinic of the University of Ilorin Teaching Hospital following traditional treatment of cataract known as couching between April 1999 and December 2001 were reviewed retrospectively. All the patients presented as a result of poor vision in the couched eyes and complications recorded include glaucoma, optic atrophy and panuveitis.

Traditional couching is not an effective alternative procedure for cataract surgery in Mali.
Schémann JF, Bakayoko S, Coulibaly S. Ophthalmic Epidemiol. 2000 Dec;7(4):271-83.
In order to evaluate the relative effectiveness and other outcomes of the traditional procedure compared to the modern surgical intervention, authors conducted a population-based survey in a rural district of Mali in 1996. From a total population of 99,800 there were 85 individuals (0.085%) who had been operated by intracapsular extraction (ICCE) without lens implantation and authors paired these with 82 individuals operated by the traditional method and by a local healer.

Traditional methods of treatment of cataract seen at Korle-Bu Teaching Hospital.
Ntim-Amponsah CT. West Afr J Med. 1995 Apr-Jun;14(2):82.
Fourteen eyes in eleven patients treated by the traditional methods for cataract were evaluated. Three different methods of treatment were classified from the cases: intracapsular (the traditional couching), extracapsular, and zonulysis.

Evaluation of the traditional Arabic technique of couching in the treatment of cataract in Mali (author's transl)
Queguiner P. Med Trop (Mars). 1981 Sep-Oct;41(5):535-40. French.
This is a study of 52 cases of treatment of cataract by couching. This technique, still much used in African traditional medicine, is first described and then the results are considered.

Quality of Life

Quality of life and visual impairment from cataract in Satkhira district, Bangladesh.
Polack S, Kuper H, Wadud Z, Fletcher A, Foster A. Br J Ophthalmol. 2008 Aug;92(8):1026-30.
To evaluate a vision-related quality of life (QOL) scale (World Health Organization Prevention of Blindness and Deafness Visual Function 20-WHO/PBD VF20) and explore the impact of cataract visual impairment on vision- and health-related QOL in people >or=50 years from Satkhira district, Bangladesh. Demonstration of the validity and reliability of the WHO/PBD VF20 in this population supports its suitability as a tool for assessing vision-related QOL in low-income settings.

Discrete time representation of the formula for calculating DALYs.
Elbasha EH. Health Econ. 2000 Jun;9(4):353-65.
The global burden of disease (GBD) was measured using a new indicator called disability-adjusted life years (DALYs). The results show that there is an appreciable difference in %age terms (14.06%) between the burden of cataract in Sub-Saharan Africa in 1990 calculated using the new and the old formulae.

The impact of cataract on time-use: results from a population based case-control study in Kenya, the Philippines and Bangladesh.
Polack S et al. Ophthalmic Epidemiol. 2008 Nov-Dec;15(6):372-82.
The aim of this study was to examine the relationship between visual impairment from cataract with time-use in adults (aged ≥ 50 years) in Kenya, Bangladesh, and The Philippines. Cases were substantially less likely than controls to participate in productive activities, including paid work and non-market activities and in leisure outside of the household.

Health-related quality of life of cataract patients: cross-cultural comparisons of utility and psychometric measures.
Lee JE, Fos PJ, Zuniga MA, Kastl PR, Sung JH. Ophthalmic Epidemiol. 2003 Jul;10(3):177-91.
This study was conducted to assess the presence and/or absence of cross-cultural differences or similarities between Korean and United States cataract patients. Subjects in Korea and the United States were significantly different in quality of life, functional status and clinical outcomes.

Cataract visual impairment and quality of life in a Kenyan population.
Polack S, Kuper H, Mathenge W, Fletcher A, Foster A. Br J Ophthalmol. 2007 Jul;91(7):927-32.
The aim of the study was to evaluate the World Health Organization Prevention of Blindness and Deafness 20-item Visual Functioning Questionnaire (WHO/PBD VF20), a vision-related quality of life scale, and to describe the relationship between cataract visual impairment and vision- and generic health-related quality of life, in people >or=50 years of age in Nakuru district, Kenya. The modified WHO/PBD VF20 demonstrated good psychometric properties.

Visual function and quality of life among visually impaired and cataract operated adults. The Pakistan National Blindness and Visual Impairment Survey.
Taylor AE et al. Ophthalmic Epidemiol. 2008 Jul-Aug;15(4):242-9.
To assess visual functioning and quality of life in a representative sample of normally sighted, visually impaired and cataract operated individuals in Pakistan, visual functioning (VF) and quality of life (QOL) questionnaires were administered to participants Of 16,507 adults. There were strong correlations between visual acuity and VF/QOL.

Visual functioning and quality of life outcomes among cataract operated and unoperated blind populations in Nepal.
Pokharel GP, Selvaraj S, Ellwein LB. Br J Ophthalmol. 1998 Jun;82(6):606-10.
Visual acuity and vision related quality of life outcomes in cataract surgery were evaluated in a population based survey in two geographic zones in Nepal. Cataract surgery outcomes, whether measured by traditional visual acuity or by patient reported VF/QOL, are at levels many would consider unacceptably low. It is apparent that in the quest to reduce cataract blindness much more attention must be given to improving surgery outcomes.

Vision-specific function and quality of life after cataract extraction in south India.
Oliver JE et al. J Cataract Refract Surg. 1998 Feb;24(2):222-9.
This study assessed visual and overall patient function after intracapsular (ICCE) and extracapsular (ECCE) cataract extraction in rural South India. Patients in rural south India having ECCE with posterior chamber IOL implantation obtained better postoperative visual function, quality of life, and visual acuity than those receiving ICCE with aphakic spectacle correction.

Visual acuity and quality of life outcomes in patients with cataract in Shunyi County.
Zhao J, Sui R, Jia L, et al. China Am J Ophtalmol. 1998;126:515–523.
The aim of this study is to measure visual acuity and vision-related quality of life in individuals in rural China operated on for cataract. Of the 87 individuals operated on for cataract, 12% (10/87) had presenting visual acuity of 6/18 or more in both eyes, and 24.1% (21/87) had less than 6/60.

Visual acuity and quality of life in patients with cataract in Doumen County, China.
He M, Xu J, Li S, Wu K, Munoz SR, Ellwein LB. Ophthalmology. 1999 Aug;106(8):1609-15.
The aim of this study was to evaluate the effectiveness of cataract surgery in achieving sight restoration and vision-related quality-of-life (QOL) in patients from rural southern China. Patients in rural southern China are not realizing the full sight-restoring potential of modern-day cataract surgery. Remedial efforts are needed to improve the performance of local eye surgeons.

Impact of presbyopia on quality of life in a rural African setting.
Patel I et al. Ophthalmology. 2006 May;113(5):728-34.
This study determined the impact of uncorrected presbyopia on quality of life in rural Tanzania. Uncorrected presbyopia was found to have a significant impact on vision-related quality of life in a rural African setting.

Evaluation of quality of life in patients with cataract in Hong Kong.
Chan CW, et al. J Cataract Refract Surg. 2003 Sep;29(9):1753-60.
The aim of this study was to evaluate the quality of life in patients in a public hospital in Hong Kong before and after cataract surgery using a new questionnaire. The preoperative visual acuity in the operated eye had a low correlation (0.11) with the quality-of-life score; visual acuity in the better eye had a higher correlation (0.29). Quality-of-life improvement was moderately correlated with visual acuity improvement and patient satisfaction.

Quality of life assessment of cataract surgery in elderly population of Doumen County, Guangzhou Province
He M, Xu J, Wu K, Li S. Zhonghua Yan Ke Za Zhi. 2002 Oct;38(10):594-7. Chinese.
This study sought to evaluate the outcome of cataract surgery in elderly population in Doumen County, Guangdong Province by assessment of subjective visual function and quality of life. scores of VF and QOL are significantly correlated with the visual status. Subjective visual function and quality of life could not be significantly improved after cataract surgery in this target population. 

Quality-of-life and visual function assessment after phacoemulsification in an urban indian population.
Mamidipudi PR et al. J Cataract Refract Surg. 2003 Jun;29(6):1143-51.
The goal of this study was to assess patients' quality of life (QoL) and overall visual function (VF) after phacoemulsification with intraocular lens (IOL) implantation in an urban Indian population. Improvement in health-related QoL and VF occurred within 3 months of cataract extraction.

Relationship of cataract symptoms of preoperative patients and vision-related quality of life.
Lee JE, Fos PJ, Sung JH, Amy BW, Zuniga MA, Lee WJ, Kim JC. Qual Life Res. 2005 Oct;14(8):1845-53.
This study was conducted in an attempt to describe the status of cataract symptoms of preoperative cataract patients, as well as to determine the relationship between cataract symptom and vision-related quality of life measures. The results indicate that cataract symptoms are highly associated with vision-related quality of life.

Relationship between vision impairment and eye disease to vision-specific quality of life and function in rural India: the Aravind Comprehensive Eye Survey.
Nirmalan PK et al. Invest Ophthalmol Vis Sci. 2005 Jul;46(7):2308-12.
The aim was to determine the impact of vision impairment and eye diseases on vision-specific quality of life and visual function in an older population of rural southern India. Presenting vision in the better eye was associated with quality of life and vision function in this older population of rural south India. 

Impact of impaired vision and eye disease on quality of life in Andhra Pradesh.
Nutheti R et al. Invest Ophthalmol Vis Sci. 2006 Nov;47(11):4742-8.
The aim of this study was to determine the impact of visual impairment and eye diseases on quality of life (QOL) in an older population of Andhra Pradesh in southern India. Decreased QOL was associated with the presence of glaucoma or corneal disease independent of visual acuity and with cataract or retinal disease as a function of visual acuity. Visual impairment from uncorrected refractive errors was not associated with decreased QOL.

Restoring sight: how cataract surgery improves the lives of older adults.
Polack S Community Eye Health J 2008;21(66): 24-25.
In-depth interviews were conducted in Kenya and Bangladesh with adults over the age of 50 who had recently undergone cataract surgery. Older adults with visual impairment had greater difficulties with their daily activities than those without impairment. These difficulties varied considerably according to older adults' lifestyle, environment, and social support, as well as the severity of their vision loss.

Cataract Surgery—Outcomes, Rates, Procedures

Cataract in Senegal
Williamson W et al. Rev Int Trach Pathol Ocul Trop Subtrop Sante Publique. 1991;68:187-96. French.
1000 cataracts were cured thanks to surgery at the Ophthalmological Centre of BOPP in Dakar. The authors analyzed them according to several aspects (age, sex, aetiology and anatomical shape of the cataracts), according to the therapeutical results and complications.

Cataract in the Kingdom of Morocco: indications for surgery and functional results.
Négrel AD; Moroccan Evaluation Team of the Blindness Prevention Programme. Ophthalmic Epidemiol. 2005 Feb;12(1):25-9.
This study sought to investigate the results of cataract surgery in different settings in the Kingdom of Morocco. Thirty-four % of patients (better eye acuity) and 95.5% of operated eyes had a visual acuity of less than 3/60 pre-operatively. Six to eight weeks post-operatively 84.0% of patients (better eye acuity) and 74.7% of operated eyes achieved a visual acuity of 6/18 or better.

Comparative study of continuous and interrupted sutures in cataract surgery in eye camps.
Singh G. Ophthalmologica. 1983;187(1):19-24.
In a comparative study performed to evaluate continuous and interrupted corneoscleral sutures under special conditions of eye operation camps, researchers performed 86 cataract extractions under local anaesthesia. The results and complications were comparable in the two groups.

Ambulatory surgery of cataracts in Eastern Senegal
Rozot P et al. Rev Int Trach Pathol Ocul Trop Subtrop Sante Publique. 1990;67:219-32. French.
The epidemiologic data and surgical results of 253 cataract extractions performed in a new department of Ophthalmology in Eastern Senegal were reviewed. 87 per cent have been operated without hospitalization, with restricted follow up. The complication rate was low, showing that this kind of surgery was suitable to local socio-economical conditions.

Outcome of cataract surgery in central India: a longitudinal follow-up study.
Reidy A, Mehra V, Minassian D, Mahashabde S. Br J Ophthalmol. 1991 Feb;75(2):102-5.
An epidemiological follow-up study of patients who had intracapsular cataract extraction in a voluntary hospital and its associated eye camps in Central India has for the first time evaluated the outcome one year after surgery in terms of visual acuity, use of spectacles, and improvement in income and mobility. The findings indicate that under these fairly typical conditions, 92% of the cases have adequate vision of 6/18 or better one year after surgery.

Frown incision for minimizing induced astigmatism after small incision cataract surgery with rigid optic intraocular lens implantation.
Singer JA. J Cataract Refract Surg 1991;17:677-688.
A new technique, the frown incision, was developed and a series of 62 eyes with 6 mm and 7 mm incisions for intercapsular phacoemulsification and implantation of a 6 mm or 7 mm one-piece biconvex poly(methyl methacrylate) (PMMA) posterior chamber intraocular lens with single horizontal mattress suture closure was prospectively evaluated for induced astigmatism.

Cataract surgery in a leprosy population in Liberia.
Frucht-Pery J, Feldman ST. Int J Lepr Other Mycobact Dis. 1993 Mar;61(1):20-4.
In Liberia, 43 eyes of 30 patients with ocular leprosy underwent cataract extraction; 33 eyes had extracapsular cataract extraction (ECCE) and 10 eyes had intracapsular cataract extraction (ICCE). In 95% of the eyes, the postoperative vision improved by 2 Snellen lines or more, but functional visual acuity (better than 20/200) was achieved in only 65% (82% post-ECCE and 10% post-ICCE).

Assessment of cataract surgery in rural India. Visual acuity outcome.
Murthy GV, Gupta SK, Talwar D. Acta Ophthalmol Scand. 1996 Feb;74(1):60-3.
A socio-epidemiological assessment of what happens to the visual outcome after camp-based intracapsular cataract extraction was conducted in 6 villages and periurban areas in North India. 70% of the respondents were satisfied with the surgical outcome. 76% of those with unilateral aphakia and 8.3% of those with bilateral aphakia were regularly using spectacles. 58.3% were satisfied with the spectacles. Dissatisfaction was generally due to lack of visual improvement.

Stones in the eye": post cataract suture irritation--a transcultural study from Sierra Leone, West Africa.
Winter JD. Insight. 1994 Dec;19(4):8-10
A retrospective study of 1214 outpatients in Sierra Leone, West Africa was done to answer the question, "What is the visual acuity following extracapsular cataract extraction (ECCE) with an intraocular lens (IOL) for patients in a developing country?" Only 24% achieved uncorrected pseudophakic visual acuity of 20/20 to 20/50.

The pattern of cataract surgery in India: 1992.
Gupta AK, Ellwein LB. Indian J Ophthalmol. 1995 Mar;43(1):3-8.
This study characterizes cataract surgery in India in terms of practice setting and surgical procedure. Of the 1,023,070 cataract cases reported, two-thirds were private patients. Among private patients, 26.0% received extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation and 20.7% received ECCE without an IOL.

The pattern of cataract and the postoperative outcome of cataract extraction in Ethiopian leprosy patients as compared to nonleprosy patients.
Girma T, Mengistu F, Hogeweg M. Lepr Rev. 1996 Dec;67(4):318-24.
Sixty leprosy and 100 nonleprosy patients were assessed and underwent intracapsular cataract extraction. Leprosy patients with cataract were much younger than nonleprosy patients. The leprosy group had a significantly higher rate of complications and this was seen more in paucibacillary cases.

Outcome of cataract surgery by a general medical doctor at district level, Zimbabwe: a retrospective follow-up study.
Killestein J, Hillegers M, van der Windt C, Stilma JS. Int Ophthalmol. 1996-1997;20(5):279-83.
From January 1990 until October 1992, 103 Zimbabwean patients underwent intracapsular cataract extraction by a general medical doctor. This factual report suggests that cataract surgery performed by a general medical doctor is an alternative for clearing the cataract backlog in developing countries.

Phacoemulsification at King Khaled Eye Specialist Hospital--the experience of the past.
Teichmann KD, et al. Int Ophthalmol. 1997;21(1):19-25.
This study examined the outcome of phacoemulsification (PE) compared to standard extracapsular surgery before the introduction of state-of-the-art techniques (capsulorhexis, hydrodissection, nuclear cracking, nuclear chopping, sutureless incisions) and sophisticated equipment. The outcome of PE was better than that of standard extracapsular cataract extraction in the same setting. 

The distribution of cataract surgery services in a public health eye care program in Nepal.
Marseille E, Brand R. Health Policy. 1997 Nov;42(2):117-33.
Equity is analyzed here by comparisons of surgical coverage rates for major sub-groups within the intended beneficiary population of the Nepal blindness program (NBP). Substantial differences in surgical coverage were found between males and females and between different age groups of the same gender. Among the cataract blind, the surgical coverage of males was 70% higher than that of females.

Intracapsular cataract extraction: experience of a general surgeon in Niger, West Africa.
Chew A. Aust N Z J Ophthalmol. 1997 Feb;25(1):43-6.
Data on all consecutive planned intracapsular cataract extractions performed between January 1994 and July 1995 inclusive were collected prospectively and the visual outcome as well as surgical complications were analyzed. All the patients were blind pre-operatively, with visual acuities of 3/60 or less. Functional vision (6/60 or better) was restored in 95% of all cases.

Population-based assessment of the outcome of cataract surgery in an urban population in southern India.
Dandona L et al. Am J Ophthalmol. 1999 Jun;127(6):650-8.
The goal of this research was to assess the outcome of cataract surgery in an urban population in southern India. The very high rate of very poor and poor visual outcome, predominantly as a result of surgery-related causes and inadequate refractive correction, in this urban population of India suggests that more attention is needed to improve the visual outcome of cataract surgery.

Cataract surgery in India: results of a 1995 survey of ophthalmologists.
Gupta AK, Tewari HK, Ellwein LB. Indian J Ophthalmol. 1998 Mar;46(1):47-50.
The aim of this study was to investigate cataract surgery procedures and caseloads among Indian ophthalmologists in private and government practices. Surgeons operating in both private and government facilities carry an average annual caseload of 861 cataract surgeries, which is twice that of their colleagues operating exclusively in either private or government settings.

A population based eye survey of older adults in Tirunelveli district of south India: blindness, cataract surgery, and visual outcomes.
Nirmalan PK et al. Br J Ophthalmol. 2002 May;86(5):505-12.
The goal of this study was to assess the prevalence of vision impairment, blindness, and cataract surgery and to evaluate visual acuity outcomes after cataract surgery in a south Indian population. Presenting blindness was associated with older age, female sex, and illiteracy. Cataract was the principal cause of blindness in at least one eye in 70.6% of blind people. The prevalence of cataract surgery was 11.8%-with an estimated 56.5% of the cataract blind already operated on.

Evaluation of visual outcome of cataract surgery in an Indian eye camp.
Kapoor H, Chatterjee A, Daniel R, Foster A. Br J Ophthalmol. 1999 Mar;83(3):343-6.
The aim was to evaluate the results of cataract surgery performed in a rural Indian eye camp. This evaluation suggests that it is possible to obtain acceptable results from cataract extraction with experienced ophthalmologists in well conducted Indian eye camps.

CATARACT SURGICAL COVERAGE: An Indicator to Measure the Impact of Cataract Intervention Programme
Limburg H, Foster A. Community Eye Health. 1998;11(25):3-6.
This study describes Cataract Surgical Coverage (CSC) as an indicator to measure the impact of cataract intervention programmes. Cataract Surgical Coverage (VA<3/60) ranged from 42% to 68% (for persons) and from 22% to 45% (for eyes) in 19 districts of Karnataka State. The coverage for males was higher than for females.

Monitoring visual outcome of cataract surgery in India.
Limburg H, Foster A, Vaidyanathan K, Murthy GV. Bull World Health Organ. 1999;77(6):455-60.
Two simple methods of assessing visual outcome following cataract surgery were evaluated in India.
The visual outcome following cataract surgery could be monitored on a regular basis by ophthalmologists, using either of the methods evaluated, an exercise which in itself is likely to improve the outcome of surgery.

Visual outcomes after cataract surgery and cataract surgical coverage in India.
Bachani D, Gupta SK, Murthy GV, Jose R. Int Ophthalmol. 1999;23(1):49-56.
Visual outcomes of 2369 cataract operated persons (3655 eyes) across seven major Indian states were assessed in 1998. 9.54 per cent of the examined population had undergone operation for cataract in one or both eyes. Intra-capsular cataract extraction was the commonest surgical modality adopted (91.62%). Intraocular lens implants resulted in better visual outcomes with 71.4 per cent of such patients achieving a good visual outcome.

Cataract surgical coverage: results of a population-based survey at Nkhoma, Malawi.
Eloff J, Foster A. Ophthalmic Epidemiol. 2000 Sep;7(3):219-21.
The study sought to determine the cataract surgical coverage (CSC) in the close proximity of Nkhoma Hospital, Malawi. The prevalence of blindness in this age group was 3.72%, of which 62% was due to cataract. The cataract surgical coverage for people with blinding cataract was calculated at 14.8%, and for eyes with cataract, 8.5%.

Visual outcome following cataract surgery in rural punjab.
Anand R, Gupta A, Ram J, Singh U, Kumar R. Indian J Ophthalmol. 2000 Jun;48(2):153-8.
In a cluster sample survey in rural areas of Punjab visual outcome after cataract surgery was assessed. Cataract surgery related complications were the principal causes leading to blindness in 50 of 72 eyes; these included corneal oedema, (17/72;23.3%), retinal detachment (14/72;19.4%), and aphakic glaucoma (13/72;18.05%).

Manual sutureless cataract surgery using a claw vectis.
Akura J, Kaneda S, Shiro Hatta S, et al. J Cataract Refract Surg 2000;26:491-496.
Two-handed sandwich methods of extracapsular cataract extraction using a self-sealing incision have proved difficult for many inexperienced surgeons. Authors developed a simpler 1-handed technique using a claw vectis-a vectis with a claw placed on its tip. When the nucleus is pulled through the scleral tunnel, it is fixed by the claw and is smoothly removed from a wound of a size comparable to that in the sandwich method.

Outcomes of extracapsular surgery in eye camps of eastern Nepal.
Shrestha JK, Pradhan YM, Snellingen T. Br J Ophthalmol. 2001 Jun;85(6):648-52.
This study assessed the outcome of 166 eyes at 6 weeks and 14 and 32 months after extracapsular cataract surgery with and without implantation of intraocular lens in refugee camps of eastern Nepal.  It was found that ECCE surgery in eye camps in this setting gave unacceptable outcomes because of a high rate of capsular rupture and posterior capsular opacification. 

High volume sutureless intraocular lens surgery in a rural eye camp in india.
Balent LC et al. Ophthalmic Surg Lasers. 2001 Nov-Dec;32(6):446-55.
This study describes the use of small incision sutureless cataract surgery (SISCS) that permits high-volume, high-quality, and low-cost surgery. Postoperatively, 60.0% attained uncorrected vision of 6/24 or better. There was little difference in visual results or complication rates among the three techniques. The most striking finding is the speed of SISCS, which enables experienced surgeons to perform the technique in 3.8 to 4.2 minutes.

Cataract surgery output and cost of hospitalization for cataract surgery in the University of Benin Teaching Hospital.
Osahon AI. West Afr J Med. 2002 Jul-Sep;21(3):174-6.
This study highlights the meager contribution of teaching hospitals to the prevention of blindness. Several factors including ignorance, poverty, socioeconomic and political tensions and teaching hospital bureaucracy are no doubt responsible for this. Hospitalization for cataract surgery is becoming very unpopular in the developed world as this tends to increase cost of surgery.

The Sivaganga eye survey: II. Outcomes of cataract surgery.
Thulasiraj RD, Reddy A, Selvaraj S, Munoz SR, Ellwein LB. Ophthalmic Epidemiol. 2002 Dec;9(5):313-24.
The purpose of this research was to assess the clinical outcomes of cataract surgery in rural southern India. Visual acuity outcomes in pseudophakic eyes were good. More attention must be given to needless vision impairment among the cataract-operated because of inadequate aphakic correction, especially among those operated on in government facilities, the illiterate, and those living in rural villages.

On the practicalities of eye camp cataract extraction and intraocular lens implantation in Nepal.
Ruit S, Brian G, Hollows F. Ophthalmic Surg. 1990 Dec;21(12):862-5.
Based on researchers’ experience in Nepal, they discuss the practicalities of performing extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation in the context of the third-world eye camp. At slightly less than 30 minutes per case, while not as quick as an intracapsular cataract extraction (ICCE) with a Graefe section, the trade-off between vision result and operation time, according to patients, is very much in favor of the ECCE/IOL technique. 

Extracapsular cataract and lens implant surgery in developing countries: keeping it simple.
Spencer MF. Ophthalmic Surg. 1990 Jun;21(6):447-52.
Extracapsular cataract extraction and posterior chamber lens implantation would be the ideal method of rehabilitating the cataract blind of the developing world. However, these procedures usually have been considered too complex, time-consuming, and "high tech" to be used in these areas of the world. In the context of an appropriate support program, they can be performed rapidly and safely using a few simple, manual instruments.

High volume efficient cataract surgery in developing countries.
Christy NE. Int Ophthalmol. 1990 May;14(3):141-6. Review.
The use of simple, flexible, efficient eye departments which make good use of available personnel and appropriate technology can be a very effective method of offering eye care and cataract surgery to large numbers of patients in the tropics and elsewhere.

Mortality and cataract: findings from a population-based longitudinal study.
Minassian DC, Mehra V, Johnson GJ. Bull World Health Organ. 1992;70(2):219-23.
A random sample of 11 village communities provided 1020 persons aged 40-64 years, who were examined in 1982 and again reassessed in 1986.

Procedures involving star-shaped capsulectomy for managing congenital cataracts in developing nations.
Berger RR, Kenyeres AM, Van Coller B, Pretorius CF. Ophthalmic Surg. 1994 Sep-Oct;25(9):649-53.
The inexpensive instrumentation used and the low rate of perioperative complications encountered studied patients make the described two techniques attractive alternatives for managing congentital cataracts in developing nations.

Is anterior chamber lens implantation after intracapsular cataract extraction safe in rural black patients in Africa? A pilot study in KwaZulu-Natal, South Africa.
Cook CD, Evans JR, Johnson GJ.Eye. 1998;12 ( Pt 5):821-5.
With financial remuneration, the follow-up rate at 8 weeks increased from the usual 30% to 72%. At 6 months, 67% of eyes achieved a correlated visual acuity of 6/18 or better. Thirty per cent had persistent uveitis, 16% had peripheral anterior synechiae beyond the points of haptic contact, and 5% had an intraocular pressure greater than 21 mmHg.

Audit of outcome of an extracapsular cataract extraction and posterior chamber intraocular lens training course.
Alhassan MB, Kyari F, Achi IB, Ozemela CP, Abiose A. Br J Ophthalmol. 2000 Aug;84(8):848-51.
Forty one patients (24.3%) were blind before surgery, two of whom (1.2%) remained blind afterwards. The most common intraoperative complication was posterior capsular rent which occurred in 10 eyes (5.7%); striate keratopathy/corneal oedema and cortical remnant were the most common immediate postoperative complications, occurring in 44.6% and 8.0%, respectively.

Controlling astigmatism in cataract surgery requiring relatively large self-sealing incisions.
Akura J, Kaneda S, Hatta S, et al. J Cataract Refract Surg 2000;26:1650-1659.
This stude evaluated the results of a modified self-sealing incision for achieving astigmatic neutrality in cataract surgery requiring a 6.0 to 7.0 mm incision as well as the methods of correcting preexisting astigmatism using these incisions. In cataract surgery using relatively large scleral self-sealing incisions, the BENT frown incision effectively achieved astigmatic neutrality. The incisions on the temporal or superior steep astigmatic axis (with selective shape) reduced astigmatism in almost all cases.

Longitudinal study on visual outcome and spectacle use after intracapsular cataract extraction in northern India.
Gupta SK, Murthy GV, Sharma N. BMC Ophthalmol. 2003 Jul 28;3:9.
The aim of this study is to assess visual outcome and perceived benefits of post-operative use of aphakic spectacles. Following intracapsular cataract extraction, provision of the best correction after cataract surgery is desirable to obtain an optimal visual outcome.

Cataract blindness and visual outcome of cataract surgery in a tribal area in Pakistan.
Anjum KM et al. Br J Ophthalmol. 2006 Feb;90(2):135-8.
This study estimated the rates of cataract blindness and cataract surgical coverage and assessed the visual outcome of cataract surgery. The overall prevalence of bilateral cataract blindness was 4.8% (95% CI: 3.8% to 5.9%). Women had a 2.1-fold greater prevalence of bilateral cataract blindness than men.

Models for improving cataract surgical rates in southern China.
Xu J, Zhu S, Li S, Pizzarello L. Br J Ophthalmol. 2002 Jul;86(7):723-4.
This demonstration project in Guangdong Province was designed to test various strategies to improve the cataract surgical rate. The cataract surgery rate (CSR) per million was 366 in the county where training took place, 588 where the fee was lowered, and 1140 where both interventions took place. The improvement in CSR was highly significant (p<0.001).

The Sivaganga eye survey: I. Blindness and cataract surgery.
Thulasiraj RD et al. Ophthalmic Epidemiol. 2002 Dec;9(5):299-312.
The purpose of this research was to assess the prevalence of visual acuity impairment, blindness, and cataract surgery among older adults in rural southern India. Blindness with presenting visual acuity was associated with older age and illiteracy. Cataract was the principal cause of blindness in one or both eyes in 69.4% of those presenting blind.

Extracapsular cataract surgery compared with manual small incision cataract surgery in community eye care setting in western India: a randomised controlled trial.
Gogate PM et al. Br J Ophthalmol. 2003 Jun;87(6):667-72.
To study "manual small incision cataract surgery (MSICS)" for the rehabilitation of cataract visually impaired and blind patients in community based, high volume, eye hospital setting; to compare the safety and effectiveness of MSICS with conventional extracapsular cataract surgery. MSICS and ECCE are both safe and effective techniques for treatment of cataract patients in community eye care settings.

Outcome and number of cataract surgeries in India: policy issues for blindness control.
Dandona L et al. Clin Experiment Ophthalmol. 2003 Feb;31(1):23-31.
The goal of the research is to assess what impact attention to quality of cataract surgery and postoperative follow up can have on cataract blindness in India, and to estimate the number of surgeries needed to eliminate cataract blindness in India.  In the population-based sample, of the 129 operated eyes, 51 (39.5%) were blind after surgery, which included 41 (31.8%) from cataract surgery-related causes. The number of persons in whom blindness is being averted due to cataract surgery in India is currently a very small fraction of the number blind from cataract.

Monitoring cataract surgical outcome in a Nigerian mission hospital.
Ezegwui IR, Ajewole J. Int Ophthalmol. 2009 Feb;29(1):7-9.
This study sought to evaluate the visual outcome of cataract operations in a Nigerian mission hospital. The main cause of poor visual outcome in the center is unsuspected co-morbidity.

Cataract surgical coverage and outcome of cataract surgery in a rural district in Malawi.
Courtright P; Chikwawa Survey Team. Can J Ophthalmol. 2004 Feb;39(1):25-30.
The purpose of this study was to determine the cataract surgical coverage and the outcome of cataract surgery in a rural district in Malawi to assess past performance of cataract surgical services. The cataract surgical coverage rate was 35.6% at a visual acuity level of 6/60, and 55.3% at a level of 3/60. Cataract surgical coverage in this population is similar to that reported from other countries in Africa. As in other settings, cataract surgical coverage was lower in women than in men.

Coverage of cataract surgery per person and per eye: review of a community-based blindness survey in Oman.
Khandekar R, Mohammed AJ. Ophthalmic Epidemiol. 2004 Oct;11(4):291-9.
The purpose of this study was to compare the calculation of cataract surgery services coverage on a per eye and per person basis. The two methods of calculating the coverage of cataract services give different results and both are useful for monitoring ophthalmic services.

Current trends in cataract surgery in Thailand--2004 survey.
Chaidaroon W, Tungpakorn N, Puranitee P. J Med Assoc Thai. 2005 Nov;88 Suppl 9:S43-50.
The aim of this study was to survey and investigate the current trend of cataract surgery in Thai ophthalmologists in 2004. In cataract surgery, 99.2% were still doing cataract surgery, the average number of cataract surgery procedures per surgeon per month was 25.6, 89.8% preferred phacoemulsification, and 42.5%  preferred acrylic lens. The posterior capsular tear was the most common complication.

Cataract surgical coverage and outcome in the Tibet Autonomous Region of China.
Bassett KL et al. Br J Ophthalmol. 2005 Jan;89(1):5-9.
A recently published, population based survey of the Tibet Autonomous Region (TAR) of China reported on low vision, blindness, and blinding conditions. This paper presents detailed findings from that survey regarding cataract, including prevalence, cataract surgical coverage, surgical outcome, and barriers to use of services. 

Visual experience during cataract surgery: a nation-wide survey on the knowledge of optometry students.
Tan CS, Tang W, Tan SB, Au Eong KG. Ophthalmic Physiol Opt. 2005 May;25(3):219-23.
This study aimed to determine the knowledge and beliefs of optometry students on the subject of patient’s visual experiences.  Many optometry students correctly believed that patients might experience a variety of visual sensations during cataract surgery under local anesthesia. The majority were also aware that patients might be frightened by this and felt that preoperative counseling would be helpful.

Outcome and benefits of small incision cataract surgery in Jos, Nigeria
Mpyet C, Langnap L, Akpan S. Niger J Clin Pract. 2007 Jun;10(2):162-5.
This study reports the outcome of small incision cataract surgery in a developing country.
Seventy-one eyes were included in this study. Uncorrected visual acuity at five days postop was good in 31 (43.7%) eyes and 49 (69.0%) eyes after six weeks of surgery. Six weeks postop, four (5.6%) eyes had poor outcome. The most common intraoperative complication was rupture of the posterior capsule while retinal lesions were the most common cause of poor visual outcome.

Visual outcomes and astigmatism after sutureless, manual cataract extraction in rural China: study of cataract outcomes and up-take of services (SCOUTS) in the caring is hip project, report 1.
Lam DS et al. Arch Ophthalmol. 2007 Nov;125(11):1539-44.
This study examined the visual acuity and astigmatism of persons undergoing cataract extraction by local surgeons in rural China. Results confirm the effectiveness of skill transfer in this setting, with superior outcomes to most studies in rural Asia and to eyes in this cohort operated on at other facilities.

Visual function and postoperative care after cataract surgery in rural China: study of cataract outcomes and up-take of services (SCOUTS) in the caring is hip project, report 2.
Congdon NG, Rao SK, Zhao X, Wang W, Choi K, Lam DS. Arch Ophthalmol. 2007 Nov;125(11):1546-52.
The aim of this research was to study the postoperative visual function and uptake of refraction and second-eye surgery among persons undergoing cataract surgery in rural China. Visual function was high in this cohort. Potential benefit of refraction and second-eye surgery was substantial, but uptake of services was modest. Programs to improve service uptake should focus on reading glasses and cost-reduction strategies such as tiered pricing.

Acceptance of cataract surgery in a cohort of Tanzanians with operable cataract
Chibuga E, Massae P, Geneau R, Mahande M, Lewallen S, Courtright P. Eye. 2008 Jun;22(6):830-3.
This is a population-based prospective (cohort) study of cataract patients from 12 villages in Hai district of Kilimanjaro region, Tanzania. Among patients eligible for surgery (128), 31 could not be followed up after 1 year due to deaths, moving, and refusal. Among the remaining patients, 18 accepted surgery in the first year and four accepted in the second year. Among these 22 patients, only five were blind or with severe visual impairment. The most elderly were those least likely to accept surgery.

High-volume surgery in developing countries.
Yorston D. Eye. 2005;19: 1083-1089.
This article reviews innovations in cataract surgery in poor countries that are intended to reverse barriers to access.  Increasing the number of operations through close involvement with the community, and improved surgical outcomes, enables the cost of surgery to be reduced and leads to further growth in volume.

Outcomes of high volume cataract surgeries in a developing country.
Venkatesh R et al. Br J Ophthalmol. 2005 Sep;89(9):1079-83.
This study analyzed the outcome of high volume cataract surgery in a developing country, community based, high volume eye hospital. High volume surgery using appropriate techniques and standardized protocols does not compromise quality of outcomes.

Causes of poor outcome after cataract surgery in Satkhira district, Bangladesh.
Lindfield R, Polack S, Wadud Z, Choudhury KA, Rashid AKMM, Kuper H Eye 2008 Aug;22(8):1054-6.
The aim of this study was to assess the frequency and causes of poor and borderline outcome after cataract surgery in a population-based case series in Satkhira district, Bangladesh.  Borderline and poor outcomes were most commonly due to lack of spectacles (25.8%), poor selection (33.8%), or surgical complications (30.6%).

Measuring cataract surgical services in children: an example from Tanzania.
Courtright P et al. Br J Ophthalmol 2008 92: 1031-1034.
Information on all children receiving surgery for congenital/developmental cataract in the two Child Eye Health Tertiary Facilities (CEHTF) in Tanzania was collected for 2004-6 and an annual childhood cataract surgical rate (CCSR) was calculated per region.  Overall, the CCSR (2006) in Tanzania was 9.9 per million population, ranging from 32.3 for regions where CEHTF are located to 5.4 for regions not adjacent to CEHTF regions. There were, on average, 148 boys for every 100 girls receiving surgery.

Cataract surgery in Togo
Mensah A et al. Sante. 2003 Jan-Mar;13(1):5-8. French.
This study attemped to estimate the number of cataract surgeries and the Cataract Surgery Rate (CSR) in the administrative regions. 1995 to 2001, 3,885 cataract surgeries were performed. Public services predominated with 53.03% (n=2061) of the cataracts operated followed by confessional hospitals with 37.1% (n=1443) and private clinics 3.4% (n=143). Decentralised eye healthcares provided 241 cataract extractions.

SICS--a cost effective alternative to phacoemulsification for developing countries in Nepal.
Nowak R. Klin Oczna. 2008;110(1-3):92-7.
The purpose of this study is to describe such a technique, little known in Poland--manual small incision cataract surgery (SICS), where the whole nucleus is removed through a self-sealing sclero-corneal tunnel.

Small-incision manual extracapsular cataract surgery in Ghana, West Africa.
Guzek JP, Ching A. J Cataract Refract Surg. 2003 Jan;29(1):57-64.
The purpose of this study is to evaluate the results of small-incision manual extracapsular cataract extraction surgery (ECCE) in a district hospital in West Africa. The final visual acuities were similar between the 2 groups, with more than 90% of eyes in both groups achieving a final best corrected visual acuity of at least 20/60. Eyes in the small-incision group had faster visual recovey, a lower incidence of fibrinous iritis (P =.02), and were more likely to have round pupils than eyes in the control group. The main complication of small-incision surgery was moderate corneal edema, which persisted until at least the 1-week visit in 14 eyes (7%).

The effect of glasses on visual function following cataract surgery in a cataract camp.
Maki J et al. Br J Ophthalmol. 2008 Jul;92(7):883-7.
This study sought to investigate visual and functional impact of glasses following cataract surgery in a high-volume cataract camp as measured by the World Health Organization Prevention of Blindness Visual Function Questionnaire. Postoperative glasses result in modest improvements in visual acuity. Total WHO/PBD-VFQ scores did not change significantly following glasses, but the overall and near vision subscales did improve. The net beneficial effect of glasses was small relative to cataract surgery itself.

A nationwide survey on the knowledge and attitudes of Malaysian optometry students on patients' visual experiences during cataract surgery.
Tan CS, Chen AH, Au Eong KG. Ann Acad Med Singapore. 2006 Feb;35(2):72-6.
This study aims to determine optometry students' beliefs and knowledge of visual sensations experienced by patients during cataract surgery under regional and topical anesthesia. Many optometry students are aware that patients might encounter a variety of visual sensations during cataract surgery under local anesthesia.

Outcome of cataract surgery at one year in Kenya, the Philippines and Bangladesh.
Lindfield R et al. Br J Ophthalmol. 2009 Jul;93(7):875-80.
The goal of this study was to assess the change in vision following cataract surgery in Kenya, Bangladesh and the Philippines and to identify causes and predictors of poor outcome. 452 eyes of 346 people underwent surgery. 124 (27%) eyes had an adverse outcome. In Kenya and the Philippines, the main cause of adverse outcome was refractive error (37% and 49% respectively of all adverse outcomes) then comorbid ocular disease (26% and 27%). There was no significant association between adverse outcome and gender, age, literacy, poverty or preoperative visual acuity.

Cataract surgical coverage and outcome in Goro District, Central Ethiopia.
Bejiga A, Tadesse S. Ethiop Med J. 2008 Jul;46(3):205-10.
This study assessed cataract surgical coverage and outcome in Goro District, Central Ethiopia. Cataract surgical coverage found in this survey is reasonably comparable to reports from other developing countries. However, the visual outcome after cataract surgery was significantly lower compared to the WHO recommendations.

Cataract surgery and intraocular lens manufacturing in India.
Aravind S, Haripriya A, Sumara Taranum BS. Curr Opin Ophthalmol. 2008 Jan;19(1):60-5. Review.
The purpose of this review is to update the reader regarding the Indian scenario of cataract surgery and intraocular lens manufacturing.

http://www.who.int/blindness/Pages%20from%20Vision2020%20-report.pdf
WHO Vision 2020 Global Initiative for the Elimination of Avoidable Blindness database on cataract surgical rate by county.

Large-Scale/State Conducted Surveys

Evaluation of a national eye care programme: re-survey after 10 years.
Faal H et al. Br J Ophthalmol. 2000 Sep;84(9):948-51.
To goal of this study was to evaluate the long term results of glaucoma surgery among people in East Africa. Nearly half of those with glaucoma among residents of rural African villages accepted the offer of surgical therapy. While technical success was achieved at satisfactory levels, the development of cataract must be considered an important issue for application of glaucoma surgical therapy programs.

Cataract-related blindness in Morocco. The Moroccan Group of Epidemiologic Evaluation of Blindness
Négrel AD, Chami Khazraji Y, Azelmat M. Med Trop (Mars). 1995;55(4 Pt 2):421-4.
A population-based survey using a stratified (urban/rural) sampling design for random selection of clusters was carried out in the Kingdom of Morocco from May 15 until June 30, 1992. The crude point prevalence of blindness was 0.8%, that of bilateral poor vision was 2.3%, and that of unilateral poor vision was estimated to be 2.8%.

National survey of blindness and low vision in The Gambia: results.
Faal H, Minassian D, Sowa S, Foster A. Br J Ophthalmol. 1989 Feb;73(2):82-7.
A population based survey of blindness and eye disease has been conducted throughout the whole country of The Gambia, and 8174 people were examined. The prevalence of blindness (best acuity less than 3/60) was 0.7% and low vision (6/24-3/60) 1.4%. The causes of blindness were cataract (55%), non-trachomatous corneal opacity/phthisis (20%), and trachoma (17%).

Ocular pathology in West Cameroon
Moussala M et al. Rev Int Trach Pathol Ocul Trop Subtrop Sante Publique. 1989;66(1-2):85-91. French.
In a study carried out in West Cameroon Province where 1749 patients were involved, the author aimed at studying the ocular pathology of this area. It appeared from this study that infectious and inflammatory diseases of the anterior segment of the eye and of the eye-lids are by far the most widespread.

Causes of blindness and visual impairment in urban and rural areas in Beijing: the Beijing Eye Study.
Xu L, Wang Y, Li Y, Wang Y, Cui T, Li J, Jonas JB. Ophthalmology. 2006 Jul;113(7):1134.e1-11.
This article evaluated the causes of visual impairment and blindness in adult Chinese in an urban and rural region of Beijing, China. The most frequent cause of low vision and blindness in adult Chinese is cataract, followed by degenerative myopia and glaucomatous optic neuropathy, with degenerative myopia dominating in younger groups and cataract dominating in elder groups.

Prevalence of blindness and visual impairment in Nigeria: the National Blindness and Visual Impairment Study.
Kyari F, Gudlavalleti et al. Invest Ophthalmol Vis Sci. 2009 May;50(5):2033-9.
To determine the prevalence of blindness and visual impairment among adults aged > or = 40 years in Nigeria, a sample of sample of 15,027 Nigerians were screened. Prevalence of blindness (< 20/400 in the better eye) and severe visual impairment (< 20/200-20/400; presenting vision) was 4.2% and 1.5% respectively. Blindness was associated with increasing age, being female, poor literacy, and residence in the North.

Causes of blindness, low vision, and questionnaire-assessed poor visual function in Singaporean Chinese adults: The Tanjong Pagar Survey.
Saw SM, Foster PJ, Gazzard G, Seah S. Ophthalmology. 2004 Jun;111(6):1161-8.
The aim of this study was to determine the prevalence rates and causes of low vision, blindness, and patient-assessed deficient visual function among Singaporean Chinese adults. The age- and gender-adjusted rates of low vision and blindness were 1.1% and 0.5%, respectively. Glaucoma is a leading cause of blindness in Singaporean Chinese adult.

Rapid assessment of cataract surgical coverage in rural Zululand.
Rotchford AP, Johnson GJ. S Afr Med J. 2000 Oct;90(10):1030-2.
This study describes a simple and inexpensive assessment of CSC based on screening of pensioners at pension delivery sites in a rural district. CSC was found to be 38.5% (95% confidence interval 29.1-47.9%). Blindness prevalence was 10.3%, with 69.0% due to cataract.

Rapid assessment of avoidable blindness in Western Rwanda: blindness in a postconflict setting.
Mathenge W, Nkurikiye J, Limburg H, Kuper H. PLoS Med. 2007 Jul;4(7):e217.
The aim of this study was to conduct a Rapid Assessment for Avoidable Blindness to estimate the magnitude and causes of visual impairment in people aged > or = 50 y in the postconflict area of the Western Province of Rwanda, which includes one-quarter of the population of Rwanda. Among the people aged 50 years or above 2,565 are expected to be blind, 1,824 to have severe visual impairment, and 8,055 to have visual impairment.

Rapid assessment of cataract blindness in India.
Bachani D, Murthy GV, Gupta KS. Indian J Public Health. 2000 Jul-Sep;44(3):82-9.
28,055 persons aged 50 yrs+ from seven states in India were surveyed by a rapid assessment technique for cataract blindness. Descriptive statistics were collected, such as the prevalence of bilateral blindness (vision < 6/60 in the better eye) was 11.68 % (95% C.I. 10.54-12.81) and Age and occupational status were associated with blindness prevalence.

Rapid assessment of avoidable blindness and needs assessment of cataract surgical services in Satkhira District, Bangladesh.
Wadud Z et al. Br J Ophthalmol. 2006 Oct;90(10):1225-9.
The aims of this study were to estimate the magnitude and causes of blindness in people aged > or =50 years in Satkhira district, Bangladesh, and to assess the availability of cataract surgical services. Although the prevalence of blindness and visual impairment was lower than expected, the CSR is inadequate to meet the existing need, and the quality of surgery needs to be improved.  

Prevalence and causes of blindness in the Tunisian Republic. Results of a national survey conducted in 1993. Tunisian Team on the Evaluation of Blindness
Ayed S, Négrel AD, Nabli M, Kamel N, Jebri AM, Siddhom M. Sante. 1998 Jul-Aug;8(4):275-82.
This study sought to estimate the prevalence of visual impairment and blindness; to identify the major causes of visual impairment and blindness and to estimate their overall impact, particularly on cataracts. Cataracts, particularly associated with aging, were the main cause of blindness (66%) and bilateral visual impairment (54.6%).

Magnitude and causes of blindness and low vision in Anambra State of Nigeria (results of 1992 point prevalence survey.
Ezepue UF. Public Health. 1997 Sep;111(5):305-9.
The aim was to provide baseline data for the planning, implementation and evaluation of both the state's and the National Programme for Prevention of Blindness. The prevalence of blindness in the state is estimated to be 0.33% +/- 0.27%.

Rapid assessment of avoidable blindness in Nakuru district, Kenya
Mathenge W et al. Ophthalmology. 2007 Mar;114(3):599-605.
Aims were to estimate the prevalence of avoidable blindness in > or =50-year-olds in Nakuru district, Kenya, and to evaluate the Rapid Assessment for Avoidable Blindness (RAAB), a new methodology to measure the magnitude and causes of blindness. The prevalence of bilateral blindness was 2.0% , and prevalence of bilateral visual impairment was 5.8% in the sample. Definite avoidable causes of blindness (i.e., cataract, refractive error, trachoma, and corneal scarring) were responsible for 69.6% of bilateral blindness and 74.9% of bilateral visual impairment.

Prevalence and causes of blindness and visual impairment in Limbe urban area, South West Province, Cameroon.
Oye JE, Kuper H. Br J Ophthalmol. 2007 Nov;91(11):1435-9.
This study is a rapid assessment of cataract surgical services to estimate the prevalence and causes of blindness and visual impairment in members of the population aged >/=40 years in the Limbe urban area, Cameroon.  Cataracts were the most common cause of severe visual impairment (43%) and visual impairment (48%). Most cases of blindness (50%), severe visual impairment (57%) and visual impairment (78%) were avoidable.

Rapid Assessment of Avoidable Blindness in Kunming, China.
Wu M, Yip JLY, Kuper H. Ophthalmology. 2008 Jun;115(6):969-74.
This study estimated the magnitude and causes of visual impairment (VI) in 2588 people aged 50 years and over in Kunming using the Rapid Assessment for Avoidable Blindness methodology. The main cause of blindness was cataract (63.2% of blindness), followed by nontrachomatous corneal scar (14.7%), glaucoma (7.4%), and other posterior segment disease/neurologic disorders (4.2%).

Evaluation of the first 5 years of a national eye health programme in Vanuatu.
Williams C et al. Clin Experiment Ophthalmol. 2008 Mar;36(2):162-7.
This study sought to evaluate against its objectives the achievements of the first 5 years of a national eye health programme in Vanuatu. The evaluation highlighted the limitations of inadequate project design and that, without addressing further human resource development and the Ministry of Health's wavering financial commitment, there are potential risks to ongoing services.

The Pyhäjärvi Cataract Study. I. Study design, baseline characteristics and the demand for cataract surgery.
Falck A, Kuoppala J, Winblad I, Tuulonen A. Acta Ophthalmol. 2008 Sep;86(6):648-54.
The Pyhäjärvi Cataract Study aims to study demand for cataract surgery in the population of a rural town in Finland. Practically no hidden demand for cataract surgery was found in the study population as defined by the national criteria for cataract surgery in Finland. This reflects the fact that the current Finnish health care system appears to recognize and treat cataract patients very well, even in rural areas.

Impact of posterior subcapsular opacification on vision and visual function among subjects undergoing cataract surgery in rural China: Study of Cataract Outcomes and Up-Take of Services (SCOUTS) in the Caring is Hip Project, report 5.
Congdon N et al. Br J Ophthalmol. 2008 May;92(5):598-603.
The aim of this research was to study the effect of posterior capsular opacification (PCO) on vision and visual function in patients undergoing cataract surgery in rural China, and to compare this with the effect of refractive error. The prevalence of PCO and impact on vision and visual function in this cohort was modest 1 year after surgery.

Ocular biometry and determinants of refractive error in rural Myanmar: the Meiktila Eye Study.
Warrier S et al. Br J Ophthalmol. 2008 Dec;92(12):1591-4.
This article describes the ocular biometry and determinants of refractive error in an adult population in Myanmar. This Burmese population, particularly women, has a relatively short AL and ACD. NO is the strongest predictor of refractive error across all age groups in this population.

Rapid Assessment of Avoidable Blindness in India.
Neena J; Rapid Assessment of Avoidable Blindness India Study Group. PLoS One. 2008 Aug 6;3(8):e2867.
The study determined magnitude and causes of avoidable blindness in India in 2007 among the 50+ population. Cataract 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.

Ophthalmic manifestations of HIV infections in India in the era of HAART: analysis of 100 consecutive patients evaluated at a tertiary eye care center in India.
Gharai S, Venkatesh P, Garg S, Sharma SK, Vohra R. Ophthalmic Epidemiol. 2008 Jul-Aug;15(4):264-71.
To evaluate ophthalmic manifestations in patients with Human Immunodeficiency Virus (HIV) infection in the era of highly active antiretroviral therapy (HAART) at the apex institute for eye healthcare in India. CMV Retinitis (20%) (20/100) is still the most common manifestation of HIV infection in this series, even in the era of HAART, and is more common than HIV vasculopathy.

Workforce

Ophthalmic manpower in India--need for a serious review.
Kumar R. Int Ophthalmol. 1993 Oct;17(5):269-75.
An attempt has been made to estimate the number of ophthalmic surgeons (OSs) in India, their distribution amongst the constituent states/union territories.  With an ophthalmic surgeon:population ratio of 1:107,000 (similar to that in the UK), an increasing amount of blindness in India, the output by ophthalmic surgeons continues to be low.

Eye diseases and control of blindness in Zambia.
Shukla SM. Soc Sci Med. 1983;17(22):1781-3.
This paper discusses the present state of health services in Zambia both in terms of training of personnel and health care delivery. The training in ophthalmology of medical students is poor and of medical auxiliaries almost non-existent.

 Research of the exploitation of human resources in blind prevention and primary eye care.
Wei J, Zhao Y, Li X, Ma Y, Liu L, Qu Y. Yan Ke Xue Bao. 1995 Mar;11(1):1-4.
This research studied how to establish a relatively advanced blindness prevention and eye care cause in economically underdeveloped countryside. 1986, the ratio of the number of the eye care workers of all levels to the number of the whole population in the prefecture was 1:26,000. In 1992, it rose to 1:17,000.

Human resources development for the prevention of blindness in Anglophone West Africa.
Odusote KA. West Afr J Med. 1998 Jan-Mar;17(1):1-8.
Eight categories of eye care workers were identified and personnel to population ratios adopted for each. Curriculum was developed and training begun for two new cadres-Primary Eye care Trainers and Diplomate Ophthalmologist.

Work capacity and surgical output for cataract in the national capital region of Delhi and neighbouring districts of north India.
John N, Murthy GV, Vashist P, Gupta SK. Indian J Public Health. 2008 Oct-Dec;52(4):177-84.
The aims of this study were to ascertain time taken for cataract surgery by ophthalmologists in the National Capital Region of Delhi and neighbouring districts, and to determine what work output is feasible with the available ophthalmologists. Ninety % ophthalmologists completed surgery in 41.3 minutes. The 10th and 90th %ile for case duration time was 15.5 and 78.4 minutes respectively. Median surgical time was lowest for ophthalmologists working in the NGO sector (10 minutes), compared to the government (23.5 minutes), and private sector (17.3 minutes).

Socio-cultural influences on eye health in a rural underserved community of Oyo state.
Fafowora OF. West Afr J Med. 1995 Jul-Sep;14(3):134-6.
To enhance planning of an eye health programme for a rural underserved community, focus group discussions were conducted. The results suggest that the planned intervention is timely and appropriate.

Basic ophthalmic assessment and care workshops for rural health workers.
Brian G, Dalzell J, Nangala S, Hollows F. Aust N Z J Ophthalmol. 1990 Feb;18(1):99-102.
The inequitable distribution of medical services in Australia means that many rural dwellers do not have easy access to ophthalmic care. In regions with no medical personnel, appropriately trained rural health workers may provide ophthalmic assessment, primary treatment, and, in some circumstances, definitive care.

Attacking the backlog of India's curable blind. The Aravind Eye Hospital model.
Natchiar G, Robin AL, Thulasiraj RD, Krishnaswamy S. Arch Ophthalmol. 1994 Jul;112(7):987-93.
New programs incorporating local customs and efficiently using available resources must be created to prevent the escalation of blindness and to rehabilitate patients already disabled with cataracts. We describe a system of high-quality, high-volume, cost-effective cataract surgery, using screening eye camps and a resident hospital.

Use of our existing eye care human resources: assessment of the productivity of cataract surgeons trained in eastern Africa
Courtright P, Ndegwa L, Msosa J, Banzi J. Arch Ophthalmol. 2007 May;125(5):684-7.
This study measured the productivity of cataract surgeons in Africa and assessed the factors that predict high productivity. More than 77,000 cataract surgeries were performed in the years 2000 through 2004, resulting in an annual productivity rate of 243 surgeries per surgeon. Higher productivity was associated with having 2 or more cataract surgical sets, a well-functioning operating microscope, 3 or more nursing support staff, and a community program that includes transporting patients to the hospital.

Narrowing the gap between eye care needs and service provision: the service-training nexus.
Masnick K. Hum Resour Health. 2009 Apr 23;7:35.
This paper presents a highly flexible competencies-based multiple entry and exit training system that matches and adapts training to the prevailing population and service needs and demands, while lifting overall standards over time and highlighting the areas of potential benefit. The underlying principles used to derive this model can be applied to many eye care systems in many developing countries.

An assessment of the eye care workforce in Enugu State, south-eastern Nigeria.
Eze BI, Maduka-Okafor FC. Hum Resour Health. 2009 May 12;7:38.
On the availability and distribution of an appropriate eye care workforce in reaching the goals of "VISION 2020: The right to sight", the global initiative for the elimination of avoidable blindness launched jointly by the World Health Organization and the International Agency for the Prevention of Blindness. There is a sufficient eye care workforce in Enugu Urban. However, the misdistribution of the workforce creates a major barrier to uptake of eye care services.

Economic Burden and Cost Effectiveness

The cost of the surgical treatment of cataracts at the African Institute of Tropical Ophthalmology (Bamako, Mali)
Guillemot de Liniers F et al. Sante. 1994 Jul-Aug;4(4):275-9.
To try to reduce the cost of surgery, authors analysed the various elements involved at the African Institute of Tropical Ophthalmology (AITO) in Bamako (Mali). The results show that the cost of the removal of the lens at the AITO is 15,200 FCFA (or $56). Installing an intra-ocular lens significantly improves the outcome for a similar cost (16,500 FCFA or $60).

Cost analysis of eye camps and camp-based cataract surgery.
Murthy GV, Sharma P. Natl Med J India. 1994 May-Jun;7(3):111-4.
Reseachers estimated the costs incurred in performing cataract operations in makeshift comprehensive eye care camps and suggest that comprehensive eye camps are cost-effective.

Cost-effective cataract surgery in developing nations.
Schwab L. Ophthalmic Surg. 1987 Apr;18(4):307-9.
The logistics of providing cataract surgical care in developing nations are complex. Simplifying the cataract operation, employing appropriate technology, and training non-physicians in intraocular surgery is efficient cost-effective strategy in many developing African nations.

Potential lost productivity resulting from the global burden of uncorrected refractive error.
Smith TS et al. Bull World Health Organ. 2009 Jun;87(6):431-7.
This study estimated the potential global economic productivity loss associated with the existing burden of visual impairment from uncorrected refractive error (URE). An estimated 158.1 million cases of visual impairment resulted from uncorrected or undercorrected refractive error in 2007; of these, 8.7 million were blind. The authors estimated the global economic productivity loss in international dollars (I$) associated with this burden at I$ 427.7 billion before, and I$ 268.8 billion after, adjustment for country-specific labour force participation and employment rates.

Economic burden of blindness in India.
Shamanna BR, Dandona L, Rao GN. Indian J Ophthalmol. 1998 Sep;46(3):169-72.
The economic burden of blindness in India for the year 1997 based on our assumptions is Rs. 159 billion (US$ 4.4 billion), and the cumulative loss over lifetime of the blind is Rs. 2,787 billion (US$ 77.4 billion). Childhood blindness accounts for 28.7% of this lifetime loss. The cost of treating all cases of cataract blindness in India is Rs. 5.3 billion (US$ 0.15 billion).

The cost of cataract surgery in a public health eye care program in Nepal.
Marseille E, Gilbert S. Health Policy. 1996 Feb;35(2):145-54.
Using data from the Lumbini Zonal Eye Care Program in Nepal, the authors estimated marginal costs, capital costs, and average recurring costs for a public health cataract program with and without donor agency overhead expenditures.

Cost-effectiveness of cataract surgery in a public health eye care programme in Nepal.
Marseille E. Bull World Health Organ. 1996;74(3):319-24.
Presented is an assessment of the cost-effectiveness of cataract surgery using cost and services data from the Lumbini Zonal Eye Care Programme in Nepal. The analysis suggests that cataract surgery may be even more cost-effective than previously reported.

Cost-effectiveness of public-funded options for cataract surgery in Mysore, India.
Singh AJ, Garner P, Floyd K. Lancet. 2000 Jan 15;355(9199):180-4.
Researchers assessed the cost-effectiveness of public-funded options for delivering cataract surgery in Mysore, Karnataka State, India. User satisfaction was higher with other providers (medical college hospital 82% [63-94]; non-government hospital 85% [72-93]), and fewer patients remained blind. Camps were a low-cost option, but the poor outcomes reduced their cost-effectiveness to US$97 per patient.

Cost-effectiveness analysis of cataract surgery: a global and regional analysis.
Baltussen R, Sylla M, Mariotti SP. Bull World Health Organ. 2004 May;82(5):338-45.
This study sought to estimate the population health effects, costs and cost effectiveness of selected cataract surgery interventions in areas of the world with different epidemiological profiles. Intra- and extra-capsular cataract surgeries are cost-effective ways to reduce the impact of cataract-blindness. Extra-capsular cataract surgery is more cost-effective than intra-capsular surgery in all regions considered.

Economic cost of cataract surgery procedures in an established eye care centre in Southern India.
Muralikrishnan R, Venkatesh R, Prajna NV, Frick KD. Ophthalmic Epidemiol. 2004 Dec;11(5):369-80.
The purpose of this study was to estimate the direct and indirect costs of three cataract surgery procedures: extracapsular cataract extraction with intra-ocular lens implantation (ECCE-IOL), phacoemulsification (PHACO) and manual small incision cataract surgery (MSICS) using economic costing principles in Tamil Nadu, South India during 2000-01. Results suggest that MSICS may have a lower societal cost than other options.

Analysis of costs and benefits of the Gambian Eye Care Program.
Frick KD, Foster A, Bah M, Faal H. Arch Ophthalmol. 2005 Feb;123(2):239-43.
This study sought to estimate the net benefit of the Gambian Eye Care Program (GECP) using a limited definition of benefits from a societal perspective. In 1996, 1658 fewer individuals were blind than would have been without GECP.  Although the net benefit between the blindness surveys was negative, the net lifetime benefit was 1.01 US million dollars (1995 dollars), yielding an internal rate of return of 10%.

Global cost-effectiveness of cataract surgery.
Lansingh VC, Carter MJ, Martens M. Ophthalmology. 2007 Sep;114(9):1670-8.
The aim of this research was to determine the cost-effectiveness of cataract surgery worldwide and to compare it with the cost-effectiveness of comparable medical interventions. The cost-utility of cataract surgery varies substantially, depending how the benefit is assessed and on the duration of the assumed benefit.

Why do phacoemulsification? Manual small-incision cataract surgery is almost as effective, but less expensive.
Gogate P, Deshpande M, Nirmalan PK. Ophthalmology. 2007 May;114(5):965-8.
The aim was to compare the cost of phacoemulsification with foldable lenses with that of manual small-incision cataract surgery (SICS) in a hospital setting. Phacoemulsification needs additional cost for the machine (depreciation), replenishment of parts, and annual maintenance contract. Manual SICS is far more economical than phacoemulsification. Its visual result is comparable with that of phacoemulsification and is as safe. 

Diabetic Retinopathy

Prevalence of diabetic retinopathy in rural China: the Handan Eye Study.
Wang FH et al. Ophthalmology. 2009 Mar;116(3):461-7.
This study describes the age- and gender-specific prevalence, characteristics, and severity of diabetic retinopathy (DR) in a rural population in northern China. Of 387 participants (6.9%) were diagnosed with diabetes mellitus, including 247 subjects with new diabetes mellitus (NDM) and 140 subjects with known diabetes mellitus (KDM).

Prevalence and risk factors for cataracts in persons with type 2 diabetes mellitus.
Kim SI, Kim SJ. Korean J Ophthalmol. 2006 Dec;20(4):201-4.
This study was performed to quantitatively evaluate the prevalence and risk factors of cataracts in Korean patients with type 2 diabetes mellitus. The duration of diabetes was the most significant risk factor for cataracts in patients with diabetes. This finding indicates that the accumulated effect of hyperglycemia is related to lens transparency in patients with diabetes.

Diabetic eye disease in Central Africa.
Rolfe M. Diabetologia. 1988 Feb;31(2):88-92.
Six hundred African diabetic patients were examined using a standardised technique based on the World Health Organisation Multinational Study, in which no country from Africa was represented. Thirty-four % of patients had retinopathy and 13% were affected by cataract.

Prevalence of retinopathy in a Sri Lankan diabetes clinic.
Fernando DJ, Siribaddana S, De Silva, Subasinge Z. Ceylon Med J. 1993 Sep;38(3):120-3.
The aim of this study was to determine the prevalence of diabetic retinopathy among patients with non-insulin dependent diabetes (NIDDM) attending a Sri Lankan diabetes clinic and assess the skills of non-ophthalmologist in screening for retinal disease. Retinopathy accounts for significant visual handicap. Untreated cataract is more commonly associated with blindness.

Prevalence and determinants of diabetic retinopathy and cataracts in West African type 2 diabetes patients.
Rotimi C et al.  Ethn Dis. 2003 Summer;13(2 Suppl 2):S110-7.
This study aimed to quantify the prevalence of, and risk factors for, diabetic retinopathy and cataracts in patients with type 2 diabetes, and their spouse controls, enrolled from 5 centers in 2 West African countries (Ghana and Nigeria).Cataracts were a more important cause of vision impairment than was diabetic retinopathy in this cohort. The prevalence of cataracts in patients with diabetes was more than twice that of their spouse controls, indicating that type 2 diabetes is an important risk factor for cataract formation.

Diabetic retinopathy progression and visual outcome after phacoemulsification in South-Asian and Afro-Caribbean patients with diabetes.
Chatterjee S, Savant VV, Stavrou P. Eye. 2004 Jun;18(6):575-9.
This research sought to determine diabetic retinopathy or maculopathy progression and visual outcome following phacoemulsification in South-Asian and Afro-Caribbean patients with diabetes. Retinopathy or maculopathy progression was noted in seven patients (23.4%), two South-Asians, and five Afro-Caribbeans. There was no significant difference in the number of operated and fellow eyes whose retinopathy or maculopathy progressed postoperatively.

Screening for diabetic retinopathy: a comparative study between hospital and community based screening and between paying and non-paying patients.
Afghani T, Qureshi N, Chaudhry KS. J Ayub Med Coll Abbottabad. 2007 Jan-Mar;19(1):16-22.
Prevalence of diabetes and diabetic retinopathy varies in the population considering the background and financial status. The prevalence of diabetic retinopathy was two times more in the affluent hospital patients as compared to poor hospital patients or rural population. For each known diabetic, there were four previously undiscovered diabetics in the rural population, and two previously undiscovered diabetics in hospital based population.

Prevalence of and factors associated with diabetic retinopathy among diabetics in Nepal: a hospital based study.
Shrestha MK, Paudyal G, Wagle RR, Gurung R, Ruit S, Onta SR. Nepal Med Coll J. 2007 Dec;9(4):225-9.
The objective of the study is to estimate the prevalence of and factors associated with Diabetic Retinopathy among diabetics in a Tertiary Eye Care Centre, Nepal. The prevalence of Diabetic Retinopathy was 44.7% (166) with non-proliferative Diabetic Retinopathy presented 85.5% (142) and 14.5% (24) were proliferative Diabetic Retinopathy.

Screening uptake in a well-established diabetic retinopathy screening program: the role of geographical access and deprivation.
Leese GP, Boyle P, Feng Z, Emslie-Smith A, Ellis JD. Diabetes Care. 2008 Nov;31(11):2131-5. Aug 26.
The objective of this study was to identify criteria that affect uptake of diabetes retinal screening in a community screening program using mobile retinal digital photography units. Social deprivation is strongly associated with poor attendance at retinal screening events. Time traveled to screening event was not associated with attendance in this study of a mobile retinal screening service, which visited general practitioner surgeries.

Prevalence and risk factors for diabetic retinopathy: a population-based assessment from Theni District, south India.
Namperumalsamy P et al. Br J Ophthalmol. 2009 Apr;93(4):429-34.
The aim of this study was to estimate the prevalence of diabetic retinopathy (DR) and the possible risk factors associated with DR, in a population of south India. Among the 25 969 persons screened for diabetes mellitus (DM), 2802 (10.8%) were found to have DM. DR was detected in 298 (1.2%) of 25 969 subjects.

Age-related Cataract/Blindness

Visual impairment from age-related cataract among an indigenous African population.
Komolafe OO, Ashaye AO, Ajayi BG, Bekibele CO. Eye. 2009 Mar 6.
This paper determines the magnitude of visual impairment (VI) resulting from lens opacity/cataract among a rural population in southwestern Nigeria. VI from cataract remains a public health problem in the Akinyele district of Nigeria. The need for a comprehensive cataract surgical service using the VISION 2020 model is necessary in the district if the burden from the backlog of visually disabling cataract is to be reduced.

Relationship between reproductive exposures and age-related cataract in women.
Noran NH, Salleh N, Zahari M. Asia Pac J Public Health. 2007;19(2):23-8.
The objective of this study is to evaluate the relationship between reproductive exposures and age-related cataract among women. Females with 29 years or less of endogenous estrogen exposure of, have almost three times the risk of developing age related cataract.

Age-related eye disease in the elderly members of rural African community.
Fafowora OF, Osuntokun OO. East Afr Med J. 1997 Jul;74(7):435-7.
The results of eye examination of the elderly persons (above age sixty years) in a rural population in south-western Nigeria are presented. Cataract was the commonest cause of blindness and low vision. Age-related macular degeneration (ARMD) and glaucoma were also important causes.

Senile cataract and trachoma in Tunisia
Ayed S et al. Rev Int Trach Pathol Ocul Trop Subtrop Sante Publique. 1992;69:139-46.
Risk factors for senile cataract which were evidenced are: diabetes or abnormal glucose test tolerance, high systemic blood pressure, especially diastolic, low education and non professional occupation, family history of cataract.

Prevalence of age-related cataract among adults aged 50 and above in four rural areas in western China
Bao YZ, Cao XG, Li XX, Chen J, Hu JX, Zhu T. Zhonghua Yi Xue Za Zhi. 2008 Jun 24;88(24):1697-702.
The aim of this study was to assess and compare the prevalence of age-related cataract (ARC) among adults aged 50 years or older in Western China. Results indicated that ARC prevalence among the permanent rural residents aged 50 and above in Western China is higher than that in Eastern China.

An overview of eye problems in Singapore's elderly.
Chew PT, Chee CK. Singapore Med J. 1991 Aug;32(4):268-70. Review.
Medical problems increase in frequency with advancing age. Ophthalmic problems are no exception, and add to disability in the elderly. Cataract, glaucoma, diabetic retinopathy, retinal detachment and age-related maculopathy are common blinding problems in middle-aged to elderly patients.

A rural population based case-control study of senile cataract in India.
Sreenivas V et al. J Epidemiol. 1999 Nov;9(5):327-36.
This study seeks clues to the etiology of senile cataract, so that strategies to prevent or even delay cataract formation could be planned. Systolic blood pressure, duration of exposure to sunlight per day were associated with senile cataract.

The prevalence of refractive errors and its determinants in the elderly population of Mashhad, Iran.
Yekta AA et al. Ophthalmic Epidemiol. 2009 May-Jun;16(3):198-203.
Thi aim of this study was to determine the prevalence rates of refractive errors in elderly people in Mashhad, Iran. The prevalence of myopia was 27.2%; 29.6% in men and 22.5% in women. The rate of myopia showed an increase with age.

Morbidity and health care utilisation among elderly people in Mmankgodi village, Botswana.
Clausen F, Sandberg E, Ingstad B, Hjortdahl P. J Epidemiol Community Health. 2000 Jan;54(1):58-63.
This study evaluates the health status among the elderly in a village in Botswana and their pattern of health care utilization. The most frequent health problems were related to the musculoskeletal system. Eye diseases, including cataract and blindness, were also common.

A population-based eye survey of older adults in a rural district of Rajasthan: I. Central vision impairment, blindness, and cataract surgery.
Murthy GV et al. Ophthalmology. 2001 Apr;108(4):679-85.
The aim of this study was to assess the prevalence of central vision blindness and cataract surgery in older adults in rural northwest India. Blindness, particularly blindness because of cataract, continues to be a significant problem among the elderly living in remote areas of rural northwest India. Increased attention should be given to reaching women and the illiterate.

Evaluation of the health and functional status of older Indians as a prelude to the development of a health programme.
Dey AB, Soneja S, Nagarkar KM, Jhingan HP. Natl Med J India. 2001 May-Jun;14(3):135-8.
This study assessed the health and functional status of older Indians seeking health services. Multiple chronic illnesses, frequent acute illnesses and deficits of vision and hearing are the major health and functional problems of the health-seeking older population in India. 

An epidemiological study on senile cataract in urban and rural areas of Chengdu
Liu C et al. Hua Xi Yi Ke Da Xue Xue Bao. 2002 Apr;33(2):256-8. Chinese.
This study sought to find out the status and distribution characteristics of senile cataract, which is one of the common diseases affecting the quality of life of the elderly people. It was found that the prevalence of senile cataract was 52.3% in urban area and 51.3% in rural area.

Ophthalmic survey of an old people's home in Nigeria
Adio AO. Niger J Med. 2006 Jul-Sep;15(3):288-90.
This study emphasizes the need for regular check up of our geriatric population to enable early detection of ocular health problems and thus prevent avoidable disability and dependency.60% had associated systemic illnesses. 85% had visual acuity of less than 3/60 in the better eye. Cataract was the cause of 40% of the ocular morbidity and also caused 57% of the blindness.

Prevalence and causes of visual impairment among the elderly in Nantong, China.
Li L, Guan H, Xun P, Zhou J, Gu H. Eye. 2008 Aug;22(8):1069-75.
This study investigated the prevalence and causes of visual impairment among adults aged 60 and above in Nantong city, China. Blindness and low vision were prevalent in the urban area of China, especially in the elderly women, with cataract the most common cause in the Chinese elderly. The study highlights an urgent necessity for launching some programs for blindness and low vision prevention, especially on the early treatment of cataract.

Cataract blindness and surgery among the elderly in rural southern Harbin, China.
Li Z, Cui H, Zhang L, Liu P, Yang H. Ophthalmic Epidemiol. 2009 Mar-Apr;16(2):78-83.
The purpose of this study was to examine the prevalence of cataract blindness, cataract surgical coverage, and surgical outcome by a population-based survey in an elderly rural Chinese population. The overall prevalence of bilateral cataract blindness was 1.3%. Researchers found that aging, female gender, and illiteracy were associated with prevalence of bilateral cataract blindness.

Relation of age-related cataract with obesity and obesity genes in an Asian population.
Lim LS et al. Am J Epidemiol. 2009 May 15;169(10):1267-74.
Obesity shows an inconsistent association with cataract although causality has not been established. The results of this study do not support a causal association between obesity and cortical or PSC cataract.

Prevalence and Causes of Eye-Diseases

Measuring the burden of ocular morbidity.
Panda A, Upadhyay MP, Kumar N, Badhu B, Koirala S. Trop Doct. 2002 Oct;32(4):227-30.
This hospital-based study highlights the spectrum of eye ailments in 35,273 patients who attended the Department of Ophthalmology at the B P Koirala Institute of Health Sciences, Eastern Nepal. Cataract was the most common problem for which patients needed ophthalmic advice; diabetic and hypertensive retinopathy were frequent occurrences and infection was a common problem. 

Correction of refractive error in the adult population of Bangladesh: meeting the unmet need.
Bourne RR, Dineen BP, Huq DM, Ali SM, Johnson GJ. Invest Ophthalmol Vis Sci. 2004 Feb;45(2):410-7.
The purpose of this study was to assess the extent of uncorrected refractive error and associated factors in Bangladesh and to suggest ways in which this need can be met. In Bangladesh, there is low spectacle coverage with a large unmet need. This survey identified risk groups, in particular women and those living in rural areas. This description of the availability of refractive services suggests areas for improvement (e.g., off-the-shelf spectacles) that may enable Bangladesh to achieve the goals of the World Health Organization's Vision 2020 initiative.

Cataract and corneal opacity are the main causes of blindness in the Samburu tribe of Kenya.
Whitfield R Jr, Schwab L, Bakker NJ, Bisley GG, Ross-Degnan D. Ophthalmic Surg. 1983 Feb;14(2):139-44.
An ocular status survey of the Samburu tribe of Kenya was carried out. There were 844 survey members in an age and sex stratified cluster sample. The prevalence of those who were found to have moderate visual loss or worse (less than 20/60 [6/18] in the better eye) was 3.8%.

Review of recent surveys on blindness and visual impairment in Latin America.
Limburg, H et al. J Ophthalmol 2008 92(3):315-319.
The prevalence of bilateral blindness ranged from 1.3% in urban Buenos Aires, Argentina, to 4.0% in two rural districts of Peru; low vision from 5.9% in Buenos Aires to 12.5% in rural Guatemala. Cataract was the main cause of blindness (41-87%), followed by posterior segment disease (7-47%). Avoidable blindness ranged from 43% in urban Brazil to 94% in rural Guatemala.

Incidence of cataracts in the mobile eye hospitals of Nepal.
Brandt F et al. Graefes Arch Clin Exp Ophthalmol. 1982;218(1):25-7.
The incidence of cataract in Nepal was determined from data collected in 14 mobile eye hospitals (called 'eye camps'). The %age of cataract patients in the OPD was less in the mountains (13.8%) than in the Tarai plains (19.8%).

Indications for penetrating keratoplasty in India.
Dandona L et al. Indian J Ophthalmol. 1997 Sep;45(3):163-8.
This study evaluated indications for PK in a mayor eye care institution through record analysis of 1,954 patients with PK.  Corneal scarring, including adherent leukoma, and active infectious keratitis are relatively more common indications whereas keratoconus, pseudophakic bullous keratopathy and Fuchs' dystrophy are less common indications for PK in India than reported from the developed world.
Blindness and visual impairment in a region endemic for onchocerciasis in the Central African Republic.
Schwartz EC et al. Br J Ophthalmol. 1997 Jun;81(6):443-7.
A population based survey of blindness and visual impairment was conducted in the district of Bossangoa, Central African Republic. Around 95.5% of all blindness could potentially have been prevented or treated.

Evaluation of E-optotypes as a screening test and the prevalence and causes of visual loss in a rural population in SW Uganda.
Mbulaiteye SM, et al. Ophthalmic Epidemiol. 2002 Oct;9(4):251-62.
The purpose of this study was to describe the prevalence of visual loss in rural Uganda and the screening accuracy of E-optotypes when used by non-medical staff. It was found that cataract and refractive errors were responsible for most of the visual loss in rural Uganda. Snellen's E-optotypes provide a suitable cost-saving tool for conducting population-based eye surveys in sub-Saharan Africa.

Follow-up study of blindness attributed to cataract in Karnataka State, India.
Limburg H, Kumar R. Ophthalmic Epidemiol. 1998 Dec;5(4):211-23.
This article is a presentation of the results of rapid assessments of bilateral cataract blindness in persons 50 years of age and older in 19 districts of Karnataka State, India. The results suggest an increase in cataract blindness since the previous survey of 1986.

The incidence of cataract in India is an overestimate.
Thomas R, Muliyil J. Natl Med J India. 1998 Jul-Aug;11(4):182-4.
Data obtained from surveys using distant direct ophthalmoscopy (DDO) with an undilated pupil for the detection of cataracts suggest an annual incidence of 3.8 million cataracts and over 9 million cataract-blind people in India today. Caluclations suggest that the incidence of cataract may have been overestimated by approximately 60%; corroborative evidence is provided.

Profile of blindness in Nepal: a hospital based study.
Rizyal A, Karmacharya PC, Koirala S. Nepal Med Coll J. 2005 Jun;7(1):54-7.
A hospital based prospective study was conducted at B P Koirala Lions Center for Ophthalmic Studies to determine the causes of blindness. The main diseases in the order of prevalence--cataract, corneal diseases, trauma and posterior segment diseases--were identified as the major causes of blindness.

Uncorrected refractive error in the northern and eastern provinces of Sri Lanka.
Tahhan N et al. Clin Exp Optom. 2009 Mar;92(2):119-25.
The data collected from the eye-care delivery program during 2005 are summarized in this report, as an evidence base for planning future eye-care interventions in these provinces or similar areas.

Ocular problems of young adults in rural Nigeria.
Nwosu SN. Int Ophthalmol. 1998;22(5):259-63.
The purpose of this research was to determine the common eye diseases as well as the prevalence and causes of blindness and visual impairment in young adult residents of rural areas of Anambra State, Nigeria. The common ocular problems in the 510 young adults examined were presbyopia (33.3%), refractive errors (41.1%), allergic conjunctivitis (8.2%), pterygium (8.2%), pingueculum (5.9%) and colour vision defect (2.4%).

Eye diseases and the causes of blindness in the southwestern Equator (equatorial forest) in Zaire, data from an eye camp in three rural centers.
Kaimbo WA Kaimbo D, Missotten L. Bull Soc Belge Ophtalmol. 1997;265:59-65.
This study determined frequencies of eye diseases and causes of blindness in a rural area. Cataract and glaucoma were the major ocular diseases found. Among the patients 1/5 was legally blind, and common causes of blindness were: cataract (54%), glaucoma (30%), uveitis (6%), corneal disorder (5%), retinitis pigmentosa (3%), atrophy of eye (3%).

Cataract blindness on the rise? Results of a door-to-door examination in Mohadi.
Limburg H, Vaidyanathan K, Pampattiwar KN. Indian J Ophthalmol. 1996 Dec;44(4):241-4.
A census survey in Mohadi block, Bhandara district of Maharashtra, indicated that the prevalence of blindness and cataract blindness has increased, compared with the 1986 survey. Around one third of the persons blind from cataract have been covered by surgical services. To increase coverage, more emphasis on information, education and communication is essential.

Morbidity and disability in elderly Zimbabweans.
Allain TJ et al. Age Ageing. 1997 Mar;26(2):115-21.
The purpose of this study was to record the prevalence of disability (impairment of activities of daily living), subjective morbidity (symptoms), the social circumstances and the utilization of health services in a group of elderly Zimbabweans. Less than 4% experienced difficulty with self-maintenance activities of daily living, but 30% had difficulty with instrumental activities. The former were all visually impaired and both visual and mobility problems contributed to the latter.

Prevalence of blindness in a rural ophthalmically underserved Nigerian community.
Fafowora OF. West Afr J Med. 1996 Oct-Dec;15(4):228-31.
A blindness prevalence survey was performed in Ifedapo Local Government Area of Oyo state in Nigeria to provide baseline data for evaluation and monitoring of eye care services in the area. The community prevalence rate of blindness (WHO definition) was 0.15% and prevalence rate of low-vision (WHO definition) was 0.56%.

Eye diseases and blindness in Adjumani refugee settlement camps, Uganda.
Kawuma M. East Afr Med J. 2000 Nov;77(11):580-2.
The goal of this study was to determine the prevalence and causes of the blindness and ocular morbidity amongst Sudanese refugees; to prioritise and provide eye care services to the refugees and; to device administrative strategies and logistics of prevention and control of blinding diseases among the refugees. One hundred and forty six patients (21%) were bilaterally blind, and 77 patients (11%) were unilaterally blind. The three leading causes of blindness are cataract (42%), xerophthalmia (28%) and trachoma (21%). Glaucoma and other non-specified causes were responsible for the remaining blindness (9%).

Survey of blindness in rural communities of south-western Nigeria.
Adeoye A. Trop Med Int Health. 1996 Oct;1(5):672-6.
A population based survey of rural communities in the Akinlalu-Ashipa ward of Ife North Local Government in Osun State, Nigeria, was conducted to determine the prevalence and causes of blindness. The major causes of blindness were cataract and its sequelae (48.1%), onchocerciasis (14.8%), primary open angle type glaucoma (11.1%), corneal scar/phthisis bulbi (7.4%) and optic atrophy (7.4%).

Causes of visual impairment in central Ethiopia.
Alemayehu W, Tekle-Haimanot R, Forsgren L, Erkstedt J. Ethiop Med J. 1995 Jul;33(3):163-74.
A survey conducted on a stable, mainly rural population of 60,820 in Central Ethiopia revealed an overall blindness prevalence of 1.1%. A follow up study was carried out to accurately determine the etiologies and causes of visual loss and impairment.

Eye surgery in Sudan
Graf HP. Klin Monatsbl Augenheilkd. 1990 May;196(5):438-41. German.
A seven-week stay in the Sudan in the winter of 1988/89 revealed the ophthalmological problems of this Third World country. As a result of the catastrophic shortage of local doctors, many cases of eye disease have progressed to terminal stages. Of 990 patients examined, 80% were unilaterally or bilaterally blind. The three main causes of blindness were cataract, trachoma, and glaucoma.

Impact of a sight-saver clinic on the prevalence of blindness in northern KwaZulu.
Cook CD, Stulting AA. S Afr Med J. 1995 Jan;85(1):28-9.
Eight sight-saver clinics were held between 1990 and 1993. The prevalence of blindness due solely to age-related cataract was reduced by 25% to 0.29%. The overall prevalence of blindness was reduced by 4% to 0.96% (95% CI 0.72 - 1.20).

Prevalence and incidence of blindness due to age-related cataract in the rural areas of South Africa.
Cook CD, Stulting AA. S Afr Med J. 1995 Jan;85(1):26-7.
The study was designed to measure both the prevalence and the incidence of cataract blindness in the population. The prevalence of cataract blindness was 0.59% in 1990 and 1993. Among a rural population of approximately 19 million South Africans, there is a backlog of 113,000 unoperated cataract-blind people and an incidence of 27,000 new cataract blind per year.

Prevalence of blindness and visual impairment in the region of Ségou, Mali. A baseline survey for a primary eye care programme.
Kortlang C, Koster JC, Coulibaly S, Dubbeldam RP. Trop Med Int Health. 1996 Jun;1(3):314-9.
A survey to determine the prevalence and causes of blindness and visual impairment in the Extreme North Province of Cameroon was conducted in the Spring of 1992. Approximately 1.2% of the sample was bilaterally blind.

Blindness and visual impairment amongst rural Malays in Kuala Selangor, Selangor.
Zainal M, Masran L, Ropilah AR. Med J Malaysia. 1998 Mar;53(1):46-50.
A population-based cross-sectional study was carried out to determine the prevalence of visual impairment and blindness and its causes amongst the adult rural Malay population in the district of Kuala Selangor, Selangor. The crude prevalence of visual impairment and blindness were 0.7% and 5.6% respectively. Age was the most important factor associated with the prevalence; gender, level of education and level of income was not significantly related.

Causes and prevalence of non-vision impairing ocular conditions among a rural adult population in sw Uganda.
Kamali A et al. Ophthalmic Epidemiol. 1999 Mar;6(1):41-8.
A survey was conducted to determine the prevalence and causes of NVIC in a Ugandan adult population and compared to findings with the work pattern of the district hospital. The four commonest NVIC observed at the outreach clinic were: presbyopia (48%), allergic conjunctivitis (20%), early cataract (9%) and infective conjunctivitis (8%), the same conditions as those most commonly seen at the district hospital.

A population-based eye survey of older adults in a rural district of Rajasthan: I. Central vision impairment, blindness, and cataract surgery.
Murthy GV et al. Ophthalmology. 2001 Apr;108(4):679-85.
The aim of this study was to assess the prevalence of central vision blindness and cataract surgery in older adults in rural northwest India. Presenting blindness was associated with increasing age, female gender, lack of schooling, and rural residence. Cataract was the principal cause of blindness in one or both eyes in 67.5% of blind persons, with uncorrected aphakia and other refractive error affecting 18.4% in at least one eye.

Unilateral visual impairment in an urban population in southern India.
Dandona L et al. Indian J Ophthalmol. 2000 Mar;48(1):59-64.
This study assessed the prevalence and causes of unilateral visual impairment in the urban population of Hyderabad city as part of the Andhra Pradesh Eye Disease Study. The major causes of visual impairment 39.9% were refractive error (42.9%), cataract (14.4%), corneal disease (11.5%), and retinal disease (11.2%). Of this unilateral visual impairment was blindness.

Causes of blindness in Northern Tanzania: a hospital and rural health centre based study.
Poole TR. Int Ophthalmol. 2001;24(4):195-8.
The goal of this study is to identify the main causes of blindness in Northern Tanzania. The main cause of bilateral blindness was cataract [39%]. The other chief causes of blindness were glaucoma, trauma and corneal scarring. The most important cause of corneal scarring, approximately half the cases, was microbial keratitis. Refractive error alone was responsible for 4.2% of bilateral blindness, of which 2.7% was uncorrected post-cataract surgery aphakia.

Causes of blindness and needs of the blind in Mansoura, Egypt.
el-Gilany AH, el-Fedawy S, Tharwat M. East Mediterr Health J. 2002 Jan;8(1):6-17.
A study of 113 blind people in Mansoura, Egypt highlighted the causes and risk factors for blindness, and health and social care needs of the blind. In two-thirds of cases, blindness occurred before 10 years of age. Risk factors for blindness were reported by more than half the study population.

Visual impairment in a Taiwanese population: prevalence, causes, and socioeconomic factors.
Liu JH, Cheng CY, Chen SJ, Lee FL. Ophthalmic Epidemiol. 2001 Dec;8(5):339-50.
Reserachers sought to estimate the prevalence of visual impairment among an elderly population in urban Taiwan, determine the causes of visual impairment, and gain information about certain socioeconomic factors associated with visual impairment. Three major causes of visual impairment were cataract (30.4%), high myopic macular degeneration (25.0%), and age-related macular degeneration (14.3%). In multivariate analysis, age was positively correlated with visual impairment and higher education level was associated with a significant decrease in the odds of being visually impaired.

Review of findings of the Andhra Pradesh Eye Disease Study: policy implications for eye-care services.
Dandona R, Dandona L. Indian J Ophthalmol. 2001 Dec;49(4):215-34.
The objectives of APEDS were to determine the prevalence and causes of blindness and visual impairment, prevalence of and risk factors for major eye diseases, barriers to eye-care services, and quality of life among the visually impaired. Cataract and refractive error were responsible for 60.3% of blindness and 85.7% of moderate visual impairment. Increasing age, decreasing socioeconomic status, female gender, and rural area of residence were associated with higher risk of blindness. 

A population based eye survey of older adults in Tirunelveli district of south India: blindness, cataract surgery, and visual outcomes.
Nirmalan PK et al. Br J Ophthalmol. 2002 May;86(5):505-12.
The goal of this study was to assess the prevalence of vision impairment, blindness, and cataract surgery and to evaluate visual acuity outcomes after cataract surgery in a south Indian population. Treatable blindness, particularly that associated with cataract and refractive error, remains a significant problem among older adults in south Indian populations, especially in females, the illiterate, and those living in rural areas.

Prevalence and causes of blindness and low vision in Dambatta local government area, Kano State, Nigeria.
Abdu L. Niger J Med. 2002 Jul-Sep;11(3):108-12.
This study showed that 93% of the blindness was avoidable in the sense that it could have been primarily prevented or, is treatable. 92% of the causes of low vision are avoidable.

High prevalence of nuclear cataract in the population of tropical and subtropical areas.
Sasaki H et al. Dev Ophthalmol. 2002;35:60-9.
No significant difference was seen in the prevalence of nuclear opacity between males and females in any of the groups. Although the common factors of the living conditions in the subjects with a high prevalence of nuclear opacity appear to be high UV exposure and high ambient temperature, future investigations should be made to disclose the possible cause.

The prevalence and causes of visual impairment in central Sri Lanka the Kandy Eye study.
Edussuriya K et al. Ophthalmology. 2009 Jan;116(1):52-6.
The aim of this study was to determine the prevalence and causes of uncorrectable visual impairment in the Kandy District of central Sri Lanka. The prevalence of blindness was 1.1%. The prevalence of visual impairment was 5.9%.

Incidence of visual loss in rural southwest Uganda.
Mbulaiteye SM et al. Br J Ophthalmol. 2003 Jul;87(7):829-33.
Visual loss in R2 occurred in 56 (2.8%) of 1997, yielding a crude incidence rate of 9.9, and an age standardised incidence rate of 13.2, per 1000 PY. Incidence of visual loss increased with age from 1.21 per 1000 PY among people aged 13-34 to 64.2 per 1000 PY in those aged 65 years or older (p for trend >0.001). The six commonest causes of visual loss were: cataract, refractive error, macular degeneration, chorioretinitis, glaucoma, and corneal opacity.

Planning low vision services in India : a population-based perspective.
Dandona R et al. Ophthalmology. 2002 Oct;109(10):1871-8.
The aim was to assess the prevalence and causes of low vision in a population in southern India for planning low vision services. Low vision was present in 144 participants, an age, gender, and urban-rural distribution adjusted prevalence of 1.05%.

Prevalence and causes of blindness in Otibhor Okhae Teaching Hospital, Irrua, Edo State, Nigeria.
Dawodu OA, Osahon AI, Emifoniye E. Ophthalmic Epidemiol. 2003 Dec;10(5):323-30.
This hospital-based retrospective study was aimed at providing baseline information on the causes of blindness in the locality. Over 6% (555) of new patients seen during this period were uniocularly blind while 3.9% (354) were binocularly blind. The leading causes of uniocular blindness were cataract, open-angle glaucoma and corneal ulceration/leucoma. Binocular blindness was mainly due to cataract, open-angle glaucoma and aphakia.

Blindness and vision impairment in a rural south Indian population: the Aravind Comprehensive Eye Survey.
Thulasiraj RD et al. Ophthalmology. 2003 Aug;110(8):1491-8.
The aim of this study was to determine the prevalence of blindness and vision impairment in a rural population of southern India. Age-related cataract was the most common potentially reversible blinding disorder (72.0%) among eyes presenting with blindness.

Prevalence of pseudoexfoliation syndrome in Ethiopian patients scheduled for cataract surgery.
Teshome T, Regassa K. Acta Ophthalmol Scand. 2004 Jun;82(3 Pt 1):254-8.
The goal of this study was to evaluate the prevalence of pseudoexfoliation syndrome (PEX) among Ethiopian patients with age-related cataract scheduled for surgery. The prevalence of PEX among Ethiopian patients with cataract is high and occurs at a relatively younger age when compared to previous reports from Europe. Pseudoexfoliation syndrome has been found to be significantly associated with hypermature cataract, higher mean IOP, IOP > 21 mmHg and glaucoma.

Blindness and eye diseases in Tibet: findings from a randomised, population based survey.
Dunzhu S et al. Br J Ophthalmol. 2003 Dec;87(12):1443-8.
The objective of the survey was to determine the prevalence of blindness and visual impairment, as well as cataract surgical coverage and surgical outcome in the TAR. Blindness is a serious public health problem in Tibet, with prevalence higher than in similar studies in eastern China. As elsewhere in the world, women have an excess burden of blindness compared to men.

Prevalence and causes of blindness in a tropical African population.
Adeoti CO. West Afr J Med. 2004 Jul-Sep;23(3):249-52.
A population based survey of Egbedore Local Government area (LGA), a tropical African population in Osun State, Nigeria was conducted to determine the prevalence and causes of blindness in the community, Osun State, It is found that 1.18% of the population was blind by WHO standard. Cataract alone accounted for 47.4% of the blind, uncorrected aphakia 18.4%, glaucoma 15.8%, phthisis bulbi 5.3%, uveitis, optic atrophy, macular degeneration, retinitis pigmentosa and refractive error all accounted for 2.6% each.

Prevalence and causes of visual impairment and blindness in a rural population in Sepang district, Selangor.
Reddy SC, Rampal L, Nurulaini O. Med J Malaysia. 2004 Jun;59(2):212-7.
A community based cross-sectional study was carried out to determine the prevalence and causes of visual impairment and blindness in residents aged forty years and above in kampung Jenderam Hilir of Sepang district, Selangor state. Refractive errors (56%), cataract (20.1%), glaucoma (4.4%) and diabetic retinopathy (1.3%) were found to be causing visual impairment and blindness.

Prevalence of cataract in rural Indonesia.
Husain R et al. Ophthalmology. 2005 Jul;112(7):1255-62.
The aim of this study was to describe the prevalence of cataract in adults in rural Sumatra, Indonesia. Cataract prevalence in adults aged 21 years and older in rural Indonesia is among the highest reported in Southeast Asia.

Prevalence of blindness in people over 40 years in the volta region of ghana.
Guzek JP, Anyomi FK, Fiadoyor S, Nyonator F. Ghana Med J. 2005 Jun;39(2):55-62.
The aim of this study was to assess the presenting visual acuities of individuals who had undergone extracapsular cataract extraction with an intraocular lens implant. Those who had ECCE/IOL surgery had a presenting visual acuity of 20/60 or better in 65% of eyes while those who had ICCE surgery achieved this level in only 30% of eyes.

Prevalence of blindness and low vision of people over 30 years in the Wenchi district, Ghana, in relation to eye care programmes.
Moll AC et al. Br J Ophthalmol. 1994 Apr;78(4):275-9.
A population based survey on the prevalence of major blinding disorders was conducted in the Wenchi district in central Ghana between March and May 1991. The causes of blindness were determined as cataract (62.5%), onchocerciasis (12.5%), corneal opacity (non-trachomatous) (8.2%), refraction anomalies (4.2%), phthisis bulbi (4.2%), optic atrophy (4.2%), and vascular retinopathy (4.2%).

The frequency distribution of ocular disease by age in Imo State Nigeria.
Anyanwu E, Nnadozie JN. J Am Optom Assoc. 1993 Oct;64(10):704-8.
Of the total disease conditions, 42 % fell within the 0-30 age group, 44 % fell within the 31-60 age group and 14 % fell between 61-90. The relative incidence of ocular disease within this clinic population was: 32.8 % conjunctivitis; 28.8 % cataract; 15.5 % glaucoma; 11.5 % pterygium; 1.8 % optic atrophy; and 9.5 % other.

Blindness in the tropics.
Narita AS, Taylor HR. Med J Aust. 1993 Sep 20;159(6):416-20.
Blindness is a major problem in most developing countries. It occurs at ten times the rate seen in the developed countries and in over 80% of cases is either preventable or curable. The four main causes are cataract, trachoma, onchocerciasis and xerophthalmia.

Prevalence and causes of low vision and blindness in northern KwaZulu.
Cook CD, Knight SE, Crofton-Briggs I. S Afr Med J. 1993 Aug;83(8):590-3.
A survey of the prevalence of blindness and low vision was conducted in the Ingwavuma district of KwaZulu to assess the effectiveness of existing eye care facilities in the prevention and treatment of impaired vision and blindness. Existing eye care services for the region have reduced the prevalence of blindness by only 7.0%.

Blindness and eye disease in Kenya: ocular status survey results from the Kenya Rural Blindness Prevention Project.
Whitfield R et al. Br J Ophthalmol. 1990 Jun;74(6):333-40.
A series of eight regional eye surveys were conducted in Kenya as part of the Kenya Rural Blindness Prevention Project. The results showed that 0.7% of rural Kenyans are blind in the better eye by WHO standards, and another 2.5% suffer significant visual impairment.

Ocular disease and ophthalmic services in Malawi.
Chirambo MC, Tizazu T. Soc Sci Med. 1983;17(22):1773-80.
About 1% of the population of Malawi is blind. The major contributors are cataract (40%), trachoma and other infections (15%) and measles/Vitamin A deficiency (15%).

Survey of ophthalmic conditions in rural Lesotho.
Gordon YJ, Mokete M. Doc Ophthalmol. 1980 Oct 15;49(2):285-91.
The first survey of ocular problems in rural Lesotho was conducted by a visiting eye team and consisted of an examination of 1266 ophthalmic clinic patients at 15 representative sites throughout the country. The most common ocular conditions encountered were: conjunctivitis, refractive error, vernalis, senile cataract, glaucoma, corneal opacities and trauma.

Cataract: the leading cause of blindness and vision loss in Africa.
Steinkuller PG. Soc Sci Med. 1983;17(22):1693-702.
Senile cataract is a non-preventable disease of aging, having its biggest impact in the over-60 age group. Published clinic and hospital data, population-based surveys and World Health Organization estimates indicate that 1.2% of the entire population of Africa is blind, and that cataract causes 36% of this blindness.

Prevalence and causes of blindness in the northern Transvaal.
Bucher PJ, Ijsselmuiden CB. Br J Ophthalmol. 1988 Oct;72(10):721-6.
During November 1985 a survey was carried out to determine the prevalence and causes of blindness in the Elim Hospital district of Gazankulu in the Northern Transvaal, South Africa. The main causes of blindness were senile cataract (55%), corneal scarring due to trachoma (10%), uncorrected aphakia (9%), and open-angle glaucoma (6%).

Common causes of blindness in Zaïre.
Kayembe L. Br J Ophthalmol. 1985 May;69(5):389-91.
An analysis of 50 000 patients' medical records was made to determine the commonest causes of blindness in Zaïre. It was found that the commonest causes of blindness in order of frequency were glaucoma (31%), cataract (18.4%), optic atrophy (16.3%), onchocerciasis (4.9%), and corneal leucoma (4.9%).

Causes of blindness in northern Nigeria.
Kragha IK.nAm J Optom Physiol Opt. 1987 Sep;64(9):708-10.
An analysis of the causes of blindness in northern Nigeria was undertaken. The leading causes of blindness in order of frequency of occurrence were cataracts, glaucoma, corneal diseases, trachoma, and trauma.

Prevalence of blindness and visual impairment in the Luapula Valley, Zambia.
Sukwa TY et al. Trop Geogr Med. 1988 Jul;40(3):237-40.
A community based cross-sectional study on the prevalence and causes of blindness and visual impairment was carried out between August and December 1985 in the Luapula Valley. The overall prevalence of monocular and bilateral blindness was 6.9% and 3.6% respectively.

A prevalence survey of ophthalmic diseases among the Turkana tribe in north-west Kenya.
Loewenthal R, Pe'er J. Br J Ophthalmol. 1990 Feb;74(2):84-8.
A prevalence survey of ophthalmic disease was conducted among the Turkana tribe in northwest Kenya. The findings show the prevalence of blindness to be 1.1% and the prevalence of blindness in one eye to be 6.8%. The major causes of blindness up to age 35 were corneal disease from xerophthalmia and trachoma and above age 45 cataract.

Prevalence and causes of blindness in the Congo
Négrel AD et al. Bull World Health Organ. 1990;68(2):237-43. French.
A population-based survey on the prevalence of blindness and eye disease has been conducted throughout the Congo. The prevalence of blindness (visual acuity less than 3/60 in the better eye) was 0.3% (5700 people). The prevalence of low vision (visual acuity between 6/24 and 3/60 in the better eye) was 2.1%.

Trachoma and blindness in the Nile Delta: current patterns and projections for the future in the rural Egyptian population.
Courtright P, Sheppard J, Schachter J, Said ME, Dawson CR. Br J Ophthalmol. 1989 Jul;73(7):536-40.
A population based survey of trachoma and blindness was conducted in a rural Nile Delta hamlet. Of residents 25 years old 90% had substantial conjunctival scarring. Severe conjunctival scarring was commoner among women (84%) than men (58%), and three-quarters of older women had trichiasis/entropion compared with 57% of older men.

Blindness and visual impairment in Anambra State, Nigeria.
Nwosu SN. Trop Geogr Med. 1994;46(6):346-9. Review.
A study of all new patients seen over a 12-month period in a teaching hospital eye clinic in anambra State, Nigeria shows that 257 out of 820 (31.3%) had low vision in at least one eye.

An ophthalmic survey of African patients presenting at rural eye clinics in South Africa.
Herse P. Optom Vis Sci. 1991 Sep;68(9):738-42.
The records of 10,254 people attending rural eye clinics in South Africa during 1984-85 were analyzed to determine the reasons for presentation. The main reasons for presentation were refractive error, conjunctivitis, and cataract.

Community-based eye health survey in areas of Buan-Kun and Dobong-Ku in Korea.
Kim WS, Kim IS, Hu JU, Kim JC, Kim JD, Koo BS. Korean J Ophthalmol. 1990 Dec;4(2):103-7.
This survey comparing the primary causes of eye disease and visual impairment between rural and urban areas was conducted from the beginning of February through May of 1989. In causes of blindness, cataract (51.1%) was followed by macular degeneration (17.4%), corneal opacity (13.0%), and vascular retinopathy (9.8%) in Buan-Kun, while cataract (56.0%), macular degeneration (6.7%), corneal opacity (6.7%), and phthisis (6.7%) were recorded in that order in Dobong-Ku.

The prevalence of age related cataract in the Asian community in Leicester: a community based study.
Das BN, Thompson JR, Patel R, Rosenthal AR. Eye. 1990;4 ( Pt 5):723-6.
A community based ophthalmic survey has been carried out in the city of Leicester. Age-related cataract was found to develop earlier in the Asians. A strict vegetarian diet was found to b e a significant risk factor for age-related cataract in the Asian Community in Leicester.

Causes of blindness and visual handicap in the Central African Republic.
Potter AR. Br J Ophthalmol. 1991 Jun;75(6):326-8.
The causes of bilateral blindness (best visual acuity less than 3/60) in 1371 people in the Central African Republic seen between 1985 and 1989 who attended eye clinics in 10 out of the 16 prefectures across the country are given. The main causes of bilateral blindness were cataract (51%), glaucoma (12.7%), and onchocerciasis (8.1%).

Prevalence and causes of vision loss in central Tanzania.
Rapoza PA, West SK, Katala SJ, Taylor HR. Int Ophthalmol. 1991 Mar;15(2):123-9.
A population-based survey of the prevalence of major blinding disorders was conducted in three villages in central Tanzania. In those age seven and older, the prevalence of bilateral blindness was 1.26% and monocular was 4.32% and the prevalence of visual impairment was 1.75%.

Congenital malformations of the eyeball and its appendices in Zaire
Kaimbo Wa Kaimbo D et al. Bull Soc Belge Ophtalmol. 1994;254:165-70.
The aim of this study was to determine the epidemiology of congenital eye malformations. The prevalence rate of congenital eye malformations was 2.2%. Congenital cataract (38%), atresia of the naso-lacrimal duct (10%), congenital glaucoma (9%), congenital ptosis (8%), microphthalmos (8%), albinism of iris (8%), microcornea (7%) were the most frequent eye malformations.

Congenital eye anomalies in Enugu, South-Eastern Nigeria.
Chuka-Okosa CM, Magulike NO, Onyekonwu GC. West Afr J Med. 2005 Apr-Jun;24(2):112-4.
The goal of this study was to determine the types of congenital ocular anomalies seen in the eye clinic of the University of Nigeria Teaching Hospital Enugu, over an 8-year period from January 1992 to December 1999.  Congenital cataract was the most frequently occurring congenital ocular anomaly (42.6%); followed by congenital glaucoma (22.2%) and anophthalmia/microphthalmia and congenital esotropia (9.3%) each.

Blindness and low vision in adults in Ozoro, a rural community in Delta State, Nigeria.
Patrick-Ferife G, Ashaye AO, Qureshi BM.Niger J Med. 2005 Oct-Dec;14(4):390-5.
The objective of this article is to determine the prevalence and causes of blindness and low vision in Ozoro, a rural town of Delta State in Nigeria, in order to provide baseline information for planning a prevention of blindness programme. The prevalence of blindness for people of 40 years and above was 6.3% and low vision VA 6/24 to 3/60 in the better eye was 25.2%. The estimated prevalence of bilateral blindness for all ages was 1.3% and low vision was 5%.

Causes of blindness in Southwestern Nigeria: a general hospital clinic study.
Oluleye TS, Ajaiyeoba AI, Akinwale MO, Olusanya BA. Eur J Ophthalmol. 2006 Jul-Aug;16(4):604-7.
This hospital-based study was carried out to assess the common causes of blindness in Ibadan, the largest city in the southwestern part of Nigeria, and to strengthen the primary eye care approach to control and reduction of cases of blindness in the community. leading causes of bilateral blindness were cataract, 171 (36%); glaucoma, 138 (29%); and optic atrophy, 21 (4%).

Prevalence and causes of blindness in the rural population of the Chennai Glaucoma Study.
Vijaya L et al. Br J Ophthalmol. 2006 Apr;90(4):407-10.
Reseachers studied the prevalence and causes of blindness in a rural south Indian population. Cataract was responsible in 74.62% of eyes; glaucoma, cystoid macular oedema, optic atrophy, and corneal scars accounted for 3.79% each.

Prevalence and causes of blindness and low vision in southern Sudan.
Ngondi  et al. PLoS Med. 2006 Dec;3(12):e477.
The goal of this research was to estimate the prevalence of blindness and low vision, identify the main causes of blindness and low vision, and estimate targets for blindness prevention programs in Mankien payam (district), southern Sudan. Prevalence of blindness was 4.1%; prevalence of low vision  was 7.7%; whereas prevalence of monocular visual impairment was 4.4%.

Causes of blindness at Nkhoma Eye Hospital, Malawi.
Sherwin JC, Dean WH, Metcalfe NH. Eur J Ophthalmol. 2008 Nov-Dec;18(6):1002-6.
This hospital-based study was undertaken in order to investigate the etiology of blindness at Nkhoma Eye Hospital, Malawi. The most common diagnosis in new outpatients was cataract (52.8%), followed by glaucoma (8.1%), corneal pathology (7.2%), uveitis (4.5%) and maculopathy (3.2%). There were 742 (35.6%) patients with unilateral blindness and 331 (15.9%) patients with bilateral blindness.

Prevalence of idiopathic macular hole in adult rural and urban south Indian population.
Sen P, Bhargava A, Vijaya L, George R. Clin Experiment Ophthalmol. 2008 Apr;36(3):257-60.
This article considered patient sources of knowledge about cataract surgical services, and strategies for financing surgery in rural China. Prevalence rate of idiopathic macular hole in South India appears to be comparable to that seen worldwide.

Ocular health status of rural dwellers in south-western Nigeria.
Adegbehingbe BO, Majengbasan TO. Aust J Rural Health. 2007 Aug;15(4):269-72.
The goal of this study was to determine the prevalence and causes of ocular morbidity, visual impairment and blindness, and suggest strategies for blindness prevention in a rural population. Of the 2201 patients examined, 298 (13.5%) had signs and symptoms of ocular disease. The common eye problems encountered were cataract (48.0%), glaucoma (21.1%), allergic conjunctivitis (16.4%), refractive errors (12.4%), age-related macular degeneration (0.7%) and corneal opacities (0.7%).

The spectrum of Vogt-Koyanagi-Harada disease in Tunisia, North Africa
Khairallah M et al. Int Ophthalmol. 2007 Apr-Jun;27(2-3):125-30.
This study analyzes the clinical profile of Vogt-Koyanagi-Harada (VKH) disease in Tunisia, North Africa. Of all the uveitis cases diagnosed during the study period, VKH disease was the fourth most commonly occurring type (7.4%).

Prevalence of visual impairment and blindness in a Nairobi urban population.
Ndegwa LK, Karimurio J, Okelo RO, Adala HS.East Afr Med J. 2006 Apr;83(4):69-72.
The goal of this study was to determine the prevalence and causes of visual impairment and blindness among Kibera slum dwellers. The prevalence of blindness and visual impairment was 0.6% and 6.2% respectively.

Prevalence and causes of blindness and visual impairment in Muyuka: a rural health district in South West Province, Cameroon.
Oye JE, Kuper H, Dineen B, Befidi-Mengue R, Foster A. Br J Ophthalmol. 2006 May;90(5):538-42.
The purpose of this research was to estimate the prevalence and causes of blindness and visual impairment in the population aged 40 years and over in Muyuka, a rural district in the South West Province of Cameroon. 1787 people were examined (response rate 89.3%). The prevalence of binocular blindness was 1.6%, 2.2% for binocular severe visual impairment, and 6.4% for binocular visual impairment.

Prevalence of blindness and visual impairment in Atakunmosa West Local Government area of southwestern Nigeria.
Onakpoya OH et al. Tanzan Health Res Bull. 2007 May;9(2):126-31.
The objective of this study was to define areas of eye care need and develop programme for elimination of avoidable blindness in the region. Blindness was caused mainly by cataract (57.2%), glaucoma (14.3%) and congenital childhood blindness (14.3%). Cataract (57.7%), glaucoma (16.7%) and uncorrected refractive error (15.4%) were the leading causes of visual impairment. Blindness was avoidable in 85.7% of cases.

Ophthalmological screening via a hospital boat : Field study for planning future health care services in remote villages at the Volta Lake in Ghana.
Frimpong-Boateng A et al. Ophthalmology. 2008 Sep 11. German.
A maiden voyage on a hospital boat was carried out to determine the spectrum of ophthalmological diseases in a rural and secluded area on the Volta Lake in Ghana in order to improve future health care services. A total of 1,246 citizens were examined. The mean age was 23.7 years and the mean visual acuity was 6/6 (log MAR 0.0+/-0.3. The main cause of blindness was a cataract with 45.8%, followed by pathological conditions of the optic disc with 29.2%.

Functional presbyopia in a rural Kenyan population: the unmet presbyopic need.
Sherwin JC et al. Clin Experiment Ophthalmol. 2008 Apr;36(3):245-51.
The aim of this study was to estimate the prevalence of presbyopia, and the functional impairment and spectacle use among persons with presbyopia in a rural Kenyan population. Survey analysis found that there is a high prevalence of uncorrected presbyopia in low-income regions, which is associated with near-vision functional impairment.

Spectrum of eye disorders among diabetes mellitus patients in Gaborone, Botswana.
Mengesha AY. Trop Doct. 2006 Apr;36(2):109-11.
This cross-sectional study was designed to determine the spectrum and prevalence of eye disorders among diabetes mellitus (DM) patients in Gaborone, Botswana. Refractive error (29.2%) was the most prevalent followed by cataract (20.2%), retinopathy (9.2%), pterygeum (6.7%), glaucoma (2.5%) and keratopathy (0.7%).

Blindness and visual impairment among the elderly in Ife-Ijesha zone of Osun State, Nigeria.
Adegbehingbe BO et al. Indian J Ophthalmol. 2006 Mar;54(1):59-62.
This study provides information on the prevalence of visual impairment, blindness and the leading causes of visual changes among the elderly in Ife-Ijesha zone of Osun state in Nigeria. Out of the 681 elderly who presented for medical checkup, 445 had eye problems.

A proposed rapid methodology to assess the prevalence and causes of blindness and visual impairment.
Dineen B, Foster A, Faal H. Ophthalmic Epidemiol. 2006 Feb;13(1):31-4.
The goal of this study was to determine whether a sample of the 50-year-old and above population would provide comparable information to a total population-based survey. The distribution by cause of blindness was similar for the total population and for those aged 50 years and above. Cataract and uncorrected aphakia accounted for 46% and 13%, respectively, in the total population and 48% and 15% in the 50 year and above age group.

Ocular disease at Lere local government outreach post in Kaduna State of northern Nigeria
Ogwurike SC. West Afr J Med. 2007 Jan-Mar;26(1):20-3.
The aim of the study was to analyse the ocular diseases that were seen at an outreach post. Bacterial conjunctivitis was the most commonly occurring condition at (23.3%) of the total followed by cataracts constituting (16.3 %) of all diagnoses. This was closely followed by vernal and allergic conjunctivitis making up 11.6% and 11.3% respectively.

Assessment of visual status of the Aeta, a hunter-gatherer population of the Philippines (an AOS thesis).
Allingham RR. Trans Am Ophthalmol Soc. 2008;106:240-51.
A screening study was performed to assess levels of visual impairment and blindness among a representative sample of older members of the Aeta, an indigenous hunter-gatherer population living on the island of Luzon in the Philippines. Visual impairment was present in 48% of uncorrected and 43% of pinhole corrected eyes in the oldest age-group. Six % of the screened population was bilaterally blind. The major causes of blindness were readily treatable.

Prevalence of eye signs in congenital rubella syndrome in South India: a role for population screening.
Vijayalakshmi P et al. Br J Ophthalmol. 2007 Nov;91(11):1467-70.
This population-based study was aimed at screening children below 5 years of age for ocular signs suspicious of CRS. Cataracts among children have a high sensitivity for detecting CRS in India. It is the only clinical eye finding that has a high enough sensitivity and specificity to be useful as a screening tool for CRS.

Magnitude and causes of unilateral absolute blindness in a region of Oman: a hospital-based study.
Bansal RK, Khandekar R, Nagendra P, Kurup P. Eur J Ophthalmol. 2007 May-Jun;17(3):418-23.
The aim of this study was to report the magnitude and causes of unilateral absolute blindness and barriers faced by persons with unilateral blindness in the South Batinah region of Oman. Cataract and glaucoma were important determinants of visual impairment in the fellow eyes of this cohort. These patients are at higher risk of developing bilateral impairment and need special care to prevent/treat visual disabilities in the fellow eyes.

Epidemiology of Bietti's keratopathy. Study of risk factors in Central Africa (Chad)
Resnikoff S. J Fr Ophtalmol. 1988;11(11):733-40. French.
A significant relation between the CDK prevalence and the kind of climate was found: the more the climate is dry; the more the higher the frequency: subdesert area = 1.57%, Sahelian area = 0.73%, tropical area = 0.18%.

Cataract survey in the local area using photographic documentation.
Sasaki K et al. Dev Ophthalmol. 1987;15:28-36.
An epidemiological survey of cataract was performed in a limited local population. The % prevalence of cataracts including early senile changes was 33.9% in the 40-year-old population, 62.8% in the 50, 76.2% in the 60, 84.0% in the 70 and 100% for those in their 80s.

Causes and prevalence of blindness in the Northern Province of Sierra Leone.
Stilma JS, Bridger S. Doc Ophthalmol. 1983 Dec 15;56(1-2):115-22.
The causes of blindness in Sierra Leone were studied in 7286 new patients attending the eye clinic in the year 1981. Blindness was present in 762 persons, due to cataract (39%), ocular onchocerciasis (30%), primary glaucoma (8%), measles keratitis (3%), trachoma (3%) and other causes.

The causes and profile of visual loss in an onchocerciasis-endemic forest-savanna zone in Nigeria.
Umeh RE. Ophthalmic Epidemiol. 1999 Dec;6(4):303-15.
In an onchocerciasis-endemic forest-savanna mosaic zone of southeastern Nigeria, blindness was found in 5.4% of 1,217 people who voluntarily attended for examination from a population of 14,000. Apart from cataract, the most important causes of blindness in the area were eye diseases that are known to be associated with onchocerciasis.

 Acceptability of aphakic correction. Results from Karnali eye camps in Nepal.
Hogeweg M, Sapkota YD, Foster A. Acta Ophthalmol (Copenh). 1992 Jun;70(3):407-12.
Of 235 aphakic patients followed for 1-10 years in Karnali, Nepal, 23% were wearing aphakic spectacles in good condition, 25% had lost or broken their spectacles, 31% were wearing scratched or repaired spectacles, 5% never received spectacles and 16% were dissatisfied, of which 84% still had good phakic vision in the fellow eye.

Increase in mortality associated with blindness in rural Africa.
Taylor HR, Katala S, Muñoz B, Turner V. Bull World Health Organ. 1991;69(3):335-8.
Forty-seven persons were identified with visual impairment (visual acuity of 6/60 or less in their better eye) during a population-based survey in 1986 of eye disease in three villages in central Tanzania. Four years later, 41 (87%) of them and 70 (82%) of 84 age-, sex-, and village-matched controls with normal functional vision were traced, and those who were still alive were re-examined.

Causes of blindness in the western province of Cameroon.
Tabe Tambi F. Rev Int Trach Pathol Ocul Trop Subtrop Sante Publique. 1993;70:185-97.
2,600 patients (1,416 females and 1,244 males) were consulted in the lone eye department of the Western Province of the Republic of Cameroon during the one-year period from 1st March 1991 to 29th February 1992. The main causes of bilateral blindness were: cataract (43.2%), glaucoma (20.4%), uveitis (8.5%), onchocerciasis (8.5%), cortical and visual pathway dysfunction (7.4%), and others (12%).

Ocular morbidity at a small eye unit in Jimma town, south western Ethiopia: a three year analysis.
Zerihun N. East Afr Med J. 1994 Jul;71(7):470-2.
Conjunctivitis, trachoma, cataract, and refractive errors, were the leading causes of ocular morbidity accounting for 35.5%, 16.8%, 10.6% and 9.7% of the cases respectively.

Blindness from uveitis in a hospital population in Sierra Leone.
Ronday MJ, Stilma JS, Barbe RF, Kijlstra A, Rothova A. Br J Ophthalmol. 1994 Sep;78(9):690-3.
A retrospective study was conducted to assess the causes of blindness and visual impairment in patients who visited an eye hospital in Sierra Leone, West Africa, in 1989 and 1992. An increasing number of patients with uveitis from non-onchocercal origin was observed: almost 10% of the blindness found in 1992 was due to uveitis of non-onchocercal origin.

Risk factors for cataract: a case control study.
Ughade SN, Zodpey SP, Khanolkar VA. Indian J Ophthalmol. 1998 Dec;46(4):221-7.
This study was designed as a hospital-based, group-matched, case-control investigation into the risk factors associated with age-related cataract in central India.  14 risk factors were found significantly associated with age-related cataract.

Distribution and aetiology of blindness and visual impairment in mesoendemic onchocercal communities, Kaduna State, Nigeria. Kaduna Collaboration for Research on Onchocerciasis.
Abiose A et al. Br J Ophthalmol. 1994 Jan;78(1):8-13. Erratum in: Br J Ophthalmol 1995 Feb;79(2):197.
A total of 185 individuals (2.7%) were bilaterally blind by acuity criteria with a further 28 blind by field constriction. The overall prevalence of blindness was 3.1%. A further 118 individuals were visually impaired by WHO criteria.

Epidemiological aspects of visual impairment above 50 years in a rural area.
Singh MC, Murthy GV, Venkatraman R, Nayar S. J Indian Med Assoc. 1994 Nov;92(11):361-3, 365.
A cross-sectional survey was conducted in 5 villages in central India to find out the extent, causes and epidemiological factors for visual impairment among 903 individuals aged above 50 years; 44.3% of them were visually impaired (29.4% with low vision and 14.9% blind).

Blindness and low vision in Jimma Zone, Ethopia: results of a population-based survey.
Zerihun N, Mabey D. Ophthalmic Epidemiol. 1997 Mar;4(1):19-26.
A population-based study on the prevalence of blindness and low vision was carried out in Jimma Zone, south-western Ethiopia between November 1994 and January 1995. Sixty-three (0.85%) were blind (visual acuity less than 3/60 in the better eye) and 125 people (1.7%) had low vision (less than 6/18-3/60).

Cataract, glaucoma and season of birth amongst patients born on the Indian subcontinent.
Weale RA. Indian J Ophthalmol. 1998 Dec;46(4):211-5.
The relation between the prevalence of open-angle glaucoma and of different types of cataract on the one hand and the patient's season of birth on the other was studied with special reference to natives of the Indian Subcontinent. Both primary open-angle glaucoma (POAG) and the mixed nuclear/posterior-subcapsular type (NP) showed a statistically significant variation with the month of birth for the Asian patients, but only NP showed significant variation for the European patients in a month-by-month analysis.

Prevalence of blindness and its causes among those aged 50 years and above in rural Karnataka, South India.
Chandrashekhar TS, Bhat HV, Pai RP, Nair SK. Trop Doct. 2007 Jan;37(1):18-21.
The study aimed to estimate the prevalence of blindness and its causes among those aged 50 years and above in rural Karnataka. The study area has a high burden of cataract blindness. Cataract surgical services should be made readily accessible and available to this rural population.

Burden of moderate visual impairment in an urban population in southern India.
Dandona L et al. 1999 Mar;106(3):497-504.
This study assessed the prevalence and causes of moderate visual impairment in an urban population in southern India. Projecting the results to the 26.5% urban population of India, there would be 18.4 million (95% CI, 11.5-25.2 million) persons with moderate visual impairment in urban India alone. Refractive error was the major cause of moderate visual impairment in the population studied.

Eye diseases in general out-patient clinic in Ibadan.
Scott SC, Ajaiyeoba AI.Niger J Med. 2003 Apr-Jun;12(2):76-80.
This study was carried out to determine the pattern of eye diseases presenting to the general out-patient clinic and compare it with those in the ophthalmic clinic. (32.9%), cataract (14.7%), ocular injuries (12.8%), refractive errors (9.9%) and glaucoma (5.3%) were common eye conditions. Diseases of ocular adnexa, scleritis, aphakia and orbital tumours were rare.

Causes of low vision and blindness in rural Indonesia.
Saw SM, Husain R, Gazzard GM, Koh D, Widjaja D, Tan DT. Br J Ophthalmol. 2003 Sep;87(9):1075-8.
The objective of this study was to determine the prevalence rates and major contributing causes of low vision and blindness in adults in a rural setting in Indonesia. The major contributing causes for bilateral low vision were cataract (61.3%), uncorrected refractive error (12.9%), and amblyopia (12.9%), and the major cause of bilateral blindness was cataract (62.5%).

Congenital eye diseases at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria.
Bodunde OT, Ajibode HA. Niger J Med. 2006 Jul-Sep;15(3):291-4.
A retrospective study which reviewed the case notes of patients at OOUTH, Sagamu, Nigeria was conduced in order to document the causes of congenital eye disease.   The most common congenital disorders are cataract 50 (47.6%), congenital glaucoma 15 (14.3%), Dacryostenosis 11 (10.5%), and corneal opacity 6 (5.7%) which are causes of preventable blindness.

Prevalence of lens opacities in North India: the INDEYE feasibility study.
Murthy GV et al. Invest Ophthalmol Vis Sci. 2007 Jan;48(1):88-95.
This study sought to obtain estimates of the prevalence of lens opacities in an Indian setting by using photographically acquired lens images. Results highlight the substantial excess of lens opacities in India compared with Western populations.

Congenital eye and adnexial anomalies in Kano, a five year review.
Lawan A. Niger J Med. 2008 Jan-Mar;17(1):37-9.
The aim of the study is to determine the types of congenital eye and adnexial anomalies seen in the eye clinic of Aminu Kano Teaching Hospital Kano, Nigeria between the years 2001 to 2005. The commonest congenital anomalies are buphthalmos in 38%, cataracts in 35%, and naso lachrymal duct obstruction in 14%. Other less frequent anomalies are anophthalmia/micophthalmia, limbal dermoid cysts and aniridia.

Population-based study of presbyopia in rural Tanzania.
Burke AG et al. Ophthalmology. 2006 May;113(5):723-7.
This study determined the prevalence of presbyopia in a rural African population. The odds of developing presbyopia increased 16% per year of age from age 40 to 50, but the increase was nonsignificant at 1% per year after age 50. More severe presbyopia was associated with female gender and less with education.

Eye disease in Wesley Guild Hospital, Ilesa, Nigeria.
Adeoye AO, Omotoye OJ. Afr J Med Med Sci. 2007 Dec;36(4):377-80.
The purpose of the study is to determine the prevalence and causes of eye disease in Wesley Guild Hospital, Ilesa in order to provide a database for the planning of primary eye care delivery system. The leading diagnoses were cataract (26.0%), refractive error (18.5%), allergic conjunctivitis (12.4%) and glaucoma (10.9%).

Prevalence and causes of vision impairment and blindness in older adults in Brazil: the Sao Paulo Eye Study
Salomao SR et al. Ophthalmic Epidemiol. 2008 May-Jun;15(3):167-75
The goal of this study was to investigate prevalence and causes of vision impairment/blindness in older adults in a low-middle income area of Sao Paulo, Brazil. Presenting blindness was associated with older age and lack of schooling. Retinal disorders (35.3%) and cataract (28.3%) were the most common causes of blind eyes. Cataract (33.2%), refractive error (32.3%), and retinal disorders (20.3%) were the main causes of vision impairment with refractive error (76.8%) and cataract (12.2%) as main causes for eyes with acuity < 20/32 to > or = 20/63.

Prevalence and causes of low vision and blindness in a rural chinese adult population: the Handan Eye Study.
Liang YB et al. Ophthalmology. 2008 Nov;115(11):1965-72.
This study sought to describe the prevalence and causes of low vision and blindness in a rural population in Northern China. A higher prevalence of blindness and low vision was seen in this rural Chinese sample than has been reported from urban Chinese populations.

Influence of tobacco use on cataract development
Raju P et al. Br J Ophthalmol. 2006 Nov;90(11):1374-7.
This research attempted to study the influence of tobacco use on cataract formation in a rural South Indian population. Tobacco use was significantly associated with cataract. Smoking was not found to be significantly associated with cataract formation; however, smokeless tobacco use was more strongly associated with cataract.

Case-control study of indoor cooking smoke exposure and cataract in Nepal and India.
Pokhrel AK, Smith KR, Khalakdina A, Deuja A, Bates MN. Int J Epidemiol. 2005 Jun;34(3):702-8.
This study provides confirmatory evidence that use of solid fuel in un-flued indoor stoves is associated with increased risk of cataract in women who do the cooking. The association is not likely to be due to bias, including confounding, and strengthens the findings of three previous studies.

Pattern of treatment compliance among eye patients in a North Indian town.
Sharma M, Singh A. Ann Ital Chir. 2008 Sep-Oct;79(5):341-6.
The aim of this study was to estimate the burden of ocular morbidity in the study area and to ascertain the treatment seeking behavior of patients having ocular morbidity with particular emphasis on the degree of treatment compliance.  High prevalence of ocular morbidity was largely ignored by the sufferers. Three fourths of the patients did not comply with the treatment advised.

Prevalence of blindness and low vision in north central, Nigeria.
Rabiu MM, West Afr J. Med. 2008 Oct; 27(4): 238-44.
This study examined a population of 8,400 people in 120 communities. The prevalence of blindness in Kaduna State of Nigeria was .6%, and the prevalence of low vision was 3.2%.  Cataract accounted for 37.8%, glaucoma for 21.6%, and refractive error for 8.1%. 

Cataract in rural Myanmar: prevalence and risk factors from the Meiktila Eye Study.
Athanasiov PA, Casson et al. Br J Ophthalmol. 2008 Sep;92(9):1169-74.
To determine the prevalence of and risk factors for cataracts in a rural region of central Myanmar. The prevalence of cataract in rural Myanmar is similar to that in other developing Asian regions. Cataracts are strongly associated with increasing age, and are more common in those with lower education and lower body mass index.

Ocular Injuries

Ocular injuries in a rural Ethiopian community.
Tesfaye A, Bejiga A. East Afr Med J. 2008 Dec;85(12):593-6.
This study assesses the causes, magnitude, risk factors and visual impact of ocular injury. Ocular injury is significant (5.1%) in the community and causes monocular visual impairment in about one third (34.6%) of cases.

Epidemiological study of ocular trauma in an urban slum population in Delhi, India.
Vats, S., Murthy, G., Chandra, M., Gupta, S. K., Vashist, P., Gogoi, M.Indian J Ophthalmol 2008;56:313-6.
This cross-sectional study, conducted on 500 families each in three randomly selected urban slums in Delhi, collected demographic data for all members of these families, and clinical data for all those who suffered ocular trauma at any time, that required medical attention. Mean age at trauma was 24.2 years and the association between the age of participants and the history of ocular trauma was significant, when adjusted for sex, education and occupation.

Tears while cooking: an indicator of indoor air pollution and related health effects in developing countries.
Ellegård A. Environ Res. 1997 Oct;75(1):12-22.
Indicators for cooking fuel pollution are needed to determine the extent of fuel-related problems in developing countries and to assess the success of measures undertaken to reduce such problems. It is proposed that eye irritation in the form of tears or smarting eyes during cooking time [tears while cooking (TWC)] is a useful determinant of indoor air pollution from cooking-related sources.

Chemical injuries to the eye in Benin City, Nigeria.
Ukponmwan CU. West Afr J Med. 2000 Jan-Mar;19(1):71-6.
Twelve patients were seen with chemical injury to the eye over a five year period. The most common injurious agent was ammonia. Complications seen were corneal opacification in ten patients, symblepharon in nine patients, entropion, ectropion, cataract and staphyloma developed in some of the patients.

Ocular injuries in Malawi.
Ilsar M, Chirambo M, Belkin M. Br J Ophthalmol. 1982 Feb;66(2):145-8.
A survey was made of 205 patients admitted to hospital for ocular trauma in Malawi in south-east Africa from January 1976 to December 1977. Results of the survey show that eye trauma is a relatively common problem in this developing country, occurring most frequently in children, young adults, and males.

Eye health of industrial workers in Southeastern Nigeria.
Okoye OI, Umeh RE. West Afr J Med. 2002 Apr-Jun;21(2):132-7.
A cross-sectional ophthalmological survey to determine the ocular health in Nigerian industries was undertaken in four randomly selected industrial establishments in Enugu State of Nigeria. Of the 646 workers, 184 (28.5%) had a history of industrial accidents, 81 (12.5%) of which affected the eye. Eye injury was most commonly caused by metal chips, cement dust, fragments of wood, pieces of coal stone and welders' arc rays all of which could be prevented by wearing appropriate protective eye coverings.

Perforating eye injuries in KwaZulu.
Cook CD. S Afr Med J. 1991 Nov 2;80(9):441-4.
Data on 100 consecutive perforating eye injuries treated at Edendale Hospital, Pietermaritzburg, was collected in order to evaluate some of the features of this condition seen in KwaZulu, and also to assess the outcome of current management. Fifty-six of the injuries were due to assault and 44 were accidental.

Epidemiology of eye injuries in rural Tanzania.
Abraham DI, Vitale SI, West SI, Isseme I. Ophthalmic Epidemiol. 1999 Jun;6(2):85-94.
This study presents five- year data on hospitalized ocular injuries in a rural region in Tanzania. A third of the injuries occurred in those less than age 20. Injury with a stick was the most common cause, accounting for 67% of the cases.

Demography and prognostic factors of ocular injuries in South India.
Gothwal VK, Adolph S, Jalali S, Naduvilath TJ. Aust N Z J Ophthalmol. 1999 Oct;27(5):318-25.
The purpose of this study was to evaluate the extent of visual recovery after multi-disciplinary approach of treatment in serious ocular injuries; to determine the prognostic factors associated with poor final visual outcome and suggest adequate precautionary measures. Direct ocular trauma remains an important potentially preventable cause of ocular morbidity, but the advent of modern surgical techniques can often restore useful vision in such situations.

Ocular morbidity and fuel use: an experience from India.
Saha A, Kulkarni PK, Shah A, Patel M, Saiyed HN. Occup Environ Med. 2005 Jan;62(1):66-9.
The association of fuel use and ocular morbidity in a village in western India was investigated in a cross sectional prevalence survey involving 469 randomly selected subjects. Wood use was found to be an important factor in the etiology of age dependent cataract.

Ocular manifestations in bidi industry workers: possible consequences of occupational exposure to tobacco dust.
Mittal S, Mittal A, Rengappa R. Indian J Ophthalmol. 2008 Jul-Aug;56(4):319-22.
The goal of this study was to identify probable effects of occupational tobacco exposure among south Indian bidi-industry workers. Results suggested that a wide spectrum of ocular complications exist among these workers. Common ocular symptoms were defective vision, dull-aching headache and eye irritation.

The health of the workers in a rapidly developing country: effects of occupational exposure to noise and heat.
Gomes J, Lloyd O, Norman N. Occup Med (Lond). 2002 May;52(3):121-8.
This cross-sectional study was undertaken to assess the exposure to noise and heat, and to study the level of occupational hygiene practiced, at a foundry in a rapidly developing country.  Mild or moderate visual defects were observed among 31% of foundry workers.

Pattern and visual outcome of eye injuries in children at Abakaliki, Nigeria.
Onyekonwu GC, Chuka-Okosat CM. West Afr J Med. 2008 Jul;27(3):152-4.
The goal of this study was to ascertain the pattern and visual outcome following eye injuries in children at Abakaliki, a largely agricultural community in Southern Eastern Nigeria.  The 119 medical records of patients (adults and children) with eye injuries within the study period, 34 (28.6%) patients were those of children aged 0-15 years.

Co-Morbidities

Risk of cataract and history of severe diarrheal disease in southern India.
Bhatnagar R et al. Arch Ophthalmol. 1991 May;109(5):696-9.
A case-control study was carried out in the state of Tamil Nadu, southern India, to examine the association between the risk of visually disabling cataract and a lifetime history of severe diarrhea (including cholera). Findings of this study do not support the hypothesis of an increased risk of visually disabling cataract in persons with a positive history of severe diarrhea.

Rubella infection and other factors associated with congenital cataracts in Cape Town.
Kipps A, Sevel D, McIntyre J. S Afr Med J. 1979 Feb 17;55(7):245-7.
An analysis of 56 patients with congenital cataracts was made to determine which factors played a role in the causation of these lenticular defects in Cape Town. There is good evidence that 16% of the defects were caused by intra-uterine rubella virus infection and that a further 30% were hereditary in origin.

Dietary and lifestyle patterns in the aetiology of cataracts in Nigerian patients.
Ojofeitimi EO, Adelekan DA, Adeoye A, Ogungbe TG, Imoru AO, Oduah EC. Nutr Health. 1999;13(2):61-8.
The objective of the study was to assess the dietary and lifestyle habits of patients with cataracts. The study showed that higher %ages of controls than patients had adequate intakes of fruits and vegetables. Vitamin supplement usage was also higher in controls than patients. There was a strong negative association between past history of smoking, alcohol consumption and cataract.

Bilateral cataracts as the presenting manifestation of chronic renal failure.
Chugh SK, Goel A. J Assoc Physicians India. 1992 Apr;40(4):273-4.
A 26 year old female, a case of chronic renal failure secondary to chronic pyelonephritis with renal osteomalacia, came with dimunition vision as the presenting complaint. She was found to have bilateral cataracts. All other known causes of cataract were excluded. Cataracts due to hypocalcaemia in chronic renal failure are a rare phenomenon.

Visual problems among people with mental retardation.
Isralowitz R, Madar M, Lifshitz T, Assa V. Int J Rehabil Res. 2003 Jun;26(2):149-52.
Results of this prospective study were based on interviews and eye ophthalmologic screening of 106 adults with a moderate level of mental retardation, ranging in ages from 19 to 62 years. Findings show that only 3% of those interviewed recalled having had an eye examination, yet 24% reported that they had visual problems.

Relationship between measles, malnutrition, and blindness: a prospective study in Indian children.
Reddy V et al. Am J Clin Nutr. 1986 Dec;44(6):924-30
A prospective study was conducted in slum children to determine the incidence of post-measles corneal disease and to clarify its relationship with nutritional status. There were no significant differences in the serum levels for those with and without eye lesions, which suggests that these lesions may not be mediated simply through the effect of infection on serum concentration of vitamin A.

The epidemiology of low vision and blindness associated with trichiasis in southern Sudan
Ngondi J et al. BMC Ophthalmol. 2007 Aug 28;7:12.
This study investigated vision status associated with trachomatous trichiasis (TT) and explored age-sex patterns of low vision and blindness associated with trichiasis in Mankien district of southern Sudan where trachoma prevention and trichiasis surgery were absent. Almost 1 in 20 of the entire population suffered low vision or blindness associated with trachoma.

Ocular complications in diabetes mellitus in Zaire
Kaimbo DK, Kabongo BK, Missotten L. Bull Soc Belge Ophtalmol. 1995;255:107-13. French.
The purpose of this study was to determine the incidence of ocular complications of diabetes in Zaïre. Ocular complications were found in 200 (52%) of 382 patients and included diabetic retinopathy (32%), cataract (18%) and other manifestations (vitreous hemorrhage, diabetic papillopathy, neovascular glaucoma, rubeosis iridis, keratitis, hordeolum) were rare (2%).

Systemic diseases in age related cataract patients.
Ram J, Pandav SS, Ram B, Arora FC. Int Ophthalmol. 1994;18(3):121-5.
In order to determine the prevalence of associated systemic disease, we carried out a large eye camp based study in 6103 age related cataract patients. Seventeen % of our patients had systemic problems. Pulmonary disease was seen in 4.3%, cardiovascular disease and hypertension in 4.1%, diabetes mellitus in 3.8%, skin disorder in 1.4%, orodental disease requiring tooth extraction in 3%, and other diseases were seen in 0.4% of the cases.

Ocular manifestations of leukaemia in Ethiopians.
Alemayehu W, Shamebo M, Bedri A, Mengistu Z. Ethiop Med J. 1996 Oct;34(4):217-24.
Results of a prospective ophthalmic evaluation of 74 newly diagnosed and 34 old (on follow-up) leukaemic patients, carried out from March 1990 to December 1995 is described. Primary ocular involvement, that is leukaemic retinal infiltrates, were detected in 32% of the newly diagnosed. In contrast, none of the old leukaemic patients had this lesion.

The socioeconomic impact of human immunodeficiency virus / acquired immune deficiency syndrome in India and its relevance to eye care.
Murthy GVS. Indian J Ophthalmol. 2008 Sep-Oct;56(5):395-7.
Human immunodeficiency virus and blindness are both associated with discrimination, stigma and long-term consequences. They impact the socioeconomic fabric of the affected individuals, communities and countries. The loss in productivity and the cost of support to the affected individuals are seen in both.

Vitamin and mineral deficiencies in the developed world and their effect on the eye and vision.
Whatham A et al. Ophthalmic Physiol Opt. 2008 Jan;28(1):1-12. Review.
Vitamin and mineral deficiencies are common in developing countries, but also occur in developed countries. Authors review micronutrient deficiencies for the major vitamins A, cobalamin (B(12)), biotin (vitamin H), vitamins C and E, as well as the minerals iron, and zinc, in the developed world, in terms of their relationship to systemic health and any resulting ocular disease and/or visual dysfunction.

A study of factors related to the incidence of cataract in patients with non-insulin dependent diabetes mellitus.
Xia X, Zhang X, Xia H. Yan Ke Xue Bao. 2001 Sep;17(3):180-2.
This study investigated the factors related to the development of cataract in patients with non-insulin dependent diabetes mellitus(NIDDM). The findings indicate that prolongation of the duration of non-insulin dependent diabetes mellitus, renal dysfunction, as well as poor blood glucose control, may accelerate the development of cataract.

Ocular diseases in patients with rheumatic diseases.
Ausayakhun S, Louthrenoo W, Aupapong S. J Med Assoc Thai. 2002 Aug;85(8):855-62.
To study the distribution of ocular involvement among persons with rheumatic disease, a cross-sectional survey was performed in 224 patients attending the Division of Rheumatology, Department of Medicine, Maharaj Nakorn Chiang Mai Hospital. It was found that the ocular involvement probably related to diseases including dry eye (19.9%) and uveitis (0.4%). 

Smoking and its association with cataract: results of the Andhra Pradesh eye disease study from India.
Krishnaiah S et al. Invest Ophthalmol Vis Sci. 2005 Jan;46(1):58-65.
The aim of this study was to investigate the associations between tobacco smoking and various forms of cataracts among the people of a state in India. Increasing age was significantly associated with all cataract types and history of prior cataract surgery and/or total cataract. In multivariate analyses, after adjusting for all demographic factors and for history of smoking, females, illiterate persons, and those belonging to the extreme lower socioeconomic status group were found to have a significantly higher prevalence of any cataract.

Ocular findings in individuals with intellectual disability.
Karadag R et al. Can J Ophthalmol. 2007 Oct;42(5):703-6.
The purpose of the study was to assess refractive errors and ocular abnormalities in intellectually disabled (ID) children and adults. Ocular problems are common in ID individuals and are frequently correctable. Authors suggest that professionals provide early ophthalmologic examination and regular follow-up of young ID individuals.

HIV seroprevalence in ophthalmologic patients of Cameroon
Wilhelm F, Herz E, McArthur C, Werschnik C. Ophthalmologe. 2004 Sep;101(9):941-4. German.
Of the 2452 screened patients, 467 (19.0%) were HIV seropositive. A positive test result was obtained in 29 (5.5%) of the 525 patients in group 1, 154 (35.6%) of the 433 patients in group 2, and 284 (19.0%) of the 1494 patients in group 3. The main ocular manifestations of the 154 HIV-seropositive patients in group 2 were uveitis (17.6%), squamous cell carcinoma of the conjunctiva (14.9%), zoster ophthalmicus (14.9%), and corneal ulcers (11.0%).

The association between body mass index and age related cataract.
Noran NH, Nooriah S, Mimiwati Z. Med J Malaysia. 2007 Mar;62(1):49-52.
This study was carried out to determine the association between body mass index and age related cataract among patients attending eye clinic. Results showed no association between body mass index and age related cataract.

HIV/AIDS in ophthalmic patients: The Guinness Eye Centre Onitsha experience.
Nwosu NN. Niger Postgrad Med J. 2008 Mar;15(1):24-7.
This study sought to determine the incidence and pattern of ocular problems of HIV/AIDS at the Guinness Eye Centre Onitsha, Nigeria. Herpetic eye disease constituted 50% of the cases with herpes zoster ophthalmicus accounting for 48%. Bilateral ocular disease occurred in 19 patients (19%) viz: cytomegalovirus (CMV) retinitis (6%); corneal ulcers (6%); uveitis (4%); ocular motor palsy (2%) and ocular gunshot injury (1%).

Carotenoid status of pregnant women with and without HIV infection in Malawi.
Lan Y et al. East Afr Med J. 1999 Mar;76(3):133-7.
This is a cross-sectional study that characterized the major plasma carotenoids in 900 pregnant women with and without HIV infection in Blantyre, Malawi. There were no significant differences in plasma carotenoid levels between HIV-positive and HIV-negative women.

Glaucoma

Glaucoma in Congo.
Kaimbo Wa Kaimbo D, Missotten L.Bull Soc Belge Ophtalmol. 1997;267:21-6.
This study was conducted to determine frequencies of various types of glaucoma in an urban community of Congo. e frequency distribution of the various subtypes of glaucoma was: open-angle glaucoma (72.2%
), aphakic glaucoma (9%), uveitis glaucoma (6%), etc.

The problem of glaucoma in Africa--progress report from Cameroon
Werschnik C et al. 2005 Oct;222(10):832-4. German.
Medical therapy of glaucoma and also the surgical procedures are limited -- modern antiglaucomatosa are not available. We achieved sufficient regulation of intraocular pressure after trabeculectomy with or without cataract surgery in many cases. The success rate was decreased by severe scar reactions especially in young black people. In advanced glaucoma cases and oculus ultimus we also used the old techniques of iridencleisis.

Glaucoma in Zulus: a population-based cross-sectional survey in a rural district in South Africa.
Rotchford AP, Johnson GJ. Arch Ophthalmol. 2002 Apr;120(4):471-8.
The aim of this study was to determine the prevalence and the main types of glaucoma in a representative adult population in rural Zululand, and to describe the distribution of glaucoma-related variables in healthy subjects and those with glaucoma. The prevalence of glaucoma of all types was 4.5%, and primary open-angle glaucoma accounted for 2.7%.

Glaucoma care and clinical profile in Priest Hospital, Thailand.
Sothornwit N, Jenchitr W, Pongprayoon C. J Med Assoc Thai. 2008;91 Suppl 1:S111-8.
The aim of this study was to assess the prevalence, mechanism and status of glaucoma, and to investigate the magnitude of visual impairment from glaucoma and its relating factors in Buddhist priest and novices. Glaucoma was diagnosed in 106 (77%) patients (181 eyes); 31 patients (23%) were glaucoma suspects.

A novel approach to glaucoma screening and education in Nepal.
Thapa SS, Kelley KH, Rens GV, Paudyal I, Chang L. BMC Ophthalmol. 2008 Oct 26;8:21.
From 2004 to 2007 screening at the annual Glaucoma Awareness Week resulted in the diagnosis of 120 individuals with glaucoma, or 7.6% of total registrants.

Is the season of birth a risk factor in glaucoma?
Weale R. Br J Ophthalmol. 1993 Apr;77(4):214-7.
Several lines of research suggest that some systemic diseases, often associated with age-related conditions, may present with enhanced prevalences owing to very early influences on human development. Sex and season of birth can play a statistically significant role in the prevalence of glaucoma, which raises the possibility that environmental influences may be involved.

Glaucoma characteristics in 13 families of 2-4 generations
Agla EK, Balo KP, Agamah AK, Banla M, Koffi Gué BK. J Fr Ophtalmol. 2003 Feb;26(2):169-74. French.
From glaucomatous propositus and the presence of blindness unrelated to cataract in the ascendants, we carried out a family survey, drew up 13 family trees covering 2-4 generations in 190 participants. Glaucomatous blindness was found in 4.2% of the subjects while 2.1% presented severe vision problems, for a total of 6.3% partially sighted persons due to glaucoma in the group of 190 participants. Glaucoma was confirmed in 57 participants (30%); 24.2% had a bilateral deficit compared to 5.8% with a unilateral perimetric deficit.

Glaucoma in Africa: size of the problem and possible solutions
Cook C. J Glaucoma. 2009 Feb;18(2):124-8. Review.
The prevalence of glaucoma in East, Central, and Southern Africa can be conservatively estimated to be 10,000 people for every 1 million population. This prevalence may be higher in West Africa. The annual incidence of glaucoma can be conservatively estimated to be 400 new cases for every 1 million population.

Endophthalmitis

An outbreak of acute postoperative endophthalmitis after cataract surgery.
Ausayakhun S et al. J Med Assoc Thai. 2008 Aug;91(8):1239-43.
This article describes an outbreak of acute postoperative endophthalmitis after cataract surgery that was referred to Chiang Mai University Hospital during March 2006. In high-volume cataract surgery, an outbreak of endophthalmitis is always possible. Prompt and appropriate treatment can improve the visual outcome.

Spectrum and clinical profile of post cataract surgery endophthalmitis in north India.
Gupta A et al. Indian J Ophthalmol. 2003 Jun;51(2):139-45.
To determine the spectrum, clinical profile and risk factors for poor visual outcome in patients of post cataract surgery endophthalmitis. Our data highlights low culture positivity and a predominance of fungal pathogens as a cause of post cataract surgery endophthalmitis. 

Acute endophthalmitis outbreak after cataract surgery.
Arsan AK, Adişen A, Duman S, Aslan B, Koçak I. J Cataract Refract Surg. 1996 Oct;22(8):1116-20.
The aim of this study was to evaluate the source of organisms causing an epidemic of postoperative endophthalmitis and to emphasize the importance of prompt intervention with an early diagnosis. Intravitreal cultures showed Pseudomonas aeruginosa in four cases and coagulase-negative staphylococci in three cases; three cases were culture negative. P. aeruginosa were also isolated from irrigation solutions used on the same day.

Outbreaks of postoperative bacterial endophthalmitis caused by intrinsically contaminated ophthalmic solutions--Thailand, 1992, and Canada, 1993.
CDC. MMWR Morb Mortal Wkly Rep. 1996 Jun 14;45(23):491-4.
This report summarizes outbreaks of postoperative bacterial (Pseudomonas aeruginosa or Bacillus spp.) Endophthalmitis in Thailand and Canada; the outbreaks were associated with the intraoperative use of intrinsically contaminated basal salt solution (BSS) and hyaluronic acid.

Review and Policy Articles

Eye health programs within remote Aboriginal communities in Australia: a review of the literature.
Durkin SR. Aust Health Rev. 2008 Nov;32(4):664-76. Review.
The was a review of the literature regarding the most sustainable and culturally appropriate ways in which to implement eye health care programs within remote Aboriginal communities in Australia from a primary health care perspective.

Role of Indian Council of Medical Research (ICMR) in advancement of ophthalmic research.
Dhaliwal RS. J Indian Med Assoc. 2001 Oct;99(10):578-83.
Blindness accounts for almost 7 million Disability Adjusted Life Years (DALYS). Considering its importance ICMR has been continually conducting research in ophthalmology starting from the first nationwide blindness survey in 1970s till date. In addition ICMR also has mechanisms of sponsoring research by interested individuals which involve adhoc research schemes and fellowships. The details of these mechanisms and some of the results of major ICMR projects are presented. The identified new thrust areas and the coordinators for these are also listed.

Low vision care in India: a time for action! & Issues which need to be considered (plenary lecture, the 9th International Congress on Low Vision, July 10, 2008, 8:00 AM, Montreal, Canada).
Enoch JM. Hindsight. 2008 Oct;39(4):106-19.
In behalf of the large cohort of visually impaired patients, the author argues that a difference can be made through effective inter-professional cooperation between emerging modern optometry and more developed ophthalmology.

Primary eye care in rural sub-Saharan Africa.
Steinkuller PG.Int Ophthalmol. 1987 Dec;11(2):87-93.
Primary eye care in rural sub-Saharan Africa is reviewed. In the context of eye care delivered by village health workers living in and supported by the community, such a system of health care does not exist in Africa today.

Strategies to control cataracts
Audugé A, Schémann JF, Auzemery A, Ceccon JF, Ducousso F. Sante. 1998 Mar-Apr;8(2):144-8.
Rather than formalizing the dogmatic choices of surgical techniques and structures, the author argues that we should promote all phases of treatment from active screening and the selection of cases for surgery to the follow-up of interventions and their impact. We should also increase public awareness, develop a system for the transfer of information that is effective and improve the cost-effectiveness and capacity of the region to provide high quality services on a large scale.

Eye diseases and ophthalmological care in a developing country (author's transl)
Mandl A, Radda TM. Klin Monatsbl Augenheilkd. 1981 Dec;179(6):463-4. German.
In India, ophthalmological care has been provided for many years now in eye-camps. By way of an example the authors, assistants at the First Eye Clinic of Vienna University, describe an eye-camp in Andhra Pradesh where they worked. Work of this kind can be recommended to others.

Massive cataract relief in eye camps.
Liu HS, McGannon WJ, Tolentino FI, Schepens CL. Ann Ophthalmol. 1977 Apr;9(4):503-8.
The concept of "eye camp" represents a revolutionary approach to the massive problem of cataract-related blindness and visual disability. The "eye camp" involves comprehensive cooperative relief efforts on a large scale to combat the widespread incidence of cataract as it affects residents of rural areas, especially in developing nations.

Overview on community ophthalmology.
Johnson GJ. J Indian Med Assoc. 1999 Aug;97(8):305-8. Review.
Community ophthalmology requires a comprehensive approach for primary, secondary and tertiary prevention of all eye diseases like vitamin A deficiency, trachoma, measles, diabetic retinopathy, refractive errors, etc. Community ophthalmology is based on the principles of primary health care approach.

Global vision impairment due to uncorrected presbyopia.
Holden BA et al. Arch Ophthalmol. 2008 Dec;126(12):1731-9.Review.
This article evaluates the personal and community burdens of uncorrected presbyopia. It is estimated that there were 1.04 billion people globally with presbyopia in 2005, 517 million of whom had no spectacles or inadequate spectacles. Of these, 410 million were prevented from performing near tasks in the way they required. Vision impairment from uncorrected presbyopia predominantly exists (94%) in the developing world.

Retinopathy of prematurity: A global perspective of the epidemics, population of babies at risk and implications for control.
Gilbert, C. Early Hum Dev. 2008 Feb;84(2):77-82. Review.
This is an overview article on the global burden of Retinopathy of Prematurity. Globally at least 50,000 children are blind from retinopathy of prematurity (ROP) which is now a significant cause of blindness in many middle income countries in Latin American and Eastern Europe

Volunteer-based vision nongovernmental organizations and VISION 2020.
Pearce MG. Optometry. 2008 Aug;79(8):464-71. Review.
VISION 2020 strategies are reviewed and volunteer organizations' understanding of VISION 2020 and methods of service delivery are considered through survey results. RESULTS: From the surveys it is apparent that volunteer organizations are not aware of the VISION 2020 initiative and do not conduct their projects and programs in a way that is supported by VISION 2020.

Cataracts in India: current situation, access, and barriers to services over time.
Finger RP. Ophthalmic Epidemiol. 2007 May-Jun;14(3):112-8. Review.
Numerous barriers, such as financial reasons, distance, fear, lack of service awareness, lack of support, or other obligations, could be identified but have not been put into the wider context of health care utilization behavior. Financial barriers continue to be a major reason not to take up offered cataract surgery services.

Prevalence and causes of blindness & low vision; before and five years after 'VISION 2020' initiatives in Oman: a review.
Khandekar R, Mohammed AJ, Raisi AA. Ophthalmic Epidemiol. 2007 Jan-Feb;14(1):9-15.
The rate of disability has declined but the number of blind people has increased in Oman. The causes of blindness have changed from communicable/avoidable eye diseases to non-curable/chronic eye diseases, and the number with visual disabilities has increased. An increasing number of operations for cataract and improvements in the care for glaucoma and diabetic retinopathy are recommended.

Estimation of blindness in India from 2000 through 2020: implications for the blindness control policy.
Dandona L, Dandona R, John RK. Natl Med J India. 2001 Nov-Dec;14(6):327-34.
The planning of blindness control in India should take into account recent population-based data for the entire age range, which suggest that the number of blind persons in India is currently over 18 million. This estimate is 50% more than the figure of 12 million from a decade ago that is still quoted widely in the blindness control policy documents. If avoidable blindness is to be substantially reduced in India by 2020, effective strategies against blindness due to cataract and refractive error are needed urgently as both these conditions are relatively easy to treat.

Poverty and blindness in Africa.
Naidoo K. Clin Exp Optom. 2007 Nov;90(6):415-21. Review.
The successful implementation of Vision 2020 programs will be hindered without the development of a comprehensive, co-ordinated strategy that is cognisant of the differences that exist and the need for comprehensive solutions that are rooted in the economic and political realities of the continent as well as the individual countries and regions within countries.

International initiatives for the prevention of blindness
Klauss V, Schaller UC. Ophthalmologe. 2007 Oct;104(10):855-9. German.
The WHO has developed strategies for dealing with individual diseases, such as trachoma, onchocerciasis, childhood blindness and refractive errors. Programmes for glaucoma and diabetic retinopathy will follow. Early successes can already be recognized, especially in the rising numbers of cataract operations.

Eye health promotion and the prevention of blindness in developing countries: critical issues.
Hubley J, Gilbert C. Br J Ophthalmol. 2006 Mar;90(3):279-84. Review.
This review explores the role of health promotion in the prevention of avoidable blindness in developing countries. Using examples from eye health and other health topics from developing countries, the review demonstrates that effective eye health promotion involves a combination of three components: health education, infrastructure, and advocacy.  

What is the global burden of visual impairment?
Dandona L, Dandona R. BMC Med. 2006 Mar 16;4:6. Review.
The total number of persons with visual impairment worldwide, including that due to uncorrected refractive error, was estimated as 259 million, 61% higher than the commonly quoted WHO estimate.

Present status of eye care in India.
Thomas R, Paul P, Rao GN, Muliyil JP, Mathai A. Surv Ophthalmol. 2005 Jan-Feb;50(1):85-101. Review
India, the second most populous country in the world, is home to 23.5% of the world's blind population. Other important causes of blindness are refractive errors, childhood blindness, corneal blindness, and glaucoma. The definitions, magnitude, and present status of each of these causes of blindness, as well as efforts at control, are discussed.

Management of blinding disease: loss of immunity and superinfection.
Evans BG. Eye. 2005 Oct;19(10):1035-6. Review.
Globally the most important loss of immunity currently occurs with HIV disease. The effects of HIV on the eye, since the advent of highly active antiretroviral therapy, have been less in countries where such treatment is available but even in such situations ophthalmic zoster can occur at higher CD4 cell counts and can still cause problems.

World optometry: the challenges of leadership for the new millennium.
Di Stefano A. Optometry. 2002 Jun;73(6):339-50. Review.
The future growth of optometry within the global health community will depend on expanding this professional growth at an international level, and forging durable strategic alliances that address the significant prevention of blindness imperatives of our generation.

Blindness as a challenging medical and social problem in China.
Hu S. Yan Ke Xue Bao. 2002 Mar;18(1):4-8. Review.
This article reviews the major causes of blindness which include cataract, corneal diseases, trachoma, glaucoma, vitreoretinopathy and a number of factors contributing to blindness in children.

Prevention of blindness and priorities for the future.
West S, Sommer A. Bull World Health Organ. 2001;79(3):244-8. Review.
The impact of visual loss has profound implications for the person affected and society as a whole. The majority of blind people live in developing countries, and generally, their blindness could have been avoided or cured.

Community eye care 10 years after Alma Ata: progress, problems, and priorities for private voluntary organizations in developing nations.
Heldt JP, Wessels IF. Ophthalmic Surg. 1988 Jan;19(1):47-55.
This article describes and reviews from a managerial perspective at three levels of intervention a community eye care program for Afghan refugees established in 1982 by the League of Red Cross in Pakistan. Factors for success and problems are analyzed, and priorities for the future are suggested.

Pharmaceutical production and intraocular lens implantation: technology appropriate to the Third World.
Brian GR, Hollows FC. Ophthalmic Surg. 1989 Nov;20(11):820-2.
If intravenous fluid production is possible in this environment, as it is, then the authors contend that routine microscopic intraocular surgery (including intraocular lens implantation) should be as well. The establishment of an Eritrean facility capable of such surgery is recorded. The authors believe this type of surgery should be seriously considered in any attempt to deal with the problem of Third World cataract blindness.

Outcome and number of cataract surgeries in India: policy issues for blindness control.
Dandona L et al. Clin Experiment Ophthalmol. 2003 Feb;31(1):23-31.
The goal of this study was to assess what impact attention to quality of cataract surgery and postoperative follow up can have on cataract blindness in India, and to estimate the number of surgeries needed to eliminate cataract blindness in India. The number of persons in whom blindness is being averted due to cataract surgery in India is currently a very small fraction of the number blind from cataract

Management of cataract--a revolutionary change that occurred during last two decades.
Dada VK, Sindhu N. J Indian Med Assoc. 1999 Aug;97(8):313-7. Review.
In the field of ophthalmology, perhaps no other surgery has undergone such rapid changes in the past few decades, as the surgery for cataract. Over these years there has been an emergence of small incision cataract surgery, especially by phaco-emulsification. 

Epidemiology of cataract in India: combating plans and strategies.
Vajpayee RB, Joshi S, Saxena R, Gupta SK. Ophthalmic Res. 1999;31(2):86-92. Review.
Blindness due to cataract presents an enormous problem in India not only in terms of human morbidity but also in terms of economic loss and social burden. The WHO/NPCB (National Programme for Control of Blindness) survey has shown that there is a backlog of over 22 million blind eyes (12 million blind people) in India, and 80.1% of these are blind due to cataract.

Is current eye-care-policy focus almost exclusively on cataract adequate to deal with blindness in India?
Dandona L et al. Lancet. 1998 May 2;351(9112):1312-6. Review.
Much of the blindness in this Indian population is due to non-cataract causes. The previous national survey did not include detailed dilated-funds assessment and visual-field examination which could have led to overestimation of cataract as a cause of blindness in India. This article argues that policy-makers in India should encourage well-designed population-based epidemiological studies from which to develop a comprehensive long-term policy on blindness in addition to dealing with cataract. 

Cataract surgery in Zimbabwe: the way forward.
Masanganise R. Cent Afr J Med. 1998 Feb;44(2):48-51. Review.
Considering the infrastructure and expertise currently available, coupled with the adoption of some of the cost cutting measures suggested, Zimbabwean ophthalmologists have the potential of providing high quality cataract surgery by international standards to the public without reservations.

Epidemiology of cataract in childhood: a global perspective.
Foster A, Gilbert C, Rahi J. J Cataract Refract Surg. 1997;23 Suppl 1:601-4. Review.
Cataract is the most important cause of treatable childhood blindness. There are an estimated 200,000 children blind from cataract worldwide; 20,000 to 40,000 children with developmental bilateral cataract are born each year.

The strategy of prevention of blindness.
Hu C. Yan Ke Xue Bao. 1997 Sep;13(3):156-61.
This article discusses the goal of reducing the prevalence of blindness at 0.30% by 2,000 in our country. To realize the about goal effectively, authors argue that 4 aspects should be included. 1. Epidemiological survey of ocular diseases. 2. Measures of prevention and treatment of blindness. 3. Establishment of a primary network for the prevention and treatment of ocular diseases. 4. Strengthening the organizations for prevention of ocular diseases.

Cataract related blindness in India & its social implications.
Angra SK, Murthy GV, Gupta SK, Angra V. Indian J Med Res. 1997 Oct;106:312-24. Review.
Most of the cataract blinds in the country are in the rural areas while the surgical service delivery network is concentrated in the urban areas. Thus a large proportion of patients in the rural areas continue to remain blind. This situation has many social implications. There is loss of productivity, breakdown of interpersonal relationships, depressive manifestations, loss of self esteem and most patients lead an isolated humiliating life.

Eye care delivery in developing nations: paradigms, paradoxes, and progress.
Schwab L. Ophthalmic Epidemiol. 1994 Dec;1(3):149-54. Review.
On economic grounds alone, the U.S. eye care delivery paradigm cannot be broadly replicated in the developing world. Instead, cost-effective creative strategies, many already in place, such as mass surgery camps in Asia and delivery of eye care by non-ophthalmologists in Africa, can be expanded and streamlined.

An international perspective on optometric education.
Baldwin WR. Optom Vis Sci. 1993 Aug;70(8):634-6. Review.
In many of the world's nations, optometry hardly exists because resources are not sufficient to educate optometrists or to fund their services. In others, tradition and accommodation with other forces have rendered optometry incapable of change that would expand its scope of services.

Cataract: a critical problem in the developing world.
Enoch JM, Barroso L, Huang D. Optom Vis Sci. 1993 Nov;70(11):986-9. Review.
In this paper, authors try to raise awareness among optometrists of this major challenge. At the same time, because many individuals do not achieve good vision after surgery and because in most developing countries only one eye is operated upon, the authors emphasize the use of improved prognostic techniques to make the surgical outcome more predictable, avoiding nonproductive surgery and resultant disappointment on the part of all concerned.

Onchocerciasis and other eye problems in developing countries: a challenge for optometrists.
Berger IB, Nnadozie J. J Am Optom Assoc. 1993 Oct;64(10):699-702. Review.
Onchocerciasis, also known as River Blindness, affects about 18 million people around the world, resulting in severe visual impairment or blindness for approximately 2 million. Substantial efforts are currently underway to control the disease in Latin America and equatorial Africa, now that an effective, nontoxic medication, ivermectin, is available.

Ophthalmology in Africa.
Bolliger PA. Aust N Z J Ophthalmol. 1985 Aug;13(3):299-301.
Problems of prevention and treatment of blindness in Africa are discussed with particular reference to Tanzania.

Epidemiologic aspects of global blindness prevention.
Thylefors B, Négrel AD, Pararajasegaram R. Curr Opin Ophthalmol. 1992 Dec;3(6):824-34. Review.
Longer life expectancy is going to dramatically increase the need for eye care to prevent visual loss from such conditions as cataract, glaucoma, diabetic retinopathy, and macular degenerations. Corneal blindness, resulting mainly from trachoma and other infections, is apparently showing a downward trend, but there are still foci of severe disease.

Eye camps--providing medical coverage to the under privileged.
Puri S, Puri SG. J Acad Hosp Adm. 1992 Jul;4(2):41-2. Review.
Eye camps make a very important contribution to both curative and preventive eye health care. In addition to serving the under privileged they also lessen the burden on the existing hospitals. Planning of such camps has been described vis-a-vis description of three camps done in far-flung areas.

Blindness in the world: nursing experience in Nepal.
Arseneault R. J Ophthalmic Nurs Technol. 1992 Nov-Dec;11(6):241-6.
According to statistical data from the World Health Organization, 41 to 52 million people have a vision of 20/200 (6/60) or less; 85% of these blind live in Asia and Africa. Cataract is the leading cause of blindness in underdeveloped countries.

The role of Western ophthalmologists in dealing with cataract blindness in developing countries.
Chirambo MC. Doc Ophthalmol. 1992;81(3):349-50. Review.
The deployment of local ophthalmologists to deal with cataract load would be cost-effective in delivering appropriate eye care but the scarcity of ophthalmologists makes the option ineffective. The role of Western ophthalmologists will be considered in the provision of cataract surgical services and training of ophthalmic assistants, cataract surgeons and ophthalmologists.

The role of international non-governmental organisations in dealing with cataract blindness in developing countries.
Johns AW. Doc Ophthalmol. 1992;81(3):345-8. Review
Among the options facing the INGOs in the 1991s are the increased utilisation of eye beds through year round surgery in South Asia and shorter post-operative hospital occupancy and the possibility of putting lens implantation surgery within the economic reach of INGOs and partner NGOs and governments.

The WHO programme for the Prevention of Blindness and cataract in developing countries.
Thylefors B. Doc Ophthalmol. 1992;81(3):339-44. Review.
The WHO Programme has developed a primary health care strategy for the large-scale management of cataract which is described in this article.

Issues in establishing rural ophthalmic surgery centers.
Buck K. Coll Rev. 1987 Fall;4(2):43-52.Review.
Citizens of rural communities suffer from a lack of specialized medical care. A large %age of these citizens are elderly people who require more eye care than the rest of the population. These factors point to a need for outreach rural ophthalmic surgery centers.

Impact of technology on mass blindness in Asia.
Lim AS. Jpn J Ophthalmol. 1987;31(3):375-83. Review.
Mass blindness, a manifestation of poor organization and poverty, will double by the year 2000. The main reason is poor organisation--the failure to translate knowledge and technology into effective action. However, mass blindness in the wealthier developing nations will gradually disappear. With affluence, there will be public demand for modern technology and implant surgery will develop initially in the cities and will slowly spread to the rural communities. Japan has a unique role in controlling mass blindness, especially in the poorer developing countries. 

Current status of cataract blindness and Vision 2020: The right to sight initiative in India.
Murthy G., Gupta S.K., John N., Vashist P. Indian J Ophthalmol. 2008 Nov-Dec;56(6):489-94.
Data from three national level blindness surveys in India over three decades, and projected age-specific population till 2020 from US Census Bureau were used to develop a model to predict the magnitude of cataract blindness and impact of Vision 2020: the right to sight initiatives. Considering existing prevalence and projected incidence of cataract blindness over the period 2001-2020, visual outcomes after cataract surgery and sight restoration rate, elimination of cataract blindness may not be achieved by 2020 in India.

Who will operate on Africa's 3 million curably blind people?
Foster A. Lancet. 1991 May 25;337(8752):1267-9.
About half the 6 million blind people in sub-Saharan Africa have surgically curable cataract. The available manpower and resources can only provide services for less than 10% of the new blind cataract patients each year, and little is being done for the estimated 3 million "cataract backlog".

Can VISION 2020 be implemented in rural government settings? Findings from two programmes in Tanzania.
Eliah E et al. Trop Med Int Health. 2008 Oct;13(10):1284-7.
This study aims to generate information on essential components and the cost recovery potential of VISION 2020 programs in rural Africa. Numbers of patients receiving eye care increased sevenfold, cataract surgeries by a factor of 2.6 and spectacles dispensed by a factor of 16. Running costs were shared; the government provided 40-60%, non-government organizations 25-45%, and patient fees 15%. CONCLUSION: Comprehensive eye care can be delivered with cooperation among partners. However, continued coordination and cooperation from government and NGOs are critical to reach VISION 2020 goals.

Racial, Class, and Gender Disparities

Gender differences in adult blindness and low vision, Central Ethiopia.
Woldeyes A, Adamu Y.Ethiop Med J. 2008 Jul;46(3):211-8.
The goal of this study was to assess gender differences in prevalence rates and causes of low vision and blindness. The prevalence rates were 10.9% for bilateral low vision and 3.5% for bilateral blindness. Women comprised 59.0% of blindness, and 70.0% of low vision. The difference in gender distribution and low vision was statistically significant in all age groups.

Disparity in access to cataract surgical services leads to higher prevalence of blindness in women as compared with men: results of a national survey of visual impairment
Nkomazana O. Health Care Women Int. 2009 Mar;30(3):228-9.
The aim of the survey was to estimate the prevalence and determinants of visual impairment and blindness in Botswana 50 years and older and assess access to cataract surgical services. After adjusting for age and sex, the prevalence of bilateral cataract blindness and bilateral severe visual impairment in men is 1.0% and 1.5% compared with 1.6% and 2.1% women.

Ocular biometric values of the black African patient and theoretical consideration of the role of these values in various pathologies: analysis of 325 eyes.
Fanny A et al. J Fr Ophtalmol. 2007 Jan;30(1):68-72.
This study provides true measurements for the black African patient in Ivory Coast. It also establishes hypotheses by extrapolating the role of measurements in pathologies such as glaucoma. Significant biometric differences between men's and women's eyes, on the one hand, and between black African and white patients' eyes, on the other hand, can be observed. The reasons for these differences are several: they are natural, socioeconomic, and technical.

The epidemiology of blindness and visual loss in Hamar tribesmen of Ethiopia. The role of gender.
Courtright P, Klungsøyr P, Lewallen S, Henriksen TH. Trop Geogr Med. 1993;45(4):168-70.
A population-based survey in the Hamar tribe of Ethiopia to assess the problem of blindness and ocular morbidity was conducted. Blindness was detected in 1.9% of the Hamar. Among the age group 40 and over < 1.0% of men and 13% of women were blind.

Reversal in gender valuations of cataract surgery after the implementation of free screening and low-priced high-quality surgery in a rural population of southern China.
Baruwa E, Tzu J, Congdon N, He M, Frick KD. Ophthalmic Epidemiol. 2008 Mar-Apr;15(2):99-104.
The aim was to assess the impact of community outreach and the availability of low-cost surgeries on the willingness to pay for cataract surgery among male and female rural-dwelling Chinese. Five years of access to free cataract testing and low-cost surgery programs appears to have improved the familiarity with cataract surgery and increased the willingness to pay at least 500 RMB (US$65) for it in this rural population.

Inter-ethnic risk ratios for different types of cataract.
Weale RA. Ophthalmic Res. 1995;27(4):214-8.
Patients at Moorfields Eye Hospital were divided according to five broad geographical areas of origin in four continents, and classified according as they had cortical, nuclear, posterior subcapsular cataract or any of their combinations. Relative risk ratios and their tolerances were calculated. Risk ratios for some types of cataract were inter-related. Ethnic traits appear to be more important than climatic conditions.

Racial differences of lens transparency properties with aging and prevalence of age-related cataract applying a WHO classification system.
Sasaki K, Sasaki H, Jonasson F, Kojima M, Cheng HM. Ophthalmic Res. 2004 Nov-Dec;36(6):332-40.
The aim of this study was to investigate racial differences of lens transparency properties and the prevalence of lens opacification by age. LTP increased with aging for all nationalities. Light scattering intensity was significantly higher in the Singaporeans followed by the Icelandic subjects.

Sex inequalities in cataract blindness burden and surgical services in south India.
Nirmalan PK, Padmavathi A, Thulasiraj RD. Br J Ophthalmol. 2003 Jul;87(7):847-9.
This study was conducted to determine sex inequalities in cataract blindness and surgical services in south India. Females were less likely to be operated on for cataract although the cataract blindness burden was higher for females. 

Eye diseases in northern Nigeria: prevalence, age and sex differences.
Kragha IK. Ophthalmic Physiol Opt. 1987;7(4):481-3.
This study presents the prevalence, age, and sex differences of eye diseases in northern Nigeria using the records of 1677 eye hospital patients. The most common eye diseases are cataract, refractive error and presbyopia, and diseases of the conjunctiva and sclera.

A Case-Control Study to Assess the Relationship between Poverty and Visual Impairment from Cataract in Kenya, the Philippines, and Bangladesh.
Kuper H, Polack S, Eusebio C, Mathenge W, Wadud Z, Foster A PLoS Med. 2008 Dec 16;5(12):e244.
This population-based case–control study was conducted in three countries during 2005–2006 in order to examine the association between visual impairment from cataract and poverty in adults in Kenya, Bangladesh, and the Philippines. People with visual impairment due to cataract were poorer than those with normal sight in all three low-income countries studied.

Childbearing and risk of cataract in young women: an epidemiological study in central India.
Minassian DC, Mehra V, Reidy A. Br J Ophthalmol. 2002 May;86(5):548-50.
This study was conducted to explore possible effects of childbearing and associated adverse factors on cataract risk. Having more than three babies may substantially increase the risk of sight impairing cataract in mothers of childbearing age in central India.

Female reproductive factors and eye disease in a rural South Indian population: the Aravind Comprehensive Eye Survey.
Nirmalan PK et al. Invest Ophthalmol Vis Sci. 2004 Dec;45(12):4273-6.
The aim of this research was to determine the potential associations of female reproductive factors with age-related cataract, open-angle glaucoma, macular degeneration, and myopia in an older population of rural south India. Female reproductive factors do not appear to influence age-related cataract, open-angle glaucoma, macular degeneration or myopia significantly in rural south India.

Blindness Prevention and Risk Factors

Comparative study on preventing avoidable blindness in China and in Nepal.
Lin Y. Chin Med J. 2007;120:280–283.
The aim of this study is to compare the situation in China and in Nepal in prevention of avoidable blindness. Progress towards the "Vision 2020" target in China is much slower than that in Nepal. Further attention to address this issue is urgently needed.

Risk factors for age related cataract in a rural population of southern India: the Aravind Comprehensive Eye Study.
Nirmalan PK et al. Br J Ophthalmol. 2004 Aug;88(8):989-94.
The purpose of this research was to determine risk factors for lens opacities and age related cataract in an older rural population of southern India. Demographic risk factors-increasing age and illiteracy-were common for the three subtypes of cataract; females were more likely to have cortical cataracts and nuclear cataracts.

Preventable blindness in the east African elderly.
Wood ML.East Afr Med J. 1997 Oct;74(10):639-41.
The epidemiology and delivery of eye care for East Africa are outlined. The common causes of blindness in the elderly (> 60 years old) are discussed individually. Cataract causes (50%), trachoma (16%) and glaucoma (12%) of blindness in the East Africa Region.

The 22nd Kellersberger Memorial Lecture, 1997. Preventing loss of sight from leprosy.
Waddell KM. Ethiop Med J. 1997 Oct;35(4):263-70.
Multidrug treatment of leprosy is being dramatically successful in sterilizing the infection. However complications are still occurring, spoiling the result in some patients by residual damage, including to the eye.

A model for blindness prevention.
Jingjing X et al. 1997 Sep;13(3):162-3, 147.
This article introduces the work of the prevention and treatment of blindness of Zhongshan Ophthalmic Center, to find out the effective model of blindness prevention and treatment in China. An effective model for blindness prevention and treatment should be based on clinical service, population based epidemiological survey and local ophthalmic professionals training. International cooperation is also an important promoter. 

A blindness prevention monitoring system and its application
Ai KF. Zhonghua Yan Ke Za Zhi. 1989 Jul;25(4):230-1. Chinese.
The authors conducted a survey of blindness and low vision in the population of 49,770 in Zhong Ning County of Ningxia Province and opened up blindness prevention and treatment with emphasis on cataract. Sight was restored to 88% of the curable blind, bringing down the rate of blindness from 0.24% to 0.14%. A blindness prevention monitoring system of 4 levels was established and its application and significance in the prevention of blindness explored.

Dehydrational crises: a major risk factor in blinding cataract.
Minassian DC, Mehra V, Verrey JD. Br J Ophthalmol. 1989 Feb;73(2):100-5.
The second methodologically distinct case control study of risk factors in cataract has been carried out in a population very different in terms of environmental and sociocultural characteristics from the population investigated in the earlier study in Central India. The results strongly confirm the findings from the first study and indicate that an estimated 38% of blinding cataract may be attributable to repeated dehydrational crises resulting from severe life threatening diarrhoeal disease and/or heatstroke.

Public health ophthalmology: a comprehensive model for the prevention of blindness in developing nations.
Heldt JP. Ophthalmic Surg. 1987 Nov;18(11):835-9.
In recent years, blindness in developing nations has been increasingly recognized as a public health problem requiring new approaches. To better prepare eye care professionals to assume their multidisciplinary responsibilities as epidemiologists, health planners, administrators, and educators, a new conceptual model is presented.

Patient Perspectives

Patient satisfaction levels during teleophthalmology consultation in rural South India.
Paul PG, Raman R, Rani PK, Deshmukh H, Sharma T. Telemed J E Health. 2006 Oct;12(5):571-8.
The objective of this study was to assess patient satisfaction levels and factors influencing it during teleophthalmology consultation in India. 44.4% of the respondents were satisfied with teleophthalmology screening.

Knowledge, attitudes, and self care practices associated with age related eye disease in Australia.
Livingston PM, McCarty CA, Taylor HR. Br J Ophthalmol. 1998 Jul;82(7):780-5.
The goal of this research was to determine the level of correct knowledge about common eye disease and attitudes towards blindness prevention and treatment, and how these factors influence self care practices in a population based sample. These data show that there is a large gap in the public's knowledge and understanding of eye disease that will need to be understood for eye health promotion activities.

Postoperative cataract surgery satisfaction in a rural Kenyan clinic.
Reshef DS, Reshef SH. J Cataract Refract Surg. 1997. May;23(4):575-80.
This study sought to assess prospectively the factors influencing patient satisfaction following intracapsular cataract extraction (ICCE) surgery in a rural eye unit in Kenya. Cultural differences are paramount in determining health behavior priorities and satisfaction. The post ICCE satisfaction in developing countries must be better evaluated to achieve higher self-referral of cataract-blind patients for surgery in Africa.

The importance of informed consent in the field of ophthalmology
Yoshida A. Hokkaido Igaku Zasshi. 1998 Jan;73(1):15-20. Japanese.
Ocular diseases have some characteristics that are different from diseases of other organs. First, patients clearly can judge for themselves whether or not they can see better postoperatively. Second, because several parameters such as visual acuity and intraocular pressure, are obtained from patients, patient's families and others can objectively judge the post-treatment status.

Determinants of attendance and patient satisfaction at eye clinics in south-western Uganda.
Whitworth J et al. Health Policy Plan. 1999 Mar;14(1):77-81.
The purpose of this study was to identify the reasons for subjects deciding to attend or not attend local and referral ophthalmology clinics in south-west Uganda, and to establish the levels of satisfaction of clinic attenders with the services they received. Attendance and satisfaction with the community ophthalmology service could be improved by more intensive motivation and explanation for patients, and assistance with spectacle and transport costs.

Topical anesthesia versus retrobulbar block for cataract surgery: the patients' perspective.
Boezaart A, Berry R, Nell M. J Clin Anesth. 2000 Feb;12(1):58-60.
This study compares patients' perception of topical anesthesia (TA) with combined peribulbar and retrobulbar block (PRBB) for cataract surgery. Eighteen patients (18.37%) reported no difference between the two techniques. Ninety-six patients (97.96%) were not aware of the PRBB being injected.

Patients' opinions about day cataract surgery in a general hospital
Mili-Boussen I et al. Tunis Med. 2000 Apr;78(4):266-9. French.
The purpose of this study was to evaluate the patient satisfaction as a performance indicator of quality of health care delivery in outpatient cataract surgery.  Negative opinion was in relation with the prolonged time required for preoperative work-up which is done outside the outpatient surgery structure.

Progression of eye disease in "cured" leprosy patients: implications for understanding the pathophysiology of ocular disease and for addressing eye care needs.
Lewallen S, Tungpakorn NC, Kim SH, Courtright P. Br J Ophthalmol. 2000 Aug;84(8):817-21.
This study demonstrates that leprosy related ocular pathology progresses in some patients even after they are cured mycobiologically. The progressive leprosy related lesions are the result of chronic nerve damage; ocular lesions due to infiltration by Mycobacterium leprae did not develop.

Awareness of eye diseases in an urban population in southern India.
Dandona R, Dandona L, John RK, McCarty CA, Rao GN. Bull World Health Organ. 2001;79(2):96-102.
The goal of this study was to assess the level of awareness of eye diseases in the urban population of Hyderabad in southern India. Data suggest that there is a need for health education in this Indian population to increase their level of awareness and knowledge of common eye diseases.

Knowledge, attitudes and practices regarding glaucoma in the urban and suburban population of Lomé (Togo)
Balo PK, Serouis G, Banla M, Agla K, Djagnikpo PA, Gué KB. Sante. 2004 Jul-Sep;14(3):187-91. French.
This study was undertaken to determine the level of knowledge, the attitudes and practices regarding glaucoma in the population of Lomé. The knowledge of eye diseases accounted for 84% among the population studied; the most well-known being myopia, cataract, presbyopia, and glaucoma in decreasing order. Glaucoma was known by 228 people (29.7%) among whom 25% were aware of glaucoma blindness cases; 61.5% declared that glaucoma was a serious condition; 4.4% admitted the use of traditional eye-healers; 56.1% were not confident in the local doctors for the treatment of glaucoma.

Perception of blindness and blinding eye conditions in rural communities.
Ashaye A, Ajuwon AJ, Adeoti C. J Natl Med Assoc. 2006 Jun;98(6):887-93.
The purpose of this qualitative study was to explore the causes and management of blindness and blinding eye conditions as perceived by rural dwellers of two Yoruba communities in Oyo State, Nigeria.  Local beliefs associated with causation, symptoms and management of blindness and blinding eye conditions among rural Yoruba communities identified have provided a bridge for understanding local perspectives and basis for implementing appropriate primary eye care programs.

Impact of health education on active trachoma in hyperendemic rural communities in Ethiopia.
Edwards T, Cumberland P, Hailu G, Todd J. Ophthalmology. 2006 Apr;113(4):548-55.
Researches evaluated the impact of a health education program on the prevalence of active trachoma in children 3 to 9 years old. Overall, there was a small but statistically significant reduction in the prevalence of active trachoma between surveys, but differences between the 3 intervention arms were not statistically significant.

Leprosy and Eye Disease

Ocular leprosy in Nigeria: a survey of an Eku leprosorium.
Waziri-Erameh MJ, Omoti AE. Trop Doct. 2006 Jan;36(1):27-8.
The purpose of this research was to determine the ocular morbidity, visual disability and potential for blindness in leprosy patients recently released from treatment. Fifty-eight patients (96.67%) had ocular symptoms, the most common being blurred vision in 23 patients (38.33%). Nine patients (15%) were blind. Cataract was the most common cause of blindness occurring in three of the nine patients (33.33%)

Prevalence and causes of blindness and low vision in leprosy villages of north eastern Nigeria.
Mpyet C, Solomon AW. Br J Ophthalmol. 2005 Apr;89(4):417-9.
The goal of this study was to determine the prevalence and spectrum of ocular pathology, and the prevalence and causes of blindness and low vision in leprosy villages of north eastern Nigeria. The prevalence of blindness (VA<3/60 with available correction) was 10.4%. An additional 7.5% of subjects were severely visually impaired. Cataract was the commonest cause of blindness.

Lid surgery in patients affected with leprosy in North-Eastern Nigeria: are their needs being met?
Mpyet C, Hogeweg M. Trop Doct. 2006 Jan;36(1):11-3.
This study determined the extent to which paramedic personnel are meeting the eyelid surgical needs of leprosy patients and to investigate the barriers that may be preventing them from seeking surgery. Lack of awareness about the treatment available was the most common reason given for not seeking surgery. This study shows that despite the presence of trained paramedical staff in the community, the eyelid surgical needs of these patients are not being met primarily because the level of awareness about the availability of effective treatment still remains low.

Leprosy blindness in Nepal.
Gupta HR, Shakya S, Shah M, Pradhan HM. Nepal Med Coll J. 2006 Jun;8(2):140-2.
A comparative cross-sectional study was carried out to see the ocular involvement in leprosy leading to blindness in two groups of patients, one with the active disease and second already cured and thus released from treatment (RFT). The prevalence of ocular manifestations was seen much higher among RFT cases accounting for 66.3% in contrast to active group where only 14.3% had ocular problems.

A survey of blindness and poor vision in leprosy patients.
Yan L, Zhang G, Zheng Z, Li W, Ye G. Chin Med J (Engl). 2003 May;116(5):682-4.
This study sought to determine the prevalence, cause and distributions of blindness and poor vision in patients with leprosy. The prevalence of bilateral blindness was 7.67%, unilateral blindness 4.4%, bilateral poor vision of various degrees 9.28% and unilateral poor vision 5.84%. The prevalence of eye complications varied significantly among different groups of patients; females had a higher prevalence than males, multibacillary patients higher than paucibacillary patients, and in-patients higher than out-patients.

Ocular complications in newly diagnosed borderline lepromatous and lepromatous leprosy patients: baseline profile of the Indian cohort.
Daniel E, Koshy S, Rao GS, Rao PS. Br J Ophthalmol. 2002 Dec;86(12):1336-40.
The goal of this study was to describe ocular manifestations in newly diagnosed borderline lepromatous (BL) and lepromatous leprosy (LL) patients in India. Leprosy related ocular complications and general ocular complications are significant problems in newly diagnosed lepromatous patients.

Ocular findings in leprosy patients in Nigeria.
Nwosu SN, Nwosu MC. East Afr Med J. 1994 Jul;71(7):441-4.
An ophthalmic assessment of patients in four out of the five leprosy clinics in Anambra State, eastern Nigeria, showed that 63% had ocular disease and 43.5% had sight-threatening disorders.

Eye involvement in leprosy. A study in Togo, West Africa
Trojan HJ, Schaller KF, Merschmann W. Klin Monatsbl Augenheilkd. 1984 Oct;185(4):235-42. German.
Two groups of lepers in Togo were examined: first, 206 lepers who had had the disease for approximately 10 years and a second group (101) patients who had been suffering from it for approximately 24 years and had severe mutilations. It became apparent that sooner or later all lepers suffer from ocular complications.

Leprosy in a trachomatous population.
Schwab IR, Nassar E, Malaty R, Zarifa A, Korra A, Dawson CR. Arch Ophthalmol. 1984 Feb;102(2):240-4.
In an Egyptian leprosy hospital, 17% of 133 patients had a visual acuity of less than 3/60. Corneal opacity, phthisis bulbi, and cataract accounted for 85% of blindness.

Intraocular lens extraction/surgery/implantation

A clinical evaluation of an aspheric multifocal intraocular lens and its implications for the developing world.
Kaushik S, Kamlesh. Ophthalmic Surg Lasers. 2002 Jul-Aug;33(4):298-303.
The purpose of this research was to evaluate the clinical performance of a new aspheric multifocal intraocular lens (IOL), and to compare the results with a corresponding monofocal IOL.  Multifocal IOLs are a good option for those with nonexacting visual requirements. The loss in contrast sensitivity seems to be an acceptable trade-off for satisfactory unaided near vision.  

Primary intraocular lens implantation for penetrating lens trauma in Africa.
Bowman RJ, Yorston D, Wood M, Gilbert C, Foster A.Ophthalmology. 1998 Sep;105(9):1770-4
This study aimed to audit the surgical strategy of primary posterior chamber intraocular lens implantation for cases of recent penetrating trauma involving the lens in an African population. Results showed that this surgical strategy has proved successful, producing good visual results and causing no sight-threatening complications. Primary posterior capsulotomy may be appropriate for younger patients.

High-volume intraocular lens surgery in a rural eye camp in India.
Civerchia L et al.Ophthalmic Surg Lasers. 1996 Mar;27(3):200-8.
The authors’ objective is to demonstrate that modern surgical techniques (extracapsular cataract extraction and intraocular lens implantation, phacoemulsification and intraocular lens implantation) can be performed in a high-volume, cost effective manner, even in temporary settings. For this type of camp to operate efficiently, there must be standardization of skills among ophthalmic personnel, costs must be contained, and the organizational skills necessary to ensure smooth functioning of the camp must exist.

Intraocular lens implantation the Nigerian experience.
Agbeja AM. Afr J Med Med Sci. 1994 Sep;23(3):233-7.
Between April 1989 and December 1990, 51 patients underwent cataract extractions with implantation of intraocular lenses. A preliminary report of encouraging results is given inspite of limitations of equipment for microsurgical procedures.

A community-based evaluation of eyesight and spectacle use after intracapsular cataract extraction in northern India.
Murthy GV, Gupta SK. J Trop Med Hyg. 1995 Apr;98(2):84-8.
The visual outcome and extent of aphakic spectacle use at community level was evaluated in 177 patients who underwent ICCE in peripheral camps.  Broken spectacles was the most common cause for not using or intermittently using spectacles. The major benefits to patients were the ability to undertake personal activities, improved mobility and recognition of family members, friends and cattle.

Intraocular lens implantation in rural India.
Civerchia L et al. Ophthalmic Surg. 1993 Oct;24(10):648-52; discussion 652-3.
379 extracapsular cataract surgeries with implantation of intraocular lenses (IOLs) were performed in a public eye camp in Ganeshpuri, India. In general, surgical complications were neither severe nor frequent. More serious difficulties were associated with measuring initial IOL power, obtaining refractive data (including astigmatism), follow up of astigmatism (suture cutting), posterior capsule opacification, and associated preoperative pathology.

Results of extracapsular cataract surgery and intraocular lens implantation in Ghana.
Egbert PR, Buchanan M. Arch Ophthalmol. 1991 Dec;109(12):1764-8.
Researchers performed extracapsular cataract extraction with posterior chamber intraocular lens implantation in a simple outpatient clinic in Ghana, West Africa. Forty-nine (64%) of 77 eligible patients with follow-up times of 12 to 29 months after surgery underwent an eye examination and an interview related to activities of daily life. Preoperative visual acuity was counting fingers or worse in all but one patient. Visual acuity improved in 44 patients (90%) after surgery.

Intraocular lens implantation in developing countries.
Pe'er J, Wood M. J Cataract Refract Surg. 1990 Sep;16(5):621-3.
In this study, authors reviewed 105 of their first IOL implantations. In 60%, the uncorrected postoperative visual acuity was 20/60 or better.

Intraocular lens implantation in an underdeveloped country.
Hemo I. J Cataract Refract Surg. 1987 Jul;13(4):414-6.
The results of 152 intraocular lens implantations performed at Mbabane Government Hospital, Swaziland, Africa, on 114 African patients with senile cataracts are presented. Uncorrected visual acuity of 20/120 or better was achieved in 79.6% of patients.

Best Practices, Survey Tools, Project Evaluations

The development of the Indian vision function questionnaire: questionnaire content.
Murthy GV et al. Br J Ophthalmol. 2005 Apr;89(4):498-503.
To study attempts to elicit problem statements describing the consequences of vision impairment as a first step towards the development of a vision related quality of life instrument for use in India.

Cataract progression in India.
Srinivasan M et al. Br J Ophthalmol. 1997 Oct;81(10):896-900.
The study was undertaken to test the feasibility of using the LOCS III cataract grading scale in the field and to determine the rate of cataract progression over a 1 year period of time. The LOCS III grading scale is a feasible method for measuring lens changes in the field with the slit lamp.

From visual function deficiency to handicap: measuring visual handicap in Mali.
Schémann JF, Leplège A, Keita T, Resnikoff S. Ophthalmic Epidemiol. 2002 Apr;9(2):133-48.
The objectives of this study were twofold: a) To translate, adapt and integrate the cultural context found in Mali and validate two instruments for measuring, respectively, perceived vision and quality of life. b) To study the relationship between these variables and visual deficiencies by gender. The acceptability of the questionnaires was good (1% missing data). The convergent validity was adequate for all but one subscale (psychological).

Two strategies for correcting refractive errors in school students in Tanzania: randomised comparison, with implications for screening programmes.
Wedner S, Masanja H, Bowman R, Todd J, Bowman R, Gilbert C. Br J Ophthalmol 2008; 92;19-24.
To compare whether free spectacles or only a prescription for spectacles influences wearing rates among Tanzanian students with un/undercorrected refractive error. The prevalence of un/undercorrected RE was 1.8%.  Free spectacles and myopia were independently associated with spectacle use.

A rapid method of grading cataract in epidemiological studies and eye surveys.
Mehra V, Minassian DC. Br J Ophthalmol. 1988 Nov;72(11):801-3.
A rapid method of grading clinically important central lens opacities has been developed for use in eye surveys and in epidemiological studies of cataract and has been field-tested in a specifically designed observer agreement study in a survey of a rural community in Central India.

Creation and testing of a practical visual function assessment for use in Africa: correlation with visual acuity, contrast sensitivity, and near vision in Malawian adults.
van Dijk K et al. Br J Ophthalmol. 1999 Jul;83(7):792-5.
The purpose of this study was to develop and test a practical visual function assessment for use in developing countries. People with a higher frequency of "not applicable" responses had lower visual function scores. Multivariate modeling revealed that visual acuity and number of questions felt to be applicable were independently associated with visual function.

Establishment of a primary eye care network and creation of a cataract-free zone in Shunyi County of Beijing
Hu C, Zhao JL, Zhang QN. Zhonghua Yan Ke Za Zhi. 1994 Mar;30(2):134-7. Chinese
Based on the epidemiological survey of eye diseases in 1985, a primary eye care network was established in Shunyi County of Beijing in 1987. Cataract surgery was the primary measure for the prevention of blindness, with the aim of creating a cataract-free zone in the county. Activities are described.

Screening for chronic impairments using medical interns in rural Haryana, India.
Anand K et al. Natl Med J India. 1999 Nov-Dec;12(6):261-5.
Utilizing the rural field practice areas of medical colleges for collection of data on issues of national health importance would not only strengthen the health system in the country but also improve medical education. There is a need for a comprehensive preventive, promotive, curative and rehabilitative approach to disabilities in India. 

Eye care project in Gaur, Nepal.
Khadka KB, Naito T, Kajima M, Shiota H, Akura J, Kiryu T. J Med Invest. 2004 Aug;51(3-4):230-3.
The aim of the eye care project is to clear the backlog of cataract blindness for the people of Gaur and its surrounding districts in southeast Nepal. The purpose of this study is to analyze the progress of this eye care project.

Corneal triple procedure: indications, complications, and outcomes: a developing country scenario.
Sridhar MS, Murthy S, Bansal AK, Rao GN. Cornea. 2000 May;19(3):333-5.
Authors report the indications, complications, and outcomes of 104 corneal triple procedures in our institute. Corneal scarring with cataract is the most common reason for triple procedure in this part of the world. This is a safe surgical procedure with good graft clarity and reasonable visual recovery.

Should trichiasis surgery be offered in the village? A community randomised trial of village vs. health centre-based surgery.
Bowman RJ et al. Trop Med Int Health. 2000 Aug;5(8):528-33.
Authors conducted a randomised community trial to investigate the effect of providing surgery in villages on surgical uptake in The Gambia. Results strongly suggest better surgical uptake when surgery is provided in patients' villages due to lower cost to the patient, time saved and less fear of the operation.

Increasing cataract surgery to meet Vision 2020 targets; experience from two rural programmes in east Africa.
Lewallen S et al. Br J Ophthalmol. 2005 Oct;89(10):1237-40.
Over a few years, two programmes in rural east Africa both achieved significant increases in the number of cataract surgeries they provide, resulting in cataract surgical rates of 1583 for Kwale District in Kenya and 1165 for Kilimanjaro Region in Tanzania. Key components of success in these two programmes are described.

Privately funded quality health care in India: a sustainable and equitable model.
Samandar R et al. 2001 Aug;13(4):283-8. Review.
This case report of a privately-funded medical institution describes a successful model through which high-quality, equitable health care can be provided in a developing country.

Three months follow up of IOL implantation in remote eye camps in Nepal.
van der Hoek J. Int Ophthalmol. 1997-1998;21(4):195-7.
In early 1996 Posterior Chamber IOL Implantation was used routinely for the first time in surgical eye camps in the Dhaulagiri and Gandaki regions of Nepal. A series of follow-up camps was organized at the original locations three months following surgery to evaluate the visual outcome. This study indicates that good results can be achieved in eye camps at remote locations with the use of a standard power IOL.

Monitoring and evaluating cataract intervention in India.
Limburg H, Kumar R, Bachani D. Br J Ophthalmol. 1996 Nov;80(11):951-5. Review.
This study identified indicators to monitor and evaluate the cataract intervention programme in India. At least 2.5 million sight restoring cataract operations will have to be performed annually. Staffing levels and infrastructure resources at present allow for increased output. The effectiveness of cataract services can be increased with better case selection. 

Local anesthesia by peribulbar block for cataract extraction in an eye relief camp. A double-masked, randomized controlled trial.
Agrawal K, Saxena RC, Nath R, Saxena S. Online J Curr Clin Trials. 1993 Mar 19.
To test the hypothesis that the median scores for globe anesthesia are not significantly different for patients receiving local anesthesia (LA) by peribulbar block (PB) than for those receiving retrobulbar block (RB) for cataract surgery. PB is no different from RB in terms of producing globe anesthesia when used for cataract surgery at eye camps.

Miscellaneous

Productivity of key informants for identifying blind children: evidence from a pilot study in Malawi.
Kalua K, Patel D, Muhit M, Courtright P Eye. 2009 Jan;23(1):7-9. 
This study sought to determine the productivity of village-based 'key informants' (KIs) in identifying blind children. Village leaders tended to choose female KIs (80%) compared to male KIs (20%); however, male KIs tended to be more productive, identifying 4.22 children each (compared to 3.23 for female KIs). Male KIs were 2.7 times more likely to identify blind children compared to female KIs.

Biological diversity, dietary diversity, and eye health in developing country populations: establishing the evidence-base.
Bélanger J, Johns T. Ecohealth. 2008 Sep;5(3):244-56
Authors present a rationale for testing the dietary contribution of biological diversity to improved eye health as a case study based on existing phytochemical, pharmacological, and clinical knowledge. They consider the empirical evidence needed to substantiate, interpret, and apply this relationship at a population and ecosystem level within a unified research framework.

Eye camps in Yemen--providing medical coverage to the underprivileged.
Bamashmus MA, Al-Barrag AO. Med Sci Monit. 2008 Nov;14(11):PH41-5.
This study aimed to decrease the massive problem of cataract-related blindness and visual disability in rural areas of Yemen and reach more visually impaired and blind people to provide them with an improved standard of visual rehabilitation. The "eye camps" involved a comprehensive cooperative relief effort on a large scale to combat the widespread prevalence of cataract and chronic shortages of ophthalmic facilities and medical personnel as it affects residents of rural areas in Yemen.

Eye health in the priests and novices in central Bangkok.
Srisuwanporn S et al. J Med Assoc Thai. 2008;91 Suppl 1:S13-20.
To evaluate eye health status and screening for refractive error in priests and novices and to provide free spectacles and eye health education to fulfill the criteria of voluntary Buddhist eye health workers. Most of the priests and novices in central Bangkok had good eye health. Half of the eye problems were refractive errors.

Teleophthalmology-based rural eye care in India.
Bai VT, Murali V, Kim R, Srivatsa SK. Telemed J E Health. 2007 Jun;13(3):313-21.
This paper discusses Indian teleophthalmology projects known as Sankara Netralaya Teleophthalmology Project (SNTOP) and Aravind Teleophthalmology Network (ATN). These have proven successful in the state of Tamilnadu, India, both in rural and secondary healthcare centers.

Genetic and segregation analysis of congenital cataract in the Indian population.
Vanita, Singh JR, Singh D. Clin Genet. 1999 Nov;56(5):389-93.
Two hundred and fifty-two families with congenital cataract belonging to 13 different states of India, were clinically and genetically investigated to study their inheritance and segregation patterns. Twenty-one % of the cases were autosomal recessive, 15% autosomal dominant, 63% were simplex cases, and in the remaining cases the inheritance pattern was not clear.

Hereditary congenital cataracts associated with sickle cell anaemia in a Nigerian family.
Babalola OE, Danboyi P, Abiose AA. Trop Doct. 2000 Jan;30(1):12-4
This report relates to a four-generation family in northern Nigeria with dominantly inherited cataracts associated with recessively inherited sickle cell anaemia. It highlights the need for genetic counselling services in clinical practice in the region.

Epidemiological studies on UV-related cataract in climatically different countries.
Sasaki K et al. J Epidemiol. 1999 Dec;9(6 Suppl):S33-8.
Cataract epidemiological surveys applying objective judgment through lens images in the climatically different places of Noto and Amami, Japan, Singapore and Reykjavik, Iceland yielded several significant results about the influence of solar UV. The %age of transparent and of lens opacification was significantly higher in the Reykjavik subjects than in the Singaporeans, etc.

Ghana 1996--an ophthalmologist's experience
Novák J. Cesk Slov Oftalmol. 1997 May;53(2):136-41. Czech.
In the article, the practical experience of an eye surgeon in a small mission hospital is described.

Correlation between UVB irradiation and the proportion of cataract--an epidemiological study based on a nationwide patient survey in Japan.
Hayashi LC, Tamiya N, Yano E. Ind Health. 1998 Oct;36(4):354-60.
To provide clear information for the association between cataract and UVB irradiation, the prevalence data from the Patient Survey and UVB estimates in all the 47 prefectures in Japan were used to examine the relationship between cataract and UVB. A sex-specific logistic regression analysis revealed that the adjusted odds ratio in women was 1.118 with a 95% confidence interval of 1.058-1.183. However, the adjusted odds ratio in men was not statistically significant.

Blue-yellow colour vision in an onchocercal area of northern Nigeria.
Landers A, Murdoch IE, Birch J, Cousens SN, Babalola OE, Lawal B, Abiose A, Jones BR.
The goal of this study was to determine if the City University Tritan Test is a useful addition to visual function assessment in rural communities in northern Nigeria. It was found that blue-yellow colour vision testing is a useful addition to visual function assessment in those aged 10 years and above in rural northern Nigeria, particularly in the detection of optic nerve disease.

Visual loss in an onchocerciasis endemic community in Sierra Leone.
Whitworth JA, Gilbert CE, Mabey DM, Morgan D, Foster A. Br J Ophthalmol. 1993 Jan;77(1):30-2.
The visual acuities of 1625 individuals recruited to a community-based clinical trial of ivermectin in southern Sierra Leone were measured, and the prevalence of visual loss in this rural population where onchocerciasis is hyperendemic was determined. Cataract and onchocerciasis were the major causes of visual loss in this population. More than half of the ocular morbidity was preventable or treatable by public health measures or basic curative medicine.

A geographic approach to senile cataracts: possible links with milk consumption, lactase activity, and galactose metabolism.
Simoons FJ. Dig Dis Sci. 1982 Mar;27(3):257-64.
Examined in this article is presently available evidence for the hypothesis that some types of senile cataracts may be brought on by decades-long consumption of milk and milk products. The author approaches the question from a background of research in the geography and history of dairying as these relate to present-day differences among the world's peoples in prevalence of primary adult lactose malabsorption, which is based on a deficiency of the enzyme lactase in adulthood.

Cataracts, alopecia, and sclerodactyly: a previously apparently undescribed ectodermal dysplasia syndrome on the island of Rodrigues.
Wallis C, Ip FS, Beighton P. Am J Med Genet. 1989 Apr;32(4):500-3.
An unique autosomal recessive ectodermal dysplasia is present in 5 sibs from the Indian Ocean island of Rodrigues. The main manifestations are total congenital alopecia, bilateral congenital cataracts, and skin changes of the hands and feet including sclerodactyly, hyperkeratosis, contractures, and pseudoainhum formation.

The correlations between Central Corneal Thickness and age, gender, intraocular pressure and refractive error of aged 12-60 years old in rural Thai community.
Lekskul M et al. J Med Assoc Thai. 2005 Nov;88 Suppl 3:S175-9.
Researchers studied the normal Central Corneal Thickness (CCT) and investigate the correlation between CCT and age, gender intraocular pressure and refractive error. The CCT was independently related to the refractive error and gender Greater CCT was associated with higher intraocular pressure. Conversely, thinner cornea was correlated with older age group.

A case-control study of biometry in healthy and cataractous Eritrean eyes.
Connell B, Brian G, Bond MJ. Ophthalmic Epidemiol. 1997 Sep;4(3):151-5.
The keratometry and axial length readings of healthy eyes (405 subjects) and cataractous eyes (63 subjects) from a sample of Tigrinians living in the Eritrean capital of Asmara were obtained. The mean keratometry reading for healthy eyes was 43.37 diopters, while that for cataractous eyes was 43.57 diopters. These values were not significantly different.

Eye lesions and onchocerciasis in a rural farm settlement in Delta State, Nigeria.
Goddey NO, Oladokun OA, Andy E, Emmanuel O. J Commun Dis. 2001 Sep;33(3):185-91.
Between December 1999 and September 2000, an investigation on 326 inhabitants who voluntarily participated in screening for eye lesions and onchocerciasis in a rural farm settlement in Aniocha North local government area of Delta State, Nigeria was conducted. Microfilariae were reported in the skin tissues of 134 (41.1%) inhabitants. Of these, males had more microfiladermia (49.9%) than their female counterparts (33.3%).