Prevelence and Causes of Visual Impairment and Blindness in Older Adults in an Area of India with a High Cataract Surgical Rate

Abstract

Background: The cataract surgical rate (CSR) in Gujarat, India is reported to be above 10,000 per million population. This study was conducted to investigate the prevalence and causes of vision impairment/blindness among older adults in a high CSR area.

Methods: Geographically defined cluster sampling was used in randomly selecting persons ≥ 50 years of age in Navsari district. Subjects in 35 study clusters were enumerated and invited for measurement of presenting and best-corrected visual acuity and an ocular examination. The principal cause was identified for eyes with presenting visual acuity < 20/32.

Results: A total of 5158 eligible persons were enumerated and 4738 (91.9%) examined. Prevalence of presenting visual impairment < 20/63 to 20/200 in the better eye was 29.3% (95% confidence interval [CI]: 27.5–31.2) and 13.5% (95% CI: 12.0–14.9) with best correction. The prevalence of presenting bilateral blindness (< 20/200) was 6.9% (95% CI: 5.7–8.1), and 3.1% (95% CI: 2.5–3.7) with best correction. Presenting and best-corrected blindness were both associated with older age and illiteracy; gender and rural/urban residence were not significant.

Cataract in one or both eyes was the main cause of bilateral blindness (82.6%), followed by retinal disorders (8.9%). Cataract (50.3%) and refractive error (35.4%) were the main causes in eyes with vision acuity < 20/63 to 20/200, and refractive error (86.6%) in eyes with acuity < 20/32 to 20/63.

Conclusions: Visual impairment and blindness is a significant problem among the elderly in Gujarat. Despite a reportedly high CSR, cataract remains the predominant cause of blindness.

KEYWORDS::

• Blindness
• Cataract
• India
• Refractive error
• Visual impairment

ACKNOWLEDGMENTS

We thank Mr. Tara Dutt Pant and Mr Hira Ballabh Pant, SEWA-Rural, for assisting with the training of field workers and analysis of pilot data.

SEWA- Rural Cataract Study Group: Dr. Uday Gajiwala, Dr. Rajesh Patel, Dr. Lata Desai, Dr. Pankaj Shah and support staff of SEWA-Rural, Jhagadia, Bharuch, Gujarat, India.

Supported by the World Health Organization, Geneva, Switzerland (under National Institutes of Health [Bethesda, Maryland] contract no. N01-EY-2103).

Declaration of Interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.