Blindness and low vision in southeast Turkey

Abstract

In preparation for the planning of a regional prevention of blindness programme, a population-based survey of blindness and eye disease was conducted in two provinces (Diyarbakir and Mardin) of southeast Turkey. A stratified cluster random sampling procedure was used to select 8,571 persons. The main objectives of the survey were to assess the population need for basic ophthalmic services, both in rural and in rapidly growing urban communities, and to secure baseline data for subsequent evaluation of the programme.

The prevalence of visual impairment (best binocular vision poorer than 6/18) was estimated at 1.9% with 95% confidence limits of 1.6% and 2.1%, amounting to 29,400 +/- 4500 visually impaired persons in the regional population of 1.6 million. The prevalence of blindness (best vision poorer than 3/60) was 0.4%, and an estimated 1.5% had low vision (best vision poorer than 6/18, but not blind). Compared to the blindness prevalence of 0.2% in the European Economic Community (EEC), the age-standardised prevalence of blindness in southeast Turkey was 8 times as high.

The main causes of blindness in the sample were cataract (50%), corneal opacity (15%), glaucoma (12%), phthisis (6%) and optic atrophy (6%). Cataract and refractive errors were responsible for 52% and 26% of the low vision, respectively. Acute inflammatory trachoma was prevalent in a number of rural and urban communities, affecting an estimated 25,900 people in the region. The need for basic ophthalmic services was estimated for the two provinces. Some 26,600 were in need of cataract surgery, 4,400 needed eyelid surgery for trachoma-induced entropion, and 28,600 required spectacles to improve their visual acuity to 6/18 or better.

More than half of the current burden of severe visual loss in the two provinces of southeast Turkey is potentially remediable through the provision of cataract surgery and of spectacles to correct aphakia. The survey findings suggest that as the age structure of the regional population approaches that of the EEC through the 'ageing trend', a four-fold increase in the burden of blindness might be expected, unless improvements are made in curative and preventive ophthalmic services in parallel with the general development that improves survival.