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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.Geographically defined cluster sampling was used in randomly selecting personsor= 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 acuity20/32.A total of 5158 eligible persons were enumerated and 4738 (91.9%) examined. Prevalence of presenting visual impairment20/63 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 acuity20/63 to 20/200, and refractive error (86.6%) in eyes with acuity20/32 to 20/63.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.

AbstrA ct Purpose: Investigate the prevalence and vision-related outcomes of cataract surgery in an area of high cataract surgical rate. Methods: Cluster sampling was used in randomly selecting individuals ≥ 50 years of age in 2007. Participants were queried regarding year and place of previous cataract surgery. Cataract surgical procedures and evidence of surgical complications were recorded. The principal cause was identified for eyes presenting with visual acuity (VA) ≤ 20/40. Results: A total of 4,738 persons were examined and 834 (17.6%) had cataract surgery. Intra- ocular lenses (IOLs) were used in 84.1% of the 1,299 cataract-operated eyes, with more than half of these having manual small incision surgery. Surgical coverage among the cataract blind (visual acuity [VA] < 20/200) was estimated as 72.2%. Coverage was associated with older age, literacy, and urban residence; gender was not significant. Among cataract-operated eyes, 18.7% presented with VA ≥ 20/32 and 18.0% were < 20/200. With best-corrected acuity, the corresponding percentages were 55.7% and 11.0%. Presenting and best-corrected VA ≥ 20/63 were associated with young age, literacy, and IOL surgery; urban residence and surgery in non-governmental organizations (NGO)/ private facilities were also significant for presenting VA; and recent surgery was significant for best-corrected VA. Refractive error was the main cause of vision impairment/blindness in cataractoperated eyes. Conclusions: Refractive error and posterior capsule opacification, easily treatable causes of visual impairment, are common among the operated. A greater emphasis on the quality of visual acuity outcomes along with sustained efforts to provide access to affordable surgery is needed.

Purpose: Assess visual impairment in school children of upper-middle socioeconomic status in Kathmandu for comparison with rural Jhapa District. Methods: Random selection of classes from secondary private schools in Kathmandu was used to identify the study sample. Children in 130 classes at 43 schools were enumerated using school records and examined between January‐May 2006. Examinations included visual acuity testing, ocular motility evaluation, cycloplegic refraction, and examination of the external eye, anterior segment, media, and fundus. The principal cause was determined for eyes with uncorrected visual acuity ≤20/40. Results :A total of 4,501 children in grades 5‐9 were enumerated; 4282 (95.1%) were examined. The prevalence of uncorrected, presenting, and best-corrected visual impairment (≤20/40) in the better eye was 18.6%, 9.1%, and 0.86%, respectively. Refractive error was a cause in 93.3% of children with uncorrected visual impairment, amblyopia 1.8%, retinal disorders 1.3%, other causes 0.3%, and unexplained causes 4.4%. Among children correctable in at least one eye, 46.3% presented without the necessary spectacles. Visual impairment with myopia (-0.50 diopters) ranged from 10.9% in 10 year-olds to 27.3% in 15 year-olds, compared to 0.5%‐3.0% in rural Jhapa District. Myopic visual impairment was associated with grade level, female gender, parental education, parental spectacle usage, and Mongol ethnicity. Conclusions: Visual impairment with myopia among upper-middle socioeconomic school children in Kathmandu is higher than that in rural Nepal, and a public health problem because nearly half are without corrective spectacles. Effective strategies are needed to eliminate this easily treatable cause of visual impairment.

To assess the clinical outcomes of cataract surgery in rural southern India.Cluster sampling was used in randomly selecting a cross-sectional sample of persons 50 years of age or older for visual acuity measurement, refraction, and ocular examination in 1999. Subjects were queried as to the date and place of surgery for each cataract-operated eye. Surgical complications were noted and the principal cause of reduced vision was identified for eyes with presenting visual acuity worse than 6/18.Within the cataract-operated sample of 682 persons, 13.8% had presenting visual acuity worse than 6/60 in both eyes, 25.2% better than or equal to 6/18 in both eyes, and 37.8% were bilaterally operated on. For aphakic eyes, 50.5% presented with visual acuity better than or equal to 6/18; 82.6% with best-correction. For pseudophakic eyes, the corresponding percentages were 78.0% and 94.5%. Over one-third of all eyes were pseudophakic, and nearly three-fourths had been operated on in non-governmental facilities. Uncorrected aphakia and other refractive error were the main causes of vision impairment. In multiple logistic regression modeling, poor presenting visual acuity in aphakic eyes was associated with illiteracy, rural residence, and surgery in government facilities; gender and time period of surgery were not predictors of vision outcomes. None of these variables were associated with best-corrected outcomes in aphakic eyes, nor with presenting and best-corrected outcomes in pseudophakic eyes.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.

PURPOSE. To quantify and compare the reduction in quality of life due to visual impairment and angina using patient preferences (utilities). METHODS. Using a standard time tradeoff method, we obtained utilities for current vision, monocular and binocular blindness, current angina, and moderate angina in 60 patients with both vision problems and angina pectoris who sought care at the National Eye Institute (NEI), National Naval Medical Center, or Barnes-Jewish Hospital. Patients were characterized clinically based on visual acuity and the Duke Activity Status Index (DASI). Patients also completed a seven-item version of the NEI Visual Functioning Questionnaire and the SF-36 Health Survey Questionnaire. RESULTS. Patients had a median visual acuity of 20/100 in the worst eye, 20/40 in the better eye, and a median DASI of 24.2 (0 = severe functional limitations due to anginal symptoms, 58.2 = no limitations). There was substantial variation in utilities among patients. The average utility for current vision (...

Investigate prevalence and causes of vision impairment/blindness in older adults in a low-middle income area of Sao Paulo, Brazil.Cluster sampling, based on geographically defined census sectors, was used in randomly selecting cross-sectionally persons 50 years of age or older. Subjects were enumerated through a door-to-door survey 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 less than 20/32.A total of 4,224 eligible persons in 2,870 households were enumerated, and 3,678 (87.1%) examined. The prevalence of presenting visual acuityor = 20/32 in both eyes was 61.6% (95% confidence interval [CI]: 59.4%-63.9%), and 80.4% (95% CI: 78.8%-82.1%) with best correction. The prevalence of visual impairment (20/63 toor =20/200) in the better eye was 4.74% (95% CI: 3.97%-5.53%), and 2.00% (95% CI: 1.52%-2.49%) with best correction. The prevalence of presenting bilateral blindness (20/200) was 1.51% (95% CI: 1.20%-1.82%), and 1.07% (95% CI: 0.79%-1.35%) with best correction. 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 impairment20/63 toor = 20/200, with refractive error (76.8%) and cataract (12.2%) as main causes for eyes with acuity20/32 toor = 20/63.Vision impairment is a significant problem in older Brazilians reinforcing the need to implement prevention of blindness programs for elderly people with emphasis on those without schooling.

To assess the prevalence of visual acuity impairment, blindness, and cataract surgery among older adults in rural southern India.Random selection of village- and urban-based clusters was used to identify a cross-sectional sample of persons 50 years of age or older from the Sivaganga district of Tamil Nadu. Subjects in 25 selected clusters were enumerated through a door-to-door survey and invited to examination sites for measurement of uncorrected, presenting, and best-corrected visual acuity and ocular examination in 1999. The principal cause was identified for eyes with presenting visual acuity worse than 6/18. Quality assurance monitoring of visual acuity measurements took place in five of the study clusters.A total of 5081 persons in 3517 households were enumerated, and 4642 (91.4%) were examined. Thirty-six percent presented with visual acuity worse than 6/18 in the better eye. The prevalence of blindness, based on visual acuity worse than 6/60 in both eyes, was 6.0% (95% confidence interval [CI]: 5.1% to 6.9%) with presenting vision, and 2.5% (95% CI: 1.8% to 3.1%) with best correction. 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, and uncorrected aphakia and other refractive error affected 35.6% in at least one eye. The prevalence of cataract surgery was 14.7% (95% CI: 13.0% to 16.4%); low surgical coverage among the cataract blind was associated with illiteracy.It appears that much has been done in the prevention of blindness in Sivaganga. Nevertheless, blindness remains an important public health problem, mainly because of cataract and refractive error. Prevention of blindness programs in the area should target these two causes, with special emphasis on the elderly and the illiterate.