Elsevier

Ophthalmology

Volume 110, Issue 8, August 2003, Pages 1491-1498
Ophthalmology

Blindness and vision impairment in a rural south Indian population: the Aravind Comprehensive Eye Survey

https://doi.org/10.1016/S0161-6420(03)00565-7Get rights and content

Abstract

Objective

To determine the prevalence of blindness and vision impairment in a rural population of southern India.

Design

A population-based cross-sectional study.

Participants

A total of 17,200 subjects aged 6 years or older, including 5150 subjects aged 40 years or older from 50 clusters representative of three southern districts of Tamil Nadu in southern India.

Methods

All participants had preliminary screenings consisting of vision using a LogMAR illiterate E chart and anterior segment hand light examinations at the village level. Subjects aged 40 years or older were offered comprehensive eye examinations at the base hospital, including visual acuity using LogMAR illiterate E charts and refraction, slit-lamp biomicroscopy, gonioscopy, applanation tonometry, dilated fundus examinations, and automated Humphrey central 24-2 full threshold perimetry; subjects younger than 40 years of age who had any signs or symptoms of ocular disease were also offered comparable examinations at the base hospital.

Main outcome measures

Visual impairment was defined as best-corrected visual acuity <6/18, and blindness was defined using both Indian (<6/60) and World Health Organization (<3/60) definitions.

Results

Comprehensive examinations at the base hospital were performed on 5150 (96.5%) of 5337 persons 40 years of age or older. Among those 40 years of age and older, presenting visual acuity at the <3/60 level was present in 4.3% (95% confidence interval [CI]: 3.8, 4.9) and 11.4% (95% CI: 10.6, 12.3) at the <6/60 level. After best correction, the corresponding figures were 1.0% (95% CI: 0.79, 1.2) and 2.1% (95% CI: 1.7, 2.5). Over 70% of subjects improved their vision by at least one line, and nearly a third by three lines after refraction. Age-related cataract was the most common potentially reversible blinding disorder (72.0%) among eyes presenting with blindness.

Conclusions

Blindness and vision impairment remain major public health problems in India that need to be addressed. Cataracts and refractive errors remain the major reversible causes for the burden of vision impairment in this rural population.

Section snippets

Methods

The ACES was a population-based prevalence survey of ocular disease and visual impairment conducted in a sample of rural villages of southern Tamil Nadu, India. The specific aims of this project were to estimate the prevalence of major ocular disorders among adults 40 years of age or older and to estimate the prevalence and causes of vision loss among persons of all ages.

The sampling frame for this study consisted of a sample of typical rural districts (equivalent to counties in the United

Results

A total of 4702 households were enumerated from 14 rural blocks in which there were 17,200 subjects aged 6 years or older (Fig 1). Subjects younger than 6 years of age did not have visual acuity measured at the village level. Out of 17,200 subjects aged 6 years or older, 11,661 (67.8%) were between 6 and 39 years of age, and 5539 (32.2%) were 40 years of age or older.

Among those younger than 40 years of age, 11,583 (99.3%) received village-based screening examinations, and 78 persons (0.7%)

Discussion

Door-to-door enumeration and high participation rates among those enumerated coupled with the random nature of the sample support the generalizability of results from this study to the population of these three districts. The exclusion of villages with <350 inhabitants may have altered the representativeness of the study population, although it is unclear whether such villages might have had similar, lower, or higher rates of blindness and visual impairment. Such villages are not more or less

Acknowledgements

This study was supported in part by unrestricted grants from Allergan, Inc.; Alcon Laboratories, Inc.; and the Zeiss Corporation.

References (25)

  • Mohan M. Survey of blindness—India (1986-1989). In: Summary Results: Programme for the Control of Blindness. New Delhi:...
  • L. Dandona et al.

    Blindness in the Indian state of Andhra Pradesh

    Invest Ophthalmol Vis Sci

    (2001)
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