EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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EW INTERNATIONAL 54 December 2014 by Chiles Aedam R. Samaniego EyeWorld Asia-Pacific Senior Staff Writer T he last 2 decades have seen ophthalmologists from around the world become increasingly engaged in the eradication of preventable and treatable forms of blindness. Owing at least in part to these ef- forts, the 20-year span from 1990 to 2010 saw a 3% decrease—from 68% to 65%—in the number of people around the world blind from preventable and treatable causes, according to a study published in the December 2013 issue of The Lancet Global Health. This change may seem negligi- ble, particularly in light of the actual numbers, remaining close to 32 million people throughout that time period. However, the study's lead investigator, Rupert R.A. Bourne, MD, Vision and Eye Research Unit, Postgraduate Medical Institute, Anglia Ruskin University, Cambridge, U.K., said that the world's aging population masks the significance of the change. More than half of the world's population lives in the Asia-Pacific; here, EyeWorld focuses on 2 of the world's most populous countries— China and India—to see how the fight against blindness in the region has progressed over the same time period, and whether the Lancet study's findings reflect the experi- ence in the region. Reflecting the Lancet data In India, "the answer is a resounding 'YES,'" said N. Venkatesh Prajna, DNB, FRCO, chief of the cornea clinic, Aravind-Madurai, and director of academics, Aravind Eye Care System, India, in correspon- dence. "The incidence of blindness has decreased from 1.4% in 1976 to 1% in recent times (vision of less than 6/60)." Meanwhile, in China, the number of visually disabled people is also decreasing gradually over the years, said Li Xiaorong, MD, PhD, director, Tianjin Medical University Eye Hospital, China. This is particularly true in terms of cataract. Today, said Dr. Li, white, mature cataracts are seldom encoun- tered in clinics. "With the develop- ment of the technique, some cata- racts that could not be treated before now can be treated, so most of them can recover from blindness," he said. Dr. Prajna's experience is comparable. In India, he said, "the proportion of cataract as a cause of blindness has come down. Twen- ty years back, cataracts used to be responsible for 80% of blindness, while now it is estimated to be around 60%." Nonetheless, cataract remains the leading cause of blindness in both countries. In China, where the problem of blindness is "still very serious," Dr. Li said that the prev- alence of blindness and low vision has been estimated at 2.29% and 10.8%, respectively, with the total number of blind estimated at 75.5 million—"accounting for 20% of blindness in the world," he said. Also reflecting the Lancet data, China's large and, more to the point, aging population affects the true measure of blindness in the country. "The actual reduction in the number of blind each year is overshadowed by aging," said Dr. Li. "The national average CSR [cataract surgery rate] is 900. Based on the rate, the number of cataract will add up to about 80 to 100 million each year." The plan, he said, is therefore to improve the country's CSR to about 1,500. Reaching for balance The Lancet paper attributes the decrease in global blindness to a G lobal efforts to eradicate treatable causes of blindness are paying off, according to an article in The Lancet Global Health. The percentage of people who are blind from preventable or treatable causes is slowly dropping. Anyone who has ever volunteered to work in underdeveloped areas understands the need remains great. They also understand that the only sustainable solution is to develop local infrastructure to provide the needed care. India and China have experienced dramatic economic growth over the last 20 years. This has helped lower the overall poverty rate, which helps, but this is only part of the story. Cooperation between non-govern- mental organizations and government pro- grams has proven to be an important factor. In this article, we look at the successes in treating cataract-related blindness and contemplate the challenges that remain. John A. Vukich, MD, international editor Blindness decreases in the Asia-Pacific continued on page 56 International outlook As worldwide blindness decreases, the problem also grows more complex, as revealed by the experience of experts in India and China.