Abstract
AIM—To review the prevalence and causes of blindness in sub-Saharan Africa, the existing services and limitations, and the Vision 2020 goals for the future. METHODS—Methodologically sound population based surveys published in the past 20 years are reviewed and results for prevalence and causes of blindness are tabulated. The current resources and needs according to recent publications and international working groups are described. CONCLUSIONS—Blindness prevalence rates vary widely but the evidence suggests that approximately 1% of Africans are blind. The major cause is cataract; trachoma and glaucoma are also important causes of blindness. The bulk of blindness in the region is preventable or curable. Efforts should focus on eye problems which are universally present and for which there are cost effective remedies, such as cataract and refractive problems and on those problems which occur focally and can be prevented by primary healthcare measures, such as trachoma, onchocerciasis, and vitamin A deficiency. Major development of staffing levels, infrastructure, and community programmes will be necessary to achieve Vision 2020 goals.
Full Text
The Full Text of this article is available as a PDF (161.8 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Abou-Gareeb I., Lewallen S., Bassett K., Courtright P. Gender and blindness: a meta-analysis of population-based prevalence surveys. Ophthalmic Epidemiol. 2001 Feb;8(1):39–56. doi: 10.1076/opep.8.1.39.1540. [DOI] [PubMed] [Google Scholar]
- Abraham D. I., Vitale S. I., West S. I., Isseme I. Epidemiology of eye injuries in rural Tanzania. Ophthalmic Epidemiol. 1999 Jun;6(2):85–94. doi: 10.1076/opep.6.2.85.1560. [DOI] [PubMed] [Google Scholar]
- Adeoye A. Survey of blindness in rural communities of south-western Nigeria. Trop Med Int Health. 1996 Oct;1(5):672–676. doi: 10.1111/j.1365-3156.1996.tb00093.x. [DOI] [PubMed] [Google Scholar]
- Akogun O. B. Eye lesions, blindness and visual impairment in the Taraba river valley, Nigeria and their relation to onchocercal microfilariae in skin. Acta Trop. 1992 Jun;51(2):143–149. doi: 10.1016/0001-706x(92)90056-4. [DOI] [PubMed] [Google Scholar]
- Balo K., Negrel D. A. Les causes de cécité au Togo. J Fr Ophtalmol. 1989;12(4):291–295. [PubMed] [Google Scholar]
- Bowman R. J., Soma O. S., Alexander N., Milligan P., Rowley J., Faal H., Foster A., Bailey R. L., Johnson G. J. Should trichiasis surgery be offered in the village? A community randomised trial of village vs. health centre-based surgery. Trop Med Int Health. 2000 Aug;5(8):528–533. doi: 10.1046/j.1365-3156.2000.00605.x. [DOI] [PubMed] [Google Scholar]
- Bucher P. J., Ijsselmuiden C. B. Prevalence and causes of blindness in the northern Transvaal. Br J Ophthalmol. 1988 Oct;72(10):721–726. doi: 10.1136/bjo.72.10.721. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Burnham G. Onchocerciasis. Lancet. 1998 May 2;351(9112):1341–1346. doi: 10.1016/S0140-6736(97)12450-3. [DOI] [PubMed] [Google Scholar]
- Cerulli L., Cedrone C., Assefa C., Scuderi G. L. Assessment of visual status of the population in seven regions of Ethiopia. Rev Int Trach Pathol Ocul Trop Subtrop Sante Publique. 1984;(2-4):127–142. [PubMed] [Google Scholar]
- Chirambo M. C., Tielsch J. M., West K. P., Jr, Katz J., Tizazu T., Schwab L., Johnson G., Swartwood J., Taylor H. R., Sommer A. Blindness and visual impairment in southern Malawi. Bull World Health Organ. 1986;64(4):567–572. [PMC free article] [PubMed] [Google Scholar]
- Cook C. D., Knight S. E., Crofton-Briggs I. Prevalence and causes of low vision and blindness in northern KwaZulu. S Afr Med J. 1993 Aug;83(8):590–593. [PubMed] [Google Scholar]
- Courtright P., Kanjaloti S., Lewallen S. Barriers to acceptance of cataract surgery among patients presenting to district hospitals in rural Malawi. Trop Geogr Med. 1995;47(1):15–18. [PubMed] [Google Scholar]
- Courtright P., Klungsøyr P., Lewallen S., Henriksen T. H. The epidemiology of blindness and visual loss in Hamar tribesmen of Ethiopia. The role of gender. Trop Geogr Med. 1993;45(4):168–170. [PubMed] [Google Scholar]
- Courtright P., Lewallen S. Current concepts in the surgical management of lagophthalmos in leprosy. Lepr Rev. 1995 Sep;66(3):220–223. doi: 10.5935/0305-7518.19950024. [DOI] [PubMed] [Google Scholar]
- Courtright P., Lewallen S., Kanjaloti S., Divala D. J. Traditional eye medicine use among patients with corneal disease in rural Malawi. Br J Ophthalmol. 1994 Nov;78(11):810–812. doi: 10.1136/bjo.78.11.810. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dolin P. J., Faal H., Johnson G. J., Ajewole J., Mohamed A. A., Lee P. S. Trachoma in The Gambia. Br J Ophthalmol. 1998 Aug;82(8):930–933. doi: 10.1136/bjo.82.8.930. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Drabo P. Y., Kabore J., Lengani A. Complications du diabète sucré au Centre hospitalier de Ouagadougou. Bull Soc Pathol Exot. 1996;89(3):191–195. [PubMed] [Google Scholar]
- Elbagir M. N., Eltom M. A., Mahadi E. O., Berne C. Pattern of long-term complications in Sudanese insulin-treated diabetic patients. Diabetes Res Clin Pract. 1995 Oct;30(1):59–67. doi: 10.1016/0168-8227(95)01146-3. [DOI] [PubMed] [Google Scholar]
- Emerson P. M., Lindsay S. W., Walraven G. E., Faal H., Bøgh C., Lowe K., Bailey R. L. Effect of fly control on trachoma and diarrhoea. Lancet. 1999 Apr 24;353(9162):1401–1403. doi: 10.1016/S0140-6736(98)09158-2. [DOI] [PubMed] [Google Scholar]
- Erasmus R. T., Alanamu R. A., Bojuwoye B., Oluboyo P., Arije A. Diabetic retinopathy in Nigerians: relation to duration of diabetes, type of treatment and degree of control. East Afr Med J. 1989 Apr;66(4):248–254. [PubMed] [Google Scholar]
- Ezepue U. F. Magnitude and causes of blindness and low vision in Anambra State of Nigeria (results of 1992 point prevalence survey). Public Health. 1997 Sep;111(5):305–309. [PubMed] [Google Scholar]
- Faal H., Minassian D., Sowa S., Foster A. National survey of blindness and low vision in The Gambia: results. Br J Ophthalmol. 1989 Feb;73(2):82–87. doi: 10.1136/bjo.73.2.82. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fafowora O. F., Osuntokun O. O. Age-related eye disease in the elderly members of rural African community. East Afr Med J. 1997 Jul;74(7):435–437. [PubMed] [Google Scholar]
- Foster A. Cataract--a global perspective: output, outcome and outlay. Eye (Lond) 1999 Jun;13(Pt 3B):449–453. doi: 10.1038/eye.1999.120. [DOI] [PubMed] [Google Scholar]
- Foster A. Who will operate on Africa's 3 million curably blind people? Lancet. 1991 May 25;337(8752):1267–1269. doi: 10.1016/0140-6736(91)92929-v. [DOI] [PubMed] [Google Scholar]
- Gilbert C. E., Anderton L., Dandona L., Foster A. Prevalence of visual impairment in children: a review of available data. Ophthalmic Epidemiol. 1999 Mar;6(1):73–82. doi: 10.1076/opep.6.1.73.1571. [DOI] [PubMed] [Google Scholar]
- Gilbert C. E., Canovas R., Hagan M., Rao S., Foster A. Causes of childhood blindness: results from west Africa, south India and Chile. Eye (Lond) 1993;7(Pt 1):184–188. doi: 10.1038/eye.1993.39. [DOI] [PubMed] [Google Scholar]
- Gilbert C. E., Wood M., Waddel K., Foster A. Causes of childhood blindness in east Africa: results in 491 pupils attending 17 schools for the blind in Malawi, Kenya and Uganda. Ophthalmic Epidemiol. 1995 Jun;2(2):77–84. doi: 10.3109/09286589509057086. [DOI] [PubMed] [Google Scholar]
- Gordon Y. J., Mokete M. Diabetic retinopathy in Lesotho. Doc Ophthalmol. 1981 Jul 15;51(3):193–198. doi: 10.1007/BF00143883. [DOI] [PubMed] [Google Scholar]
- Guthua S. W., Mwaniki D. L., Maina D. M. Replacement therapy utilising autotransplanted wisdom teeth. East Afr Med J. 1994 Jan;71(1):35–38. [PubMed] [Google Scholar]
- Herse P. An ophthalmic survey of African patients presenting at rural eye clinics in South Africa. Optom Vis Sci. 1991 Sep;68(9):738–742. doi: 10.1097/00006324-199109000-00011. [DOI] [PubMed] [Google Scholar]
- Ilsar M., Chirambo M., Belkin M. Ocular injuries in Malawi. Br J Ophthalmol. 1982 Feb;66(2):145–148. doi: 10.1136/bjo.66.2.145. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Johnson J. G., Goode Sen V., Faal H. Barriers to the uptake of cataract surgery. Trop Doct. 1998 Oct;28(4):218–220. doi: 10.1177/004947559802800410. [DOI] [PubMed] [Google Scholar]
- Kaimbo D. K., Kabongo B. K., Missotten L. Les complications oculaires du diabète sucré au Zaire. Bull Soc Belge Ophtalmol. 1995;255:107–113. [PubMed] [Google Scholar]
- Kalk W. J., Joannou J., Ntsepo S., Mahomed I., Mahanlal P., Becker P. J. Ethnic differences in the clinical and laboratory associations with retinopathy in adult onset diabetes: studies in patients of African, European and Indian origins. J Intern Med. 1997 Jan;241(1):31–37. doi: 10.1046/j.1365-2796.1997.70892000.x. [DOI] [PubMed] [Google Scholar]
- Kamali A., Whitworth J. A., Ruberantwari A., Mulwanyi F., Acakara M., Dolin P., Johnson G. Causes and prevalence of non-vision impairing ocular conditions among a rural adult population in sw Uganda. Ophthalmic Epidemiol. 1999 Mar;6(1):41–48. doi: 10.1076/opep.6.1.41.1572. [DOI] [PubMed] [Google Scholar]
- Kestelyn P. The epidemiology of CMV retinitis in Africa. Ocul Immunol Inflamm. 1999 Dec;7(3-4):173–177. doi: 10.1076/ocii.7.3.173.4002. [DOI] [PubMed] [Google Scholar]
- Kortlang C., Koster J. C., Coulibaly S., Dubbeldam R. P. Prevalence of blindness and visual impairment in the region of Ségou, Mali. A baseline survey for a primary eye care programme. Trop Med Int Health. 1996 Jun;1(3):314–319. doi: 10.1046/j.1365-3156.1996.d01-44.x. [DOI] [PubMed] [Google Scholar]
- Leske M. C., Connell A. M., Schachat A. P., Hyman L. The Barbados Eye Study. Prevalence of open angle glaucoma. Arch Ophthalmol. 1994 Jun;112(6):821–829. doi: 10.1001/archopht.1994.01090180121046. [DOI] [PubMed] [Google Scholar]
- Leske M. C., Wu S. Y., Nemesure B., Li X., Hennis A., Connell A. M. Incidence and progression of lens opacities in the Barbados Eye Studies. Ophthalmology. 2000 Jul;107(7):1267–1273. doi: 10.1016/s0161-6420(00)00155-x. [DOI] [PubMed] [Google Scholar]
- Lester F. T. Clinical features, complications and mortality in type 2 (non-insulin dependent) diabetic patients in Addis Abeba, Ethiopia, 1976-1990. Ethiop Med J. 1993 Apr;31(2):109–126. [PubMed] [Google Scholar]
- Levitt N. S., Bradshaw D., Zwarenstein M. F., Bawa A. A., Maphumolo S. Audit of public sector primary diabetes care in Cape Town, South Africa: high prevalence of complications, uncontrolled hyperglycaemia, and hypertension. Diabet Med. 1997 Dec;14(12):1073–1077. doi: 10.1002/(SICI)1096-9136(199712)14:12<1073::AID-DIA498>3.0.CO;2-9. [DOI] [PubMed] [Google Scholar]
- Lewallen S., Courtright P. Peripheral corneal ulcers associated with use of African traditional eye medicines. Br J Ophthalmol. 1995 Apr;79(4):343–346. doi: 10.1136/bjo.79.4.343. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lewallen S. Herpes zoster ophthalmicus in Malawi. Ophthalmology. 1994 Nov;101(11):1801–1804. doi: 10.1016/s0161-6420(94)31099-2. [DOI] [PubMed] [Google Scholar]
- Lewallen S., Lowdon R., Courtright P., Mehl G. L. A population-based survey of the prevalence of refractive error in Malawi. Ophthalmic Epidemiol. 1995 Dec;2(3):145–149. doi: 10.3109/09286589509057096. [DOI] [PubMed] [Google Scholar]
- Lo P. I., Ho P. C., Lau J. T., Cheung A. Y., Goldschmidt E., Tso M. O. Relationship between myopia and optical components--a study among Chinese Hong Kong student population. Yan Ke Xue Bao. 1996 Sep;12(3):121–125. [PubMed] [Google Scholar]
- Mason R. P., Kosoko O., Wilson M. R., Martone J. F., Cowan C. L., Jr, Gear J. C., Ross-Degnan D. National survey of the prevalence and risk factors of glaucoma in St. Lucia, West Indies. Part I. Prevalence findings. Ophthalmology. 1989 Sep;96(9):1363–1368. doi: 10.1016/s0161-6420(89)32708-4. [DOI] [PubMed] [Google Scholar]
- Moll A. C., van der Linden A. J., Hogeweg M., Schader W. E., Hermans J., de Keizer R. J. Prevalence of blindness and low vision of people over 30 years in the Wenchi district, Ghana, in relation to eye care programmes. Br J Ophthalmol. 1994 Apr;78(4):275–279. doi: 10.1136/bjo.78.4.275. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mselle J. Visual impact of using traditional medicine on the injured eye in Africa. Acta Trop. 1998 Jun 30;70(2):185–192. doi: 10.1016/s0001-706x(98)00008-4. [DOI] [PubMed] [Google Scholar]
- Munoz B., Aron J., Turner V., West S. Incidence estimates of late stages of trachoma among women in a hyperendemic area of central Tanzania. Trop Med Int Health. 1997 Nov;2(11):1030–1038. doi: 10.1046/j.1365-3156.1997.d01-186.x. [DOI] [PubMed] [Google Scholar]
- Nwosu S. N. Prevalence and pattern of retinal diseases at the Guinness Eye Hospital, Onitsha, Nigeria. Ophthalmic Epidemiol. 2000 Mar;7(1):41–48. [PubMed] [Google Scholar]
- Négrel A. D., Avognon Z., Minassian D. C., Babagbeto M., Oussa G., Bassabi S. La cécité au Bénin. Med Trop (Mars) 1995;55(4 Pt 2):409–414. [PubMed] [Google Scholar]
- Négrel A. D., Massembo-Yako B., Botaka E., Minassian D. C., Coddy-Zitsamélé R. Prévalence et causes de la cécité au Congo. Bull World Health Organ. 1990;68(2):237–243. [PMC free article] [PubMed] [Google Scholar]
- Rapoza P. A., West S. K., Katala S. J., Taylor H. R. Prevalence and causes of vision loss in central Tanzania. Int Ophthalmol. 1991 Mar;15(2):123–129. doi: 10.1007/BF00224465. [DOI] [PubMed] [Google Scholar]
- Salmon J. F., Mermoud A., Ivey A., Swanevelder S. A., Hoffman M. The prevalence of primary angle closure glaucoma and open angle glaucoma in Mamre, western Cape, South Africa. Arch Ophthalmol. 1993 Sep;111(9):1263–1269. doi: 10.1001/archopht.1993.01090090115029. [DOI] [PubMed] [Google Scholar]
- Schwab L., Kagame K. Blindness in Africa: Zimbabwe schools for the blind survey. Br J Ophthalmol. 1993 Jul;77(7):410–412. doi: 10.1136/bjo.77.7.410. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Schwartz E. C., Huss R., Hopkins A., Dadjim B., Madjitoloum P., Hénault C., Klauss V. Blindness and visual impairment in a region endemic for onchocerciasis in the Central African Republic. Br J Ophthalmol. 1997 Jun;81(6):443–447. doi: 10.1136/bjo.81.6.443. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Schémann J. F., Sacko D., Banou A., Bamani S., Boré B., Coulibaly S., el Mouchtahide M. A. Cartographie du trachome au Mali: résultats d'une enquête nationale. Bull World Health Organ. 1998;76(6):599–606. [PMC free article] [PubMed] [Google Scholar]
- Sidibe E. H. Rétinopathie diabétique à Dakar et revue de la littérature africaine. . Diabetes Metab. 2000 Sep;26(4):322–324. [PubMed] [Google Scholar]
- Sobngwi E., Mbanya J. C., Moukouri E. N., Ngu K. B. Microalbuminuria and retinopathy in a diabetic population of Cameroon. Diabetes Res Clin Pract. 1999 Jun;44(3):191–196. doi: 10.1016/s0168-8227(99)00052-2. [DOI] [PubMed] [Google Scholar]
- Sukwa T. Y., Mwandu D. H., Ngalande T. C., Siziya S., Mukunyandela M. Prevalence of blindness and visual impairment in the Luapula Valley, Zambia. Trop Geogr Med. 1988 Jul;40(3):237–240. [PubMed] [Google Scholar]
- Tielsch J. M., Sommer A., Katz J., Royall R. M., Quigley H. A., Javitt J. Racial variations in the prevalence of primary open-angle glaucoma. The Baltimore Eye Survey. JAMA. 1991 Jul 17;266(3):369–374. [PubMed] [Google Scholar]
- Tizazu T., Mburu F. M. Prevalence and causes of vision loss in southern Sudan. Soc Sci Med. 1983;17(22):1785–1788. doi: 10.1016/0277-9536(83)90392-1. [DOI] [PubMed] [Google Scholar]
- Umeh R. E. The causes and profile of visual loss in an onchocerciasis-endemic forest-savanna zone in Nigeria. Ophthalmic Epidemiol. 1999 Dec;6(4):303–315. doi: 10.1076/opep.6.4.303.4187. [DOI] [PubMed] [Google Scholar]
- Verrey J. D., Foster A., Wormald R., Akuamoa C. Chronic glaucoma in northern Ghana--a retrospective study of 397 patients. Eye (Lond) 1990;4(Pt 1):115–120. doi: 10.1038/eye.1990.14. [DOI] [PubMed] [Google Scholar]
- Waddell K. M., Lewallen S., Lucas S. B., Atenyi-Agaba C., Herrington C. S., Liomba G. Carcinoma of the conjunctiva and HIV infection in Uganda and Malawi. Br J Ophthalmol. 1996 Jun;80(6):503–508. doi: 10.1136/bjo.80.6.503. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Waddell K. M., Saunderson P. R. Is leprosy blindness avoidable? The effect of disease type, duration, and treatment on eye damage from leprosy in Uganda. Br J Ophthalmol. 1995 Mar;79(3):250–256. doi: 10.1136/bjo.79.3.250. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wallace J., Lovell H. G. Glaucoma and intraocular pressure in Jamaica. Am J Ophthalmol. 1969 Jan;67(1):93–100. doi: 10.1016/0002-9394(69)90013-0. [DOI] [PubMed] [Google Scholar]
- West S. K., Congdon N., Katala S., Mele L. Facial cleanliness and risk of trachoma in families. Arch Ophthalmol. 1991 Jun;109(6):855–857. doi: 10.1001/archopht.1991.01080060119038. [DOI] [PubMed] [Google Scholar]
- West S. K., Munoz B., Turner V. M., Mmbaga B. B., Taylor H. R. The epidemiology of trachoma in central Tanzania. Int J Epidemiol. 1991 Dec;20(4):1088–1092. doi: 10.1093/ije/20.4.1088. [DOI] [PubMed] [Google Scholar]
- West S. K., Muñoz B., Schein O. D., Duncan D. D., Rubin G. S. Racial differences in lens opacities: the Salisbury Eye Evaluation (SEE) project. Am J Epidemiol. 1998 Dec 1;148(11):1033–1039. doi: 10.1093/oxfordjournals.aje.a009579. [DOI] [PubMed] [Google Scholar]
- West S., Lynch M., Munoz B., Katala S., Tobin S., Mmbaga B. B. Predicting surgical compliance in a cohort of women with trichiasis. Int Ophthalmol. 1994;18(2):105–109. doi: 10.1007/BF00919249. [DOI] [PubMed] [Google Scholar]
- Whitfield R., Schwab L., Ross-Degnan D., Steinkuller P., Swartwood J. Blindness and eye disease in Kenya: ocular status survey results from the Kenya Rural Blindness Prevention Project. Br J Ophthalmol. 1990 Jun;74(6):333–340. doi: 10.1136/bjo.74.6.333. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wilson M. R., Mansour M., Ross-Degnan D., Moukouri E., Fobi G., Alemayehu W., Martone J. F., Casey R., Bazargan M. Prevalence and causes of low vision and blindness in the Extreme North Province of Cameroon, West Africa. Ophthalmic Epidemiol. 1996 Mar;3(1):23–33. doi: 10.3109/09286589609071598. [DOI] [PubMed] [Google Scholar]
- Wong T. Y., Foster P. J., Hee J., Ng T. P., Tielsch J. M., Chew S. J., Johnson G. J., Seah S. K. Prevalence and risk factors for refractive errors in adult Chinese in Singapore. Invest Ophthalmol Vis Sci. 2000 Aug;41(9):2486–2494. [PubMed] [Google Scholar]
- Zerihun N., Mabey D. Blindness and low vision in Jimma Zone, Ethopia: results of a population-based survey. Ophthalmic Epidemiol. 1997 Mar;4(1):19–26. doi: 10.3109/09286589709058057. [DOI] [PubMed] [Google Scholar]
- Zhao J., Pan X., Sui R., Munoz S. R., Sperduto R. D., Ellwein L. B. Refractive Error Study in Children: results from Shunyi District, China. Am J Ophthalmol. 2000 Apr;129(4):427–435. doi: 10.1016/s0002-9394(99)00452-3. [DOI] [PubMed] [Google Scholar]