|Year : 1991 | Volume
| Issue : 3 | Page : 108-111
Common causes of blindness : A pilot survey in Jaipur, Rajasthan.
GS Rekhi, OP Kulshreshtha
S.M.S. Medical College, Jaipur, India
G S Rekhi
476/5, Raja Park, Jaipur - 302 004
Source of Support: None, Conflict of Interest: None
The cause of blindness in 1006 consecutive legally blind patients were analyzed in a large urban multidisciplinary medical center. It was found that the leading causes of blindness, in order of frequency of incidence, were cataract, corneal blindness, glaucoma and ocular trauma. The periodic collection of statistics on the relative frequency of the causes of blindness under Indian conditions is strongly suggested so that priorities can be redefined and improvements in health care may be suggested.
|How to cite this article:|
Rekhi G S, Kulshreshtha O P. Common causes of blindness : A pilot survey in Jaipur, Rajasthan. Indian J Ophthalmol 1991;39:108-11
| Introduction|| |
Prevention of blindness is an ideal which must be the first goal of ophthalmology. The old saying has it that prevention is better than cure. To tackle this problem we should know the exact incidence, nature and etiology of blindness of population under care, all of which have interactions with socioeconomic conditions, ethnic, racial and cultural propensities.
The data on prevalence of blindness in developing countries like ours are entirely different from those in developed countries like U.K. ,,, U.S.A., Australia  and Netherlands , still the Indian literature on the subject is quite scanty.
In the article we compare the causes of blindness in a large urban multidisciplinary medical center, serving a large cross section of the population with the causes of blindness reported from various parts of the world.
| MATERIAL & METHODS|| |
One thousand and six consecutive legally blind patients were selected from daily clinic appointments at S.M.S. Medical College and Hospital, Jaipur between July 1985 and July 1988. Patients were considered legally blind (as per the W.H.O. criteria) if the best corrected visual acuity was 3/60 Snellen or less in the eye with better vision, or if the visual field was diminished to 20 o or less. All the patients underwent a complete general and ocular examination. The results were then grouped in accordance with the standard elaborated and accepted by International Association for the prevention of blindness at Congress, New Delhi 1962.
| Observations|| |
Of the 1006 legally blind patients 606 (60.23%) were male and 400 (39.76%) were female. 62.62% patient were from the rural areas while 37.37% were from urban areas. Four hundred and forty patients (43.73%) became blind as a result of lenticular diseases. One hundred and eighty patients (17.89%) suffered from blindness due to glaucoma. One hundred and fifty five patients (15.40%) were blind due to corneal diseases. Ocular trauma accounted for one hundred and nineteen patients (11.82%). Diseases of the uveal tract accounted for forty five patients (4.47%) while retinal diseases were responsible for forty cases of blindness. Diseases of the optic tract and visual pathways accounted for twenty cases (1.98%).
The data from the present study show some patterns that are worthy of comment. There are many obstacles in comparing the results of surveys even when objective criteria for blindness are used because many different definitions of blindness are in use throughout the world.
The sex distribution shows an overwhelming male predominance, 60.96% against 39.03% females. This could be explained by the fact that our society is a male dominated one and the males exceed females in total population and also because males being earning members do come more often to seek medical advice, compared with females, while in Sweden  there was marginal preponderance of men 54% as compared to women 46% of blind population. There was male predominance in all age groups in our study and this tendency increased with increasing age (maximum in 4th - 7th decade) because it is partly due to the fact that part of the population is most active and also because of increasing incidence of blindness in higher age groups, since certain diseases which can cause blindness are liable to occur or develop at a certain age.
| Residential distribution|| |
In our study there was predominance of patients from rural areas 630 (62.62%) as compared to patients from urban areas 376 (37.37%) and this is statistically significant. This could be explained on the grounds that in rural areas there is far more poverty, illiteracy, and ignorance than in urban areas and also because of the fact that 75% of the Indian population live in rural areas while only 25% live in urban areas.
| Traumatic blindness|| |
Injuries were the cause of blindness in 119 patients (11.82%) only a few of them were women. The dominance of men in this group is largely because they form the majority of the work force. The maximum cases were in the Ilnd to Vth decade, this being the most active period in one's occupational and social life. Pew Limpaphyom  identified trauma in 11.18% cases of blindness in Thailand while A Nadimii  reported that injuries accounted for 33.6% of blindness in Iran. Eva Lindestd  and Col. Dickson  have reported ocular trauma to be responsible for 7.1% and 5.9% of total blindness in Sweden and Scotland. T. Motahashi  has reported blindness due to trauma in Japan around 3.2%.
The injuries were mostly due to occupational activity -71 cases of the total blind eyes due to trauma. Occupational accidents causing blindness were largely due to I.O.FB.'s with history of use of hammer and chisel, this can be explained by the fact that stone cutting and dressing of stones constitutes the major activity in housing construction in this ?art of Rajasthan. S.P.B. Percival  and S.P Dhir  et. al also have reached similar conclusions. The incidence of blindness due to trauma is less in developed countries than in developing countries because they have adopted occupational safety measures while these have yet to be implemented in developing countries.
| Glaucomatous blindness|| |
Glaucoma was responsible for 180 cases of blindness (17.89%) in this study. while other authors ,[14 ] have found it between 10 to 14% in our country. While A Nadini  and Limpaphayan, PEW  have reported that Glaucoma accounts for 10% and 12% of total blindness in Iran and Thailand. In Sweden  and Scotland  its incidence has been reported to be 3% and 8.1 % respectively. The frequency of glaucoma has sharply decreased in developed countries like the U.K., Canada and Netherlands. Blindness due to glaucoma is still a towering threat to socioeconomically under privileged population in developing and under developed countries. The high cost of medication, poor patient-compliance and follow up and also the lack of understanding of the disease process all contribute to the problem of glaucoma induced blindness. Despite the newer drug regimens and surgical advances, approaches to this disease is still a leading cause of blindness.
| Lenticular blindness|| |
Lenticular diseases were responsible for blindness in four hundred and forty patients (43.73%) of which senile cataract accounted for 371 cases (36.8%). Cataract continues to be a leading cause of blindness in our country 3 , our observation is comparable with other studies1 , conducted in our country. W.H.O.  has reported that cataract accounts for 54.0% blindness in Chad, 39% in Ghana, 45% in Kenya and 40.03% in Thailand, while in Canada  Netherlands and Sweden  it does not rank in the 1st four major causes of blindness. It indicates that there is marked scarcity of available medical services in the ophthalmic field and this prevents a significant group of under privileged population from timely removal of cataract by surgery in developing countries; while in developed countries, where ophthalmic care is relatively easy, cataract is not a leading blinding condition.
| Corneal blindness|| |
Corneal diseases were responsible for one hundred and fifty five cases (15.40%) of blindness. W.H.O. sub has also reported that corneal diseases account for the major share of blindness in Pakistan, Nepal, Kenya (36%), Uganda (40.6%) and other third world countries. Corneal blindness is much less in developed countries than in third world countries due to their socioeconomic progress which has led to a decline in corneal infections leading to corneal ulcers, nutritional deficiencies and corneal injuries which are major causes of blindness.
| Miscellaneous|| |
Disease of uveal tract (4.47%), retina (3.97%) and optic nerve and visual pathways (1.98%) completed the tally. It is to be appreciated that retinal diseases were responsible for 23% of blindness cases in Canada  and 25% in U.S.A., while in Sweden  it accounts for 33%. The difference in reporting of retinal diseases as a cause of blindness in developed countries as compared to developing countries like ours is due to their socioeconomic progress; and since blindness from nutritional deficiencies and infections of cornea have declined they have become more conscious of blindness from macular degenera tion, diabetic retinopathy reporting has increased and also because of increase in life span of their population; while we have yet to clear our backlog of waiting cataracts and intensify our fight against Infectious diseases, nutritional deficiencies and devise ways and means to decrease the percentage of preventable blindness.
In conclusion it can be stated that we have much in common with many developing countries in that cataract, corneal diseases, glaucoma and ocular trauma are among the leading causes of blindness.
It is of utmost value to collect statistics from time to time on the relative frequencies of causes of blindness so that changing trends may be noted and appropriate conclusion drawn in order to bring about effective improvement in patient care.
| References|| |
Sorsby S: The incidence and causes of blindness in England and Wales Rep Health Soc Subj (Lond) 1966; 14.
Ghafour IM, Allan D. Foulds WS: Common causes of blindness and visual handicap in the west of Scotland. Br J Ophthalmol 1983; 67:209-213.
Department of Health and Social Security: Blindness and partial sight in England 1969-1976. Reports on Public Health and Medical Subjects, No.129. London, HMSO. 1979.
Banks CN, Hutton WK: Blindness in New South Wales: An estimate of the prevalence and some of the contributing causes. Aust J Ophthalmol 1981:9: 285-288.
Doesschate JT Causes of blindness in the Netherlands. Doc Ophthalmol 1982: 52:279-285.
Lindstedt E: Causes of blindness in Sweden. Acta Ophthalmol (Copenh) 1969: 104(Suppl):22-74.
National Society to Prevent blindness: Vision problems in the US. New York. National Society to prevent Blindness 1980.
WHO Weekly Epidemiological Record 1982; 57:145-146.
W.H.O. Chronicle, 33: 275-283, 1979.
Limpaphayam PW, et al; Statistics of blindness in Thailand, Transactions of IVth Asia-Pacific Congress of Ophthalmology PP 26-29, 1972.
Nadimi A: A surgery of causes of blindness in Iran, Afro-Asian. J. Ophthalmol, PP 320-324, June 1982.
Dickson R.M.: A statistical analysis of persons certified blind in Scotland. B.J.O. PP 381-404 July 1946.
Sharma K.L., Prasad B.J., Indian J. of Med. res. 50, 842-864, Nov. 1962.
Singal D.K., et al Incidence of blindness around Miraj IJO, 1979, 27r iii: 16.
Motohashi T, Runsho Ganka, 20, 37-40; Jan 1960.
Dhir S.P, Kanwar Mohan, Munjal V.P and Jain I.S. I.J.O. 32: 289, 1984.
Perceival S.P.B.: B.J.O. 56: 454, 1972.
McDonald A.E.: Causes of blindness in Canada & analysis of 24, 605 cases registered with Canadian national Institute for blind. Canad. Med. Assoc. J. 92, 264-279, Feb 6, 1985.
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6], [Table - 7], [Table - 8], [Table - 9], [Table - 10]
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