Evaluation of a national eye care programme: re-survey after 10 years

Aim-TO re-survey the Gambia after an interval of 10 years to assess the imp act of a national eye care programme (NECP) on the prevalence of blindness and low vision. Method-Comparison of two multistage cluster random sample surveys taking in to account the marked increase in population in the Gambia, west Africa. Sa mples of the whole population in 1986 and 1996 were taken. The definition o f blindness is presenting vision less than 3/60 in the better eye, or visua l fields constricted to less than 10 degrees from fixation. Low vision is l ess than 6/18 but 3/60 or better. Causes of blindness were determined clini cally by three ophthalmologists. Results-The crude prevalence of blindness fell from 0.70% to 0.42%, a relat ive reduction of 40%. During the same 10 year period, the population increa sed by 51% from 775 000 to 1 169 000. When the results were standardised fo r age, a west to east gradient was found for changes in risk of blindness o ver the 10 year period. This matched the phased west to east introduction o f the NECP interventions. There was a modest but significant increase in th e risk of low vision across the whole country. Conclusions-The overall reduction in risk of blindness, in those areas wher e the NECP has been active, appears to justify the programme and the suppor t of donor organisations. The low vision cases due to cataract must now be addressed.