Blindness in the Indian state of Andhra Pradesh

PURPOSE. To determine the current prevalence and causes of blindness in the Indian state of Andhra Pradesh to assess if blindness has decreased since the last survey of 1986-1989. METHODS. A population-based epidemiology study, using a stratified, random, cluster, systematic sampling strategy, was conducted in the state of Andhr a Pradesh in India. Participants of all ages (n = 10,293), 87.3% of the 11, 786 eligible, from 94 clusters in one urban and three rural areas represent ative of the population of Andhra Pradesh, underwent interview and a detail ed dilated ocular evaluation by trained professionals. Blindness was define d as presenting distance visual acuity < 6/60 or central visual held < 20 d egrees in the better eve. RESULTS. Two hundred seventy-five participants were blind, a prevalence of 1.84% (95% confidence interval, 1.49%-2.19%) when adjusted for the age, sex , and urban-rural distribution of the population in 2000. The causes of thi s blindness were easily treatable in 60.3% (cataract, 44%; refractive error , 16.3%). Preventable corneal disease, glaucoma, complications of cataract surgery. and amblyopia caused another 19% of the blindness. Blindness was m ore Likely with increasing age and decreasing socioeconomic status, and in female subjects and in rural areas. Among the 76 million population of Andh ra Pradesh, 714,400 are estimated to have cataract-related blindness (615.6 00 cataract, 53,200 cataract surgery-related complications, 45,600 aphakia) , and 228,000 refractive error-related blindness (159,600 myopia, 22,800 hy peropia, 45,600 refractive error-related amblyopia). If 95% of the cataract and refractive error blindness in Andhra Pradesh had been treated effectiv ely, 3.4 and 7.4 million blind-person-years, respectively, could have been prevented. If 90% of the blindness due to preventable corneal disease and g laucoma had been prevented, another 2.7 million blind-person-years could ha ve been prevented. CONCLUSIONS. The prevalence of blindness in this Indian state has increased from 1.5% in the late 1980s to 1.84% currently, as against the target of t he National Program for Control of Blindness to reduce the prevalence to 0. 3% by 2000. The number of people with cataract-related blindness has not re duced even with the eye care policy focus on cataract. Reduction of blindne ss in India will require strategies that are more effective than those that have been pursued so far.