title: Causes of blindness and visual impairment in Pakistan. The Pakistan national blindness and visual impairment survey.
abstract: OBJECTIVE
  To determine the causes of blindness and visual impairment in adults (> or =30 years old) in Pakistan, and to explore socio-demographic variations in cause.
  
  
  METHODS
  A multi-stage, stratified, cluster random sampling survey was used to select a nationally representative sample of adults. Each subject was interviewed, had their visual acuity measured and underwent autorefraction and fundus/optic disc examination. Those with a visual acuity of <6/12 in either eye underwent a more detailed ophthalmic examination. Causes of visual impairment were classified according to the accepted World Health Organization (WHO) methodology. An exploration of demographic variables was conducted using regression modeling.
  
  
  RESULTS
  A sample of 16 507 adults (95.5% of those enumerated) was examined. Cataract was the most common cause of blindness (51.5%; defined as <3/60 in the better eye on presentation) followed by corneal opacity (11.8%), uncorrected aphakia (8.6%) and glaucoma (7.1%). Posterior capsular opacification accounted for 3.6% of blindness. Among the moderately visually impaired (<6/18 to > or =6/60), refractive error was the most common cause (43%), followed by cataract (42%). Refractive error as a cause of severe visual impairment/blindness was significantly higher in rural dwellers than in urban dwellers (odds ratio (OR) 3.5, 95% CI 1.1 to 11.7). Significant provincial differences were also identified. Overall we estimate that 85.5% of causes were avoidable and that 904 000 adults in Pakistan have cataract (<6/60) requiring surgical intervention.
  
  
  CONCLUSIONS
  This comprehensive survey provides reliable estimates of the causes of blindness and visual impairment in Pakistan. Despite expanded surgical services, cataract still accounts for over half of the cases of blindness in Pakistan. One in eight blind adults has visual loss from sequelae of cataract surgery. Services for refractive errors need to be further expanded and integrated into eye care services, particularly those serving rural populations.
authors.affiliation: Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London.
authors.forename: B
authors.initials: B
authors.lastname: Dineen
authors.forename: R R A
authors.initials: RR
authors.lastname: Bourne
authors.forename: Z
authors.initials: Z
authors.lastname: Jadoon
authors.forename: S P
authors.initials: SP
authors.lastname: Shah
authors.forename: M A
authors.initials: MA
authors.lastname: Khan
authors.forename: A
authors.initials: A
authors.lastname: Foster
authors.forename: C E
authors.initials: CE
authors.lastname: Gilbert
authors.forename: M D
authors.initials: MD
authors.lastname: Khan
mesh_terms: D000328:Adult; D017677:Age Distribution; D001766:Blindness / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D012044:Regression Analysis; D012423:Rural Health / Q000706:statistics & numerical data; D017678:Sex Distribution; D012923:Social Class; D014504:Urban Health / Q000706:statistics & numerical data; D014786:Vision Disorders / Q000453:epidemiology / Q000209:etiology*; D014792:Visual Acuity; D019987:Persons with Visual Disabilities / Q000706:statistics & numerical data*