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318 Blindness
Kogevinas M, ’t Mannetje A, Cordier S, et al. (2003) Occupation and
bladder cancer among men in Western Europe. Cancer Causes and
Control 14: 907–914.
Levi F, Lucchini F, Negri E, Boyle P, and La Vecchia C (2004) Cancer
mortality in Europe, 1995–1999, and an overview of trends since
1960. International Journal of Cancer 110: 155–169.
National Research Council, Board on Environmental Studies and
Toxicology. Subcommittee to Update the 1999 Arsenic in Drinking
Water, Report, Committee on Toxicology (2001) Arsenic in Drinking
Water: 2001 update. Washington, DC: National Academy Press.
Pereg D and Lishner M (2005) Non-steroidal anti-inflammatory drugs for
the prevention and treatment of cancer. Journal of Internal Medicine
258: 115–123.
Van der Meijden AP (1998) Bladder cancer. British Medical Journal 317:
1366–1369.
Vogelstein B and Kinzler KW (2004) Cancer genes and the pathways
they control. Nature Medicine 10: 789–799.
Blindness
S Resnikoff and R Pararajasegaram, World Health Organization, Geneva, Switzerland
ã 2008 WHO. Published by Elsevier Inc. All rights reserved.
Blindness is a health and social concern of significant public
health dimensions that, until recently, has not received the
attention it warrants on the global health agenda.
As will be seen, the majority of the world’s blind live
in developing regions and in the impoverished regions
of rapidly economically developing countries. There has
been, however, as seen in recent studies, a transition from
infection- and nutrition-related causes of blinding eye
diseases to those of a chronic nature that generally stem
from noncommunicable disorders, referred to as the
‘epidemiological transition.’ This is in keeping with the
demographic transition that is occurring at an enhanced
pace in the developing regions of the world, consequent
to their inevitable population momentum. These transi-
tions have far-reaching consequences for population eye
health, with all its implications in terms of underdevelop-
ment, social costs, and poverty alleviation in general, and
the quality of life of affected individuals and communities,
in particular. The lowered life expectancy consequent
to becoming blind is an illustrative example.
What Is Blindness?
There is no simple answer. The reason for this is that
until recently there has been great variation in the defini-
tion of blindness from one country to another. This is
despite the availability of a definition and classification
dating back to 1972 that has found international accep-
tance and was included in the 10th revision of the WHO
International Statistical Classification of Diseases Injuries
and Causes of Death.
Zeegers MP, Kellen E, Buntinx F, and van den Brandt PA (2004) The
association between smoking, beverage consumption, diet and
bladder cancer: a systematic literature review. World Journal of
Urology 21: 392–401.
Relevant Websites
http://www.nlm.nih.gov/medlineplus/bladdercancer.html –
MedlinePlus, U.S. National Library of Medicine and National
Institutes of Health: Bladder Cancer.
http://www.who.int/schistosomiasis/en/ – World Health Organization:
Schistosomiasis.
In this classification, blindness is defined as visual acu-
ity of less than 3/60 (20/400 or 0.05) or corresponding
field not greater than 10 degrees in the better eye, with best
possible correction. Low vision is defined as visual acuity
of less than 6/18 (20/70 or 0.30) but equal to or better than
3/60, or corresponding visual field not greater than
20 degrees in the better eye, with best possible correction.
Some of the definitions, such as ‘best corrected’ in the
current classification, have been under review, because they
do not reflect the true magnitude of uncorrected refractive
error as a cause of visual impairment, including blindness.
Such defective vision resulting from refractive error has
remained masked as a result of the existing definition.
The use of the concept of ‘presenting vision’ instead
of ‘best corrected vision’ will overcome this anomalous
definition. The current definition is being amended. In
addition, there is currently confusion over the use of
the term ‘low vision’ to describe the various categories
of visual impairment other than blindness. It has been
recommended that the use of the term ‘low vision’ be
avoided for use in this context.
Epidemiology
There are some limitations inherent in describing the
epidemiology of visual impairment and blindness. These
stem from the use of different definitions and visual cut-
off points for the different categories of visual impairment
in different studies. However, more recent epidemiol-
ogical surveys have begun to use more standardized
 Blindness 319

definitions and methodologies based on them. As such, glaucoma, 12%; age-related macular degeneration, 8.7%;
the recent estimation would more closely reflect the real trachoma, 3.6%; corneal opacity (various causes excluding
situation. trachoma), 5.1%; diabetic retinopathy, 4.8%; onchocercia-
sis, 1%; childhood blindness (various causes), 3.8%; and
other causes, 12.9%.
Magnitude and Causes of Visual Impairment The above conditions also predominate as causes of
visual impairment not amounting to blindness. However,
The estimate of the global magnitude of visual
in light of the data that have been recently determined in
impairment in relation to the 2002 world population was
relation to uncorrected refractive error, it is seen that this
updated using the most recent available data on blindness
represents the major causes of visual impairment, if pre-
and low vision (Pascolini et al., 2004). The number of
senting vision rather than best corrected vision is used as
people globally who are visually impaired is an estimated
the criterion, as has been recommended.
161 million, of whom 36.8 million are blind (Resnikoff et al.,
Figure 1 depicts the causes and their relative magni-
2004). A more recent estimate based on presenting vision
tude from a global perspective.
has revealed the true magnitude of visual impairment, now
estimated at 314 million (Resnikoff et al., 2007), with an
estimated 153 million cases due to uncorrected refractive
error alone, of which 8.2 million are in the blind category.
Inequity in Eye Health Status and Causes
Thus the most recent update indicates that globally
of Visual Impairment
there are 314 million persons who are visually impaired
(when presenting vision is used in studies), of whom
There is wide variation in both the prevalence and under-
45 million persons are blind.
lying causes of visual impairment and blindness based
on geographical location, demographic structure, gender,
socioeconomic status, and health system development. An
Causes of Visual Impairment Including
estimated 90% of the world’s visually impaired persons
Blindness
live in developing parts of the world.
According to WHO estimates (2002) (in, Resnikoff et al., Figure 2 illustrates the geographical distribution of
2004), the causes of blindness are as follows: cataract, 47.8%; global blindness.

Glaucoma
12% Other causes
13%

Age-related macular
degeneration
9%

Corneal opacity
5%

Diabetic retinopathy
5%

Onchocerciasis
1%
Childhood blindness
4%

Tracoma Cataract
4% 48%

Figure 1 Global causes of blindness (best corrected visual acuity). with permission from Resnikoff S, et al. (2004) Global data on visual
impairment in the year 2002. Bulletin of the World Health Organization 82: 844–851.
320 Blindness
Europe
10%
Americas
South East Asia
10%
27%
Eastern
Mediterranean
10%
Africa
17% Western Pacific
26%
Figure 2 Regional distribution of visual impairment, by WHO
regions.
Vision Impairment Across the Life Spectrum
Visual impairment is not equally prevalent across various
age groups of the population. For instance, over 82% of all
persons who are blind are 50 years and over. However, this
cohort currently represents only 19% of the global popu-
lation. Those persons 50 years and older therefore bear a
disproportionate load of blindness.
At the other end of the life spectrum, blindness in
childhood has a lower absolute prevalence, constituting
only an estimated 1.4 million children, or 3.8% of global
blindness. A child going blind in early childhood and
surviving to, say, 50 years of age has many years of blind-
ness ahead. Therefore in terms of ‘years of blindness,’
childhood blindness ranks second to blindness from cata-
ract in adults, and merits to be addressed as a global
priority in public health ophthalmology.
Gender Disparities
Gender variations have been reported in all age groups
and in all regions of the world. Consistently, for reasons
such as limited access and uptake of eye care services,
females are at a higher risk than males of being visually
impaired or blind.
Biological Determinants
Many of the causes that result in visual impairment and
blindness have biological determinants such as genetic
background, age, and gender. These are nonmodifiable,
and prevention or treatment of these are related to biomed-
ical interventions. These include treatment for cataract
and trichiasis (in trachoma) or a mix of interventions, as in
glaucoma and diabetic retinopathy. Where underlying eco-
logical determinants prevail such as in onchocerciasis and
trachoma, medical treatment together with interventions
such as vector control, personal hygiene, (e.g., face washing),
and environmental improvement are employed.
Social Determinants
An understanding of the underlying social determinants
of eye health is a necessary prerequisite not only for
an understanding of the public health dimensions of the
problem, despite the availability of appropriate knowl-
edge, technology, and skills, but also for preventing and
controlling the many determinants and diseases that lead
to visual impairment.
However, when dealing with these conditions as
causes of vision impairment and blindness in a population
setting, the existence of social determinants is often over-
looked. These include various barriers to uptake of
services. Health illiteracy, poverty along with its related
deprivations, physical and social distance from health
facilities, and cultural beliefs and barriers predominate.
In general, these factors determine the availability,
accessibility, and affordability of services even when
they are provided. Compounding these determinants of
visual impairment is the inequitable distribution of ser-
vice in terms of geographic distribution, quality, cost, and
accountability.
Prevention of Blindness: What Can Be
Done?
Cataract
Cataract remains the leading cause of blindness, account-
ing for nearly half of all cases, as shown in Figure 1,
except in the most developed countries.
This is certainly not due to the lack of an effective
intervention.
Evidence-based, cost-effective interventions are being
practiced to deal with the surgical management of cata-
ract (Baltussen et al., 2004). Removal of the affected lens
of the eye and replacement with a synthetic posterior
chamber intraocular lens (IOL) is standard practice the
world over. Refinements in technology and approaches
in IOL material and design ensure a near normal restora-
tion of vision for the large majority of patients. In low- and
middle-income countries, it has been estimated that
the cost-effectiveness ratio of these surgical interven-
tions are below US$200 per disability-adjusted life year
(DALY) averted, and less than US$24 000 in high-income
countries.
However, to be able to minimize the magnitude of
cataract as a cause of blindness, interventions must go
beyond technology to outcome-oriented interventions
that vigorously address the various social determinants

that predicate the high prevalence of cataract and other
blinding conditions in developing countries. Even in these
countries, studies have demonstrated the wide disparity
in cataract surgical rates (defined as the number of cata-
ract surgeries carried out per 1 million population annu-
ally), surgical outcome, and population coverage, not only
between countries but also between regions in the same
country.
The equitable provision of efficient and effective
health systems delivering eye care should be an essential
public health priority for all developing countries.
Trachoma
The SAFE strategy (Surgery, Antibiotics, Facial cleanliness,
Environmental improvement) is an integrated approach
based on the principles of primary health care recom-
mended by WHO to help eliminate blinding trachoma in
a sustainable manner. The four elements complement each
other and comprise a mix of primary, secondary, and
tertiary preventive interventions, with strong community
involvement and educational activities.
Studies on the cost-effectiveness of these interventions
are limited. However, the few reported studies point to a
range of approximately US$4 to US$82 per DALY averted
across trachoma-endemic areas, in the case of trichiasis
surgery. In the case of antibiotic treatment, it has been
estimated that across the endemic regions studied, the
cost per DALY averted ranged between US$4000 to
US$220 000, depending on whether the drug is part of a
donation program or is calculated at the market price.
Diabetic Retinopathy
Diabetic retinopathy, already a leading cause of blindness
in working-age populations in developed countries, is
fast assuming epidemic proportions worldwide with the
upsurge of diabetes mellitus even in developing countries.
The causes of vision loss are multifactorial and are closely
linked to the duration of diabetes. Other risk factors in-
clude uncontrolled blood sugar, high blood pressure, and
increased blood lipids.
Besides controlling the disordered metabolic state,
available interventions include periodic examination of
the ocular fundus through dilated pupils, early identifi-
cation of sight-threatening lesions, and treatment with
laser photocoagulation. Health promotion and patient edu-
cation are important supportive interventions. A multidisci-
plinary team approach to care of these patients is desirable.
Extended follow-up with careful monitoring and tracking of
patients is important. In patients with some residual vision
that is not amenable to further treatment, low-vision care
should be offered.
Blindness 321
Glaucoma
This comprises a group of conditions that lead to irrevers-
ible vision loss and blindness through damage to the optic
nerve (optic neuropathy). WHO has estimated that 4.5 mil-
lion persons are blind due to glaucoma (Resnikoff et al.,
2004). Published projections indicate that by 2010, 4.5 mil-
lion persons will be blind from open-angle glaucoma and
3.9 million from primary angle-closure glaucoma. Given
the aging of the world population, these numbers are set
to increase further by 2020 (Quigley and Broman, 2006).
Significant improvement in treatment interventions
has been made in recent years, such as laser therapy,
medication, and surgery to prevent vision loss from glau-
coma. However, given the fact that the tools currently
required for the identification, assessment, and manage-
ment of early glaucoma are often lacking, particularly in
poorer parts of the developing world, the management of
glaucoma at a community level holds many challenges.
Childhood Blindness
Childhood blindness results from a number of causes that
range from genetically determined and congenital condi-
tions to micronutrient deficiency (vitamin A) and infective
conditions (measles, ophthalmia neonatorum, rubella) to
conditions requiring specialized surgical treatment such
as childhood cataract, glaucoma, and retinopathy of
prematurity. In developed and rapidly economically devel-
oping regions of the world, retinopathy of prematurity is
more than an emerging problem. With increased survival of
low birth weight and low gestational age infants, there is
already an upsurge in vision loss from this cause.
Uncorrected refractive errors comprise a significant
cause of vision impairment, particularly among certain
ethnic groups. These have implications for child develop-
ment and education, future employment prospects, and
performance.
Considerable regional variations between and within
countries exist with regard to the magnitude and causes
of childhood blindness. Services for children are arranged
through vision screening in schools and community centers
with follow-up assessment and provision of spectacles.
A concerted primary eye care approach could control
and minimize causes related to poverty and deprivation
such as malnutrition, measles, and harmful traditional
practices. Other causes such as cataract, glaucoma, and
retinopathy of prematurity require specialized surgical
care and management, including low vision care and
inclusive education of affected children.
Uncorrected Refractive Errors
These include conditions such as myopia (nearsighte-
dness), hypermetropia (farsightedness), and astigmatism.
322 Blindness
Age-related presbyopia also falls within this category. There
are an estimated 153 million persons with visual im-
pairment due to uncorrected refractive errors (not includ-
ing presbyopia), in other words, presenting visual acuity less
than 6/18 in the better eye. This comprises the commonest
cause of visual impairment. The proportion of uncorrected
refractive errors varies based on cultural norms, gender, and
availability and affordability of services.
Services to correct disabling refractive errors should
include identification of persons requiring correction,
assessment and prescription of appropriate correction,
and the provision of spectacles that are affordable and
cosmetically acceptable.
Age-Related Macular Degeneration
This condition presents an emerging challenge given the
rapidly escalating number of older populations globally. It
is already the major cause of blindness in the developed
countries. While there is greater knowledge regarding
the cause and pathophysiology of the disease, efforts at
prevention and treatment have not been promising until
now. Ongoing research has suggested the potential value
of newer treatment modalities, but the outcome of such
treatment on a large scale has yet to be determined. In the
interim, much can be gained through the provision of
low-vision care to improve the functioning and quality
of life of these patients.
Low Vision
The following definition was agreed upon to identify
persons who could benefit from low-vision care:
A person with low vision is someone who, after medical,
surgical, and/or standard refractive intervention, has a
corrected visual acuity in the better eye of less than 6/
18 down to and including light perception or a central
visual field of less than 20 degrees, but who uses or has the
potential to use vision for the planning and/or execution
of a task.
Currently there are no global estimates of the number
of people with low vision who would benefit from low-
vision services. Based on available data, this is estimated
to be around 40–65 million. However, with the advancing
age of the population and a concomitant increase in age-
related chronic diseases such as glaucoma, diabetic reti-
nopathy, and macular degeneration, the unmet need for
low-vision services could rapidly escalate.
The coverage of low-vision services currently is
extremely sparse, even in developed countries. Low-
vision care needs to be developed in close collaboration
with the correction of uncorrected refractive errors, and
follow the same principles, such as affordability and
acceptability.
Concepts of Primary Eye Care and the
Domains of Prevention of Blindness
The basic principles of primary health care, as enshrined
in the Alma Ata declaration (1978) and subsequent World
Health Assembly resolutions, provide the basic frame-
work for the development of health systems that could
provide equitable, comprehensive, and sustainable eye
care as an integral part of health care.
Primary health care, of which prevention of blindness
needs to be an integral part, consists of:
Essential health care based on practical, scientifically
sound, and socially acceptable methods and technology
made universally accessible to individuals and families in
the community through their full participation and at
a cost that the community and country can afford to
maintain at every stage of their development in the spirit
of self-reliance and self determination.
Primary eye care comprises a simple but comprehen-
sive set of promotive, preventive, curative, and rehabilita-
tive activities that can be carried out by suitably trained
primary health-care workers, who in turn are supported
by a referral system that ought to comprise secondary and
tertiary level of services and in some regions provide
mobile services.
Available Primary Eye Care Interventions
to Eliminate Avoidable Blindness
Cataract, glaucoma, a corneal opacities (from various
causes), diabetic retinopathy, trachoma, and onchocerciasis
lend themselves to potential health promotion, prevention,
treatment, and rehabilitative strategies.
Similar interventions are possible in the case of child-
hood blindness.
Another area in which primary-level services could
provide effective support is in vision screening, early
detection, and appropriate referral of persons of all age
groups with uncorrected refractive error. This constitutes
a large segment of the population across the life spectrum
that could benefit from appropriate corrective services.
Economic Implications of Visual
Impairment and Blindness
Studies on the economic losses to individuals and society
from visual impairment and the economic gains from the
application of cost-effective interventions to prevent
blindness and restore sight provide supportive evidence
for investment in blindness-prevention programs. The
economic burden of avoidable visual impairment includes

the direct costs in terms of resources spent in individual
and community care, including the various components of
the eye care system at all levels, and the indirect costs,
which comprise a range of productivity losses, with
their far-reaching implications, social and rehabilitative
expenses, impaired quality of life, and premature death.
Studies have been published to highlight the economic
aspects of some of the commoner individual blinding
conditions such as cataract, trachoma, onchocerciasis,
glaucoma, and diabetic retinopathy. Most of these have
been carried out in developed countries.
For instance, an Australian study (Taylor et al., 2004)
assessed the overall economic impact of the five most
prevalent visually impairing conditions (75% of all
causes) in Australia (Figure 3). This included cataract,
age-related macular degeneration, glaucoma, diabetic ret-
inopathy, and errors of refraction. The economic analysis
predicted an estimated direct cost of AU$1.824 billion
(US$1.3 billion). Indirect costs were estimated to add a
further AU$8 billion (US$5.6 billion) to the annual eye
care budget for 2004. These estimates cannot be easily
extrapolated to other parts of the world, however, due to
different disease patterns, health-care costs, work force
wage structures, and social security systems.
There has been an effort to calculate on a global
basis the projected annual personal productivity loss of
individuals over the period 2000–2020 (Frick and Foster,
2003). The conservative annual estimate amounts to US
$42 billion for the year 2000. This figure was projected to
rise to US$110 billion per year (in year 2000 dollars) by
2020, if then-current prevalence levels showed no
decrease. If, however, the implementation of VISION
2020 showed successful outcomes (see ‘VISION 2020:
The right to sight’), it was estimated that the annual
productivity loss would increase to only US$58 billion
(in year 2000 dollars). It was further estimated that the
overall global saving that could accrue over 20 years
would amount to US$223 billion.
Total $1824.4m
AMD $19.4 m
1%
Cataract $326.6 m
18%
Other 59% 8% Glaucoma $144.2 m
$1095.9 m
14%
Refractive error
$261.3 m
Figure 3 Cost of eye diseases, 2004, AU$, by condition. AMD,
age-related macular degeneration. Source: Taylor H, et al. (2004)
Clear Insight: The Economic Impact and Cost of Vision Loss in
Australia. Melbourne: Center for Eye Research Australia.
Blindness 323
Partnerships for Prevention of Blindness
Global and Regional Initiatives
Onchocerciasis Control Program (OCP)
This was established in West Africa in 1974. The objec-
tives of this international collaboration were to eliminate
onchocerciasis in the 11 countries covered by the pro-
gram and consequently improve the socioeconomic con-
dition of the people, who largely comprised an agrarian
society.
African Program for Onchocerciasis Control
This was launched in December 1995 with the sole aim of
eliminating onchocerciasis from the African countries
where the disease continued to be endemic. The region
covered extended to 11 countries beyond those included
in OCP. While WHO serves as the executing agency, the
fiscal agency is the World Bank.
The primary strategic objective was to create, by 2007,
a system of community-directed distribution of ivermec-
tin, as a microfilaricidal agent, donated at no cost by
Merck. Much success has been achieved toward reaching
this objective, and steps are underway to use community-
directed distributors in the control of coexistent diseases
such as lymphatic filariasis and trachoma that respond to
periodic administration of appropriate medications.
Onchocerciasis Elimination Program
for the Americas
This is a regional initiative for Brazil, Colombia, Ecuador,
Guatemala, Mexico, and Venezuela, initiated in 1991. The
goals are to eliminate morbidity and to interrupt trans-
mission of river blindness. This is a partnership program,
including the six countries, the Pan American Health
Organization, the private sector, specialized institutions,
and international nongovernmental developmental orga-
nizations. The program strategy is to provide sustained
mass distribution of ivermectin every six months, with
the aim of reaching at least 85% of the at-risk population.
WHO Global Alliance for the Global Elimination of
(Blinding) Trachoma (GET 2020)
GET 2020 was constituted in 1997 to provide support and
technical assistance to a number of international institu-
tions and organizations, nongovernmental development
organizations, and foundations in working toward elimi-
nation of trachoma as a public health problem, using the
SAFE strategy. The Alliance meets on an annual basis and
involves concerned member state representatives. The
agenda includes the sharing of information on the prog-
ress of national programs, research initiatives and results,
future plans, and reports on available financial and in-
kind resources.
 324 Blindness
VISION 2020: The Right to Sight
On January 18, 1999, WHO’s then Director General,
Dr. Gro Harlem Brundtland, launched the Global Initia-
tive for the Elimination of Avoidable Blindness under the
title ‘VISION 2020: The Right to Sight.’ The initiative
was spurred by the dismal global data on blindness that
became available in the mid-1990s. These data were
compounded by the predicted near-doubling of the global
magnitude of visual impairment and blindness by the year
2020, with many of the underlying causes being pre-
ventable or treatable. These predictions were based on
demographic projections and a presumed relatively
unchanged eye care delivery as part of national health-
care systems. Such a scenario was likely to be realistic
in the developing countries, where the problem was
greatest and the resources for eye care are severely
limited. Moreover, these countries were beset with com-
peting demands for resources from limited health budgets
to control other priority diseases such as HIV/AIDS,
malaria, tuberculosis, and childhood diseases.
The initiative was thus seen not only as a health chal-
lenge but also as a moral imperative that needed to be
urgently addressed.
VISION 2020 is a collaborative effort conceived by the
World Health Organization and the International Agency
for the Prevention of Blindness and its constituent mem-
bers. The objective was to support member countries by
providing technical and financial support to realign and
strengthen existing national programs or to initiate and
develop new national programs aimed at the collective
achievement of the common goal of eliminating avoidable
blindness globally.
The initiative identified three strategic components as
the Framework for Action:
. Cost-effective disease control;
. Human resource development;
. Infrastructure, including appropriate technology.
The overarching supportive elements included advo-
cacy, public awareness campaigns, resource mobilization,
and improved governance and management of health
systems, including monitoring and evaluation for quality
assurance.
Partnership development was a key factor.
The underlying guiding principle was delivering eye
care as an integral part of primary health care.
Global political commitment to VISION 2020 was forth-
coming in 2003 and 2006 through the unanimous adop-
tion by the WHO member states of resolutions WHA
56.26, Elimination of Avoidable Blindness, and WHA 59.25,
Prevention of Avoidable Blindness and Visual Impairment,
respectively.
At the national level, a number of countries have signed
national declarations of support, and outcome-oriented
View publication stats
national action plans have been formulated and are being
implemented.
Overall, there is greater global awareness of the dimen-
sion of the problem of visual impairment, including blind-
ness, as a public health concern.
This has led to the all-important political commitment
at all levels to eliminate avoidable blindness as a public
health problem globally before 2020. It has also led to the
development of partnerships among a variety of partners,
such as WHO, member countries, international nongov-
ernmental developmental organizations and institutions,
academia, the corporate sector, and civil society.
The ultimate goal is to establish a sustainable, equita-
ble, and comprehensive eye care system as an integral part
of national health systems based on the principles of
primary health care.
See also: Alma Ata and Primary Health Care: An Evolving
Story; Helminthic Diseases: Filariasis.
Citations
Baltussen R, Sylla M, and Mariotti SP (2004) Cost effectiveness analysis
of cataract surgery: A global and regional analysis. Bulletin of the
World Health Organization 82(5): 338–345.
Frick KD and Foster A (2003) The magnitude and cost of global
blindness: An increasing problem that can be alleviated. American
Journal of Ophthalmology 135(4): 471–476.
Pascolini D, Mariotti SPM, Pokharel GP, et al. (2004) 2002 global
update of available data on visual impairment: a compilation of
population-based prevalence studies. Opthalmic Epidemiology 11
(2): 67–115.
Resnikoff S, Pascolini D, Etyáale D, et al. (2004) Global data on visual
impairment in the year 2002. Bulletin of the World Health
Organization 82: 844–851.
Resnikoff S, Pascolini D, Mariotti SP, and Pokharel GP (2008)
Global magnitude of visual impairment caused by uncorrected
refractive errors in 2004. Bulletin of the World Health Organization 86:
63–70.
Taylor H, Keete J, and Mitchell P (2004) Clear Insight: The Economic
Impact and Cost of Vision Loss in Australia. Melbourne, Australia:
Center for Eye Research.
Further Reading
Johnson GJ, Minassian DC, Weale CA, and West SK (eds.) (2003) The
Epidemiology of Eye Diseases, 2nd edn. London: Arnold.
Relevant Websites
http://www.cehjournal.org/ – Community Eye Health Journal.
http://www.icoph.org/ – International Council of Ophthalmology.
http://www.nei.nih.gov/ – National Eye Institute.
http://www.v2020.org/ – Vision 2020: The Right to Sight.
http://www.who.int/blindness/en/ – WHO, Prevention of Blindness and
Visual Impairment.