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By Karla Gale

LONDON (Reuters Health) – Lower socioeconomic status, whether between or within countries, is strongly associated with rates of blindness, according to investigators in India. To address such disparities, the international initiative "Vision 2020–The Right to Sight" is progressing toward its goal of eliminating needless blindness by the year 2020.

Dr. Rakhi Dandona and Dr. Lalit Dandona, of Prasad Eye Institute in Hyderabad, reviewed literature published since 1990 regarding inequalities in the prevalence and causes of blindness according to socioeconomic status.

Their research revealed that the estimated prevalence of blindness in 2000 ranged from 0.10% in countries with established market economies to 1.50% in Africa. Childhood blindness may vary as much as 10-fold between the richest countries of the world and the poorest countries, the investigators report in the British Journal of Ophthalmology for December.

Studies in India and the United States have shown discrepancies in the rates of blindness between individuals of different income categories, according to the review. There have also been reports of more blindness associated with lower levels of education and among people of different ethnicities. A meta-analysis of population-based surveys, published last year, showed that women make up approximately two-thirds of the world's blind population.

Drs. Dandona and Dandona determined that people in developing countries are more likely to experience blindness as a result of cataract, refractive error, and trachoma, whereas in developed countries, blindness is primarily associated with age-related macular degeneration.

Preventable causes of blindness predominate among children in poorer countries, including "vitamin A deficiency, measles, ophthalmia neonatorum, and use of harmful traditional eye practices," they write. At the other end of the socioeconomic spectrum, the most common causes of childhood blindness are central nervous sytem disorders and retinal conditions.

Phase I of Vision 2020, which was established in 1999 as a coalition of nongovernmental organizations and the World Health Organization (see Reuters Health report, February 19, 1999), has been completed in many target countries, a spokesperson for Vision 2020, located in Geneva, told Reuters Health.

Phase I included "helping countries get a picture of what their own situation is, the epidemiology and the burden of different blinding diseases," he said. "They became educated about what resources are available so that they can start planning for the next 5 years."

During that period, he added, countries should begin implementing basic screening and treatment programs. Specific goals include the creation of adequate eyecare facilities, particularly in underprivileged areas, and providing training to eyecare workers.

Other plans include provision of spectacles, particularly for school-age children, and prevention and treatment of nutritional deficiencies that lead to blindness. The organizations that make up the Vision 2020 coalition also hope to expand services for treating cataract.