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RESEARCH: Clare E Gilbert, S P Shah, M Z Jadoon, R Bourne, B Dineen, M A Khan, G J Johnson, M D Khan on behalf of the Pakistan National Eye Survey Study Group Poverty and blindness in Pakistan: results from the Pakistan national blindness and visual impairment survey BMJ 2007; 0: bmj.39395.500046.AEv1 [Abstract] [Full text]

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Vitamin A deficiency and measles infection are important poverty-related causes of blindness

Niyi Awofeso   (7 January 2008)

Vitamin A deficiency and measles infection are important poverty-related causes of blindness 7 January 2008
Niyi Awofeso, A/Prof., School of Public Health and Community Medicine University of New South Wales, Sydney, Australia. Send response to journal: Re: Vitamin A deficiency and measles infection are important poverty-related causes of blindness	Gilbert et al’s study apparently under-emphasized the importance of vitamin A deficiency and measles infection as important poverty-related causes of blindness in poor countries. There are at least two likely reasons for this under-emphasis. First, the focus of the WHO adult blindness classification system used by most authors conducting national blindness surveys is understandably biased towards treatable causes, and this is likely to lead to classification of the majority of cases of blindness and visual impairment due to measles/vitamin A-related corneal scarring (which is very difficult to treat) as due to other causes.1,2 Second, given that childhood blindness is second only to cataract in the magnitude of world blindness when “blind years” (the number of years a person lives with blindness) are considered, and that at least half of all cases of childhood blindness in developing countries are caused by measles and vitamin A deficiency, perhaps corneal scarring is a cause of only 11.8% of blindness in the authors’ study because of a high childhood mortality among Pakistan’s blind children.3 While studies indicate that corneal opacity account for less than 10% of all blindness globally4, in developing countries, the proportion of blindness due to corneal opacity caused by measles and vitamin A deficiency is much higher. Apart from addressing structural factors to alleviate poverty itself, these poverty- related causes of blindness and visual impairment are preventable and, if detected early, treatable.5 References 1) Gilbert et al. Poverty and blindness in Pakistan: results from the Pakistan national blindness and visual impairment survey. British Medical Journal, 2008; 336: 29-32. 2) Dineen et al. Prevalence and causes of blindness and visual impairment in Bangladesh adults: results of the national blindness and low vision survey of Bangladesh. Bri. J. Opthalmology, 2003; 87: 820-828. 3) World Health Organization. Preventing blindness in children: report of WHO/IAPB scientific meeting. Geneva: WHO, 2000. (WHO/PBL/00.77.). 4) Resnikoff S et al. Global data on visual impairment in the year 2002. Bulleting of WHO, 2004; 84: 844-851. 5) Rabiu MM, Kyari F. Vitamin A deficiency in Nigeria. Niger. J. Med., 2002; 11: 6-8. Competing interests: None declared