Deserves a higher priority than some countries are prepared to give it

About 40 million people are blind1 (defined as a corrected visual acuity of less than3/60 in the better eye2). Cataract accounts for half the cases, and trachoma, glaucoma, diabetic retinopathy, onchocerciasis, blinding malnutrition (xerophthalmia), leprosy, and trauma account for most of the rest.3 With increasing longevity and population growth, age related visual loss from cataract and glaucoma is likely to increase because eye care services are overwhelmed in all but the most economically developed countries.

Geographically, patterns of blindness vary. In the industrialised countries of North America, Europe, and Australasia blindness is mainly due to disorders of the posterior segment of the eye (for example, macular degeneration and diabetic retinopathy). In Africa, Asia, and parts of South America disorders of the anterior segment of the eye (cataract, corneal scarring from various causes, and glaucoma) predominate.4 The prevalence of blindness varies from 0. 2% in industrialised nations to 1% or more in poor areas of Africa and Asia. Even within a single country the prevalence of blindness can vary widely between different …