Corneal blindness in Platos cave: the acting forces to prevent and revert corneal opacity. Part I: epidemiology and new physiopathological concepts / A cegueira corneal na caverna de Platão: as forças para prevenir e reverter a opacidade da córnea. Parte I: epidemiologia e novos conceitos na fisiopatologia

ABSTRACT The burden of corneal blindness and visual deficiency can be felt worldwide. Its association with several endemic diseases such as childhood blindness, trauma, infectious keratitis (including variants caused by herpes, hanseniasis, and fungi), vitamin A deficiency, diabetes mellitus, and other dry eye syndromes reflects its poorly understood underlying mechanisms and suggests that the actual frequency of the disease is underestimated. The low effectiveness of preventive and therapeutic strategies against corneal scarring or deformity predicts a high frequency of patients with corneal blindness in the future. Corneal blindness is associated with environmental factors and socioeconomic limitations that restrain health assistance and maintain a modest efficiency of the current therapeutic strategies for resolving corneal diseases in large-scale programs. We present here a critical review of the concepts associated with corneal blindness that need to be considered when planning strategies to prevent and treat corneal blindness worldwide (to be able to leave Plato's cave, where corneal blindness is encaged.

RESUMO O problema da deficiência visual e da cegueira corneal abrange o mundo todo e corresponde à quarta causa de cegueira e deficiência visual, com acometimento estimado de mais de 16 milhões de pessoas. A associação com várias doenças endêmicas, como cegueira infantil, trauma, ceratites infecciosas (incluindo herpes, hanseníase e fungos), hipovitaminose A, diabetes mellitus e outras causas de síndromes de olho seco, indicam que a verdadeira frequência é subestimada e que os diferentes mecanismos são pouco conhecidos. A baixa eficácia na prevenção e tratamento da cicatriz e deformidade da córnea permite antecipar que a prevalência da cegueira corneal irá crescer no futuro. As razões para o aumento da cegueira corneal envolvem fatores ambientais, limitações socioeconômicas para ampliar a assistência à saúde e a modesta eficiência das estratégias terapêuticas para resolver o problema em grande escala. O presente trabalho traz uma revisão crítica dos conceitos associados à cegueira corneal. Essa análise é uma etapa necessária para preparar o caminho com o objetivo de deixar a caverna que encarcera a cegueira corneal, em analogia ao mito de Platão, e melhorar as estratégias para prevenir e tratar a cegueira corneal em escala mundial.

Estudo das causas de cegueira e baixa de visão em uma escola para deficientes visuais na cidade de Bauru / The study of the causes of blindness and low vision in a school for visual disabilities in Bauru city

RESUMO Objetivo: Analisar as causas de cegueira dos alunos do Lar Escola Santa Luzia Para Cegos no município de Bauru, Estado de São Paulo. ambém avaliamos e discutimos o grau de inserção social dos alunos e a facilidade de acesso à saúde e locomoção dos deficientes visuais. Métodos: Foi realizado estudo prospectivo, qualitativo e quantitativo com todos os 66 alunos do Lar Escola "Santa Luzia" Para Cegos no município de Bauru. Cada pessoa com deficiência visual respondeu a questionários sobre diversos temas e foi submetido a um exame oftalmológico que constou de: anamnese, refração e acuidade visual corrigida (AV), biomicroscopia, tonometria e exame de fundo de olho. Resultados: Do total de 66 alunos da escola, 44 participaram do estudo e 22 não quiseram ou não puderam comparecer à consulta oftalmológica. 56,81% (25) do total de participantes eram homens e 43,19% (19) mulheres. Os desafios dos alunos deste estudo compreendem basicamente a locomoção com maior autonomia, além de maiores recursos disponíveis em informática e braile. As causas mais frequentes de deficiência visual no presente estudo, em ordem crescente de prevalência foram: atrofia óptica, meningite, retinocoroidite por toxoplasmose, neurite óptica, DMRI, retinopatia da prematuridade, descolamento tracional de retina, hidrocefalia, tumor ocular, glaucoma congênito, uveíte, glaucoma, retinose pigmentar, descolamento de retina regmatogênica e trauma ocular. Conclusão: Medidas governamentais e o apoio da sociedade no sentido de uma intervenção de maneira eficaz e transformadora e de valores sociais solidários em prol da pessoa com deficiência visual são imprescindíveis para a inclusão social.

ABSTRACT Objective: To analyze the causes of blindness among students of the Lar Escola Santa Luzia Para Cegos in the city of Bauru, State of São Paulo. We also evaluated and discussed the degrees of social insertion of the students and the access to health and locomotion of the visually impaired. Methods: A prospective, qualitative and quantitative study was performed with all 66 students of the Lar Escola Santa Luzia para Cegos in the city of Bauru. Each person with visual impairment answered several questionnaires on various subjects and underwent an ophthalmologic examination consisting of: anamnesis, refraction and corrected visual acuity (VA), biomicroscopy, tonometry and fundus examination. Results: Out of the total of 66 students in the school, 44 participated in the study and 22 did not want or could not attend the ophthalmological visit. 56.81% (25) of the total participants were men and 43.19% (19) women. The students' challenges in this study basically include locomotion with greater autonomy, as well as greater resources available in computer science and Braille. The most frequent causes of visual impairment in the present study, in increasing order of prevalence were: optic atrophy, meningitis, toxoplasmosis retinocoriditis, optic neuritis, AMD, retinopathy of prematurity, tractional retinal detachment, hydrocephalus, ocular tumor, congenital glaucoma, uveitis, glaucoma, pigmentary retinitis, regmatogenic retinal detachment and ocular trauma. Conclusion: Government measures and the support of the society for effective and transformative intervention and solidarity-based social values for the visually impaired are essential for social inclusion.

National survey of blindness and visual impairment in Guatemala, 2015 / Pesquisa nacional sobre cegueira e deficiência visual na Guatemala, 2015

ABSTRACT - Purpose: To estimate the prevalence of blindness and visual impairment in older adults living in Guatemala. Methods: Participants ³50 years of age were selected using random cluster sampling and evaluated using the Rapid Assessment of Avoidable Blindness method. Visual acuity was measured, and the lens was examined. If presenting visual acuity was <20/60, it was also tested with a pinhole and fundoscopy was performed. Blindness and visual impairment were classified as moderate visual impairment (presenting visual acuity <20/60 to 20/200), severe visual impairment (presenting visual acuity <20/200 to 20/400), or blindness (presenting visual acuity <20/400). The primary cause of blindness or visual impairment in each eye was determined, and if the cause was cataracts, the barriers to treatment were assessed. Results: The study included 3,850 people ³50 years of age, of whom 3,760 (97.7%) were examined. The age- and sex-adjusted prevalence of blindness was 2.9% (95% confidence interval, 2.0%-3.8%), while 5.2% (4.0%-6.4%) presented with severe visual impairment, and 27.6% (23.3%-32.0%) presented with moderate visual impairment. Cataracts were the leading cause of blindness (77.6%), followed by other posterior segment diseases (6.0%). Cataracts caused 79.4% of cases of severe visual impairment, while uncorrected refractive errors caused 67.9% of cases of moderate visual impairment. Following cataract surgery, 75% of participants had a presenting visual acuity of 20/200 or better, and in 19.0% of participants, visual acuity was not better than 20/200 with correction. Cost was the main barrier to cataract surgery (56.7%). Conclusions: The prevalence of blindness in older adults is higher in Guatemala than in most Central American countries. Most cases of blindness and visual impairment were either preventable or treatable. Increased availability of affordable, high-quality cataract treatment would have a substantial impact on blindness prevention.

RESUMO - Objetivo: Estimar a prevalência de cegueira e de­fi­ciência visual em idosos que vivem na Guatemala. Métodos: Indivíduos com idade ³50 anos foram selecionados por amos­tragem aleatória por conglomerados, e os participantes do estudo foram avaliados pelo método de Avaliação Rápida da Cegueira Evitável. A acuidade visual foi medida e o cristalino foi examinado. Se a acuidade visual apresentada fosse <20/60, então também foi testada com um buraco estenopeico e a fundoscopia realizada. A cegueira e a deficiência visual foram classificadas como deficiência visual moderada com acuidade visual <20/60-20/200; deficiência visual grave com acuidade visual <20/200-20/400; ou cegueira com acuidade visual <20/400. A principal causa de cegueira ou deficiência visual em cada olho foi determinada, e naqueles com catarata, as barreiras ao tratamento foram avaliadas. Resultados: O estudo incluiu 3.850 pessoas com ³50 anos de idade; 3.760 (97,7%) foram examinadas. A prevalência de cegueira ajustada à idade e ao sexo foi de 2,9% (intervalo de confiança de 95%, 2,0-3,8%), 5,2% (4,0-6,4%) deficiência visual grave e 27,6% (23,3-32,0%) deficiência visual moderada. A catarata foi a principal de cegueira (77,6%), seguida de outras doenças do segmento posterior (6,0%). Catarata causada por 79,4% de deficiência visual grave, enquanto erros refrativos não corrigidos causaram 67,9% de deficiência visual moderada. Após a cirurgia de catarata, 75% dos participantes tiveram uma acuidade de 20/200, ou melhor, e 19,0% a deficiência visual não foi melhor do que 20/200 com a correção. O custo foi a principal barreira à cirurgia de catarata (56.7%). Conclusões: A prevalência de cegueira em idosos é maior na Guatemala do que na maioria dos outros países da América Central. A maioria dos casos de cegueira e deficiência visual era evitável ou tratável. O aumento da disponibilidade de tratamento de catarata a preços acessíveis e de alta qualidade teria um impacto substancial na prevenção da cegueira.

Magnitude of visual impairment, blindness and causes in the southwest region of São Paulo state, Brazil / Importância da deficiência visual, cegueira e causas na região sudoeste do estado de São Paulo, Brasil

ABSTRACT Purposes: The purpose of this study was to evaluate the magnitude and determinants of bilateral blindness and visual impairment (VI) in the southwest region of São Paulo State, Brazil. Methods: This cross-sectional study conducted during 2013 and 2014 targeted people of all ages in 10 districts in the southwest region of São Paulo State, Brazil. Ophthalmologists in a mobile unit measured visual acuity and examined eyes. Visual acuity was categorized according to the World Health Organization sex-adjusted rates with 95% confidence intervals (CI) were calculated. Number of blindness and visually impaired was projected for the entire study area. Results: We examined 2,306 participants. The age- and sex-adjusted frequency of bilateral blindness was 0.26% (95% CI: 0.1-0.4). Females (0.35%) and patients 350 years old (0.58%) had higher rate of blindness compared with males and younger individuals. The rate of severe VI was 9.1% (95% CI: 8.8-10.6) and was higher among males (11.6%) and those 350 years (12.3%). There could be 880 people with bilateral SVI in the study area. Bilateral severe VI was attributed to cataracts in 63% and was attributed to refractive error in 18%. Conclusion: Visual impairment and blindness in the study population was low and mainly due to cataract and refractive errors. Initiatives should be addressed by health care services to further reduce avoidable blindness in the region.

RESUMO Objetivos: O objetivo deste estudo foi avaliar a mag­nitude e determinantes da cegueira bilateral e deficiência visual (DV) na região sudoeste do estado de São Paulo, Brasil. Métodos: Trata-se de um estudo transversal do qual participaram pessoas de todas as idades, habitantes de 10 distritos da região sudoeste do estado de São Paulo - Brasil, nos anos de 2013-2014. Oftalmologistas avaliaram a acuidade visual e realizaram exame oftalmológico usando uma unidade móvel. A acuidade visual foi categorizada seguindo os critérios da Organização Mundial de Saúde. Foi calculada a taxa ajustada por idade-sexo e o intervalo de confiança de 95% para estimar o número de cegos e deficientes visuais na população. Resultados: Foram examinadas 2.306 pessoas. A frequência de cegueira bilateral ajustada por idade e sexo foi de 0,26% (95% CI: 0,1-0,4). Mulheres (0,35%) e indivíduos 350 anos (0,58%) foram os que tiveram maior taxa de cegueira. A taxa de deficiência visual grave foi de 9,1% (95% CI: 8,8-10,6), ocorrendo mais em homens (11,6%), com idade 350 anos (12,3%). Estimativas indicaram existência de 880 pessoas com deficiência visual grave bilateral na região. Catarata (63%) e erros refrativos (18%) foram as prin­cipais causas de deficiência visual grave. Conclusão: Deficiência visual grave e cegueira na região estudada foram baixas, sendo as causas mais frequentes a catarata e os erros de refração. Os serviços de saúde precisam implementar iniciativas para reduzir as causas evitáveis de cegueira na região.

Avaliação do perfil socioeconômico, formação profissional e estado de saúde de pessoas com deficiência visual / Evaluation of socioeconomic profile, professional training and health status of people with visual impairment

Resumo Objetivo: Verificar os aspectos socioeconômicos, a formação profissional, o nível de escolaridade e o estado de saúde de pessoas com deficiência visual. Métodos: Estudo transversal e descritivo com participação de 33 pessoas com deficiência visual, atendidas em uma Instituição Especializada para essa deficiência na cidade de Uberaba-MG, sendo 16 com baixa visão e 17 cegos. Avaliou-se os aspectos socioeconômicos por meio do instrumento Critério de Classificação Econômica Brasil (CCEB), a formação profissional e o estado de saúde foi verificado com o preenchimento de um formulário estruturado. Resultados: A faixa etária foi de 47,3 anos (± 17,2 anos), com prevalência do sexo feminino (57,5%) e da raça branca (51,5%). Em relação à formação profissional, 50% dos indivíduos com baixa visão e 52,9% com cegueira são aposentados; e a escolaridade foi de 8 anos de estudo para ambos os grupos. No estado de saúde 31,2% dos participantes com baixa visão apresentaram retinose pigmentar, e 23,5% dos participantes com cegueira apresentaram glaucoma. Em ambos grupos a maioria dos indivíduos não possuía nenhum tipo de comorbidade associado. De acordo com CCEB para o grupo baixa visão, a média da pontuação total foi de 18,4 pontos e para o grupo de cegos foi de 18,1; culminando na classificação C1 do nível socioeconômico. Conclusão: O perfil das pessoas do estudo demonstrou situações razoáveis de escolaridade, presença de indivíduos brancos e solteiros com idade economicamente ativa, com benefício de aposentadoria e classe econômica baixa.

Abstract Objective: To verify the socioeconomic aspects, the professional formation, the educational level and the state of health of people with visual deficiency. Methods: This is a cross-sectional and descriptive study with the participation of 33 people with visual impairment attended at a Specialized Institution for this deficiency in the city of Uberaba-MG, 16 with low vision and 17 with blindness. Socioeconomic aspects were evaluated through the Brazilian Economic Classification Criteria (CCEB), professional training and health status were verified by completing a structured form. Results: The age group was 47.3 years (± 17.2 years), with a prevalence of female (57.5%) and white (51.5%). In relation to professional training, 50% of the individuals with low vision and 52.9% with blindness are retired people; and schooling was 8 years of study for both groups. In the health condition 31.2% of the participants of low vision presented retinitis pigmentosa, and 23.5% of participants with blindness had glaucoma. In both groups, most individuals did not have any associated comorbidities. According to CCEB for the low vision group, the mean of the total score was 18.4 points and for the blind group was 18.1; culminating in the C1 classification of the socioeconomic level. Conclusion: The profile of the people in the study showed reasonable situations of schooling, presence of white and single individuals with economically active age, with retirement benefits and low economic class.

Causes of visual impairment and blindness in children at Instituto Benjamin Constant Blind School, Rio de Janeiro / Causas de baixa visão e cegueira infantil na Escola para cegos do Instituto Benjamin Constant, Rio de Janeiro

Abstract Objective: To determine the main causes of visual impairment and blindness in children enrolled at Instituto Benjamin Constant blind school (IBC) in 2013, to aid in planning for the prevention and management of avoidable causes of blindness. Methods: Study design: cross-sectional observational study. Data was collected from medical records of students attending IBC in 2013. Causes of blindness were classified according to WHO/PBL examination record. Data were analyzed for those children aged less than 16 years using Stata 9 program. Results: Among 355 students attending IBC in 2013, 253 (73%) were included in this study. Of these children, 190 (75%) were blind and 63 (25%) visually impaired. The major anatomical site of visual loss was retina (42%), followed by lesions of the globe (22%), optic nerve lesions (13.8%), central nervous system (8.8%) and cataract/pseudophakia/aphakia (8.8%). The etiology was unknown in 41.9% and neonatal factors accounted for 30,9% of cases. Forty-eight percent of cases were potentially avoidable. Retinopathy of prematurity (ROP) was the main cause of blindness and with microphthalmia, optic nerve atrophy, cataract and glaucoma accounted for more than 50% of cases. Conclusion: Provision and improvement of ROP, cataract and glaucoma screening and treatment and programs could prevent avoidable visual impairment and blindness.

Resumo Objetivo: Determinar as causas de cegueira e deficiência visual nas crianças matriculadas na Escola do Instituto Benjamin Constant (IBC) em 2013, para contribuir na elaboração de estratégias de controle e prevenção de causas evitáveis de cegueira. Métodos: Desenho de estudo: observacional do tipo transversal. Os dados foram coletados através dos prontuários dos alunos matriculados na Escola em 2013. As causas de cegueira foram classificadas de acordo com os registros de exames elaborados pela OMS/IAPB. Os dados foram analisados, em crianças com idade abaixo de 16 anos, usando o Programa Stata9. Resultados: Entre 355 alunos matriculados no IBC em 2013, 253 (73%) foram incluídos nesse estudo. Dessas crianças, 190 (75%) eram cegas e 63 (25%), deficientes visuais. O principal sítio anatômico, responsável pela perda visual, encontrado foi a retina (42%), seguido de lesões do globo ocular (22%), lesões no nervo óptico (13,8%), cegueira de origem no sistema nervoso central (8,8%) e catarata/pseudofácico/afácico (8.8%). A etiologia foi desconhecida em 41,9% e fatores neonatais corresponderam a 30,9% dos casos. Quarenta e oito porcento dos casos foram potencialmente evitáveis. Retinopatia da prematuridade (ROP) foi a principal causa de cegueira e microftalmia, atrofia do nervo óptico, catarata e glaucoma contaram com mais de 50% dos casos. Conclusão: A oferta e melhoria de programas de triagem e tratamento do ROP, catarata e glaucoma podem prevenir os casos de deficiência visual e cegueira evitáveis.

Tamizaje en el diagnóstico y prevalencia de retinopatía diabética en atención primaria / Coverage of a screening program and prevalence of diabetic retinopathy in primary care

Background: Diabetic retinopathy is the first cause of blindness during working years. Aim: Provide knowledge of screening coverage, prevalence and level of diabetic retinopathy in patients that belong to the Cardiovascular Health Program in primary care. Material and Methods: Analysis of retinographies performed to 9076 diabetic patients aged 61 ± 13 years (61% women) adscribed to a Cardiovascular Health program in primary care centers of South-East Metropolitan Santiago. The examination was carried out by the evaluation of retinographies by trained optometrists. Results: The coverage of the screening program was 21%. The prevalence of sight threatening diabetic retinopathy was 3,1%. The prevalence of these entities was 45% higher in people aged between 18 and 44 years than in older people. Their prevalence in urban communities was 32% higher than in rural locations. Conclusions: The coverage of the screening program is low. Diabetic patients aged 18 to 44 years and those coming from urban communities have a higher prevalence of severe non-proliferative and proliferative diabetic retinopathy.

Sociodemographic status of severely disabled and visually impaired elderly people in Turkey / Estado sociodemográfico de pacientes idosos com incapacidades graves e deficiência visual na Turquia

ABSTRACT Purpose: To identify the prevalence of ophthalmologic diseases in elderly patients who had been classified as severely disabled and to identify the ophthalmologic conditions leading to visual impairment and blindness. Methods: The medical records of 2806 patients who had applied to the Health Board of the Erzurum Region Training and Research Hospital between January 2011 and December 2012 were reviewed. One hundred ninety-nine patients aged >64 years who were classified as severely disabled with disability rates of over 50%, and who were unable to care for themselves or to move and/or communicate without help were included in the study. Results: The most frequently seen disabilities were neurological (47.2%) and those resulting from eye diseases (17.1%). The most common ophthalmologic diseases were cataract, glaucoma, and age-related macular degeneration. The mean right and left eye visual acuities were 1.17 ± 1.10 logMAR and 1.13 ± 1.0 logMAR, respectively. Of the 60 patients with ophthalmologic diseases or conditions, 33 were blind (visual acuity worse than 20/400) and 10 were visually impaired (visual acuity worse than 20/70 but better than 20/400). Cataracts were the main cause of blindness. The mean age of the patients who were still being followed up at the time of application to the disability board was significantly lower than that of the others (p =0.015). Seventy-nine percent of the blind patients were from rural areas, and 88% of these had no regular follow-up. Among the blind and visually impaired, significantly more patients from urban areas had social security insurance (SSI) than those from rural areas (p =0.043). Nearly 64% of the blind patients were women. The follow-up rate was significantly lower in women (p =0.025). According to multinomial logistic regression analysis, the visually impaired and blind patients were more likely to have lower follow-up rates than the other types of severely disabled patients (OR: 0.231, 95% Cl: 0.077-0.688, p=0.009). Conclusions: Blindness gives rise to severe disability, and the most common ophthalmologic diseases that cause severe disabilities in elderly patients are cataract, glaucoma, and age-related macular degeneration. Sociodemographic factors that may affect the accessibility of visually impaired and blind people to health services include their place of residence and gender.

RESUMO Objetivo: Identificar a prevalência de doenças oftalmológicas em pacientes idosos que tinham sido considerados como incapacitados graves, e para identificar as condições oftalmológicas que levam à deficiência visual e cegueira. Métodos: Prontuários de 2806 pacientes que tinham solicitado ao conselho de saúde do hospital de treinamento e pesquisa da região de Erzurum entre janeiro de 2011 e dezembro de 2012, foram revistos. Cento e noventa e nove idosos com mais de 64 anos, que foram considerados como incapacitados graves nos quais as taxas de incapacidade são mais de 50% e não são capazes de cuidado próprio e não são capazes de mover-se e/ou comunicar-se sem ajuda, foram incluídos no estudo. Resultados: As deficiências mais frequentemente observados são neurológicas (47,2%) e doenças oculares (17,1%). As doenças oftalmológicas mais frequentemente observadas foram catarata, glaucoma e degeneração macular relacionada à idade. Média de acuidade visual em olho direito e esquerdo foram 1,17 ± 1,10 e 1,13 ± 1,0 logMAR, respectivamente. Dos 60 pacientes, 33 apresentaram cegueira (acuidade visual pior que 20/400), 10 tinham deficiência visual (acuidade visual pior do que 20/70, melhor do que 20/400). A catarata foi a principal causa de cegueira. A idade média dos pacientes com acompanhamento no momento da solicitação ao conselho foi significativamente menor do que os demais (p=0,015). Setenta e nove por cento dos pacientes cegos eram da área rural e 88% deles não tinham acompanhamento regular. Entre cegos e deficientes visuais, a taxa de posse do seguro de segurança social (SSI) foi significativamente maior em pacientes de área urbana (p=0,043). Quase 64% dos pacientes cegos eram mulheres. A taxa de acompanhamento foi significativamente menor nas mulheres (p=0,025). De acordo com a análise de regressão logística multinominal, os pacientes com deficiência e cegos visuais eram mais propensos a ter menor taxa de acompanhamento do que os outros pacientes com deficiência grave (OR: 0,231, 95% Cl: 0,077-0,688, e p=0,009). Conclusões: A cegueira gera incapacitação grave. As doenças oftalmológicas mais frequentemente observadas que causam deficiência grave em pacientes idosos são a catarata, glaucoma e degeneração macular relacionada à idade. O local de residência e o gênero são fatores sociodemográficos que podem ter impacto sobre o acesso à saúde de pessoas com deficiência visual e cegos.

As principais causas de cegueira e baixa visão em escola para deficientes visuais / The main causes of blindness and low vision in school for blind

RESUMO Objetivo: Identificar e analisar as principais causas de cegueira e baixa visão em escola para deficientes visuais. Métodos: Foram revisados 165 prontuários de alunos portadores de deficiência visual em instituição especializada no ensino de cegos, atendidos no período de agosto de 2013 a maio de 2014. As variáveis analisadas foram: idade, gênero, acuidade visual, diagnóstico principal e secundário, tratamento, recursos ópticos prescritos e prognóstico. Resultados: Dos 165 alunos avaliados, 91 alunos (55%) são legalmente cegos e apenas 74 (45%) dos alunos são enquadrados como baixa visão. As principais causas identificadas foram: retinopatia da prematuridade (21%), atrofia de nervo óptico (18%), glaucoma congênito (16%), distrofias retinianas (11%) e neoplasias (8%). As causas de baixa visão foram: catarata congênita (18%), glaucoma congênito (15%) e cicatriz de retinocoroidite (12%). As causas de cegueira evitáveis (preveníveis ou tratáveis) no estudo perfizeram um total de 52%. Conclusão: As principais causas de cegueira e baixa visão nos alunos do Instituto Benjamin Constant são por doenças evitáveis.

ABSTRACT Objective: Identify and analyze the main causes of blindness and low vision in school for blind. Methods: One hundred sixty-five medical records of visually impaired students were reviewed in an institution specialized in teaching the blind, treated between august 2013 and may 2014. The variables analyzed were age, sex, visual acuity, primary and secondary diagnoses, treatment, optical prescription features and prognosis. Results: 165 students were evaluated, 91 students (55%) are legally blind and only 74 (45%) of the students are classified as low vision. The main causes of blindness were: retinopathy of prematurity (21%), optic nerve atrophy (18%), congenital glaucoma (16%), retinal dystrophy (11%) and cancer (8%). The causes of low vision were: congenital cataract (18%), congenital glaucoma (15%) and retinochoroidal scarring (12%). Conclusions: The main causes of blindness and low vision in the Benjamin Constant Institute are from preventable diseases.

The prevalence of self-reported vision difficulty in economically disadvantaged regions of South Africa

Background: Vision impairment, resulting in vision difficulties, is a leading cause of disability, and hence one of the key barriers for people to access education and employment, which may force them into poverty. Objectives: The objective of this study was to determine the prevalence of self reported vision difficulties as an indicator of vision impairment in economically disadvantaged regions in South Africa, and to examine the relationship between self-reported vision difficulties and socio-economic markers of poverty, namely, income, education and health service needs. Methods: A cross-sectional study was conducted in economically disadvantaged districts to collect data from households on poverty and health, including vision difficulty. As visual acuity measurements were not conducted, the researchers used the term vision difficulty as an indicator of vision impairment. Data were collected from 27 districts (74 901 respondents). Logistic regression analysis and chi-square tests were used to determine bivariate relationships between variables and self-reported vision difficulty. Kernel density estimators were used for age, categorised by self-reported and not reported vision difficulty.Results: Prevalence of self-reported vision difficulty was 11.2% (95% CI; 8.7% - 13.7%). More women (12.7%) compared to men (9.5%) self-reported vision difficulty (p 0.01). Self-reported vision difficulty was higher (14.2%) for respondents that do not spend any money. A statistically significant relationship was found between the highest level of education and self-reporting of vision difficulty; as completed highest level of education increased, self-reporting of vision difficulty became lower (p 0.01). A significantly higher prevalence of self-reported vision difficulty was found in respondents who are employed (p 0.01), 17% (95% CI: 12.8% - 21.1%). Conclusion: The evidence from this study suggests associations between socio-economic factors and vision difficulties that have a two-fold relationship (some factors such as education; and access to eye health services are associated with vision difficulty whilst vision difficulty may trap people in their current poverty or deepen their poverty status). The results are thus indicative of the need for further research in South Africa

Encuestas nacionales de ceguera y deficiencia visual evitables en Argentina, El Salvador, Honduras, Panamá, Perú y Uruguay / National surveys of avoidable blindness and visual impairment in Argentina, El Salvador, Honduras, Panama, Peru, and Uruguay

OBJETIVO: Describir la justificación y metodología usadas en la Evaluación Rápida de Ceguera Evitable empleada para efectuar encuestas a nivel nacional entre 2011 y 2013 en Argentina, El Salvador, Honduras, Panamá, Perú y Uruguay. MÉTODOS: La encuesta se dirige a personas de 50 años o más, lo que reduce al mínimo los requisitos de tamaño de la muestra, que oscila entre 2 000 y 5 000 personas. Se emplean sistemas simples de muestreo y técnicas de examen; el análisis de datos es automático y no requiere de un experto en estadística. Es relativamente económica, ya que no toma mucho tiempo, no requiere equipos oftalmológicos costosos y puede ser llevada a cabo por el personal local. Los informes son generados mediante el propio programa informático de la evaluación. RESULTADOS: Los indicadores generados son la prevalencia de la ceguera y la deficiencia visual severa y moderada (discriminadas por causas evitables y cataratas); la prevalencia de afaquia o pseudofaquia; la cobertura de la cirugía de cataratas; el resultado visual de las cirugías de cataratas; las causas de resultados malos; las barreras de acceso a la cirugía de cataratas; y los indicadores de servicio de la cirugía de cataratas. Los resultados de cada una de las encuestas serán publicados de manera secuencial en números sucesivos de la revista, y en un artículo final de resumen se hará un análisis de los resultados en su conjunto y comparativo entre las encuestas y con aquellas publicadas anteriormente, que aportará un estado de la situación actual en ese grupo de países. CONCLUSIONES: La Evaluación Rápida de Ceguera Evitable es una metodología sólida, sencilla y económica para determinar la prevalencia de ceguera y deficiencia visual y la cobertura y calidad de los servicios de salud ocular, y representa una herramienta muy valiosa para medir el progreso de los programas de prevención de la ceguera y su impacto en la población.

OBJECTIVE: Describe the rationale and methodology of the Rapid Assessment of Avoidable Blindness applied in surveys at the national level in 2011-2013 in Argentina, El Salvador, Honduras, Panama, Peru, and Uruguay. METHODS: The survey includes individuals aged 50 years and older, minimizing required sample sizes, which vary from 2 000 to 5 000 people. It uses straightforward sampling and examination techniques, and data analysis is automatic and does not require a statistician. It is relatively inexpensive, as it does not take a long time, does not require expensive ophthalmic equipment, and can be carried out by local staff. Reports are generated by the assessment software package. RESULTS: Indicators measured are prevalence of blindness and of moderate and severe visual impairment (broken down into avoidable causes and cataracts); prevalence of aphakia or pseudophakia; cataract surgical coverage; visual outcome of cataract surgeries; causes of poor outcomes; access barriers to cataract surgery; and cataract surgery service indicators. Results of each survey will be published sequentially in successive issues of the Journal, and a final summary article will analyze results as a whole and in comparison with the other surveys in this group and with those previously published, which will provide a current picture of the situation in this group of countries. CONCLUSIONS: The Rapid Assessment of Avoidable Blindness is a robust, simple, and inexpensive methodology to determine prevalence of blindness and visual impairment as well as eye health service coverage and quality. It is a very valuable tool for measuring progress by blindness prevention programs and their impact on the population.

Rapid assessment of avoidable blindness in Uruguay: results of a nationwide survey / Evaluación rápida de la ceguera evitable en Uruguay: resultados de un estudio a escala nacional

OBJECTIVE: To investigate and describe the prevalence and causes of blindness and moderate and severe visual impairment in older adults living in Uruguay. METHODS: All individuals aged ≥ 50 years old living in randomly selected clusters were eligible to participate. In each census enumeration unit selected, 50 residents aged 50 years and older were chosen to participate in the study using compact segment sampling. The study participants underwent visual acuity (VA) measurement and lens examination; those with presenting VA (PVA) < 20/60 also underwent direct ophthalmoscopy. Moderate visual impairment (MVI) was defined as PVA < 20/60-20/200, severe visual impairment (SVI) was defined as PVA < 20/200-20/400, and blindness was defined as PVA < 20/400, all based on vision in the better eye with available correction. RESULTS: Out of 3 956 eligible individuals, 3 729 (94.3%) were examined. The age- and sex-adjusted prevalence of blindness was 0.9% (95% confidence interval (CI): 0.5-1.3). Cataract (48.6%) and glaucoma (14.3%) were the main causes of blindness. Prevalence of SVI and MVI was 0.9% (95% CI: 0.5-1.3) and 7.9% (95% CI: 6.0-9.7) respectively. Cataract was the main cause of SVI (65.7%), followed by uncorrected refractive error (14.3%), which was the main cause of MVI (55.2%). Cataract surgical coverage was 76.8% (calculated by eye) and 91.3% (calculated by individual). Of all eyes operated for cataract, 70.0% could see ≥ 20/60 and 15.3% could not see 20/200 post-surgery. CONCLUSIONS: Prevalence of blindness in Uruguay is low compared to other Latin American countries, but further reduction is feasible. Due to Uruguay's high cataract surgical coverage and growing proportion of people ≥ 50 years old, the impact of posterior pole diseases as a contributing factor to blindness might increase in future.

OBJETIVO: Investigar y describir la prevalencia y las causas de la ceguera y de la discapacidad visual moderada y grave en los adultos mayores residentes en Uruguay. MÉTODOS: Todas las personas de 50 años o más que vivían en los agrupamientos seleccionados aleatoriamente reunían los requisitos para participar. En cada unidad de enumeración censal seleccionada, se escogieron 50 residentes de = 50 años de edad para participar en el estudio mediante el empleo de un muestreo por segmentos compactos. Los participantes fueron sometidos a una medición de la agudeza visual (AV) y a un examen del cristalino; los que mostraban una AV de presentación (AVP) < 20/60 también fueron sometidos a oftalmoscopia directa. La discapacidad visual moderada (DVM) se definió como una AVP < 20/60–20/200, la discapacidad visual grave (DVG) como una AVP < 20/200–20/400, y la ceguera como una AVP< 20/400, todas ellas basadas en la visión del ojo que obtuvo un mejor resultado con la corrección disponible. RESULTADOS: De las 3 956 personas que reunieron los requisitos, se examinaron 3 729 (94,3%). La prevalencia ajustada por edad y sexo de la ceguera fue de 0,9% (intervalo de confianza (IC) de 95%: 0,5–1,3). La catarata (48,6%) y el glaucoma (14,3%) fueron las principales causas de ceguera. La prevalencia de la DVG y la DVM fue de 0,9% (IC de 95%: 0,5–1,3) y 7,9% (IC de 95%: 6,0–9,7), respectivamente. La catarata fue la causa principal de DVG (65,7%), seguida del error de refracción no corregido (14,3%), que fue la principal causa de DVM (55,2%). La cobertura quirúrgica de la catarata fue de 76,8% (calculada por ojo) y de 91,3% (calculada por persona). De todos los ojos operados de catarata, 70,0% presentaba una agudeza visual de = 20/60 y 15,3% tenía una agudeza visual < 20/200 después de la intervención quirúrgica. CONCLUSIONES: En Uruguay, la prevalencia de la ceguera es baja en comparación con otros países latinoamericanos, pero es factible lograr una reducción adicional. Como consecuencia de la alta cobertura quirúrgica de la catarata y la creciente proporción de personas de = 50 años en Uruguay, la repercusión de las enfermedades de la cámara ocular posterior como factor contribuyente a la ceguera podría aumentar en el futuro.

Discapacidad visual; otra forma de verla / Visual impairment; another way of see it

La discapacidad visual es un problema de salud pública que afecta a más de doscientos ochenta y cinco millones de personas alrededor del mundo, dentro de los cuales doscientos cuarenta y seis millones sufren baja visión y treinta y nueve millones ceguera primaria. Es una entidad altamente relacionada con las condiciones socioeconómicas y las posibilidades de acceder a los servicios de salud, esto explica que entre el 80 y el 90 por ciento de las personas con alteraciones visuales sean de países en vía de desarrollo, principalmente en zonas rurales. Una infinidad de casos de ceguera y baja visión son consecuencia de eventos prevenibles, entre los cuales sobresalen los defectos refractivos no corregidos tales como astigmatismo, miopía, hipermetropía y presbicia. Es por esto que la discapacidad visual se ha convertido en una prioridad para múltiples entidades a nivel mundial, que buscan disminuir la presentación de ceguera prevenible a través de una simple corrección visual bien diagnosticada...

Visual impairment is a public health problem that affects more than two hundred eighty-five million people around the world, among them two hundred forty-six million suffer low vision and thirty-nine million primary blindness. It is highly related to socio-economic conditions and the possibilities to access to health services, explained that between 80 and 90 percent of persons with visual impairments from countries developing, mainly in rural areas. An infinite number of cases of blindness and low vision are the result of events preventable, among which stand out the uncorrected refractive errors such as myopia, hyperopia, astigmatism and presbyopia. It is for this reason that visual impairment has become a priority for many organizations around the world, seeking to reduce the presentation of preventable blindness through a simple visual correction well diagnosed...

Caracterización epidemiológica del glaucoma en la población del Servicio de Oftalmología del Hospital Nacional Arzobispo Loayza: Enero û diciembre 2012 / Epidemiological characterization of glaucoma Service population Ophthalmology Archbishop Loayza National Hospital: January to december 2012

Objetivo: Describir las características clínicas y epidemiológicas de los pacientes sometidos a estudio de glaucoma en la unidad de glaucoma del servicio de oftalmología del Hospital Nacional Arzobispo Loayza durante el periodo Enero a Diciembre 2012. Material y método:: Estudio descriptivo, retrospectivo y observacional donde se revisaron 190 historias de pacientes atendidos en la unidad de glaucoma del servicio de oftalmología del Hospital Nacional Arzobispo Loayza con sospecha de glaucoma durante el periodo Enero – Diciembre 2012. Los datos recolectados fueron vaciados a una base de datos del programa Microsoft Excel y luego trasladados al programa estadístico SPSS v.21.0.para su análisis. Resultados: De los 190 pacientes, 130 tuvieron diagnóstico de glaucoma, los datos demográficos fueron los siguientes: 88 mujeres (66,7%) y 42 varones (32,3%), la edad promedio de los pacientes con glaucoma fue61,38 años.La mayor parte de los casos fue clasificado como glaucoma primario de ángulo abierto (GPAA) que correspondeal 50% de los subtipos encontrados (n=65), seguido de los pacientes con sospecha de glaucoma (n=25, 19,23%), glaucoma primario de ángulo cerrado (GPAC), (n=20, 15,4%), hipertensión ocular (HTO), (n=17, 13,1%), glaucoma tensión normal (GTN), (n= 2, 1,5%), y glaucoma neovascular (GNV), (n=1, 0,8%). Conclusiones: La variedad más frecuente de glaucoma fue GPAA, el promedio de edad para este subtipo es de 64 años.Se encontró que el número de casos de GPAA y GPAC se incrementó al doble en pacientes mayores de 60 años de edad.

Purpose: To describe clinical and epidemiological characteristics of glaucoma patients evaluated by medical faculty of Glaucoma Unit at ArzobispoLoayza Hospital`s Ophthalmology Department since January through December 2012. Material and methods: Descriptive, retrospective and observational study of 190 medical charts of patients evaluated at Glaucoma Unit of ArzobispoLoayza Hospital since January through December 2012. The collected data were converted to Microsoft Excel program and transferred to SPSS v 21.0 for statistical analysis. Results: Of 190 patients, 130 patients were diagnosed of glaucoma: 88 women (66.7 %) and 42 males (32.3 %) with mean age of 60.18 years. Most of the cases were classified as primary open angle glaucoma (POAG corresponding to 50 % of the subtypes found (n=65), followed by glaucoma suspects (n=25, 19.23%), primary angleclosure glaucoma (PACG), (n=20, 15.4%), ocular hypertension (OHT), (n=17, 13.1%), normal tension glaucoma (NTG), (n=2, 1.5%), and neovascular glaucoma (NVG), (n=1, 0.8%). Conclusions: The most common form of glaucoma was POAG and the mean age was 64 years. It was found that the number of cases of POAG and PACG increased twofold in patients over 60 years old.

Prevalence of congenital eye anomalies in a paediatric clinic in Ghana

There is little information about the epidemiology of congenital eye anomalies in Ghana. We retrospectively reviewed the clinical records of 485 admissions to the paediatric eye centre of the Korle-Bu Teaching Hospital, Ghana [2004-2009] and 263 were diagnosed with at least one anomaly. Visual acuity was quantitatively assessed in 209 patients and 130 had some visual impairment; 49 with bilateral and 64 with unilateral blindness. The most frequent congenital anomaly overall was cataract [n = 44]. In infants, cataract was the most frequent finding [28/121]. Toddlers most frequently presented with retinoblastoma [10/65]. Glaucoma was the most frequent anomaly in preschool [9/39] and school [10/38] children. We conclude that avoidable causes of childhood blindness caused most congenital eye anomalies. Intensification of community-based health promotion and preventive eye care, early detection and provision of adequate resources for effective therapy could reverse these trends

Perfil de distribuição de erros refracionais no sul do centro-oeste do estado de São Paulo e seu impacto na acuidade visual: estudo de base populacional / Distribution profile of refractive errors in the south of the center - west of the state of São Paulo and its impact on visual acuity: population-based study

Determinar o perfil de distribuição dos erros refracionais em uma amostra populacional do centro-oeste do Estado de São Paulo, suas possíveis associações com características individuais e a influência sobre a acuidade visual. foi desenvolvido estudo de secção transversal com amostragem residencial probabilística e sistemática em nove municípios no sul do centro-oeste paulista, como parte do Projeto de Prevenção à Cegueira na Comunidade. Os indivíduos acima de um ano de idade foram submetidos a entrevista e exame oftalmológico completo. A acuidade visual em sistema Snellen e posterior conversão para logMAR foi obtida antes e após exame de refração e categorizada em quatro segmentos. Os erros refracionais foram classificados em miopia (EE ≤ - 0,50D), hipermetropia (EE ≥ 0,50D), astigmatismo (DC ≤ -0,50D) e anisometropia (diferença de EE ≥ 1,00D entre os olhos). Foi realizada a análise descritiva dos dados de prevalência na amostra, análise univariada e multivariada com modelos de regressão logística múltipla para determinar possíveis associações de prevalências. 3012 residências foram entrevistadas e 7654 indivíduos foram incluídos no estudo, sendo 62,7% mulheres, 92,1% considerados com pele branca e média para a idade de 36,89 anos (extremos de 1 a 96 anos). A miopia foi mais prevalente na terceira e quarta décadas de vida, atingindo 43,31% sem diferenças significativas entre sexos, enquanto a hipermetropia foi mais prevalente entre mulheres acima de 60 anos de idade, com uma frequência de 65,6% nesta faixa etária. O astigmatismo apresentou uma frequência progressivamente maior com a idade e semelhante entre os sexos. O eixo do astigmatismo também apresentou variação conforme a idade, com o eixo horizontal mais frequente em jovens e o vertical nos idosos...

Establish the refractive errors distribution in a population sample of the Central São Paulo State, correlations with personal features and its influence in visual acuity. A cross sectional survey was developed with randomized and systematic residential sampling in nine cities of middle region of São Paulo St/Brazil as part of Blindness Prevention Project at Community. Inhabitants above one year old were submitted to an interview and full ophthalmic exam. Visual acuity in logMAR system was determined before and after refraction exam and classified in four categories. Refractive errors were classified in myopia (SE ≤ -0,50D), hyperopia (SE ≥ 0,50D), astigmatism (CD ≤ -0,50D) and anisometrophy (SE difference between eyes ≥ 1,00D). Prevalence data sample were submitted to descriptive analysis, univariate and multivariate logistic regression models to find eventual prevalence associations. 7654 participants were included in this survey, in which 62,7% were women, 92,1% with white skin and middle age of 36,89 years old (1 to 96 years). Myopia was more prevalent at 3rd and 4th decades, achieving 43,31% without significant differences between genders, while hyperopia was more prevalent in women above 60 years old, with 65,5%. Astigmatism prevalence increased by age with no differences between genders. Astigmatism axis changed by age too, when horizontal axis were more frequently observed in youngers and vertical in olders. Anisometrophy prevalence changed by age, more frequent at extremes, achieving 32,66% after 70 years old. No significant differences were found in ethnic categories...

Prevalence and causes of blindness in an urban area of Paraguay / Prevalência e causas de cegueira em uma população urbana do Paraguai

PURPOSE: To determine the prevalence and causes of blindness in Piribebuy, Paraguay. METHODS: A population based study was conducted from September to November 2007 in Piribebuy, Paraguay. Based on the city map, seven clusters were randomly selected, containing 22 to 36 squares (423 to 578 houses) each, where all subjects > 40 years old who agreed to participate were included in the study. Presenting vision acuity (VA) was obtained for each eye, with 'E' Snellen charts 6 meters far from the patient with appropriate light. Eyes with VA<20/60 were also tested with the pinhole. Objective and subjective refraction was performed, followed by examination of anterior segment under the slit-lamp, Goldmann applanation tonometry, and pupil dilatation with 0.5% tropicamide plus 0.5% phenylephrine, followed by evaluation of the posterior pole. Best corrected visual acuity was used to classify the patients as follows: blindness was defined as visual acuity of the better eye <20/400, low vision as 20/400

OBJETIVO: Determinar a prevalência e causas de cegueira em Piribebuy, Paraguay. MÉTODOS: Um estudo populational foi conduzido de setembro a novembro de 2007 em Piribebuy, Paraguay. Baseado no mapa da cidade, sete agrupamentos foramaleatoriamente selecionados, contendo 22 a 36 quarteirões (423 a 578 casas) cada, onde todos os indivíduos > 40 anos de idade, que concordaram em participar, foram incluídos no estudo. A acuidade visual (AV) conforme apresentada foi obtida para cada olho, com Tabela de Snellen a 6 metros do paciente, com luz apropriada. Olhos com AV<20/60 também foram testados com orifício estenopeico. Refrações objetiva e subjetiva foram realizadas, seguido de avaliação da câmara anterior sob lâmpada de fenda, tonometria de aplanação de Goldmann e dilatação pupilar com tropicamida a 0.5% e fenilefrina a 0.5%, seguido de avaliação do polo posterior. A melhor acuidade visual corrigida foi usada para classificar os pacientes nos seguintes grupos: cegueira foi definida como acuidade visual do melhor olho <20/400, baixa visão como 20/400

Changing trends in the prevalence of blindness and visual impairment in a rural district of India: Systematic observations over a decade.

Context: Globally, limited data are available on changing trends of blindness from a single region. Aims: To report the changing trends in the prevalence of blindness, visual impairment (VI), and visual outcomes of cataract surgery in a rural district of Andhra Pradesh, India, over period of one decade. Settings and Design: Rural setting; cross-sectional study. Materials and Methods: Using a validated Rapid Assessment of Cataract Surgical Services (RACSS) method, population-based, cross-sectional survey was done in a rural district in the state of Andhra Pradesh, India. Two-stage sampling procedure was used to select participants ≥50 years of age. Further, a comparative analysis was done with participants ≥50 years from the previously concluded Andhra Pradesh Eye Disease Study (APEDS) study, who belonged to the same district. Statistical Analysis: Done using 11th version of Stata. Results: Using RACSS, 2160/2300 (93.9%) participants were examined as compared with the APEDS dataset (n=521). Age and sex adjusted prevalence of blindness in RACSS and APEDS was 8% (95% CI, 6.9–9.1%) and 11% (95% CI, 8.3–13.7%), while that of VI was 13.6% (95% CI, 12.2–15.1%) and 40.3% (95% CI, 36.1–44.5%), respectively. Cataract was the major cause of blindness in both the studies. There was a significant reduction in blindness following cataract surgery as observed through RACSS (17.3%; 95% CI, 13.5–21.8%) compared with APEDS (34%; 95% CI, 20.9–49.3%). Conclusion: There was a significant reduction in prevalence of blindness and VI in this rural district of India over a decade.

The challenges in improving outcome of cataract surgery in low and middle income countries.

Cataract is the leading cause of blindness globally and surgery is the only known measure to deal with it effectively. Providing high quality cataract surgical services is critical if patients with cataract are to have their sight restored. A key focus of surgery is the outcome of the procedure. In cataract surgery this is measured predominantly, using visual acuity. Population- and hospital-based studies have revealed that the visual outcome of cataract surgery in many low and middle income settings is frequently sub-optimal, often failing to reach the recommended standards set by the World Health Organization (WHO). Another way of measuring outcome of cataract surgery is to ask patients for their views on whether surgery has changed the functioning of their eyes and their quality of life. There are different tools available to capture patient views and now, these patient-reported outcomes are becoming more widely used. This paper discusses the visual outcome of cataract surgery and frames the outcome of surgery within the context of the surgical service, suggesting that the process and outcome of care cannot be separated. It also discusses the components of patient-reported outcome tools and describes some available tools in more detail. Finally, it describes a hierarchy of challenges that need to be addressed before a high quality cataract surgical service can be achieved.

Turning the tide of corneal blindness.

Corneal diseases represent the second leading cause of blindness in most developing world countries. Worldwide, major investments in public health infrastructure and primary eye care services have built a strong foundation for preventing future corneal blindness. However, there are an estimated 4.9 million bilaterally corneal blind persons worldwide who could potentially have their sight restored through corneal transplantation. Traditionally, barriers to increased corneal transplantation have been daunting, with limited tissue availability and lack of trained corneal surgeons making widespread keratoplasty services cost prohibitive and logistically unfeasible. The ascendancy of cataract surgical rates and more robust eye care infrastructure of several Asian and African countries now provide a solid base from which to dramatically expand corneal transplantation rates. India emerges as a clear global priority as it has the world's largest corneal blind population and strong infrastructural readiness to rapidly scale its keratoplasty numbers. Technological modernization of the eye bank infrastructure must follow suit. Two key factors are the development of professional eye bank managers and the establishment of Hospital Cornea Recovery Programs. Recent adaptation of these modern eye banking models in India have led to corresponding high growth rates in the procurement of transplantable tissues, improved utilization rates, operating efficiency realization, and increased financial sustainability. The widespread adaptation of lamellar keratoplasty techniques also holds promise to improve corneal transplant success rates. The global ophthalmic community is now poised to scale up widespread access to corneal transplantation to meet the needs of the millions who are currently blind.