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C. E. Gilbert, S. P. Shah, M. Z. Jadoon, R. R. Bourne, B. Dineen, M. A. Khan, M. D. Khan, Pakistan National Eye Survey Study Group; Deprivation and Visual Impairment in Pakistan. The National Blindness and Visual Impairment Survey. Invest. Ophthalmol. Vis. Sci. 2007;48(13):322.
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© ARVO (1962-2015); The Authors (2016-present)
To explore the association between visual impairment and deprivation in Pakistan.
Visually impaired adults (≥30years) were identified in a population based national survey in Pakistan. A deprivation score (at district level stratified by urban/rural location; 0 = least, 100 = highest deprivation) similar to the UNDP’s Human Poverty Index, was obtained from national census data. Subjects were categorized as living in low (<25th centile), medium (25-75th centile) or high deprivation (>75th centile) areas.
16,507 (95.3% response rate) participants were examined. Adults in Sindh province had the lowest deprivation whereas rural areas in Balochistan had the highest.The prevalence of blindness (<3/60 in the better eye) in adults with low deprivation was 2.2%, compared with 3.7% in medium and 3.9% in high deprivation areas (p<0.001). The highest prevalence of blindness was found in rural Balochistan (5.2%). The prevalence of total blindness (bilateral no light perception) was more than three times higher in highly deprived areas compared to low deprivation areas (0.24% vs. 0.07%, p<0.001).Cataract was the leading cause of blindness in all areas (51.5%), and in high deprivation areas the proportion was 52.8% compared with 46.9% in low deprivation areas (p<0.001). In adults with <6/18 in the better eye, cataract remained the leading cause in the high and medium deprived areas (47.2% and 49.4% respectively) but uncorrected refractive error was the leading cause in low deprivation areas (40.1%).10.2% of adults in low deprivation areas presented with spectacles compared to 6.7% and 4.4% in medium and highly deprived areas respectively. Spectacle coverage was more than double in low deprivation areas compared to high deprivation areas (24.8% vs 11.8%, p<0.001). Reflecting access to eye care, the cataract surgical coverage was highest in the least deprived areas (80.6%) compared to 76.8% and 75.1% in the medium and highest deprived areas.
Visual impairment and poor access to services is associated with deprivation. Control strategies need to focus on poor communities, and combating visual impairment may impact on global deprivation.
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