Current global estimates indicate that blindness affects close to 45 million people, with nine out of ten blind people living in developing countries. Blindness, with its social and economic consequences, therefore represents a significant public health problem in many parts of the world. The goal of this initiative is to address the major preventable or treatable causes of blindness, particularly in developing countries, in order to stop a further increase of the global burden of blindness. Among the priority diseases singled out in the Vision 2020 initiative are cataract and trachoma. In this issue of the Bulletin, two important papers deal with the assessment and monitoring of cataract and trachoma - clearly an essential part of measuring effective control of diseases that can lead to blindness.
Cataract is by far the most frequent cause of visual loss worldwide.
On page 455, Limburg et al. analyse the outcome of large-scale cataract surgical activities in India. The Indian National Programme for the Prevention and Control of Blindness has made impressive progress in seeking to provide cataract surgical services to all those who need them. However, Limburg et al. demonstrate the need to pay further attention to the quality of care being provided, including provision of more appropriate refractive services for patients. Also important is the trend towards better outcomes for hospital-based eye surgery, as opposed to eye camps, an issue that is being addressed in national plans for eye care in India. To tackle this problem effectively is complex , requiring not only improved access to surgery, but also managerial decisions to give priority to blind patients, to the extent that this is feasible.