Blindness: a global priority for the twenty-first century.

Vision is one of our most cherished senses. Yet, most of us can hardly imagine what it would be like to lose it -- to be unable to drive, to need assistance with daily activities, or to have difficulty recognizing friends and family members. This is the reality, however, for the nearly 45 million people worldwide who are blind (1). A further 135 million people are visually disabled, and are dependent on family and governmental support systems on a daily basis. These numbers are projected to double early this century as the population grows and ages (1), and will increase dramatically as policy-makers and health care providers recognize that even moderate vision loss severely limits many people from fulfilling their personal and economic potential (2, 3). In this issue of the Bulletin a diverse group of experts from around the world share their views on blindness prevention, summarizing the most significant advances in their respective fields, and presenting what they view to be priorities for the 21st century. The result is a collection of timely and thought-provoking reviews, commentaries, and research papers. In their article on pp. 222-226, Resnikoff & Pararajasegaram summarize WHO's contributions to blindness prevention over the past 50 years. Included are the earliest field and laboratory studies on trachoma in the 1950s, the successes of the WHO Programme for the Prevention of Blindness in decreasing vision loss due to trachoma, onchocerciasis, and xerophthalmia, and the recently launched Global Initiative for the Elimination of Avoidable Blindness (VISION 2020 -- The Right to Sight). West & Sommer (pp. 244-248) highlight the dramatic improvements that have occurred in preventing blindness due to infection and malnutrition, most notably trachoma, onchocerciasis, and xerophthalmia, but caution that lasting success may have to await the development of effective vaccines. They emphasize that the increasing size and age of the population will be major factors responsible for the emergence of glaucoma, diabetic retinopathy, and age-related macular degeneration as causes of blindness in the 21st century. Brian & Taylor (pp. 249-256) address the seemingly intractable problem of cataract, concluding that preventive measures might include reducing ocular exposure to ultraviolet-B radiation, promoting cessation of smoking, and perhaps the widespread use of the antioxidant vitamins A, C or E. Congdon (pp. 258-259), Gritz (pp. 260-261), Yorston & Abiose (pp. 257-258), and Prajna & Venkataswamy (pp. 259-260) provide independent and interesting commentaries on cataract pathogenesis, prevention, and treatment in developing countries. Bailey & Lietman (pp. 233-236) discuss ongoing WHO efforts to eliminate trachoma and suggest that implementation of the SAFE strategy (Surgery for entropion/trichiasis, Antibiotics for infectious trachoma, Facial cleanliness to reduce transmission, and Environmental improvements such as insect control and water purification) may lead to its elimination some time during this century. Dandona & Dandona (pp. 237-243) survey refractive error blindness, an enormous yet little recognized preventable form of vision loss. They suggest that large-scale screening programmes might be effective in eliminating much of this blindness, but note that this strategy will require a large number of personnel and an adequate infrastructure to make and dispense appropriate spectacles. Gilbert & Foster (pp. 227-232) point out that childhood blindness accounts for almost as many "blind years" as cataract, but that many of its causes are either preventable or treatable. They suggest a dual approach to tackle this problem, consisting of community-based efforts to reduce systemic conditions that may cause blindness along with providing well-trained primary health care givers and ophthalmologists who are familiar with paediatric eye disease. …