WORLD VIEW

Causes of low vision and blindness in rural Indonesia

S-M Saw^1,2,3, R Husain^2,3,4, G M Gazzard^3,4, D Koh¹, D Widjaja⁵ and D T H Tan^2,3,6

Series editors: W V Good, S Ruit

¹ Department of Community, Occupational and Family Medicine, National University of Singapore, 16 Medical Drive, Singapore 117597, Republic of Singapore
² Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, Republic of Singapore
³ Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, Republic of Singapore
⁴ The Institute of Ophthalmology, 11–43 Bath Street, London EC1V 9EL, UK
⁵ P Riau Andalan Pulp and Paper, Kerinci, Indonesia
⁶ Department of Ophthalmology, National University of Singapore, Singapore 117597, Republic of Singapore

Correspondence to:
Correspondence to:
Associate Professor Seang-Mei Saw, Department of Community, Occupational and Family Medicine, National University of Singapore, 16 Medical Drive, Singapore 117597, Republic of Singapore;
cofsawsm{at}nus.edu.sg

Aim: To determine the prevalence rates and major contributing causes of low vision and blindness in adults in a rural setting in Indonesia

Methods: A population based prevalence survey of adults 21 years or older (n=989) was conducted in five rural villages and one provincial town in Sumatra, Indonesia. One stage household cluster sampling procedure was employed where 100 households were randomly selected from each village or town. Bilateral low vision was defined as habitual VA (measured using tumbling "E" logMAR charts) in the better eye worse than 6/18 and 3/60 or better, based on the WHO criteria. Bilateral blindness was defined as habitual VA worse than 3/60 in the better eye. The anterior segment and lens of subjects with low vision or blindness (both unilateral and bilateral) (n=66) were examined using a portable slit lamp and fundus examination was performed using indirect ophthalmoscopy.

Results: The overall age adjusted (adjusted to the 1990 Indonesia census population) prevalence rate of bilateral low vision was 5.8% (95% confidence interval (CI) 4.2 to 7.4) and bilateral blindness was 2.2% (95% CI 1.1 to 3.2). The rates of low vision and blindness increased with age. The major contributing causes for bilateral low vision were cataract (61.3%), uncorrected refractive error (12.9%), and amblyopia (12.9%), and the major cause of bilateral blindness was cataract (62.5%). The major causes of unilateral low vision were cataract (48.0%) and uncorrected refractive error (12.0%), and major causes of unilateral blindness were amblyopia (50.0%) and trauma (50.0%).

Conclusions: The rates of habitual low vision and blindness in provincial Sumatra, Indonesia, are similar to other developing rural countries in Asia. Blindness is largely preventable, as the major contributing causes (cataract and uncorrected refractive error) are amenable to treatment.

Keywords: blindness; low vision; prevalence; Indonesia

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