Editor,—The prevalence of blindness in Africa, both for adults and children, is the highest in the world.1

Cataract accounts for over half of this blindness and a large part of the remainder (trachoma, xerophthalmia, onchocerciasis, glaucoma) is preventable.2

There is on average one ophthalmologist per million population in Africa today. Most of these specialists are practising in the capital cities and large conurbations.3 Yet a majority of the population still resides in rural areas gaining a livelihood from subsistence farming. Access to affordable eye care for most people is therefore severely limited.

In English speaking Africa the penury of ophthalmic nurses and doctors is being tackled realistically with diploma and fellowship training courses available in west, east, and southern Africa. But the 19 French speaking countries south of the Sahara lag far behind, with only a few teaching centres that are incapable of meeting the shortfall of trained eye workers and whose expertise is largely unadapted to the realities of the region. Up to a third of all ophthalmologists in francophone Africa perform no surgery at all and those who do perform, on average, only 160 cataract operations each …