Every minute of the day a child is born blind or acquires blindness, with most cases of blindness occurring in developing nations.1 The excess in prevalence of childhood blindness in the poorest regions of the world is caused by many factors. Vitamin A deficiency and measles lead to corneal scarring; inadequate vaccination programmes result in high rates of congenital rubella and acquired rubeola; and inadequate treatment programmes allow manageable disorders such as congenital glaucoma and retinopathy of prematurity to damage vision. Many of these causes of blindness could be avoided or treated with proper resources.

One of the most common and avoidable causes of blindness in children in the developing world is cataract.2 Experience of treating childhood cataract in the United States is illuminating in this regard. Cataract ranked as a leading cause of childhood blindness in the USA 40 years ago,3 but with modern surgical techniques, improved diagnostic programmes, and rubella vaccination programmes cataract is now an uncommon cause of childhood blindness. Unfortunately, superimposing successful cataract management programmes from well to do regions onto poor regions is not so simple. The task of …