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Rapid assessment of avoidable blindness in Papua New Guinea: a nationwide survey
  1. Ling Lee1,2,
  2. Fabrizio D'Esposito3,
  3. Jambi Garap4,5,
  4. Geoffrey Wabulembo6,7,
  5. Samuel Peter Koim4,5,
  6. Drew Keys1,4,5,8,
  7. Anaseini T Cama9,
  8. Hans Limburg10,
  9. Anthea Burnett1,2
  1. 1 Brien Holden Vision Institute, Sydney, New South Wales, Australia
  2. 2 School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
  3. 3 Knowledge and Innovation Division, The Fred Hollows Foundation, Melbourne, Victoria, Australia
  4. 4 PNG Eye Care, National Capital District, Papua New Guinea
  5. 5 PNG National Prevention of Blindness Committee, National Capital District, National Capital District, Papua New Guinea
  6. 6 School of Medical and Health Sciences, University of Papua New Guinea, National Capital District, Papua New Guinea
  7. 7 CBM International, National Capital District, Papua New Guinea
  8. 8 International Agency for the Prevention of Blindness, London, UK
  9. 9 Pacific Trachoma Initiative, The Fred Hollows Foundation, Sydney, New South Wales, Australia
  10. 10 Health Information Services, Grootebroek, The Netherlands
  1. Correspondence to Dr Ling Lee, Brien Holden Vision Institute, Sydney, NSW 2052, Australia; l.lee{at}


Objective To estimate the prevalence and main causes of blindness and vision impairment in people aged 50 years and older in Papua New Guinea (PNG).

Design National cross-sectional population-based survey in National Capital District (NCD), Highlands, Coastal and Islands regions.

Methods Adults aged 50 years and above were recruited from 100 randomly selected clusters. Each participant underwent monocular presenting and pinhole visual acuity (VA) assessment and lens examination. Those with pinhole VA<6/12 in either eye had a dilated fundus examination to determine the primary cause of reduced vision. Those with obvious lens opacity were interviewed on barriers to cataract surgery.

Results A total of 4818 adults were examined. The age-adjusted and sex-adjusted prevalence of blindness (VA <3/60), severe vision impairment (SVI, VA <6/60 but ≥3/60), moderate vision impairment (MVI, VA <6/18 but ≥6/60) and early vision impairment (EVI, VA <6/12 but ≥6/18) was 5.6% (95% CI 4.9% to 6.3%), 2.9% (95% CI 2.5% to 3.4%), 10.9% (95% CI 9.9% to 11.9%) and 7.3% (95% CI 6.6% to 8.0%), respectively. The main cause of blindness, SVI and MVI was cataract, while uncorrected refractive error was the main cause of EVI. A significantly higher prevalence of blindness, SVI and MVI occurred in the Highlands compared with NCD. Across all regions, women had lower cataract surgical coverage and spectacle coverage than men.

Conclusions PNG has one of the highest reported prevalence of blindness globally. Cataract and uncorrected refractive error are the main causes, suggesting a need for increased accessible services with improved resources and advocacy for enhancing eye health literacy.

  • epidemiology
  • public health
  • blindness
  • vision

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  • Contributors LL, JG, GW, SPK, DK, ATC, HL and AB designed and conducted the survey. LL, FD'E, HL and AB analysed the data. LL, FD'E and AB prepared the manuscript. All authors edited and reviewed the manuscript, and agree with the final version of the manuscript and agree to be accountable for all aspects of the work.

  • Funding The Fred Hollows Foundation, Australia.

  • Disclaimer This work is original, has not been published and is not being considered for publication elsewhere. There are no conflicts of interest for any of the authors that could have influenced the results of this work. All authors have contributed significantly to the project and subsequent drafting, revising and approval of the final version submitted.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Medical Research Advisory Committee of PNG (MRAC No.16.35), the Milne Bay Provincial Research Committee (DPA: 3-15) and The University of New South Wales Human Research Ethics Committee (HC16804).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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