Bulletin of the World Health Organization

Author reply to: Estimation of global visual impairment due to uncorrected refractive error

Silvio Mariotti a, Serge Resnikoff a, Donatella Pascolini a

In response to the letter by L Dandona & R Dandona,1 we would like to point out that the study to which they refer (BMC Medicine 2006;4:6) – certainly a useful study in its own right – was not included in the references of our own paper as it informed neither the approach we took to our analysis nor the geographical scope of our work. Our study included data sources for all age groups from 68 surveys in 31 countries, chosen with epidemiological criteria different from those used by L Dandona & R Dandona, who derived their global estimates from nine surveys in eight countries. Our work presents an age-specific algorithm developed for missing data.

May we also point out a misinterpretation of our findings in this letter with regard to India. According to the estimated presenting and best-corrected blindness (visual acuity < 6/60) for people aged 50 years and older in 15 Indian states reported by Murthy et al.,2 the reduction of visual impairment after correction is 42% and not one-fifth. The authors themselves point this out by saying that “the blindness load could be nearly halved by correction”.

We agree with L Dandona & R Dandona’s emphasis on the need for new definitions. This issue has been extensively discussed since a consultation on refractive errors held by WHO in 2000. The International Council of Ophthalmology adopted a resolution in 2002, followed in 2003 by a WHO consultation on the development of standards for characterization of visual loss and visual functioning, which led to significant changes in definitions and categorizations.3 These have been subsequently integrated into the revision of the 10th International Classification of Diseases. ■



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