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Alfred Sommer Johns Hopkins School of Hygiene and Public Health, 615 North Wolfe Street, Suite 1041, Baltimore, Maryland 21205-2179 Visually disabling diseases are particularly topical as we grapple with new ways to deliver health services, recognize the imperative of functional status and its impact on quality of life, and seek new opportunities for prevention. It is also timely. Rigorous population-based studies in the U.S. and elsewhere are, for the first time, revealing the magnitude, causes, and impact of disabling ocular disease. The impacts of visual impairment and blindness were emphasized by the World Bank's landmark publication, World Development Report 1993: Investing in Health (26). It introduced the Disability Adjusted Life Year (DALY) as a basis for quantifying the global burden of disease and the relative costeffectiveness of alternative interventions. The most cost-effective is $1 per DALY gained from vitamin A distribution to prevent blindness. In the United States and other developed countries, a considerableproportion of visual impairment can be corrected with appropriate spectacles. Blindness, at either the U S . (20/200 or worse) or WHO (worse than 20/400) definitions, inevitably represents established pathology (23). Prevalence rates of blindness increase with age, particularly among the elderly (9,23), secondary to
Annual Review of Public Health – Annual Reviews
Published: May 1, 1996
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