Causes of blindness at Nkhoma Eye Hospital, Malawi J.C. SHERWIN 1 , W.H. DEAN 2 , N.H. METCALFE 2 1 Centre for Eye Research Australia, University of Melbourne, Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Victoria - Australia 2 Nkhoma Eye Hospital - Malawi INTRODUCTION The majority of blindness in sub-Saharan Africa is treat- able. In 2001, it was estimated that approximately 1% of Africans were blind, with cataract accounting for approxi- mately half of all cases (1). “VISION 2020: The Right to Sight” was launched in 1999 as a partnership between the World Health Organization (WHO) and the Internation- al Agency for the Prevention of Blindness (IAPB), and is the global initiative for elimination of avoidable blindness (WHO/PBL/97.61 Rev 1). Important principles inherent to European Journal of Ophthalmology / Vol. 18 no. 6, 2008 / pp. 1002-1006 1120-6721/1002-05$25.00/0 © Wichtig Editore, 2008 PURPOSE. The majority of blindness in Sub-Saharan Africa is treatable. This hospital-based study was undertaken in order to investigate the etiology of blindness at Nkhoma Eye Hos- pital, Malawi. M ETHODS. One ophthalmologist examined 2082 consecutive new patients who presented to the outpatient department at Nkhoma Eye Hospital, Malawi in 2006. Data recorded included age, sex, visual acuity and diagnosis. Patients were classified as blind if their best corrected visual acuity was <3/60 in one eye (unilateral) or two eyes (bilateral). RESULTS. The most common diagnosis in new outpatients was cataract (52.8%), followed by glaucoma (8.1%), corneal pathology (7.2%), uveitis (4.5%) and maculopathy (3.2%). There were 742 (35.6%) patients with unilateral blindness and 331 (15.9%) patients with bilateral blindness. Unilateral blindness was present in 37.4% of males and 26.5% of females. The most common causes of unilateral blindness were lens pathology (57.8%), followed by glau- coma (12.1%), corneal pathology (10.0%) and uveitis (6.1%). Bilateral blindness was pre- sent in 12.5% of males and 16.8% of females respectively. The most common causes of bi- lateral blindness were lens pathology (54.4%), followed by glaucoma (19.9%), retinopathy (3.6%), maculopathy (3.6%), uveitis (3.6%) and corneal pathology (3.3%). CONCLUSIONS. Cataract is the most common cause of blindness in Nkhoma. Resultantly, cataract management is preferentially targeted in the Nkhoma VISION2020 Programme. Training of auxiliary eye personnel in cataract diagnosis and surgery may assist in this approach. (Eur J Ophthalmol 2008; 18: 1002-6) KEY WORDS. Cataract, Malawi, Sub-Saharan Africa, Blindness Accepted: May 8, 2008 SHORT COMMUNICATIONS & CASE REPORTS a district VISION 2020 programme include cost-effective disease prevention and treatment, human resources, and infrastructure development. These principles should be integrated into existing national healthcare systems and be sustainable, equitable, and of a high standard. In Malawi, there are three tertiary eye centers, which are located at Nkhoma, Lilongwe, and Blantyre. Nkhoma Eye Hospital is situated 40 km from the capital Lilongwe and has 35 full-time staff including a full-time ophthalmologist. A second full-time ophthalmologist was posted to Nkhoma in December 2007. The catchment area of