Sri Lanka

Number of Blind

Sri Lanka’s blind population is estimated to be between 92,920 [13] and 150,000 [4]

Number of Curable Blind

A 2005 study of individuals in North and Eastern Sri Lanka found:

11,388 people experienced visual impairment (near- and far-sightedness) caused by refractive errors

2,180 people experienced visual impairment (clouded vision) caused by cataracts [15]

Number of people with cataract blindness: 64,579 [13]

Prevalence of Curable Blind

The Fred Hollows Foundation estimates that the national blindness prevalence is 0.5% [13] while the WHO estimates that less than 0.3% of the population of Sri Lanka is blind [8] and 1-2% has low vision (even after treatment) [9]

A 2005 study surveyed the clinical records of 96 eye clinics in North and Eastern Sri Lanka to determine the common causes of visual impairment and conditions that might lead to vision impairment in the future. The records provided information on nearly 15,000 individuals. Information was also recorded about the outcomes of eye care treatment and barriers that prevented people from receiving care.

78% of visual impairment was caused by uncorrected refractive errors (11,388 people)

15% of visual impairment was caused by cataract (2,180 people)

5% of those with cataracts were referred for surgery (695 people) because of visual acuity cutoffs (6/36 or worse) [15]

Most Common Types of Curable Blindness

Main causes of blindness: Cataract (70%) [13], refractive error [13], glaucoma [13], diabetic retinopathy [4], and childhood blindness [4]

A 1995 study examined 226 children with varying degrees of visual impairment attending 6 different schools for the blind. Cataracts (the most common cause of avoidable childhood blindness) were the cause of 17% of blindness/severe visual impairment. Bilateral microphthalmos contributed to 25% of visual impairment.[5]

A study from 2000 found: 33.2% of children suffered visual loss due to Congenital Anomolies of the Globe, 26.1% due to Microphthalmos (abnormal smallness of one or both eyes), 7.1% due to Anophthalmos (complete absence of ocular tissue).

Other causes include heredity, intrauterine infections during pregnancy, alcohol use, vitamin deficiencies, radiation, pesticides, etc. [12]

Age Range of Affected Population

Prevalence of blindness in Sri Lankan children from a 2000 study – 0.3/1000 [12]

A 2009 study was conducted to determine the prevalence of uncorrectable visual impairment in the Kandy District of Sri Lanka. All of the 1375 participants were over the age of 40 and the most common causes of visual impairment were cataract and age related macular degeneration. The overall prevalence of blindness was 1.1% and of visual impairment was 5.9%. [6]

33.2% of children in Sri Lanka attending schools for the blind have severe visual loss. This percentage is on the high end of the range within this study. By comparison, only 1.4% of children attending schools for the blind in Cuba have severe visual loss.[12]

Age Related Macular Degeneration is a major cause of visual impairment in Sri Lanka. [11]

A 1996 childhood blindness study was conducted with children (age 0-15) in India and Sri Lanka. It was found that approximately 50% of childhood blindness in these countries was avoidable. Improving maternal and child health services and developing specialized pediatric eye care services would benefit children in these countries. The eye services most needed are cataract surgery and interventions for severely visually impaired children. This study also indicated that there are no well done studies on the prevalence of childhood blindness in Asian countries. They estimate approximately 4,000 (± 1000) children in Sri Lanka are blind. Approximately 20-100 new children become blind each year. The estimates are largely dependent on socioeconomic status and availability of healthcare services.[7]

Gender Breakdown of Affected Population

Information Unavailable

Racial/Ethnic Breakdown of Affected Population

Sinhalese ethnicity, which makes up 74% of the population [13], was significantly associated with Age Related Macular Degeneration.[11]

Income Range of Affected Population

Information Unavailable

City/Rural Breakdown of Affected Population

Information Unavailable

Single/Married Breakdown of Population

Information Unavailable

Cases of family history/genetic factors

Major Congenital Anomalies of the Globe can be passed from parent to child through chromosomal abnormalities. [12]

Causes of Blindness

Cataracts, refractive errors, glaucoma, diabetic retinopathy, and childhood blindness.[4]

Awareness of curable blindness/different types of treatment

Information Unavailable

Percent of individuals with access to clean water

Population with sustainable access to improved drinking water sources: Rural – 79%, Urban – 98% [18]

Population with sustainable access to improved sanitation: Rural – 86%, Urban – 89% [18]

*As of 2006, 2 years after the Indian Ocean Tsunami

Level of government intervention

The World Health Organization recognizes Sri Lanka as having made “impressive successes” in eliminating blindness.[10]

Although there are regional disparities, the Millennium Development Goals have been met in Sri Lanka. Most people in Sri Lanka live within 5km of a health care facility though primary care facilities are under used and often lack the necessary staff. Urban areas attract medical staff but there is a shortage of nurses and paramedics in these areas. Health care in Sri Lanka is free, but this may not be sustainable in the future.[15]

According to Vision 2020 – Sri Lanka signed the Global Initiative for the Elimination of Avoidable Blindness, created a National Committee, and a National Plan as of the December 2006 deadline. Sri Lanka also participated in a Vision 2020 workshop [1] [13]

Amount of economic burden/economic productivity

Eye care services and treatments are expensive. One estimate indicates that up to one quarter of the population in Sri Lanka needs vision correction services and does not have access to care. Those who do have access are often unable to afford glasses.[17]

Level of access to eye doctors per 1000 individuals

The Fred Hollows Foundation reports: 38 ophthalmologists [13]

Vision 2020 provides guidelines on the number of ophthalmologists needed in an area based on population (4 per million residents).  This translates to Sri Lanka needing a minimum of 80 ophthalmologists.[13]

90% of people in Sri Lanka have never had an eye examination. A lack of trained eye care professionals within Sri Lanka leads to a lower quality of care. In parts of Sri Lanka there is only two eye care providers (one optician and one ophthalmologist) serving 1.3 million people.[17]

Success of eye surgeries

In 2010, a cross sectional survey looking at the prevalence of cataracts in the Kandy District of Sri Lanka was conducted. 1375 individuals over the age of 40 years participated in the study. The prevalence of cataract was 33.1%. There was no significant relationship noted between a patient’s cataract and his/her gender, smoking habits, or outdoor occupations. Less education (being illiterate) and shorter height were associated with an increased likelihood of cataract and needs further study. The study noted an “unusually low prevalence of nuclear cataract” in this region.[3]

In 2009, a cross sectional survey looking at cataracts in the rural villages of central Sri Lanka. 1375 people participated. Those with a visual acuity worse than <6/18 were asked to participate in a verbal questionnaire.

The results of this study found:

More men than women obtained cataract surgery.

2/3 of participants refused cataract surgery because of: “no desire to improve vision, fear of surgery, and lack of awareness”

41.9% of individuals with <6/18 visual acuity had cataract surgery

76.8% of individuals with <6/60 visual acuity had cataract surgery

82.7% of individuals with <3/60 visual acuity had cataract surgery [2]

The Fred Hollows Foundation reports that 1,337 surgeries/1 million citizens per year take place.[13] The majority of cataract operations in Sri Lanka involve an intraocular lens implantation.[2]

Cataract Surgical Rate – 2538 [1]

*(CSR is the number of cataract operations performed per million population per year based on information from the World Health Organization and the International Agency for the Prevention of Blindness)