Keeping an Eye on Blindness, A Regional Issue
MONASTIR—This city on the central coast of Tunisia lies in the heart of the country’s tourism economy. Five-star, all-inclusive resorts have been built en masse to house the European tourists who descend on the sandy beaches during the summer months. And yet behind the grandeur, local residents of this North African country—especially the women—still suffer from visual loss and blindness triggered by largely preventable or treatable causes such as cataracts.
A cataract is when the lens of the eye becomes cloudy. Drugs can’t treat the problem, but a relatively straightforward surgical procedure can remove the cloudy lens to be replaced by a clear artificial one. Cataract surgery is the most common type of operation performed in the United Kingdom and typically takes just 30 to 45 minutes to complete, but many people in the Arab world still do not get the surgery.
The number of people who suffer from impaired vision or blindness due to preventable or easily treatable causes in the Middle East and North Africa is falling, but at a slower rate compared to other regions, say experts.
Moncef Khairallah, an assistant professor in the department of ophthalmology at Fattouma Bourguiba University Hospital in Monastir, conducted a systematic review of medical studies on blindness and visual loss due to cataracts.
Khairallah concluded that the percentage of moderate-to-severe visual impairment cases caused by cataract in the Middle East and North Africa decreased by 28 percent between 1990 and 2010. That’s in line with the global averages, which decreased by very similar rates, but it’s still far behind what other regions with similar economies achieved in the same time. For example, Latin American countries in the tropics managed a decrease of 37 percent.
Richer regions reached even greater reductions, such as Western Europe, which saw a fall of 43 percent.
“Cataract is still a major cause of visual problems in our region,” says Khairallah. “But it can be so easily treated and corrected. This is preventable.”
New causes of impaired vision or blindness—often linked to lifestyle changes—are also emerging, warned Khairallah. Diabetes is perhaps the most obvious example of this. It can decrease blood supply to the eyes to such an extent that it can cause visual loss or even blindness.
Additionally, women are much less likely to access medical services for visual problems than men.
These patterns are not unique to Tunisia. Other countries in the Arab world are facing similar challenges.
“Women are three times less likely to seek relevant healthcare services for [visual problems] in developing countries,” says Ahmed Mousa, founder and chairman of the Nourseen Charity Foundation for Community Ophthalmology in Egypt.
In a 2014 study, Mousa conducted a survey to estimate the prevalence and causes of vision loss in four Upper Egypt villages. The principal cause of clinical blindness was cataract, which was responsible for 60 percent of cases. The second most common cause, at 16 percent, was uncorrected refractive errors, which include nearsightedness and farsightedness—these could have been easily solved with very basic interventions like eye tests and spectacles.
Mousa also found that the women in these communities were more than twice as likely to be blind as the men.
“The problem is usually one of economics,” says Mousa. “If you have a mother and a father with cataracts, then the man goes to have the surgery because he’s likely the one earning money for the family.”
But there are also cultural barriers at play for women. “There are other factors like the ability to leave the house and get to hospital. She would need someone to look after her children, for example,” says Mousa. “All of these things have an effect, but the economic limitations are still the major cause.”
Another 2015 study, which looked at causes and prevalence of vision loss in Jordan, agreed that cataracts were the main cause, followed by diabetes.
What these studies show, according to Khairallah, is that Arab countries are facing a double-edged sword when it comes to fighting against blindness. “We are facing new diseases like diabetes, which are known to be a problem in developed countries,” he says, “but still with the carryover of diseases like cataracts.
It’s important to know and quantify these trends, he adds. “It helps decision makers to have evidence-based policies to reduce blindness.”