Rapid Assessment of Avoidable Blindness: The First Ophthalmic National Survey

The Garo Meghrigian Institute for Preventive Ophthalmology (Meghrigian Institute) at the Avedisian Onanian Center for Health Services Research and Development (CHSR) of the Turpanjian School of Public Health (SPH) of the American University of Armenia (AUA) with financial support from the Lions Club International Foundation (LCIF), conducted the first nationwide epidemiological survey in Armenia using the Rapid Assessment of Avoidable Blindness (RAAB) methodology.

The project aimed to estimate the prevalence of ocular morbidity and its potential causes, as well as vision loss due to cataract and other major causes, among the population aged 50 and over in Armenia. The project also evaluated the effectiveness of the innovative public health approach implemented in the Gegharkunik marz (region) of Armenia — an intervention supported by the LCIF SightFirst grant in 2003-2008 that provided high-quality cataract surgery to underserved populations to reduce cataract-related ocular morbidity and vision loss. The nationwide RAAB in Armenia covered all marzes of the country, including Yerevan, with a sample size of 2,258 participants. For the second objective, the sample size included 1,099 participants from Gegharkunik marz.

The age- and gender-adjusted prevalence of bilateral blindness and severe, moderate, and early visual impairment were 1.5%, 1.6%, 6.6%, and 16.0%, respectively. There was no gender-related difference in the prevalence of bilateral blindness. The prevalence of bilateral blindness increased with age and was considerably higher in participants aged 80 and over (9.2%). Untreated cataract was responsible for 43.9% of all blindness cases. Cataract Surgical Coverage (CSC) was 89.8% in the sample. The main barriers to cataract surgery among the population were “cost,” “need not felt,” and “fear.” The nationwide study in Armenia confirmed that cataract is the main cause of blindness. Given that cataract blindness is avoidable, strategies should be developed to further increase the volume and quality of cataract surgery in Armenia.

The comparison of the Rapid Assessment of Cataract Surgical Services (RACSS) findings conducted in Gegharkunik marz in 2003-2004 with the RAAB data from Gegharkunik marz in 2019 demonstrated that the prevalence of blindness and visual impairment substantially decreased over time among residents of Gegharkunik marz aged 50 and over. The age- and gender-adjusted prevalence of bilateral blindness decreased from 2.0% to 1.4%, severe visual impairment from 5.1% to 2.2%, and moderate visual impairment from 16.0% to 7.3% in Gegharkunik from 2003-4 to 2019. Untreated cataract was responsible for 71.9% of all blindness cases in 2003-4. This rate was reduced to 40.9% in 2019 — lower than the national estimate. The estimates of untreated cataract as the principal cause of blindness in Gegharkunik marz were lower compared to the estimates of all other marzes of Armenia, excluding Yerevan (47.8%). The CSC for eyes rose in Gegharkunik Province from 16.9% in 2003-4 to 37.4% in 2019 among those with visual acuity of <6/18. These findings show that the intervention to strengthen primary and secondary ophthalmic care in Gegharkunik marz and establish the Lions Regional Ophthalmic Unit of Sevan — supported by the LCIF SightFirst grant — has been effective in improving access to quality cataract surgery and ophthalmic care to underserved populations.

The AUA Turpanjian School of Public Health works actively to improve population health and health services in Armenia and beyond through interdisciplinary education and development of public health professionals to be leaders in public health, health services research and evaluation, and health care delivery and management.