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Objective: To determine the prevalence of blindness and of cataract blindness in persons 50 years of age or older in Piura and Tumbes, which are two departments in northern Peru, and to describe the coverage and quality of cataract surgery services in that area, and the barriers that prevent access to those services., Methods: Systematic sampling of persons 50 years old or older was done in Piura and Tumbes between August 2002 and March 2003, with 80 clusters of 60 people each being selected. Of the 4 800 persons chosen, 4,782 of them were examined, using a survey instrument that gathered general information on each person, the results of the visual acuity test and the lens examination, and information on cataract surgery or why that surgery had not been done. Visual acuity (VA) testing was done with a Snellen optotype with the letter "E," with sizes of 20/60 and 20/200 at distances of 6 m and 3 m, respectively, with the person using the visual correction (glasses) available. When the VA was less than 20/60 in one of the eyes, vision was tested with pinhole glasses., Results: The prevalence of bilateral blindness (VA < 20/400) due to cataract, adjusted by age and sex, was 2.1% (95% confidence interval (CI): 1.7% to 2.6%). Among the 193 persons with bilateral blindness due to any cause, cataract was the cause in 104 of them (53.9%). The prevalence of blindness due to cataract or other causes increased with age and was higher in women than in men. Only 25% of the persons studied who needed cataract surgery had had that done. The prevalence of bilateral VA less than 20/200 due to unoperated cataract was 6.3% (95% CI: 5.3% to 7.3%); only 12% of the persons with that level of visual deficiency had had cataract surgery. The VA of 26% of the eyes operated on for cataract was lower than 20/200. The reasons given by persons who needed cataract surgery but who had not had it included not being able to pay for the operation (28%), lack of knowledge concerning cataracts (25%), fear of the operation (23%), and fear of completely losing their sight (17%)., Conclusions: Most of the cases of blindness and of serious deficiency in visual acuity in persons 50 years old or older in Piura and Tumbes are due to uncorrected refractive defects, especially cataracts. The high prevalence of bilateral blindness due to cataracts (2.1%) could be reduced with measures that facilitate access to appropriate treatment.

In the year 2004 there were an estimated 220,000-320,000 people in The Netherlands with visual impairment. In 150,000-220,000 (70%) of them the visual impairment is either curable or could have been prevented. Those most at risk are people with intellectual disabilities, elderly people in care institutions, elderly people in general and diabetics. 'Vision 2020 Netherlands', an initiative of the World Health Organization, was launched to eliminate avoidable visual impairment in the Netherlands by the year 2020 by means of awareness campaigns, implementation of screening programmes and by expanding eye care capacity through efficient cooperation between the professional groups involved in eye care.

Purpose: To estimate the burden of visual loss and blindness due to cataract in people aged 50 years and over in Paraguay., Methods: Forty clusters of 60 persons each who were 50 years and older (2400 eligible persons) were selected by systematic random sampling from the entire population of Paraguay. A total of 2136 persons were examined (89% coverage)., Results: For the population 50 years and over, the age- and gender-adjusted prevalence of bilateral blindness (VA < 3/60 with available correction) was 3.14% (95% CI: 2.2-4.4). The adjusted prevalence of bilateral cataract blindness (VA < 3/60) was 2.01% (95% CI: 1.3-3.0), making cataract the major cause of bilateral blindness in this age group (64%). The adjusted prevalence of bilateral severe visual impairment (VA < 6/60 with available correction) was 5.17% (95% CI: 3.9-6.7) and the adjusted prevalence of severe visual impairment due to bilateral cataract (VA < 6/60) was 3.09% (95% CI: 2.2-4.3). The cataract surgical coverage (persons) was 44% for bilaterally blind persons with VA < 3/60; 36% for persons with bilateral VA < 6/60; and 28% for any eye with VA < 6/60 due to cataract. With IOL implantation, 77% of the operated eyes could see 6/18, against 46% of the non-IOLs (p < 0.005), a significant better outcome., Conclusion: There is a need to increase the cataract surgical coverage in Paraguay. The number of eye surgeons is adequate but the accessibility of cataract surgical services in rural areas and the affordability of surgery to large sections of society are major constraints.

Aim: To present the results of a rapid assessment of cataract surgical services in Chakwal District, Pakistan., Methods: 40 clusters of 40 persons of 50 years and older (1600 eligible persons) were selected by systematic random sampling from the entire Chakwal district. A total of 1505 persons were examined (coverage 94%)., Results: Cataract is the major cause of bilateral blindness (46.5%). The age and sex adjusted prevalence of bilateral cataract blindness (VA < 3/60) in people of 50 years and older was 2.0% (95% CI: 1.2-3.2%), with a cataract surgical coverage of 92% for males and 73% for females, a significant difference. The prevalence of bilateral cataract and VA < 6/60 in persons of 50 years and older was 5.1% (95% CI: 3.6-6.9), an estimated total of 8833 persons. In this last group, the surgical coverage was 66% (persons) and 50% (eyes). Of the patients operated with IOL implantation, 12% could not see 6/60, while 36% of those operated without IOL could not see 6/60. 'No services' (18%) and 'cannot afford' (18%) were mentioned most as reasons why surgery had not been done, followed by 'no information' (13%), 'waiting for maturity' (12%) and 'old age, no need for surgery' (12%)., Conclusion: The number of cataract operations in Chakwal District can be increased by reducing the threshold for cataract surgery to VA < 6/60 or less. A special approach to operate more females may be required. Results from this survey can be used for a planning exercise to optimize eye care services in the district. Sustained efforts have to be made to increase the number of IOL surgeries, through making IOL surgery available locally at an affordable cost.

Purpose: To test the validity and repeatability of a newly designed Trachoma Rapid Assessment (TRA) methodology., Method: Results from an initial TRA in 20 villages (TRA1) are compared with those of a second validation TRA (TRA2) after 6 weeks in 13 villages, randomly selected out of the original 20, conducted by different field staff. Findings of TRA1 and TRA2 are compared with those of a door-to-door survey of the entire population of all 13 villages., Results: There is a considerable amount of variation between the results of TRA1 and TRA2 and between the results of both TRA's and the door-to-door survey. Even indicators that should have remained the same, like distance to Primary Health Centre or distance to trichiasis surgery facility, scored differently., Conclusions: The TRA methodology is easy to use and the results are quickly available. The scoring system indicates which intervention(s) of the SAFE strategy are needed and facilitates priority setting. The definition of some indicators, like availability and use of latrines, may need modification. In some cases, the scoring system seems to exaggerate differences between the actual findings. The consistency between two TRA's in the same village is low and the accuracy in measuring the actual situation is doubtful.

Purpose: To assess results of a vision screening programme in schools in India, 5 years after its introduction., Material: Questionnaires on school eye screening activities were sent to 200 randomly selected districts., Methods: Data from 61 districts were analysed, using process indicators to assess performance at different stages of the screening procedure., Results: Teachers screened 5.39 million children in 61 districts. Refraction was done on 205,082 children (3.8%) and 43,922 children (0.8%) were provided with spectacles. Children of 10-15 years have more refractive errors. Different stages in the procedure are evaluated., Conclusion: Vision screening in schools has been taken up successfully in many districts in India. This has reduced the workload of eye care staff and increased the coverage. The simplicity of the procedure facilitates widespread application. Many parents take their children to the private sector for services. Monitoring and reporting needs to be improved.

Aim: Presentation of the results of rapid assessments of bilateral cataract blindness in persons 50 years of age and older in 19 districts of Karnataka State, India., Materials: A total of 21,950 persons 50 years of age and older in 19 out of 20 districts were examined. In each district, 15 clusters were randomly selected and in each cluster the visual acuity and lens status were assessed in 90 persons 50 years of age and older., Methods: Systematic Random Cluster Sampling was used. Assuming a prevalence of at least 4.3% and a design effect of 1.5, the survey was designed to give an estimated prevalence with a sampling error of 20% or less at 80% confidence. Visual acuity was measured with a tumbling E chart at 6 meters distance with available correction. Lens status was assessed by distant direct ophthalmoscopy with undilated pupil under semi-dark conditions., Results: The average age and sex adjusted prevalence of cataract blindness was 4.93%, with a variation of 1.58% to 7.24% in different districts. The prevalence in females was higher than in males. Cataract Surgical Coverage, an indicator for coverage and service utilization, varied from 42% to 68% in different districts. On average, males had a higher coverage than females. Of all aphakic eyes in the sample, 26.4% could not see 6/60. Barriers to cataract surgery are linked to service providers., Conclusions: Rapid assessments for cataract blindness in persons aged 50 years and older can be conducted at district level in India with existing resources and at affordable costs. The results suggest an increase in cataract blindness since the previous survey of 1986. The long-term visual outcome needs improvement. Change in barriers to cataract surgery requires a shift in health education strategy and messages. The large variation in prevalence justifies district-level surveys. A change in the sampling frame from 15 clusters of 90 to 28 x 40 or 37 x 30 will increase the precision.

Aim: To describe Cataract Surgical Coverage (CSC) as an indicator to measure the impact of cataract intervention programmes., Methods and Materials: Cataract Surgical Coverage, both for 'eyes' as well as 'persons', was calculated from community based surveys conducted in 19 rural districts in the south-west and one urban district in the north-west of India., Results: Cataract Surgical Coverage (VA<3/60) ranged from 42% to 68% (for persons) and from 22% to 45% (for eyes) in 19 districts of Karnataka State. The coverage for males was higher than for females. In Ahmedabad the coverage was high with 93% for persons and 83%for eyes., Discussion: Together with prevalence data, Cataract Surgical Coverage can provide important information on the impact of cataract intervention programmes. Regular assessment of prevalence and coverage indicators through focused community surveys will reveal trends. Coverage indicators are also important as input data for mathematical models to predict future trends in cataract blindness.

A prospective study on the results of chemotherapy selected by the treatment chemotherapy resistance test of Limburg an Krahe (oncobiogram) of 191 cancers of the ovary from the same department from the years 1962-1978 is presented. In 152 cases (79.6%) surgical or radio-therapy was impossible or insufficient because of the advanced spread of the tumour (T4 of FIGO 3 and 4). Nevertheless in the hopeless state T4 Nx M1b (N = 89) a two years survival rate of 58% was obtained following the selective treatment according to the oncobiogram compared to 28% two years survival in blind chemotherapy. The five year survival rate was 38% compared to 18%. The total five years survival rate of all patients was 25% in a series with 80% inoperable cases. The advantages of chemotherapy following the oncobiogram with the chemotherapy resistance test compared to treatment after other testing methods or compared to blind chemotherapy are described and discussed in detail.

A prospective study of 25 cases of primary carcinoma of the breast was established. The patients were treated by radical mastectomy and lymphadenectomy followed by chemotherapy with Vincristin, Adriblastin and Endoxan. No radiotherapy was employed. During a 12 month follow-up, no patient, had recurrence or progression of the tumor. It is too early to evaluate the treatment definitively regarding survival and definite value of the method. The theoretical and experimental considerations for ancillary chemotherapy are discussed.