Causes of visual impairment in applications for blindness certificates in a tertiary center of Bihar and its role in health planning

PURPOSE: To analyze applications for blindness certificates to find causes of visual impairment (VI), handicap, and blindness in a tertiary hospital of Bihar. METHODS: Applications for blindness certificates were analyzed over a two-year period. The main cause of blindness, visual handicap, and VI in these applications was ascertained by age group and etiology. VI disability percentages and definitions proposed by Governmen of India (category 0–4; 20–100%) were used to categorize and give percentage to all applicants. Results were compared with data from studies on blindness certificates and population based studies. RESULTS: In total, 203 applicants were reviewed. Mean age was 23.5 ± 7.9 years. Overall, most common cause of visual handicap (40–100% impairment) and blindness (75–100% impairment) was macular pathology (P<.05), while most common cause of overall VI (20–100% impairment) was amblyopia. In age group 0–15 years, most common causes of blindness/visual handicap were congenital globe and hereditary retinal or optic nerve disorders (P = 0.016). In age group 16–30 years, macular pathology was the most common cause of visual handicap [P = 0.007], while amblyopia was the most common cause of VI [P = 0.00]. Between 31 and 45 years of age group, corneal scar in one eye was the most common cause of VI, while macular scar in both eyes was the most common cause of visual handicap. Glaucoma and diabetic retinopathy were the most common causes of blindness/visual handicap between 46 and 65 years and above 65 years of age, respectively. Data about causes of VI such as amblyopia, complicated cataract surgery, and one eyed blindness could not be ascertained by analyzing blindness certificate alone. CONCLUSION: Data from applications for blindness certificates provide valuable information regarding different causes of VI that might otherwise not be eligible for blindness certification and provide an insight into the overall trends in disease profile and service delivery.