Etiology of blindness in an urban community hospital setting

Objective: To determine the cause of monocular and binocular blindness in a predominately nonwhite urban community hospital setting. Design: Retrospective hospital-based cross-sectional study, Participants: All 3562 unique subjects examined in the New and General Ophthalmology clinic at Parkland Memorial Hospital, Dallas, Texas, from July 1 to September 30, 1998. Methods: The EYEstation program by Datamedic was queried to conduct a detailed review of electronic medical records of the participants listed previously. Main Outcome Measures: Blindness was defined as visual acuity less than or equal to 20/200 in at least one eye. Records of blind subjects were subjected to further review. Results: Of the 3562 subjects examined, 321 (9.0%) were blind in one eye and 76 (2.1%) were blind in both eyes. Retinal disease was the leading cause of blindness (90 = 22.7%), with retinal vascular occlusions and retinal detachments accounting for more than half of retinal causes. Trauma (71 = 17.9%), diabetes (68 = 17.1%), and glaucoma (62 = 15.6%) were the next most frequent causes. Trauma was the leading cause of blindness among subjects less than 40 years old and among blind new subjects. The most common cause of blindness among the 40- to 59-year-old age group was diabetes, accounting for 26.1% of cases. Age-related macular degeneration accounted for only 1.3% (n = 5) of blindness. Conclusions: Retinal diseases, especially retinal vascular occlusions and retinal detachments, are leading causes of blindness in this predominately nonwhite and uninsured subject population, Trauma is a significant cause of severe, unilateral vision loss, especially in the young and in newly presenting subjects. Diabetes was the leading cause of blindness among the 40- to 59-year-old population. Age-related macular degeneration plays a relatively minor role in the cause of blindness in the study population. (C) 2000 by the American Academy of Ophthalmology.