¹International Centre for Eye Health, London School of Hygiene and Tropical Medicine & Department of Epidemiology and International Eye Health, Institute of Ophthalmology, UCL, UK

Correspondence: GJ Johnson, MA MD BChir FRCS(C) FRCOphth DCEH, 17 Lucerne Road, Summertown, Oxford OX2 7QB, UK. Tel: +44 (0)1865 556513; Fax: +44 (0)1865 310941; E-mail: g.j.johnson@btopenworld.com

Abstract

The use of the 'environment' has become extended to include population changes, the 'domestic' environment, and cultural factors, in addition to physical influences such as global warming and ultraviolet radiation (UVR). The likely effects of each of these classes of agents on the eye and rates of blindness are illustrated by reference mainly to cataract and trachoma—two of the commonest causes of the world blindness.

Trachoma infection and its blinding consequences could be eventually eliminated by environmental measures and changes in behaviour. While the threat of increased incidence of blindness from cataract due to ozone depletion and greater solar UVR has receded, global warming may become a factor in the early onset and rapid progression of cataract. Although we continue to need research into the physical and biological causes of cataract, elimination of world blindness will only be achieved when we understand the conceptual and cultural environments which are inhibiting the acceptance of cataract surgery.