Opinion Article

Causes of Blindness in Thammasat Eye Center

Woranart Tattiyakul1, Nichadee Sukjira2*, Kritrath Panittaveekul3, Suntaree Thitiwichienlert4, Pakornkit
Phrueksaudomchai1, Promporn Patarajierapun1
1 Cornea and Refractive Surgery Specialist, Thammasat University Hospital, Thailand
2General
Ophthalmologist, Amnat-Charoen Hospital, Thailand
3Vitreoretinal
Specialist and Pediatric and Strabismus Specialist, Thammasat University Hospital, Thailand
4Pediatric and Strabismus Specialist, Thammasat University Hospital, Thailand

*Correspondence author: Nichadee Sukjira, MD, General Ophthalmologist at Amnat-Charoen Hospital, Thailand; Email: [email protected]

Abstract
Citation: Tattiyakul W, et al. Causes
of Blindness in Thammasat Eye Blindness is a significant public health issue worldwide and understanding its causes is crucial
Center. J Ophthalmol Adv Res. for effective management and prevention. This study aims to investigate the causes of blindness
2025;6(2):1-5. at the Thammasat Eye Center, a tertiary care facility within Thammasat Hospital in Thailand.
https://doi.org/10.46889/JOAR.2025. As a tertiary care center, the Thammasat Eye Center provides advanced ophthalmic services,
6209 including education, diagnosis and treatment for patients with visual impairment and
blindness. Data were collected through a pilot retrospective chart review, focusing on patients
Received Date: 11-06-2025 aged 15 years and older who had visual impairment worse than 20/400 in one or both eyes
Accepted Date: 28-06-2025 during the period from January to December 2563.
Published Date: 04-08-2025 Patients with incomplete documentation or non-cooperation in visual acuity assessment were
excluded. Given its role as a tertiary care center, the Thammasat Eye Center is committed to
adhering to ethical guidelines, with patient data anonymized to ensure confidentiality. Data
analysis will be conducted using the Stata program and Microsoft Excel. The findings from this
Copyright: © 2025 by the authors. study will contribute valuable insights into the causes of blindness at the Thammasat Eye
Submitted for possible open access Center, aiding in developing effective interventions and improving eye health services,
publication under the terms and particularly in the context of a tertiary care facility.
conditions of the Creative Commons
Attribution (CCBY) license
Keywords: Blindness; Thailand; Thammasat Eye Center
(https://creativecommons.org/li
censes/by/4.0/).
Introduction
Studying the causes of blindness is crucial for reducing the number of visually impaired individuals in the future [1,2]. It is
especially important for planning a comprehensive eye health service system at Thammasat Hospital, a tertiary care center in
Thailand, encompassing both treatment and prevention of eye conditions. The Ophthalmology Center, a part of Thammasat
Hospital, plays a significant role in providing specialized ophthalmic services and is particularly important in caring for patients
with visual impairment and blindness. The center offers a range of services, including eye health education, accurate diagnosis
of the causes of visual loss and advice on the best treatment and care for patients with visual problems or correctable conditions.
Furthermore, it plays a vital role in advising on preventive measures for eye diseases and promoting an environment that
safeguards visual health. Understanding the causes of blindness is an essential tool in managing eye health, reducing potential
eye damage and mitigating the risks posed to the population's sight-threatening conditions in the future.

Background
The World Health Organization (WHO) defines blindness as a visual acuity of less than 3/60 (20/400 Snellen) in the better eye
with the best possible correction or a visual field of less than 10 degrees from the point of fixation, even with the best possible
vision in the eye [3]. In simpler terms, a person with blindness has severely impaired vision, making it challenging to see objects
clearly or with a limited field of vision.

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The World Health Organization (WHO) identifies several major causes of blindness globally, encompassing cataracts, glaucoma,
Age-Related Macular Degeneration (AMD), diabetic retinopathy, trachoma, onchocerciasis (river blindness) and childhood
blindness [4-10]. Cataracts are the leading cause of blindness worldwide, resulting from a clouding of the eye's lens. Glaucoma
damages the optic nerve, leading to visual loss and is often associated with increased intraocular pressure [11,12]. AMD affects
the macula, causing a significant loss of central vision in older adults [13]. Diabetic retinopathy results from high blood sugar
levels damaging retinal blood vessels, leading to visual problems and blindness in severe cases [14]. Trachoma is an infectious
eye disease that can cause corneal damage and blindness, particularly in areas with limited access to healthcare [15].
Onchocerciasis is caused by parasitic worm infection and transmitted through blackfly bites, leading to severe itching, skin
changes and blindness [16]. Childhood blindness can result from congenital conditions, infections, trauma and malnutrition [17].

It is crucial to understand that the prevalence of these causes may vary across different regions worldwide. Studies such as "The
First Rapid Assessment of Avoidable Blindness (RAAB) in Thailand" [18]. have provided valuable insights into the prevalence
of avoidable blindness in specific regions. As a tertiary care center in Thailand, the Thammasat Eye Center plays a pivotal role
in addressing avoidable blindness and targeted interventions to reduce visual impairment and blindness in the region. The study
conducted by Teekhasaenee, et al., utilized the Rapid Assessment of Avoidable Blindness (RAAB) methodology, which provides
rapid and reliable data on the prevalence and causes of blindness and visual impairment.

In addition to regional assessments like RAAB in Thailand, global efforts have been made to understand the magnitude and
trends of blindness and visual impairment. The systematic review and meta-analysis by Bourne, et al., examined the global
prevalence of blindness and distance and near visual impairment, offering comprehensive insights into the worldwide burden
of visual impairment [19]. Understanding global trends is essential for Thammasat Eye Center as a tertiary care facility, as it
enables the development of evidence-based strategies and programs to prevent and treat the major causes of blindness
worldwide.

The Thammasat Eye Center's status as a tertiary care facility underscores its role in providing advanced eye care services,
including specialized treatments and interventions. As a tertiary care center, it plays a crucial role in the management of complex
cases, offering a multidisciplinary approach to address challenging visual impairments and blindness. The budget allocated for
patient care reflects the center's commitment to providing state-of-the-art treatments, advanced technology and specialized
medical expertise to improve patient outcomes.

Together, the findings from studies like RAAB in Thailand and global analyses, including Bourne, et al., meta-analysis, contribute
to a better understanding of the causes and prevalence of blindness [18]. These insights are instrumental in formulating effective
public health policies, enhancing eye care services and allocating resources to reduce the burden of visual impairment and
improve overall eye health worldwide. The current study on the causes of blindness at the Thammasat Eye Center adds to this
body of knowledge, providing valuable information specific to the region and aiding in the development of targeted
interventions to address visual impairment and blindness in the studied population.

Method
Study Design: Pilot Retrospective Chart Review (Table 1)
Sample Size: Patients aged 15 years and older at Thammasat Hospital with visual impairment (VA worse than 20/400) in one or
both eyes.
Exclusion Criteria: Patients who did not cooperate in VA assessment or had incomplete electronic OPD records.
Data Collection: Patient data were extracted from electronic OPD records and recorded on a case record form.
Data Analysis: Data were analyzed using the Stata program and Microsoft Excel.
Ethical Considerations: The study protocol was approved by the institutional review board and all patient data were anonymized
to ensure confidentiality.

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Categories Number Average

Gender
- Male 4495 41.16%
- Female 6465 58.84%
Age
- 15-30 years 721 6.58%
- 31-45 years 919 8.38%
- 46-60 years 2704 24.67%
- 61-75 years 4846 44.22%
- More than 75 years 1768 16.13%
Ocular Disease (eyes)
- Normal eyes 12669 57.81%
- Age-related macular 291 1.33%
degeneration (AMD)
- All other globe/CNS 303 1.38%
Abnormalities
- Complicated cataract surgery 52 0.24%
- Congenital eye diseases 54 0.25%
- Corneal opacity 312 1.42%
- Diabetic retinopathy 823 3.76%
- Glaucoma 563 2.57%
- Other acquired posterior 900 4.11%
Segment Diseases
- Phthisis bulbi 52 0.24%
- Refractive error 4626 21.11%
- Uncorrected aphakia 20 0.09%
- Untreated cataract 1251 5.71%
Table 1: Demographic data.

This paper “Other acquired posterior segment diseases” encompass a range of ocular conditions affecting the back part of the
eye. These include retinal detachment, macular hole, epiretinal membrane, retinitis pigmentosa, retinal vascular diseases, central
serous chorioretinopathy and posterior uveitis. On the other hand, a separate category comprises “All other globe/CNS
abnormalities”. These encompass optic nerve hypoplasia, papilledema, nystagmus, strabismus, ocular motor disorders, Horner’s
syndrome, ocular myasthenia gravis, cranial nerve palsies, Cerebral Visual Impairment (CVI) and cortical blindness (Table 2,3).

Causes of Blindness RE

Age-related All other Complicated Congenital Cornea Diabetic Other Refractive Uncorrecte Untreated
macular globe/CNS cataract eye l retinopathy acquired error d aphakia cataract
degeneration abnormalitie surgery diseases opacity posterior
s segment
diseases
Degree of ตาปกติ Glaucoma Phthisis Grand
Blindness bulbi Total
Blindness 6.51% 12.47% 0.94% 1.88% 11.33% 12.01% 18.71% 22.20% 3.49% 0.67% 0.94% 8.85% 1

97 186 14 28 169 179 279 331 52 10 14 132 1,491

Mild vision 0.21% 1.16% 0.44% 0.21% 0.56% 4.01% 1.75% 2.91% 80.70% 0.08% 7.96% 1
impairment
10 56 21 10 27 193 84 140 3,881 4 383 4,809

Moderate 0.12% 4.00% 2.83% 0.81% 0.53% 3.20% 14.24% 6.67% 12.54% 28.48% 0.04% 26.54% 1
vision
impairment 3 99 70 20 13 79 352 165 310 704 1 656 2,472

Normal 99.94% 0.01% 0.05% 0.01% 1

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12,653 1 6 1 12,661

Severe 0.62% 8.07% 5.38% 1.66% 2.69% 7.66% 20.50% 7.04% 24.64% 5.18% 0.21% 16.36% 1
vision
impairment 3 39 26 8 13 37 99 34 119 25 1 79 483

Grand 57.81% 1.33% 1.38% 0.24% 0.25% 1.42% 3.76% 2.57% 4.11% 0.24% 21.11% 0.09% 5.71% 1
Total
12,669 291 303 52 54 312 823 563 900 52 4,626 20 1,251 21,916

Table 2: Causes of blindness RE.

Percentage of Disease in Each Visual Range

Age-related All other Complicated Congenital Other

macular globe/CNS cataract eye acquired
degeneration abnormalities surgery diseases posterior
Corneal Diabetic segment Refractive Uncorrected Untreated
opacity retinopathy diseases error aphakia cataract
Degree of ตาปกติ Glaucoma Phthisis Grand
Blindness bulbi Total
Blindness 0 6.50570087 12.4748491 0.93896714 1.87793427 11.335 12.005366 18.7123 22.1998659 3.48759222 0.670691 0.93896714 8.853119 100%

Mild vision 0 1.166667 0.4375 0.2083333 0 0.5625 4.0208333 1.77083 2.91666667 0 80.85417 0.0833333 7.979167 100%
impairment
Moderate 0 3.99838449 2.82714055 0.80775444 0.52504039 3.1906 14.216478 6.66397 12.5201939 0 28.67528 0.04028772 26.53473 100%
vision
impairment
Normal 100% 0 0 0 0 0 0 0 0 0 0 0 0 100%

Severe 0 8.125 5.4166667 1.666667 2.7083333 7.7083 20.625 7.08333 24.79166667 0 5.208333 0.20833333 16.45833 100%
vision
impairment
Grand 57.80708 1.32779704 1.38255156 0.23726957 0.24639533 1.4236 3.7662473 2.5689 4.10658879 0.23726957 21.10787 0.09125753 5.708158 100%
Total

Table 3: Percentage of disease in each visual range.

Results
A total of 21,916 eyes were included in the analysis. The mean age of participants was 61 years. Among the participants, 58.84%
were female. Visual impairment was categorized into four degrees: normal vision, mild visual impairment, moderate visual
impairment, severe visual impairment and blindness. The percentage distribution among these categories was 57.81%, 21.90%,
11.30%, 2.19% and 6.8%, respectively. The most common etiology of visual impairment was "Refractive error," accounting for
21.11% of cases, followed by “untreated cataract” (5.71%), “Other acquired posterior segment diseases” (4.11%), "Diabetic
retinopathy" (3.76%), "Glaucoma" (2.57%) and "Corneal opacity" (1.42%). Other causes contributed to smaller percentages of
cases.

Among participants with blindness, the highest percentage of visual loss was attributed to "Other acquired posterior segment
diseases" (22.2%), followed by "Glaucoma" (18.71%), " All other globe/CNS abnormalities" (12.47%) and " Diabetic retinopathy "
(12.01%). In contrast, for participants with mild visual impairment, the main cause of visual loss was "Refractive error" (80.7%),
while in cases of moderate visual impairment, "Refractive error" also dominated as the primary cause (28.48%). Notably, " Other
acquired posterior segment diseases " was identified as the main cause of severe visual impairment (24.64%). Additionally, the
study observed that medical blindness in both the right and left eyes was rare, affecting only 0.14% of the total participants, while
the vast majority had no medical blindness (98.34%).

Conclusion
This comprehensive analysis of the causes of visual impairment and blindness within the population served by the Thammasat
Eye Center offers critical insights into addressing preventable and treatable conditions. The predominant causes identified-
namely "Refractive error," "Diabetic retinopathy," "Glaucoma," and "Age-related macular degeneration"-highlight key areas for
targeted interventions and public health initiatives. Early detection and management of these conditions emerge as paramount
strategies for alleviating the burden of visual impairment. The Thammasat Eye Center, functioning as a tertiary care facility,
plays a pivotal role in this endeavor. Its commitment to advanced treatments, access to cutting-edge technology and specialized
medical expertise, as reflected in the allocated budget for patient care, underscores its dedication to optimizing patient outcomes
and visual health.

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The major cause of blindness within the population served by the Thammasat Eye Center is “Other acquired posterior segment
disssseases” which are unpreventable cause. Notably, the rarity of medical blindness in both eyes, affecting only a minuscule
percentage of participants, underscores the Center's efficacy in preventing and managing conditions that may lead to severe
visual loss or blindness. The insights gleaned from this study hold significant implications for healthcare providers and
policymakers alike. They inform the development of strategies to enhance eye care services, promote eye health awareness and
ensure equitable access to vision screening-especially crucial in a tertiary care setting like the Thammasat Eye Center. This body
of work not only advances our understanding of the causes and prevalence of visual impairment and blindness but also serves
as a foundational resource for shaping evidence-based policies and interventions to improve eye health on a global scale.

Conflict of Interest
The authors declare no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding Details
No author has a financial or proprietary interest in any material or method mentioned.

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