Purpose
To assess blindness prevalence and that caused specifically by cataract in rural southern China.

Design
Population-based, cross-sectional study.

Participants
A total of 5342 persons older than 50 years of age.

Methods
Visual acuity and eye examinations were performed in the summer of 1997 in a random sample of villages in Doumen County. Differences in blindness prevalence associated with age, gender, and education were explored using logistic regression. The survey was preceded by a pilot study in which operational methods were refined and quality assurance measures were performed.

Main outcome measures
Distance visual acuity and lens status.

Results
Bilateral blindness (presenting visual acuity < 0.10) was found in 4.37% (95% confidence interval, 3.67%–5.06%). Blindness was associated with increasing age (P < 0.001) and with the lack of education (P < 0.01). Cataract was the principal cause of blindness in at least one eye in 61.5% of blind people, with refractive error responsible for another 10%. An estimated 40% of the cataract blind were operated on; surgical coverage was lowest among the elderly, women, and those without schooling, although not at statistically significant levels.

Conclusions
Despite the increased attention given to eye care in Doumen County, blindness remains a major public health problem. Cataract surgery is reaching fewer than half of those who could benefit from it.