{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T18:07:15Z","timestamp":1779214035789,"version":"3.51.4"},"reference-count":31,"publisher":"BMJ","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["207472\/Z\/17\/Z"],"award-info":[{"award-number":["207472\/Z\/17\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100017151","name":"The Queen Elizabeth Diamond Jubilee Trust","doi-asserted-by":"crossref","award":["TG002"],"award-info":[{"award-number":["TG002"]}],"id":[{"id":"10.13039\/100017151","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2026,5,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background\/aims<\/jats:title>\n                    <jats:p>Corneal opacity (CO) is a significant cause of vision impairment and blindness worldwide. The first National Eye Health Survey in The Gambia (1986) and follow-up (1996) showed a decline in the crude prevalence of blindness but an increase in blindness from non-trachomatous CO. This study aimed to provide an update on the prevalence of CO and identify associated risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Multi-stage stratified cluster random sampling was used to select a nationally representative sample of 10\u2009800 adults aged \u226535 years. Distance best-corrected visual acuity was assessed with Peek Acuity. Ophthalmologists examined participants to identify trachomatous trichiasis, pterygium, CO, corneal ulcers and band keratopathy. CO was graded using a previously described system. Counts and prevalence estimates were based on the weighted sample, corrected for age\/sex imbalance. The main outcome was the prevalence of CO. Multivariable logistic regression identified risk factors associated with CO.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>9188 participants were examined. CO was found in one or both eyes in 878 participants, giving an age\u2013sex-adjusted prevalence of 9.6% (95% CI 8.7 to 10.5). CO was more likely unilateral (n=673) than bilateral (n=205). Among affected eyes, 41.0% had moderate or severe vision impairment or blindness. Risk factors independently associated with CO included trachomatous trichiasis (OR 5.22 [95% CI 3.46 to 7.86]), older age (OR 4.06 [95% CI 2.54 to 6.47]), male sex (OR 1.58 [95% CI 1.34 to 1.86]) and rural residence (OR 1.62 [95% CI 1.15 to 2.28]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The prevalence of CO in The Gambia remains high. Focused national efforts to prevent and treat CO are urgently needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjo-2025-328816","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T17:20:19Z","timestamp":1779211219000},"page":"bjo-2025-328816","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence and risk factors associated with corneal opacity in The Gambia"],"prefix":"10.1136","author":[{"given":"Denis","family":"Erima","sequence":"first","affiliation":[{"name":"Sheikh Zayed Regional Eye Care Centre, Banjul, Gambia"},{"name":"Masaka Regional Referral Hospital, Masaka, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1552-8814","authenticated-orcid":false,"given":"Elliott H","family":"Taylor","sequence":"additional","affiliation":[{"name":"International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John A","family":"Okoh","sequence":"additional","affiliation":[{"name":"Sheikh Zayed Regional Eye Care Centre, Banjul, Gambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Segun I","family":"Olaniyan","sequence":"additional","affiliation":[{"name":"Sheikh Zayed Regional Eye Care Centre, Banjul, Gambia"},{"name":"Department of Ophthalmology, University College Hospital Ibadan, Ibadan, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3328-3698","authenticated-orcid":false,"given":"Suzannah J","family":"Bell","sequence":"additional","affiliation":[{"name":"International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ben","family":"Kirkpatrick","sequence":"additional","affiliation":[{"name":"Moorfields Eye Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannaa","family":"Bobat","sequence":"additional","affiliation":[{"name":"Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5662-3325","authenticated-orcid":false,"given":"Covadonga","family":"Bascaran","sequence":"additional","affiliation":[{"name":"International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Cassels-Brown","sequence":"additional","affiliation":[{"name":"The Fred Hollows Foundation, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9099-7400","authenticated-orcid":false,"given":"Hannah","family":"Faal","sequence":"additional","affiliation":[{"name":"University of Calabar Teaching Hospital, Calabar, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Min J","family":"Kim","sequence":"additional","affiliation":[{"name":"International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6287-0384","authenticated-orcid":false,"given":"Islay","family":"Mactaggart","sequence":"additional","affiliation":[{"name":"International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abba","family":"Hydara","sequence":"additional","affiliation":[{"name":"Sheikh Zayed Regional Eye Care Centre, Banjul, Gambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1872-9169","authenticated-orcid":false,"given":"Matthew J","family":"Burton","sequence":"additional","affiliation":[{"name":"International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK"},{"name":"National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"2026051910201116000_bjo-2025-328816v1.1","doi-asserted-by":"crossref","first-page":"e1221","DOI":"10.1016\/S2214-109X(17)30393-5","article-title":"Global causes of blindness and distance vision impairment 1990-2020: a systematic review and meta-analysis","volume":"5","author":"Flaxman","year":"2017","journal-title":"Lancet Glob Health"},{"key":"2026051910201116000_bjo-2025-328816v1.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2023.03.012"},{"key":"2026051910201116000_bjo-2025-328816v1.3","doi-asserted-by":"publisher","DOI":"10.1590\/S0042-96862001000300009"},{"key":"2026051910201116000_bjo-2025-328816v1.4","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.19.232660"},{"key":"2026051910201116000_bjo-2025-328816v1.5","doi-asserted-by":"crossref","first-page":"18","DOI":"10.4103\/njo.njo_34_16","article-title":"Prevalence and determinants of corneal blindness in a Semi-Urban population of southwest Nigeria","volume":"25","author":"Seidu","year":"2017","journal-title":"Niger J Ophthalmol"},{"key":"2026051910201116000_bjo-2025-328816v1.6","unstructured":"Ukety T . Rapid assessment of avoidable blindness report of findings from Democratic Republic of Congo, Ituri, Aru and Mahagi. 2015. Available: https:\/\/www.raab.world\/survey\/democratic-republic-congo-ituri-aru-and-mahagi-2015"},{"key":"2026051910201116000_bjo-2025-328816v1.7","unstructured":"Kikira S . Rapid assessment of avoidable blindness report of findings from Uganda, Northern, Karamoja. 2015. Available: https:\/\/www.raab.world\/survey\/uganda-northern-karamoja-2015"},{"key":"2026051910201116000_bjo-2025-328816v1.8","unstructured":"Berhane Y . National survey on blindness, low vision and trachoma in Ethiopia. 2006. Available: http:\/\/www.pbunion.org\/Countriessurveyresults\/Ethiopia\/Ethiopian_National_Blindness_and_trachoma_survey.pdf"},{"key":"2026051910201116000_bjo-2025-328816v1.9","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.09-3507"},{"key":"2026051910201116000_bjo-2025-328816v1.10","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.73.2.82"},{"key":"2026051910201116000_bjo-2025-328816v1.11","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.84.9.948"},{"key":"2026051910201116000_bjo-2025-328816v1.12","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1038\/sj.eye.6700027","article-title":"Non-trachomatous corneal opacities in the Gambia--aetiology and visual burden","volume":"16","author":"Bowman","year":"2002","journal-title":"Eye (Lond)"},{"key":"2026051910201116000_bjo-2025-328816v1.13","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2021-320008"},{"key":"2026051910201116000_bjo-2025-328816v1.14","doi-asserted-by":"crossref","DOI":"10.12688\/wellcomeopenres.16531.1","article-title":"The Gambia National Eye Health Survey 2019: survey protocol","volume":"6","author":"Hydara","year":"2021","journal-title":"Wellcome Open Res"},{"key":"2026051910201116000_bjo-2025-328816v1.15","unstructured":"Statistics GBo . The gambia- population and housing census. 2013. Available: https:\/\/catalog.ihsn.org\/index.php\/catalog\/6065"},{"key":"2026051910201116000_bjo-2025-328816v1.16","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1001\/jamaophthalmol.2015.1468","article-title":"Development and Validation of a Smartphone-Based Visual Acuity Test (Peek Acuity) for Clinical Practice and Community-Based Fieldwork","volume":"133","author":"Bastawrous","year":"2015","journal-title":"JAMA Ophthalmol"},{"key":"2026051910201116000_bjo-2025-328816v1.17","unstructured":"WHO . ICD-11 for mortality and morbidity statistics (version: 04\/2019)\u20149D90 vision impairment including blindness. 2019. Available: https:\/\/icd.who.int\/browse11\/l-m\/en#\/http%3a%2f%20%2fid.who.%20int%2ficd%2fentity%2f1103667651"},{"key":"2026051910201116000_bjo-2025-328816v1.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2011.06.045"},{"key":"2026051910201116000_bjo-2025-328816v1.19","unstructured":"PopulationPyramid.net . Population pyramids of the world from 1950 to 2100. n.d. Available: https:\/\/www.populationpyramid.net\/gambia\/2019"},{"key":"2026051910201116000_bjo-2025-328816v1.20","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2014-305945"},{"key":"2026051910201116000_bjo-2025-328816v1.21","doi-asserted-by":"publisher","DOI":"10.1080\/09286586.2017.1337912"},{"key":"2026051910201116000_bjo-2025-328816v1.22","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.81.8.622"},{"key":"2026051910201116000_bjo-2025-328816v1.23","doi-asserted-by":"crossref","first-page":"e144","DOI":"10.1016\/S2214-109X(20)30489-7","article-title":"Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study","volume":"9","author":"Steinmetz","year":"2021","journal-title":"Lancet Glob Health"},{"key":"2026051910201116000_bjo-2025-328816v1.24","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1111\/ceo.12330","article-title":"Corneal blindness: a global problem","volume":"42","author":"Robaei","year":"2014","journal-title":"Clinical Exper Ophthalmology"},{"key":"2026051910201116000_bjo-2025-328816v1.25","unstructured":"World Health Organization . State of the world\u2019s sight: vision 2020: the right to sight: 1999-2005. 2005. Available: https:\/\/apps.who.int\/iris\/handle\/10665\/43300"},{"key":"2026051910201116000_bjo-2025-328816v1.26","first-page":"619","article-title":"Childhood blindness from corneal ulceration in Africa: causes, prevention, and treatment","volume":"64","author":"Foster","year":"1986","journal-title":"Bull World Health Organ"},{"key":"2026051910201116000_bjo-2025-328816v1.27","unstructured":"World Health Organization . WHO alliance for the global elimination of trachoma by 2020: progress report. 2019. Available: https:\/\/apps.who.int\/iris\/handle\/10665\/333444"},{"key":"2026051910201116000_bjo-2025-328816v1.28","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0010282","article-title":"The Gambia has eliminated trachoma as a public health problem: Challenges and successes","volume":"16","author":"Aboe","year":"2022","journal-title":"PLoS Negl Trop Dis"},{"key":"2026051910201116000_bjo-2025-328816v1.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.survophthal.2018.03.001"},{"key":"2026051910201116000_bjo-2025-328816v1.30","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2013-003787","article-title":"Geographical prevalence and risk factors for pterygium: a systematic review and meta-analysis","volume":"3","author":"Liu","year":"2013","journal-title":"BMJ Open"},{"key":"2026051910201116000_bjo-2025-328816v1.31","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2019-314015"}],"container-title":["British Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bjo-2025-328816","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T17:20:23Z","timestamp":1779211223000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjo.bmj.com\/lookup\/doi\/10.1136\/bjo-2025-328816"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,19]]},"references-count":31,"alternative-id":["10.1136\/bjo-2025-328816"],"URL":"https:\/\/doi.org\/10.1136\/bjo-2025-328816","relation":{},"ISSN":["0007-1161","1468-2079"],"issn-type":[{"value":"0007-1161","type":"print"},{"value":"1468-2079","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,19]]}}}