The purpose of this study was to evaluate the causes and distribution of blindness in a locally representative sample of subjects aged 40 years and older and to assess the basis for the higher rate of bilateral blindness in blacks compared with whites. Of the 5,308 subjects screened in East Baltimore, 64 were blind in both eyes.

The patterns and causes of blindness differed for blacks and whites. The major causes of blindness among blacks were unoperated cataract (27%) and primary open-angle glaucoma (19%), and the major causes among whites were macular degeneration (30%) and unoperated senile cataract (13%). Forty-one percent of the blind blacks were less than 65 years of age, almost twice the proportion of whites. The high rate of blindness in younger blacks was due to glaucoma, trauma, diabetes, and hereditary retinopathy.

The authors point out two important race-related patterns. First, vision in 41 of the 128 blind eyes could definitely or probably be improved by appropriate management which generally included cataract surgery, and cataract surgery was likely to benefit a greater number of blacks than whites. Second, with regard to primary open-angle glaucoma, shown to be a major cause of blindness in blacks, it was not likely that access to health care was associated with glaucoma blindness in this sample because equal proportions of subjects with glaucoma were aware that they had the disease. The authors suggested that compliance and the effectiveness of therapy might have varied between the races.