Vision and Inequality: Preventable Blindness as an Ethical Challenge in Mexico

December 1, 2025
Author: Ana Corina Ballout Hernández 
Versión en español

Preventable blindness has become one of the most urgent health and ethical challenges in Mexico today. According to the Mexican Society of Ophthalmology, approximately 80% of cases could be prevented with timely diagnosis and access to quality ophthalmologic services. Inequities in access keep thousands of people at risk of losing their vision. Prevention requires clinical action and a comprehensive ethical commitment.

Vision loss is not merely a biomedical problem. It is an expression of structural inequality that disproportionately affects older adults, marginalized communities, and patients with chronic diseases. The World Health Organization estimates that more than one billion people worldwide live with visual impairment that could have been prevented or has yet to be treated. In Mexico, this reality is intensified by social determinants such as socioeconomic status, limited healthcare coverage, insufficient health education, and a lack of specialized services across various regions.

From a bioethical perspective, preventable blindness directly challenges the principles of justice, equity, beneficence, and non-maleficence. Losing sight when accessible, effective, and well-established interventions exist constitutes avoidable harm. This harm is exacerbated when it undermines autonomy, mobility, work capacity, and social participation.

In Mexico, three conditions account for most cases and exemplify the intersection of social vulnerability and healthcare neglect. Presenting them clearly helps illustrate the magnitude of the challenge.

Main Causes of Blindness in Mexico

• Untreated cataracts:
They are the leading cause of treatable blindness in older adults. In Querétaro, 29.8% of blindness cases in people aged 50 and older are attributed to cataracts (López-Star et al., 2018). Although cataract surgery is outpatient, safe, and highly effective, thousands of people lack access to it. Major barriers include inability to pay (38.3%), lack of available services (10.6%), and fear of the procedure. These data show that cataract blindness is not a technical problem, but a symptom of structural inequality.

• Diabetic retinopathy: The leading cause of irreversible blindness in working-age adults. One in three patients with diabetes in Mexico presents some degree of diabetic retinopathy (APEC, 2022). In the same Querétaro study, diabetic retinopathy accounted for 17.5% of blindness cases and 32.9% of functional low vision. Although up to 98% of vision loss can be prevented through metabolic control and annual eye exams, 58.6% of participants with known diabetes had never undergone a retinal examination. This reflects a dual ethical failure: the underdiagnosis of diabetes and the absence of systematic screening that could protect vulnerable populations.

• Glaucoma: The main cause of irreversible blindness in Mexico and worldwide. It is estimated that more than one million people in the country live with glaucoma, yet up to 80% are unaware of it (González Rodríguez, n.d.). Its silent nature demands robust strategies for education, screening, and follow-up. From a clinical ethics standpoint, glaucoma underscores the importance of patient empowerment: no one should lose their vision due to involuntary ignorance or lack of adequate information.

Evidence shows that prevention is simple, effective, and affordable: annual ophthalmologic examinations, screening for individuals with diabetes and hypertension, strict glycemic control, regular intraocular pressure evaluations, and timely referrals to specialists. Prevention, however, is not merely a clinical act—it is an ethical imperative rooted in justice. It involves ensuring real and equitable access to the tools that allow people to preserve their visual health.

Paradoxically, structural barriers remain the most persistent cause of preventable blindness. The RAEH study in Querétaro revealed a set of obstacles that systematically affect the most vulnerable groups: lack of access to services, shortage of specialized infrastructure, fear of surgery, late diagnoses, economic limitations, and widespread lack of awareness about the importance of visual health. These barriers are not simply administrative challenges—they represent ethical dilemmas involving the State’s responsibility, the professional duty to provide adequate information, and the need for public policies that prioritize collective wellbeing.

The situation becomes even more urgent given Mexico’s rapidly aging population. By 2030, the number of people aged 50 and over will double, doubling the demand for cataract surgery, diabetic retinopathy monitoring, and glaucoma management. Failing to anticipate this reality constitutes an ethical lapse in public health: fair planning, appropriate resource allocation, and national prevention strategies are essential to avoid a future in which preventable blindness becomes a silent crisis.

Conclusions

Preventable blindness in Mexico must be understood not only as a clinical issue but as an ethical problem deeply rooted in social inequality. Although we have safe surgical procedures, effective treatments, and reliable diagnostic tools, thousands continue to lose their sight due to preventable causes. Untreated cataracts, undiagnosed diabetic retinopathy, and unrecognized glaucoma do not reflect individual failures but structural deficiencies that expose long-standing inequities in access to healthcare.

From a bioethical perspective, preventing blindness involves promoting social justice, protecting human dignity, and ensuring that no one faces avoidable harm due to economic, geographic, or educational disadvantages. Preventable blindness not only limits visual ability—it impacts autonomy, social participation, employment opportunities, and the life projects of those affected. Therefore, prevention must be seen as a shared responsibility among the State, healthcare professionals, academic institutions, and society as a whole.

Strengthening diabetes screening, expanding access to cataract surgery, implementing early glaucoma detection programs, and developing culturally sensitive educational campaigns are essential steps toward a more equitable system of visual health. Likewise, reducing economic barriers, addressing fear of surgery through trustworthy information, and training professionals committed to equity are necessary strategies for building a clearer future for the population.

In the context of demographic growth and rising chronic disease burden, Mexico stands at a critical juncture. Without ethical population-level prevention policies, preventable blindness may become a painful indicator of structural inequality. Acting today is essential to ensure a more just, humane, and healthy tomorrow. Vision is more than a sense—it is a window to autonomy, education, and social participation. Protecting it is, therefore, an inescapable ethical obligation.

References

1. APEC. (2022, febrero 28). Retinopatía diabética: Una de las primeras causas de ceguera irreversible en México. https://blog.apec.org.mx/blog/retina/retinopatia-diabetica-ceguera-irreversible-mexico/  
2. González Rodríguez, L. C. (s.f.). Las 3 principales causas de ceguera en México: un reto de salud pública. https://enlacevisual.com.mx/blog/principales-causas-de-ceguera/  
3. López-Star, E. M., Allison-Eckert, K., Limburg, H., Brea-Rodríguez, I., & Lansingh, V. C. (2018). Evaluación rápida de la ceguera evitable, incluida la retinopatía diabética, en Querétaro, México. Revista Mexicana de Oftalmología, 92(2), 84–93. https://www.medigraphic.com/pdfs/revmexoft/rmo-2018/rmo182c.pdf  
4. Organización Mundial de la Salud. (2023, agosto 10). Ceguera y discapacidad visual. https://www.who.int/es/news-room/fact-sheets/detail/blindness-and-visual-impairment  
5. Tenorio, G. (s.f.). Retinopatía diabética: la causa más frecuente de ceguera en México. Nuevos conceptos.
En A. González Chávez, R. López Espinosa & J. A. Mesa Pérez (Eds.), Manual práctico para la detección y el tratamiento integral del síndrome metabólico (pp. 261–269).
https://books.google.com.mx/books?id=-ANjEQAAQBAJ  
6. Toche, N. (2024, enero 11). En México, 80% de los casos de ceguera podrían evitarse. El Economista.
https://www.eleconomista.com.mx/arteseideas/En-Mexico-80-de-los-casos-de-ceguera-podrian-evitarse-20240111-0013.html 

Ana Corina Ballout Hernández is a graduate of the Medicine program at Universidad Anáhuac México Norte, with a particular interest in ophthalmology and medical bioethics. She is currently completing her social service at CADEBI, where she actively participates in projects that integrate clinical ethics with academic and public health initiatives. Her long-term goal is to specialize in ophthalmology and later pursue a subspecialty in anterior segment surgery. This article was prepared with the assistance of ChatGPT, an artificial intelligence tool developed by OpenAI. 

The opinions expressed in this blog are the sole responsibility of the authors and do not necessarily reflect the official position of CADEBI. As an institution committed to inclusion and plural dialogue, CADEBI promotes and disseminates a diversity of voices and perspectives, convinced that respectful and critical exchange enriches our academic and educational work. We value and encourage all comments, responses, or constructive critiques that readers may wish to share.