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Am J Ophthalmol. 2018 Sep;193:xix-xxvii. doi: 10.1016/j.ajo.2018.06.006. Epub 2018 Jun 12.

Cuban Epidemic Optic Neuropathy (1991-1993) and José Saramago's Novel Blindness (1995).

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Department of Ophthalmology and Visual Sciences, and the Center for History of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA. Electronic address:
Department of English, Washington University, St. Louis, Missouri, USA.



This article reviews the history of Cuban epidemic optic neuropathy (1991-1993), which caused visual loss, peripheral neuralgias, and other neurologic symptoms in over 50,000 persons, an incidence of almost 0.5% of the entire population. The clinical findings, etiology, and treatment are described. We then relate the Cuban epidemic to the fictional epidemic of contagious blindness depicted by Nobel Laureate José Saramago in his 1995 novel Blindness. This novel describes an unnamed modern city in which all inhabitants, except the ophthalmologist's wife, are affected with a white, not black, blindness.


Historical review and literary essay.


The sources for the Cuban epidemic were an extensive review of the published literature and personal communications with physicians who treated these patients. Both authors have analyzed the novel and the critical literature about Saramago's writings.


Though Saramago uses the epidemic of blindness as an allegory to comment on human weakness and immorality, he may also have known of the actual Cuban epidemic. Saramago was a lifelong member of the Communist party, as well as a friend of Fidel Castro and admirer of the Cuban government. We have no proof that Blindness was influenced by the Cuban epidemic, but we find it plausible.


It is valuable to examine the real and fictional epidemics side by side, not least because Saramago's novel depicts the actions of an ophthalmologist during an epidemic of blindness. Ophthalmologists may be interested in a novel that uses the language of eyes, vision, sight, and blindness extensively.


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