Elimination of avoidable blindness due to cataract: Where do we prioritize and how should we monitor this decade?

Abstract

Background:In the final push toward the elimination of avoidable blindness, cataract occupies a position of eminence for the success of the Right to Sight initiative.Aims:Review existing situation and assess what monitoring indicators may be useful to chart progress towards attaining the goals of Vision 2020.Settings and Design:Review of published papers from low and middle income countries since 2000.Materials and Methods:Published population-based data on prevalence of cataract blindness/visual impairment were accessed and prevalence of cataract blindness/visual impairment computed, where not reported. Data on prevalence of cataract blindness, cataract surgical coverage at different visual acuity cut offs, surgical outcomes, and prevalence of cataract surgery were analyzed. Scatter plots were used to look at relationships of some variables, with Human Development Index (HDI) rank. Available data on Cataract Surgical Rate (CSR) was plotted against prevalence of cataract surgery reported from surveys.Results:Worse HDI Ranks were associated with higher prevalence of cataract blindness. Most studies showed that a significant proportion of the blind were covered by surgery, while a fifth showed that a significant proportion, were operated before they went blind. A good visual outcome after surgery was positively correlated with higher surgical coverage. CSR was positively correlated with cataract surgical coverage.Conclusions:Cataract surgical coverage is increasing in most countries at vision <3/60 and visual outcomes after cataract surgery are improving. Establishing population-based surveillance of cataract surgical need and performance is a strong monitoring tool and will help program planners immensely.

Blindness and visual impairment due to age-related cataract in sub-Saharan Africa: a systematic review of recent population-based studies

“…In these studies, the CSC for persons for blinding cataract ranged from 22% to 70%, and was usually higher in men reflecting probably gender inequity in access to cataract surgical services 36. CSR is positively correlated with CSC,25 but CSC does not take into account the quality of surgery provided.…”

“…A substantial increase in CSR is needed to reduce blindness and VI due to cataract in SSA. Worse HDI ranks are associated with a higher prevalence of cataract blindness, and in SSA a much higher proportion of individuals undergoing surgery for cataract have preoperative blindness or SVI compared with higher-income populations 25. The challenge remains reaching blind and visually impaired people by providing accessible, affordable and sustainable cataract surgical services.…”

Cataract-Related Visual Impairment Corrected by Cataract Surgery and 10-Year Mortality: The Liwan Eye Study

“…Cataract remains the leading cause of visual impairment, accounting for almost one-half of all cases. 2 There is consistent evidence showing that persons with cataract have a higher risk of mortality compared with persons without cataract. [3][4][5][6][7][8][9][10] Cataract surgery is the only effective treatment for people with cataract, and is the most commonly performed clinical procedure in the medical field.…”

Inequality in cataract blindness and services: moving beyond unidimensional analyses of social position

“…Cataract blindness and services are unequally distributed across countries and regions, with higher rates of cataract blindness and worse cataract service indicators in poorer and less developed settings 1 4. Within countries, women generally5 6 —but not always7 —are more likely to be cataract blind than men, with lower access to and use of cataract surgical services.…”