Cataract prevalence, cataract surgical coverage and barriers to uptake of cataract surgical services in Pakistan: the Pakistan National Blindness and Visual Impairment Survey

• Published in: British journal of ophthalmology Vol. 91; no. 10; pp. 1269 - 1273
• Main Authors: Jadoon, Z, Shah, S P, Bourne, R, Dineen, B, Khan, M A, Gilbert, C E, Foster, A, Khan, M D
• Format: Journal Article
• Language: English
• Published: BMA House, Tavistock Square, London, WC1H 9JR BMJ Publishing Group Ltd 01.10.2007; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Adult; Age Distribution; Aged; Aphakia, Postcataract - epidemiology; Aphakia, Postcataract - etiology; barriers to eye care; Biological and medical sciences; Blindness; Blindness - epidemiology; Blindness - etiology; Cataract - complications; Cataract - economics; Cataract - epidemiology; Cataract Extraction - economics; Cataract Extraction - psychology; cataract surgical coverage; Cataracts; Developing countries; Eye surgery; Eyes & eyesight; Female; Health Care Costs; Humans; Illiteracy; LDCs; Lens diseases; Male; Medical sciences; Middle Aged; Miscellaneous; Ophthalmology; pakistan; Pakistan - epidemiology; Pathology; Patient Acceptance of Health Care - psychology; Population; Prevalence; Pseudophakia - epidemiology; Pseudophakia - etiology; Rural areas; Sex Distribution; Surgery; Vision disorders; Vision Disorders - epidemiology; Vision Disorders - etiology; Visual impairment; World View; Asia; Pakistan; India; Cataract; Prevalence; Vision disorder; Uptake; Eye disease; Survey; Lens disease; Treatment; Surveillance; Visual impairment; Surgery; Blindness; Ophthalmology; Anterior segment disease
• ISSN: 0007-1161; 1468-2079
• DOI: 10.1136/bjo.2006.106914

Aim:To estimate the prevalence of visual impairment and blindness caused by cataract, the prevalence of aphakia/pseudophakia, cataract surgical coverage (CSC) and to identify barriers to the uptake of cataract services among adults aged ⩾30 years in Pakistan.Methods:Probability proportional-to-size procedures were used to select a nationally representative sample of adults. Each subject underwent interview, visual acuity measurement, autorefraction, biometry and ophthalmic examination. Those that saw <6/12 in either eye underwent a more intensive examination procedure including corrected visual acuity, slit lamp and dilated fundus examination. CSC was calculated for different levels of visual loss by person and by eye. Individuals with <6/60 in the better eye as a result of cataract were interviewed regarding barriers.Results:16 507 Adults were examined (95.5% response rate). The crude prevalence of blindness (presenting <3/60 in the better eye) caused by bilateral cataract was 1.75% (95% CI 1.55%, 1.96%). 1317 Participants (633 men; 684 women) had undergone cataract surgery in one or both eyes, giving a crude prevalence of 8.0% (95% CI 7.6%, 8.4%). The CSC (persons) at <3/60, <6/60 and <6/18 were 77.1%, 69.3% and 43.7%, respectively. The CSC (eyes) at <3/60, <6/60 and <6/18 were 61.4%, 52.2% and 40.7%, respectively. Cost of surgery (76.1%) was the main barrier to surgery.Conclusion:Approximately 570 000 adults are estimated to be blind (<3/60) as a result of cataract in Pakistan, and 3 560 000 eyes have a visual acuity of <6/60 because of cataract. Overall, the national surgical coverage is good but underserved populations have been identified.