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

Z Jadoon¹, S P Shah², R Bourne², B Dineen², M A Khan¹, C E Gilbert², A Foster², M D Khan¹ and on behalf of the Pakistan National Eye Survey Study Group

¹ Pakistan Institute of Community Ophthalmology, Kyber Institute of Ophthalmic Medical Sciences, Peshawar, Pakistan
² International Centre for Eye Health, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

Correspondence to:
Shaheen Shah, Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; shaheen.shah{at}lshtm.ac.uk

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.

Abbreviations: CSC, Cataract surgical coverage; CSR, cataract surgical rate; NWFP, North West Frontier Province; WHO, World Health Organisation

Keywords: cataract surgical coverage; barriers to eye care; pakistan; blindness; visual impairment

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