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Br J Ophthalmol doi:10.1136/bjo.2006.106914

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

  1. Zahid Jadoon (zahid{at}pico.org.pk),
  2. Shaheen Pravin Shah (shaheen.shah{at}lshtm.ac.uk),
  3. Rupert Richard Bourne (rupert.bourne{at}lshtm.ac.uk),
  4. Brendan Dineen,
  5. Mohammad A Khan,
  6. Clare E Gilbert,
  7. Allen Foster,
  8. Mohammad D Khan
  1. Pakistan Institute of Community Ophthalmology, Kyber Institute of Ophthalmic Medical Sciences, Pakistan
  2. International Centre for Eye Health, London School of Hygiene and Tropical Medicine, United Kingdom
  3. International Centre for Eye Health, London School of Hygiene and Tropical Medicine, United Kingdom
  4. International Centre for Eye Health, London School of Hygiene and Tropical Medicine, United Kingdom
  5. Pakistan Institute of Community Ophthalmology, Kyber Institute of Ophthalmic Medical Sciences, Pakistan
  6. International Centre for Eye Health, London School of Hygiene and Tropical Medicine, United Kingdom
  7. International Centre for Eye Health, London School of Hygiene and Tropical Medicine, United Kingdom
  8. Pakistan Institute of Community Ophthalmology, Kyber Institute of Ophthalmic Medical Sciences, Pakistan
    • Published Online First 7 June 2007

    Abstract

    Aim: To estimate the prevalence of visual impairment and blindness due to cataract, the prevalence of aphakia/pseudophakia, the 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. Cataract surgical coverage was calculated for different levels of visual loss by person and by eye. Individuals with <6/60 in the better eye due to 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) due to bilateral cataract was 1.75% (95% CI: 1.55, 1.96%). 1,317 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.

    Conclusions: There are estimated to be approximately 570,000 adults who are blind (<3/60) from cataract in Pakistan, and 3,560,000 eyes with a visual acuity of < 6/60 due to cataract. Overall, the national coverage is good but underserved populations have been identified.

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