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Cataract and “Vision 2020—the right to sight” initiative
  1. London School Hygiene and Tropical Medicine, Keppel Street, London WC1 E7HT, UK

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In 1999 the World Health Organization and the International Agency for Prevention of Blindness announced a joint programme to eliminate unnecessary blindness. The programme is called “Vision 2020—the right to sight”.1 Key to this initiative is the provision of sufficient, successful, and sustainable cataract services for all communities. The questions that therefore arise include: what is a sufficient; what is a successful; and what is a sustainable cataract service?2 Two articles in this issue of the BJO from Korea3 and Nepal4 evaluate cataract services using a variety of performance indicators—cataract surgical coverage, barriers to access, and outcome of surgery.

How many cataracts need to be operated?

The aim of a cataract service is to operate on sufficient cataracts each year (cataract surgical rate; CSR), so that everyone with “operable” cataract (visual loss justifying surgery) can receive surgery if they wish (100% coverage). The cataract surgical coverage is defined as the proportion of patients (or eyes) with “operable” cataract, who have already received surgery. As reported in the paper from Korea, coverage varies according to the level of visual acuity used to indicate surgery, being 78% in people less than 6/60 and 55% for less than 6/18. Coverage surveys from other parts of the world have reported: Malawi <15%,5 Paraguay 36%,6 and Karnataka State, India 40%7 for bilateral <6/60 due to cataract. There is as far as I am aware no report from industrialised countries.

The CSR is the number of operations performed in a year for a given population (usually expressed as ops/year/million population) Rates vary from 6300 in Australia8 to 100 in Nigeria.9 Figure 1 schematically shows statistics used to evaluate and audit cataract services.

Figure 1

Analysis for cataract services per million population.

The World Health Report10 estimates that approximately 20 million people are bilaterally blind (less …

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