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Age related cataract remains the major cause of blindness throughout the world.1 It is estimated that the present number of 20 million of cataract blind will double by the year 2020. The main reasons for low uptake of cataract surgery in developing countries are poor surgical outcome2 and high cost. Various strategies have been suggested by the global initiative “Vision 2020: the right to sight” to reduce cataract blindness.3
In Nepal, on “World Sight Day,” Lahan Eye Hospital and Tilganga Eye Centre jointly convened a one week cataract surgical “workshop” from 8–13 October 2001. A total of 1542 patients with operable cataract were identified in 49 screening camps in rural areas of south east Nepal and transported to Lahan Eye Hospital. During 6 days 2292 eye operations were performed, of which 2167 were cataract extractions (range 286–594 per day).
The operations were performed by six experienced eye surgeons using a sutureless non-phaco technique, removing the nucleus through a self sealing corneoscleral tunnel. Biometry was performed and a calculated PC IOL inserted in 374 (18%) cases; the remaining 1741 (82%) received a +22 dioptre PC IOL.
After excluding 23 cataract operations on children, 21 combined glaucoma procedures, and eight lens induced glaucoma surgeries, the surgical outcome on the remaining 2115 cataract extractions was evaluated.
The uncorrected visual acuity at discharge (94% on first postoperative day) was 6/6–6/18 in 49.9% and less than 6/60 in 3.0% of eyes (Table 1). The reasons for poor outcome are shown in Table 2.
The cost of consumables including IOL, medicines, anaesthesia, viscoelastic, irrigation solution, disinfectant, and dressings was less than $10 per cataract operation.
Well organised cataract screening camps combined with efficient base hospital surgery, using a safe surgical technique which provides early and good visual outcome, can be a strategy to reduce the backlog of cataract blindness in rural communities in developing countries.
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