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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
  1. Z Jadoon1,
  2. S P Shah2,
  3. R Bourne2,
  4. B Dineen2,
  5. M A Khan1,
  6. C E Gilbert2,
  7. A Foster2,
  8. M D Khan1,
  9. on behalf of the Pakistan National Eye Survey Study Group
  1. 1
    Pakistan Institute of Community Ophthalmology, Kyber Institute of Ophthalmic Medical Sciences, Peshawar, Pakistan
  2. 2
    International Centre for Eye Health, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
  1. Shaheen Shah, Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; shaheen.shah{at}


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.

  • cataract surgical coverage
  • barriers to eye care
  • pakistan
  • blindness
  • visual impairment

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  • Funding organisations: Sightsavers International; CBM; Fred Hollows Foundation; World Health Organization, Pakistan

  • Competing interests: None.

  • Abbreviations:

    Cataract surgical coverage


    cataract surgical rate


    North West Frontier Province


    World Health Organisation

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