Effective Cataract Surgical Coverage

Background

Effective cataract surgical coverage (eCSC) measures the number of people in a population who have been operated on for cataract, and had a good outcome, as a proportion of all people operated on or requiring surgery. Therefore, eCSC describes service access (ie, cataract surgical coverage, [CSC]) adjusted for quality. In 2021, Member States at the 74th World Health Assembly endorsed a global target for eCSC of a 30-percentage point increase by 2030. We analysed Rapid Assessment of Avoidable Blindness (RAAB) survey data to generate new estimates of eCSC and CSC establish a reference point to start monitoring progress towards the 2030 target.

The Research

We used data from 148 RAAB surveys undertaken in 55 countries (between 2003 and 2021) to calculate eCSC, CSC, and the relative quality gap (% difference between eCSC and CSC). We compared median eCSC between WHO regions and World Bank income strata and calculated the pooled risk difference and risk ratio comparing eCSC in men and women. Almost all the data included in the analysis is available open access via the RAAB repository (www.raab.world). In addition, we presented a minor update to the method of calculating CSC/eCSC from survey data.

Findings

We found a wide range of eCSC estimates, ranging from 3·8% (95% CI 2·1–5·5) in Guinea Bissau, 2010, to 70·3% (95% CI 65·8–74·9) in Hungary, 2015, and the relative quality gap from 10·8% (CSC: 65·7%, eCSC: 58·6%) in Argentina, 2013, to 73·4% (CSC: 14·3%, eCSC: 3·8%) in Guinea Bissau, 2010. Median eCSC was highest among high-income countries (60·5% [IQR 55·6–65·4]; n=2 surveys; 2011–15) and lowest among low-income countries (14·8%; [IQR 8·3–20·7]; n=14 surveys; 2005–21). eCSC was higher in men than women (148 studies pooled risk difference 3·2% [95% CI 2·3–4·1] and pooled risk ratio of 1·20 [95% CI 1·15–1·25]).

Acknowledgements and funding

The RAAB project is funded by Indigo Trust and Peek Vision. Matthew Burton and Andrew Bastawrous are supported by the Wellcome Trust.

Publications

McCormick I, Butcher R, Evans JR, et al. Effective cataract surgical coverage in adults aged 50 years and older: estimates from population-based surveys in 55 countries. The Lancet Global Health 2022; 10, e1744-53. https://doi.org/10.1016/S2214-109X(22)00419-3

Associated resources

WHO Report of the 2030 targets on effective coverage of eye care

https://www.who.int/publications/i/item/9789240058002