Effective cataract surgical coverage study published

Effective cataract surgical coverage study published

The RAAB team at the International Centre for Eye Health have led the most extensive analysis of RAAB repository survey data to date. Estimates of effective cataract surgical coverage were calculated from 148 RAABs done in 55 different countries between 2003 and 2021. The findings have been published in The Lancet Global Health and the analysis provided the data for WHO’s Report of the 2030 targets on effective coverage of eyecare.

What is effective cataract surgical coverage?

Cataract is the leading cause of blindness globally and typically the main cause of blindness found in RAAB surveys. Effective cataract surgical coverage (eCSC) is a cataract service indicator that measures the number of people who have received good quality cataract surgery as a proportion of all people having received surgery or still requiring it. eCSC measures the coverage of cataract services in a population, corrected for quality. Quality is measured in terms of post-operative presenting visual acuity.

Why is it important to measure?

eCSC allows eye care planners to assess the coverage and quality of services for a leading cause of vision impairment in the population aged 50 years and older. Low eCSC in an area should prompt providers to consider both aspects of cataract care–access and quality–to improve services. Further, RAAB results show eCSC disaggregated by sex (and optionally disability status) to enable monitoring disparities of service provision. In this way, eCSC is an important indicator of eye health within universal health coverage, which promotes access to affordable, quality health care for all people everywhere. eCSC is one of thirteen core indicators in WHO’s new 2022 Eye care indicator menu.

What did the analysis find?

There was considerable variation in eCSC by country, with 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. Countries in high-income settings had the highest eCSC and low-income countries the lowest, reflecting a gradient of available resources and subsequent cataract output. On average, eCSC was 3.2% (95% CI 2.3–4.1) higher in men than women.

What’s next?

In 2021, Member States at the World Health Assembly endorsed a global target for 2030: to improve eCSC by 30 percentage points. More available data supports the case for eCSC to be included in broader universal health coverage and sustainable development goal frameworks. There are considerable eye health data gaps around the world, with several countries and regions with no or very limited eCSC data. We encourage all organisations with RAAB survey data to make it available open access via this repository so we can include it in subsequent analyses. ICEH will contact survey Principal Investigators to make this invitation to share data, join the RAAB International Co-author Group and help raise the profile of eye health on the global agenda.

Figure showing country estimates of eCSC and CSC

Cataract surgical threshold of less than 6/18 and 6/18 threshold for a good outcome. CSC=cataract surgical coverage. eCSC=effective cataract surgical coverage.