Global and Indian Challenges in Treating Cataract
The greatest challenge in treating cataracts globally and in India remains the growing 'backlog' of patients with cataract blindness in developing regions due to lack of access to affordable surgery, with universal health coverage being the main solution to make quality cataract services accessible to all. 1
Global Challenges in Cataract Treatment
Epidemiological Burden
- Cataract is the leading cause of reversible blindness and visual impairment globally 2
- 94 million people are blind or visually impaired globally, with cataract being the most common cause 1
- Blindness from cataract is more common in populations with low socioeconomic status and in developing countries 2
Access to Care Challenges
- Insufficient number of ophthalmologists to meet global demand 3
- Growing backlog of patients with cataract blindness in developing regions 2
- Training of cataract surgeons does not keep pace with increasing demand associated with aging populations 2
- Global inequity in surgical service quality remains a significant limitation 1
Economic Barriers
- Cost of surgery remains a significant barrier in many regions 3
- Low government funding for eye care services in many countries 3
- Insufficient eye care infrastructure in developing regions 3
India-Specific Challenges and Progress
Historical Context and Progress
- India performed approximately 0.5 million cataract surgeries in 1981-1982, which increased dramatically to 4.8 million in 2006 4
- Intraocular lens acceptance has improved significantly to 90% by 2006 4
- Surgical techniques have evolved from sutured extracapsular cataract surgery to small-incision cataract surgery 4
Unique Indian Solutions
- Development of low-cost indigenous eye-care consumables 4
- Evolution of the Indian intraocular lens industry from low-cost manufacturing to quality-conscious, technology-driven production 4
- Implementation of innovative service delivery models like the Aravind Eye Hospital model, which uses screening eye camps and resident hospitals to provide high-volume, cost-effective cataract surgery 5
Persistent Challenges in India
- Urban-rural divide in surgical techniques (phacoemulsification with foldable lenses in urban settings vs. manual small-incision cataract surgery in rural areas) 4
- Need for continued infrastructure development and enhanced training 4
- Ensuring consistent quality of surgical outcomes across diverse healthcare settings 1
Technological and Clinical Considerations
Surgical Techniques
- Phacoemulsification is the gold standard in developed countries 2
- Manual small-incision cataract surgery is frequently used in developing countries including India 2
- Femtosecond laser-assisted cataract surgery is an emerging technology, though initial data show no superiority over current techniques 2
Quality Improvement Strategies
- Implementation of preoperative risk assessment and risk reduction strategies 1
- New surgical technologies have made cataract surgery possible at earlier stages of cataract severity 1
- Recent development of simulators for training ophthalmologists in manual small-incision cataract surgery 3
Path Forward
- Focus efforts and resources on developing models for efficient delivery of cataract surgical services in underserved regions 2
- Invest in eye care infrastructure and training of additional ophthalmologists 3
- Implement universal health coverage to make quality cataract services accessible to all 1
- Continue developing cost-effective surgical techniques and locally manufactured supplies 4
- Expand successful models like screening eye camps that overcome barriers to adequate eye care 5