How do we stop the poor and isolated going blind from cataract?

Ahead of the course Global Blindness: Planning and Managing Eye Care Services, lead educator Dr Daksha Patel of the London School of Hygiene & Tropical Medicine discusses the major yet solvable problem of cataract blindness in low and middle-income countries.

Ahead of the course Global Blindness: Planning and Managing Eye Care Services, lead educator Dr Daksha Patel of the London School of Hygiene & Tropical Medicine, discusses the major yet solvable problem of cataract blindness in low and middle-income countries.

Blind woman spinning wool by hand in Taquile, Peru

A blind woman spinning wool by hand in Taquile, Peru. Photo by Thomas Quine on Flickr.

Cataract is a clouding of the lens in the eye, mostly linked with ageing, which impedes the passage of light and reduces the clarity of vision. Treatment involves a relatively simple procedure (in trained hands) to replace the clouded lens with an artificial intraocular lens (IOL). It is one of the most cost-effective medical interventions.

The unacceptable tragedy is that most of the blindness seen in low and middle-income countries is due to cataract. The proportion of blindness from cataract in people aged over 50 ranges from as low as 5% in developed countries to more than 50% in poor and remote areas of the world.

Is the solution more cataract surgery?

In a way, yes, but many low and middle-income countries must first overcome competing challenges in their health systems.

Limited health budgets are spent on infectious conditions and non-communicable diseases, which have higher mortality and morbidity. And there is an acute shortage of human resources for eye health. Some low-income countries have less than one ophthalmologist per million population, compared to over 100 ophthalmologists per million in many high-income countries.

In circumstances like these, specialist clinical knowledge and surgical skills in eye care will never be enough. In addition, public health approaches, to promote and provide targeted eye health care, are central to eliminating cataract blindness.

Success depends on building partnerships

Waiting for the blind patient to “find their way” to eye care services is the least effective model of eye care service.

Instead, delivery of eye care must be built on partnerships:

  • At the community level: to understand and address barriers to uptake of surgery
  • Through referral networks: by developing capacity within a health system, to support  patients and ensure they know when and where to go
  • With surgical teams: perhaps the only stage at which an eye specialist with surgical training is required. The multifunctional team at the hospital level, will manage and coordinate availability of appropriate infrastructure and technology.
  • Via training partnerships: for capacity building, to meet the eye health human resource shortage and strengthen long-yerm development in training for eye care.
  • Partnerships between governments, non-governmental organisations, charities and religious institutions: these are instrumental in supporting and strengthening an eye health system.

As the world population continues to grow and age, we need to balance our traditional clinical and surgical approach to cataract treatment with radical new ideas at a global and local level.

Learn more about cataract blindness

In our free online course, Global Blindness: Planning and Managing Eye Care Services, we will explore strategies to improve uptake of services and maximise utilisation of available human resources.

The course promotes a shift in thinking – going beyond the needs of a single patient in front of a clinician, towards eye health service provision at a population level.

You will discover the models of care provided through interesting case studies from India, Madagascar, Nigeria, Tanzania and Pakistan. The key lessons learnt from these settings are applicable globally in low and middle-income health systems, as well as in hard-to-reach population groups.

Discover more, join Global Blindness: Planning and Managing Eye Care Services now.

Category Healthcare

Comments (21)

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  • Elizabeth van Heyningen

    This has to be one of the most critical issues for the elderly. I come from an affluent society in Africa where most of us ‘blue eyes’ have been exposed to a lot of sun. I am 74 and almost everyone of my generation, class and ‘race’ have had cataract operations. I bless the the ophthalmologists daily. However, that is beside the point. I know, as an historian, working on the records of Dr Fitzgerald of the King William’s Town ‘Native’ Hospital in the 1850s-1860s, cataracts were a concern even then. He was praised for his work as an ophthalmologist and especially for his cataract operations. Presumably he restored light, if not sight – but the point is that his patients were local Xhosa, so this is not a change (surely not a disease) not confined to the light eyed. In my view cataract operations are one of the great advances in medicine and, if I knew how to fund it for those who do not have that wonderful assistance, absolutely I would.
    Elizabeth van Heyningen

  • Mary Braybrooke

    We too in Britain are trying to increase the role of optometrists as with an ageing population we are trying to localise minor eye problems. We are in a privileged position compared with many countries but our Health service is in deep financial trouble.

  • Pankaj tiwari

    Instead of ophthalmologist, optometrist are also qualified enough to differentiate diseases, treatment, counselling.
    So if alone optometrist and Optitian with 2 social worker eye screening camp easily carried out and sight threatening eye disease were prevented.
    Topic will be
    What are the permission requires to organise eye screening camp in rural areas of india specially in uttar pradesh and all over the world make a role for optometrist in community as an independent eye care consultant who differentiate population which is the main target for iabp and vision 20 20 initiative but
    Make simple Terms and conditions for NGO’S to organise eye screening camp in rural areas with permission and presence of registered and qualified optometrist with latest cheapest arclight ophthalmoscope and peek retina adapter.
    Practically eye community programme will be easy and cover all parts of world.

    • Elizabeth van Heyningen

      Of course there are things one can do to assist loss of sight. But cataracts are especially (I’m 74) one of the creeping changes of age. I’m a patient, not a doctor, but I am aware of what happens to sight as one ages. The other problem is macular degeneration and that is much more intractable. The cataract operation is relatively simple but, of course, it demands great skill on the part of the surgeon and the manufacture of the lenses. This is not primary health care, and it’s expensive but the value is enormous. Hard to finance but so worthwhile!

  • Pankaj tiwari

    Great news we are very much interested in it but please include a topic ” role of optometrist ” and their role in eye checkup an screening camp because there are large no of optometrist in these countries they are jobless if they will get arclight or peek retinal adapter for eye screening in rural areas of india specially in uttar pradesh blindness will be cured 100% optometrist are primary eye care ophthalmic consultant they can easily detect and categories the patients to related treatment in screening and images and report will be e-mail to the ophthalmologist for further opinion.
    Ophthalmologist are too expensive and busy if optometrist can screen people’s in community and send report to hospital for further reference critical management’s are easily turned out into a great outcome of vision.
    If optometrist organise eye screening camp in rural areas of india specially in uttar pradesh where never camp organised and thousands are suffering from visual impairment, ctaract, glaucoma, presbyopia, etc. Ophthalmologist are busy in hospitals optometrist can help in community with manpower and services which are the basic need in ngo for social development in eye care.

  • Ndawona Master Chisale

    I would like to congratulate the team for administering this course on line i hope and believe that at the end of this, new knowledge will be gain so that we can use in our working facilities as health worker working to combat avoidable blindness in our country. Ndawona Master chisale – Malawi

  • de Montaxel

    A simple cure of Eye related diseases is made available to the sub-Saharan Africa, unfortunately we have to sale it the less privileged and the most affected by this syndrome for a subsidized amount of US$ 7, If we want to achieve the 2020 goal we have to put our act together.
    Doctor Patel, I will be glad to send you some of this capsules for your perusal, it works on any individual.
    I will give a link of testimonials of African patients if permitted.

  • moses makoi

    Blindness is a global problems

  • Vincent

    I totally agree with Dr Patel, in poor countries like here in Malawi, the government does not care about eyes condtions, as they care about Malaria. The hospitals do not have essential eye drugs, lack of equipments and lack of human resourses. We have many people who have cataracts, but there is no help

  • Madalo Mtsinje

    Cataract is indeed one of themajor courses of blindness in elderly population in Malawi and other countries in the world.I agree with Dr.Patel that the bigger challenge in the developing countries is lucky of human resources, lucky of information on eye health care in the community ,lucky of resources andpartnership between government and chrstian organisation in providing care.

  • Mavi Rondaris

    I agree with Dr. Patel in saying that the success of any eye health program is in partnerships. Also, I think the bigger challenge with these partnerships is keeping the transparency between stakeholders and the community they serve, as well as upholding ethical conduct of the service provider as they keep their ultimate goal to serve the community’s eye health needs and not primarily for financial gain.

  • Ogiemudia O. McHillary O.D.

    My opinion is in Public Private Partnership as an important strategy to the management of blindness and visual impairment in the low- and middle-incoming countries.
    Gratitude to all those behind this arrangement for free Online training of eye care personnel.

  • Basilio Martins Pinto, MPH

    Timor is a tiny country, with 1 million population. However, limited trained Eye Care Workers, compiting programs in term of policies and decision making priority, the focus is more to infection diseases control, MMR is high, Malnutrition. Therefore, we have to work on advocay, awarness, obviously with evidence based informed policy and decision making on eye problems, followed by enough funding for HR training on eye care personals and services delivry at community level and strengthening secondary services and referal system! Think Globally and act locally!

  • Dr Narendra Kumar

    A nice post on cataract – the commonest cause of curable blindness in India and several other countries – and on the need for mass eradication of this malady – Editor, Optometry Today

  • CHRISTIAN TETTEH DUAMOR

    I would like to put eye care services in the perspectives of primary health care, it must be available, accessible, affordable and acceptable by target population. so, we need to shape eye care service seeking behaviours at the community level. In many settings, this will just be the beginning, so we need to employ strategies like the use of Community Drug Distributors (CDDs) by the CDTI programme, where these community health workers (CDDs) are trained to mount regular surveillance through screening and refer cases to the nearest ophthalmologist. Clearly, this will also call for strategic placement of eye care personnel and infrastructure; in many low and middle-income settings these professionals prefer to work in city centers. I think eye service managers should open up and governments must also be willing to commit the requisite resources.

  • ahlam

    eyes care must be start from child

  • Dr. Rasi

    I think strong partnership is important to the management of blindness in the low and middle incoming countries. thanks Dr. Pattel

  • Grace wachira

    Concur with him for that is exactly where we are in my work station

  • Mathew Mbwogge

    I strongly adhere to Dr, Daksha’s pertinent points raised herein. Also thanking him for this course that will be a real professional uplift for many folks. Talking about low and middle income countries where the average income is very low but at the same time privates health expenses are mostly out-of-pocket, emphasis need to be placed on service quality and developing a population based program rather than a hospital based program. In these countries not only is one likely to find a single ophthalmologist per million of people but the very few become congested in the cities and big towns where living conditions are well-off.
    Contemplating on how the rejected, isolated, abandoned, underprivileged can be encouraged towards the uptake of eye care will also strongly have to do like I said earlier on with “community ophthalmology”, whereby the patient through constant eye camps feels the presence of the ophthalmologist or eye care services. Feeling the presence of theses services will also mean that they will not have to move long to attain the hospital. This warrants that the hospital itself be a “community one”

  • ambe emelda ateh

    this is just a true picture of the eye setting in which i work.this enrich me.

  • Ngwayi Denis Nyanchi

    All the points are very true in my setting.The discussion is as if it is focused on my center.