“Cataract targets to be missed while millions die untreated” is not the headline we hoped to glean from new analysis led by the International Centre for Eye Health (ICEH). But, from our experience working for international development organization Sightsavers across Africa and Asia, we were not unduly surprised by the findings.
At the 2021 World Health Assembly, global leaders committed to increasing effective coverage of cataract surgery by 30 percentage points by 2030. But the ICEH research predicts that progress will fall short: only an 8.4 percentage points increase is predicted globally, with Africa being predicted to increase coverage by only 4 percentage points between 2020 and 2030. In a slightly better position, South-East Asia is predicted to see a 13.7 percentage points increase, but this still falls far short of the World Health Assembly’s 30 percentage points target.
Despite being treatable with simple, cost-effective surgery, cataracts still remain the world’s leading cause of blindness. The ICEH estimates that in 2025, one in two people globally who needed cataract surgery couldn’t access it. In Africa, this figure increased to three in every four people.
These bleak figures reflect what we see on the ground. Persistent barriers to accessing cataract surgery, gender inequities, and variations in outcome quality all mirror the realities faced by many of the communities we work with in Africa and Asia. A shortage of ophthalmologists and other eye care professionals, as well as lack of health equipment, medicine, and consumables only exacerbates this already dire situation.
The barriers highlighted above don’t necessarily affect everyone equally. In our work, we see that women remain disproportionately underserved in ophthalmology. This healthcare inequity is reflected in the ICEH paper. In Africa, it is estimated that effective cataract surgical coverage will increase by 3.6 percentage points for women by 2030, compared to 4.4 percentage points for men. While the difference is not statistically significant elsewhere, the research shows gender inequity remains in most regions.
We all know the impact falling short on effective cataract surgery coverage will have for individuals, communities, and society. In Africa and Asia particularly, vision loss and visual impairment can reduce social, economic, and educational participation, impact quality of life, and trap millions in a cycle of poverty. Indeed, research from the IAPB, Seva Foundation, and Fred Hollows Foundation estimated that addressing preventable vision impairment in low- and middle-income countries could boost economies by millions – or even billions in some cases.
There are places that can act as models of good practice such as India, Malaysia, and Rwanda. The work those areas are doing to improve outcomes and services aligns closely with the progress we observe when governments and health professionals invest in eye care services.
Sightsavers is working with ministries of health and other partners in Africa and Asia to accelerate progress toward the global cataract target. This includes supporting integration of eye care into health systems, strengthening referral pathways, health professional training, provision of equipment and supplies, expanding access for underserved communities, and increasing awareness of the services already available. We also conduct our own research and collaborate with partners on sector papers, including this ICEH analysis.
Since the World Health Assembly’s target was set, we’ve seen steady – if uneven – progress in global cataract surgery coverage. Many countries have expanded their surgical capacity, improved referral pathways, and placed greater emphasis on surgical quality as a result of the target. And we have seen that when countries invest in training, equipment, and equitable outreach, improvement in cataract surgery coverage can be achievable, even in resource-constrained settings.
For example, in the Koulikoro region of Mali, we measured a 50% reduction in the prevalence of blindness and a large increase in effective cataract surgical coverage. Coverage among women is increasing at a faster rate than among men, which shows that it is indeed possible to close the gender gap. And in Nampula in Mozambique, we also saw an improvement in post-surgical outcomes after the introduction of optical biometry.
Governments can significantly contribute to reducing the burden of cataracts by strengthening primary eye care systems, expanding equitable access to surgery, and investing in workforce development. Tangible change can be made by prioritizing access to cataract care within national health plans, allocating funding for surgical services, and increasing community-based screening. Policies that subsidize surgery, reduce out-of-pocket costs, and support outreach in remote areas are critical to reaching underserved populations.
Ophthalmologists and other health professionals also have an important role to play through adopting high volume and high quality surgical models, strengthening their referral pathways, and participating in ongoing training. Creating partnerships with NGOs and local communities can also help to boost awareness, early detection, and follow-up care.
Individuals we encounter during our work help to highlight the impact that quality cataract surgery can have on a person’s life. For instance, take Aziza in Mozambique – Aziza had to give up her farming duties due to cataracts, relying on her family to cook for her, as well as support her with personal hygiene, eating, and drinking. Now, thanks to cataract surgery provided by a Sightsavers-supported project, Aziza has her independence back. She can take care of herself, sell beans to earn a living, and do household chores. Reflecting on how she felt after surgery, Aziza remarked: “I was starting to dance right at the hospital when I saw that I was already seeing everything around me…Now I can see everything perfectly.”
Embedding strong eye care initiatives within our national systems will lead to more people like Aziza being able to access timely life-changing surgery, and build long-term, sustainable change in cataract services around the world. To our peers in Africa and Asia, we say “Don’t give up!” Hope remains, and we can transform lives, communities, and nations through improving access to cataract surgery.
Emma Jolley and Sumrana Yasmin are, respectively, a co-author and study group member for the cataract surgical coverage estimates research led by the International Centre for Eye Health.
At the 2021 World Health Assembly, global leaders committed to increasing effective coverage of cataract surgery by 30 percentage points by 2030. But the ICEH research predicts that progress will fall short: only an 8.4 percentage points increase is predicted globally, with Africa being predicted to increase coverage by only 4 percentage points between 2020 and 2030. In a slightly better position, South-East Asia is predicted to see a 13.7 percentage points increase, but this still falls far short of the World Health Assembly’s 30 percentage points target.
Despite being treatable with simple, cost-effective surgery, cataracts still remain the world’s leading cause of blindness. The ICEH estimates that in 2025, one in two people globally who needed cataract surgery couldn’t access it. In Africa, this figure increased to three in every four people.
These bleak figures reflect what we see on the ground. Persistent barriers to accessing cataract surgery, gender inequities, and variations in outcome quality all mirror the realities faced by many of the communities we work with in Africa and Asia. A shortage of ophthalmologists and other eye care professionals, as well as lack of health equipment, medicine, and consumables only exacerbates this already dire situation.
The barriers highlighted above don’t necessarily affect everyone equally. In our work, we see that women remain disproportionately underserved in ophthalmology. This healthcare inequity is reflected in the ICEH paper. In Africa, it is estimated that effective cataract surgical coverage will increase by 3.6 percentage points for women by 2030, compared to 4.4 percentage points for men. While the difference is not statistically significant elsewhere, the research shows gender inequity remains in most regions.
We all know the impact falling short on effective cataract surgery coverage will have for individuals, communities, and society. In Africa and Asia particularly, vision loss and visual impairment can reduce social, economic, and educational participation, impact quality of life, and trap millions in a cycle of poverty. Indeed, research from the IAPB, Seva Foundation, and Fred Hollows Foundation estimated that addressing preventable vision impairment in low- and middle-income countries could boost economies by millions – or even billions in some cases.
There are places that can act as models of good practice such as India, Malaysia, and Rwanda. The work those areas are doing to improve outcomes and services aligns closely with the progress we observe when governments and health professionals invest in eye care services.
Sightsavers is working with ministries of health and other partners in Africa and Asia to accelerate progress toward the global cataract target. This includes supporting integration of eye care into health systems, strengthening referral pathways, health professional training, provision of equipment and supplies, expanding access for underserved communities, and increasing awareness of the services already available. We also conduct our own research and collaborate with partners on sector papers, including this ICEH analysis.
Since the World Health Assembly’s target was set, we’ve seen steady – if uneven – progress in global cataract surgery coverage. Many countries have expanded their surgical capacity, improved referral pathways, and placed greater emphasis on surgical quality as a result of the target. And we have seen that when countries invest in training, equipment, and equitable outreach, improvement in cataract surgery coverage can be achievable, even in resource-constrained settings.
For example, in the Koulikoro region of Mali, we measured a 50% reduction in the prevalence of blindness and a large increase in effective cataract surgical coverage. Coverage among women is increasing at a faster rate than among men, which shows that it is indeed possible to close the gender gap. And in Nampula in Mozambique, we also saw an improvement in post-surgical outcomes after the introduction of optical biometry.
Governments can significantly contribute to reducing the burden of cataracts by strengthening primary eye care systems, expanding equitable access to surgery, and investing in workforce development. Tangible change can be made by prioritizing access to cataract care within national health plans, allocating funding for surgical services, and increasing community-based screening. Policies that subsidize surgery, reduce out-of-pocket costs, and support outreach in remote areas are critical to reaching underserved populations.
Ophthalmologists and other health professionals also have an important role to play through adopting high volume and high quality surgical models, strengthening their referral pathways, and participating in ongoing training. Creating partnerships with NGOs and local communities can also help to boost awareness, early detection, and follow-up care.
Individuals we encounter during our work help to highlight the impact that quality cataract surgery can have on a person’s life. For instance, take Aziza in Mozambique – Aziza had to give up her farming duties due to cataracts, relying on her family to cook for her, as well as support her with personal hygiene, eating, and drinking. Now, thanks to cataract surgery provided by a Sightsavers-supported project, Aziza has her independence back. She can take care of herself, sell beans to earn a living, and do household chores. Reflecting on how she felt after surgery, Aziza remarked: “I was starting to dance right at the hospital when I saw that I was already seeing everything around me…Now I can see everything perfectly.”
Embedding strong eye care initiatives within our national systems will lead to more people like Aziza being able to access timely life-changing surgery, and build long-term, sustainable change in cataract services around the world. To our peers in Africa and Asia, we say “Don’t give up!” Hope remains, and we can transform lives, communities, and nations through improving access to cataract surgery.
Emma Jolley and Sumrana Yasmin are, respectively, a co-author and study group member for the cataract surgical coverage estimates research led by the International Centre for Eye Health.
