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Wednesday, 3 April 2013

Improving the quality of life (QoL) of people with cataract

Globally, 45 million out of 314 million visually impaired people are blind and 90% of them live in low-income countries. Limited available data suggest that visual impairment (e.g., cataract and refractive errors) and eye diseases (e.g., presbyopia, conjunctivitis, corneal opacity etc.) affect up to 25% of the population in LICs at any point of time. According to the WHO, one adult goes blind every second, and one child becomes blind every minute. Visual impairment and eye diseases has a gender dimension as well: globally, two-thirds of the blind people are women. A higher mortality among the blinds has been observed, especially among the children. Blindness has also high financial costs to the governments globally: it is projected to rise to US$110 billion per year by 2020 from estimated annual cost of US$42 billion in 2000.

There is an intricate relationship between visual impairment such as blindness (e.g., due to cataract) and poverty (through interference with income and livelihood) and as such, has profound effects in achieving the MDGs. Empirical evidences exist for the blind people to be more income poor, unemployed, and excluded from services such as education and health care, and social safety nets. A direct link between eye health and poverty has also been observed in Kenya, Bangladesh and Philippines.

Correction of visual impairment with modern cataract surgery (including intraocular lens replacement) is safe and improves vision-related quality of life. However, due to a number of barriers such as lack of awareness, beliefs and perceptions about cataract, cost associated with surgery (even if the surgery itself is free), availability of and distance to service facilities, logistics of getting to the service delivery points, fear of surgery etc., and supply side barriers, may hamper the uptake of cataract surgery. The stigma often attached to blindness can mean that visually impaired people risk being ostracised or cast out of their communities, putting them at further risk. 

Bangladesh is estimated to have a prevalence of 1.53% and 4% bilateral blindness among adults ≥30 and children 5-15 years of age respectively. For people living in poverty in Bangladesh (31% of the people living below poverty line), the impact of blindness can be extremely serious.  It interferes with their income-earning activities in productive work and therefore supporting their families, and makes them vulnerable to different forms of discrimination and social exclusion.

Eighty percent of the blindness in Bangladesh is due to cataract. However, current cataract surgery coverage (CSC) can meet only one-third of the total needs of the country. As a signatory to the ‘Vision 2020: Right to sight’ campaign, Bangladesh is committed to eliminate avoidable blindness from the country by 2020. The ‘Vision Bangladesh Project’ is a joint venture of BRAC, Sight savers International and Government of Bangladesh is working to this goal. BRAC is responsible for demand creation for cataract services at the grassroots while Sight savers is responsible for supply side interventions such as cataract surgery. The latter are implemented through partnership with surgery facilities of the local NGOs and GoB. At the community level, BRAC’s frontline health workers conduct social mobilization for cataract care, outreach activities and screening for cases. Vision Bangladesh project is now working to eliminate cataract blindness from Sylhet by 2014. Later, this will be scaled up to the rest of the country.

Source: Strengthening eye health: a focus for health systems. Sightsavers Policy Briefing. Sightsavers International.

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