Improving cataract services in the Indian context

In many countries, the number of cataract operations performed is inadequate to deal even with the people who have newly become blind from cataract, let alone those who are already blind or visually impaired. There is, therefore, a backlog of cases needing surgery. This could be due to low surgical capacity (people are on a waiting list) or to a lack of demand for cataract surgery (people haven’t come forward for the services they need and there is therefore no waiting list). India has been very successful in raising its cataract surgical rate (the number of operations per million people, per year), from just over 700 in 1981, to 6,000 in 2012.1,2 This is much closer to the estimated cataract surgical rate of 8,000 –8,700 needed to eliminate blindness due to cataract in India.3 Much of this is the result of increased efficiency, with surgeons being able to perform twenty operations per day thanks to innovations in surgical technique, good team work with appropriate staffing levels, use of day case surgery, and improvements in operating theatre design.4 In order that people can come for surgery in large numbers, however, demand for cataract surgery must be created in the community. This means that: