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Conquering world blindness

Ending cataract blindness is an essential and attainable goal. Roibeard Ó hÉineacháin reports

Roibeard O’hEineachain

Posted: Monday, February 1, 2021


Serge Resnikoff MD, PhD

Around half of the world’s blind population could have their vision restored if the necessary training and resources were made available for the elimination of blindness due to cataract, asserts Prof Serge Resnikoff MD, PhD, President and Chair of Organisation pour la Prévention de la Cécité (OPC), Paris, France.
“Keeping in mind that cataract accounts for between 40-to-50% of all causes of world blindness and the vast majority of preventable blindness, the priority is to do much more cataract surgery. That is where the fight has to take place,” Prof Resnikoff told the 38th Congress of the ESCRS.
He noted that if using a visual acuity of 3/60 as the threshold of clinical blindness, there are roughly 17 million people that are in urgent need of benefiting from cataract surgery. Lowering the threshold of visual disability to 3/18 raises that number to roughly 100 million. At present, only 20-to-25 million surgeries are performed worldwide.
The vast majority of people who are blind from cataract live in Asia, particularly in China, India, Southeast Asia and Oceania. These are places where most people live and where the ageing of the population is progressing at a very high rate.
Even in the high-income countries of Europe and North America, the ageing populations are leading to significant numbers of patients being blind due to cataract. Conversely, sub-Saharan Africa has a relatively small number of people in urgent need of cataract surgery because of its much younger population.
Quality as well as quantity
In addition to the need for an increased volume of surgeries is the need in many places for improvements in the quality of cataract surgery, Prof Resnikoff said. A recent review of cataract surgery outcomes in 19 mainly lower- and middle-income countries showed that 20-to-40% of patients had a postoperative visual acuity of less than 6/60, he reported.
Providing adequate quality cataract surgery will require significant investment in infrastructure, equipment, consumables and human resources, especially well-trained ophthalmic surgeons, he noted.
Prof Resnikoff maintained that conquering cataract blindness is not an over-ambitious goal. He noted that just as surgical techniques have improved, so has surgical training, making it much easier to quickly train surgeons to perform quality cataract surgery.
He also pointed to the example of trachoma, which was for centuries the world’s leading cause of blindness but which through a concerted global effort has now been virtually eliminated in all but a few countries.
Serge Resnikoff: serge.resnikoff@gmail.com