AI Insight
This study combined a population-based eye health survey of 3,867 people aged 50 and older with a new Health System Module to assess both eye disease prevalence and healthcare capacity in a defined catchment area in India. The research found that 2.2% of participants had blindness and 29.5% had visual impairment, with unoperated cataracts causing 76.5% of blindness and uncorrected refractive error causing 79.2% of mild impairment. Despite the region performing 7,165 cataract surgeries per million people annually, an estimated 41,165 individuals still had vision loss from cataracts, revealing significant gaps between service provision and population need.
Why it matters
This integrated assessment approach provides a more complete picture for planning eye care services by linking population needs with actual healthcare system capacity. The study revealed critical data collection gaps across providers and demonstrated that even when surgical rates exceed national averages, substantial unmet need persists, highlighting the importance of monitoring effective coverage rather than just service volume.
Understand the Science
by Shalinder Sabherwal, Ian McCormick, Mohd Javed, Jacqueline Ramke, Shamanna B. R, Sandeep Buttan, Atanu Majumdar, Pushkar Silwal, Simrat Chandi, Basitali Lakhani, Shreya Tyagi, Utsav Deep, Vaibhav Jain, Andrew Bastawrous
Background
Planning eye care services often relies on either population need or facility capability, but seldom both. We provide a complete catchment-level assessment by integrating Rapid Assessment of Avoidable Blindness epidemiological estimates with the new Health System Module..
Methods
A population-based survey using the Rapid Assessment of Avoidable Blindness, including a diabetic retinopathy module, was conducted in a defined service area of a surgical centre and its affiliated vision centres. The Health System Module captured cataract, refractive, and diabetic retinopathy service availability and data quality across all major providers.
Results
Of the 4,095 participants enumerated, aged 50 and older, 3,867 (94.4%) were examined. The age- and sex-adjusted prevalence of blindness was 2.2%, higher in women (2.8%) than men (1.6%) (p < 0.001), while visual impairment affected 29.5%. Unoperated cataract accounted for 76.5% of blindness, 84.3% of severe, and 54.7% of moderate impairment; uncorrected refractive error caused 79.2% of mild impairment. Cataract surgical coverage was 59.6% at 6/12 and 70.3% at 6/18, with a 36.6% quality gap. A higher proportion of operated patients had a good outcome (74.4%) when surgery was performed within 2 years, compared with 57.0% when performed earlier (p < 0.0001). Distance refractive error coverage was 14.0%, lower among women (9.5%) than men (19.5%) (p < 0.001). Of the 14 providers, data on cataract surgeries were available from 12, on glasses from four, on visual acuity before and after surgery from one, and on DR services from none. Combined RAAB and Health System Module results showed that although the cataract surgical rate of 7,165 surgeries per million people annually exceeded the national average, an estimated 41,165 individuals had blindness or visual impairment from cataract in both eyes.
Conclusion
Integrating RAAB with a structured health system assessment enabled a unique, comprehensive situational analysis linking epidemiological needs with service capacity. It also highlighted data gaps, feasibility and operational limitations regarding data for cataract, refractive, and diabetic retinopathy services in the region. This model can guide regional planning and strengthen monitoring of effective coverage. However, challenges in data collection can reduce the programmatic utility of the Health System Module.