Cataract top cause of blindness in India, finds survey

Cataract is the leading cause of blindness in people above 50 years, according to the National Blindness and Visual Impairment Survey India 2015-19. The condition is behind 66.2 per cent blindness cases, 80.7 per cent severe visual impairment cases and 70.2 per cent moderate visual impairment cases in the age group.

And these could have been avoided — around 93 per cent of blindness cases and 96.2 per cent of visual impairment cases in this age group were avoidable. Of all the avoidable causes, more than half were treatable, found the survey.

The survey was conducted by Dr Rajendra Prasad Centre for Opthalmic Sciences, All India Institute of Medical Sciences, New Delhi, at the behest of Union Ministry of Health and Family Welfare. The survey was conducted in 31 districts of 24 states and the results were extrapolated for the entire country.

India was the first country to launch the National Programme for Control of Blindness in 1976 to reduce blindness prevalence to 0.3 per cent by 2020. But, the estimated prevalence of blindness still stands at 1.99 per cent, severe visual impairment at 1.96 per cent, moderate visual impairment at 9.81 per cent and moderate severe visual impairment at 11.77 per cent, according to the survey released on October 10, 2019. 

Bijnor in Uttar Pradesh has the highest population suffering from blindness (3.67 per cent) and visual impairment (21.82 per cent), found the survey. It was followed by Warangal and Nalbari with difference of less than one per cent point.

Also, blindness is more pronounced among illiterates (3.23 per cent) than literates (0.43 per cent) and more prevalent in rural population (2.14 per cent) than urban (1.80 per cent), found the AIIMS survey.

Untreated not the only cause

Cataract-related surgical complications was the second-highest causable factor for blindness with 7.2 per cent cases in people above 50 years, showed the survey. Other causes included infectious and non-infectious corneal opacity (scarring of cornea), glaucoma and aphakia (absense of lens in the eye).

Also, refractive errors (near or far sightedness) was found to be responsible for 70.6 per cases of early visual impairment.

The coverage of cataract surgery among blinds was 93.2 per cent in men and 91.9 per cent in women aged above 50, found the survey. An earlier AIIMS research had also pointed out several reasons why women are 69 per cent more at risk of developing cataract.

Among the visually impaired, this coverage was 74 per cent, it added.

Around 40 per cent of cataract surgeries were performed in government facilities, while the rest took place in private or non-profit facilities. But, of all the operations, 57.8 per cent cases saw very good visual outcome, while the rest were good, borderline or even poor, found the report.

“Most important reasons for poor outcome were other co-morbidities and operative complications. Borderline visual outcome was due to refractive error and operative complications,” the report added.

Cost, a barrier

Cost was the biggest barrier in accessing a cataract surgery. It was the reason for 22.1 per cent blindness cases and lack of awareness was behind 18.4 per cent cases, who did not feel any need of the surgery, according to the report.

The World Vision Report released by the World Health Organization (WHO) on October 8, 2019 also pointed out that high costs involved in accessing eye care, especially, for rural populations was a major driver of visual impairment. It called for expansion of Universal Healthcare Coverage and including eye care services in it.

In population below 50 years, the prevalence of blindness was 0.52 per cent as against the target of 0.3 to be achieved by 2020. The proportion of female cases was more and the major cause of visual impairment in them was found to be refractive errors.

There’s a silver lining though.

The prevalence of blindness in population above 50 years dropped to 1.99 per cent in 2018 from 5.3 per cent in 2001. Visual impairment also reduced to 13.73 per cent in 2018 from 32.1 per cent in 2001.

India has successfully met the WHO target of 25 per cent reduction from 2014-19 in visual impairment from the baseline level of 2010, the survey found.

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