95 million people worldwide are affected by blindness or severe visual impairment due to cataracts according to the WHO. Nearly 90% of the world’s blind live in the poorest countries in the world. Cataracts in particular are disproportionately prevalent in low-and-middle-income countries, where they account for 50% of all blindness, compared to just 5% of blindness in the West. The truth is that cataracts are not that difficult or even expensive to cure when people have access to affordable eye care.
Unfortunately, most people do not.
The impact is that millions of people worldwide live with blindness despite the fact that they could be easily cured. At a recent microsurgical outreach camp of the Tej Kohli & Ruit Foundation in Nepal, in April 2021, one patient was 14-year-old Bipani Rai, who lives in a remote village in the foothills of the Himalayas.
Bipani was born visually impaired with cataracts in both eyes. When her family brought her to an outreach camp by the Tej Kohli & Ruit Foundation that was happening near their village, they didn’t know what to expect or whether they would get help. Bipani was immediately selected for surgery and just one day later after surgery, her bandages were removed, and she could see properly for the first time in her life.
Two things about this are illuminating. The first is that a child had been living with blindness for 14 years because her family has resided to the notion that there was simply no prospect of them obtaining treatment. The second is that stories like this are not rare. Young people like Bipani are literally ‘out of sight’ for the overwhelming majority of people in the West, and so we assume that such cases do not exist in volume. Except they do.
The socio-economic effect of cataract surgery is substantial. It allows people to increase their economic productivity by up to 1,500% of the cost of the surgery during the first postoperative year. This return is empirically proven but is also self-evident since most who go blind with cataracts are disenfranchised from work or education. In the case of Bipani, she is looking forward to studying and living the life of a normal 14-year-old.
Curing a person of cataracts has a socioeconomic ‘ripple effect’ that positively impacts whole families in poor communities and has a particular impact on the empowerment of women and girls. The responsibility for caring for families who are blind typically falls upon girls, which disenfranchises them from education. Without education or independence, many girls and condemned into the cycle of poverty that causes needless blindness.
There is also gender inequality in cataract surgical coverage in poorer countries. Studies show that men are more likely to receive treatment than women. But when micro-surgical outreach camps select patients for free surgery based on need rather than gender, women in poor communities get empowered. This is reliably and statistically proven to be one of the biggest catalysts for reducing extreme poverty.
For the past two decades, the prevalence of cataracts has been declining worldwide as rates of cataract surgery have increased because of the improved techniques and active surgical initiatives. Most cataract patients are now able to have their surgery as a day-case procedure in eyecare ‘camps’ created by organisations like the Tej Kohli & Ruit Foundation.
But population growth and increased longevity mean that even as the incidence of cataracts has fallen, the total number of people with cataracts has grown, especially in low-and-middle-income countries. But to ‘solve’ needless blindness and recoup the subsequent reductions in extreme poverty, what is needed is a global health policy ‘for the masses’ that seeks to develop infrastructure, personnel, and strategies to provide eye care for all.