Rapid Assessment of Cataract Surgical Services (RACSS) in District Narowal - Punjab (Pakistan).

Ismatullah Chaudhry


Aim:  A population based cross sectional rapid assessment of cataract surgical services in the District of Narowal-Punjab,Pakistan. Methods:  Systematic cluster random sampling methodology was used to enumerate a cross sectional sample of 2000 people living in the district of Narowal in 40 clusters, aged 50 yrs or older. Eligible subjects were examined through a door-to-door survey in the mid of 2003. Presenting visual acuity as well as with pinhole was measured and ocular examination was performed. The principal cause of blindness or low vision was identified for eyes as well as persons with presenting visual acuity of less than 6/18. Subjects found with cataract were asked why they had not sought medical attention so far. Results:  A total of 1950 persons out of the sample of 2000 could be examined (97.50%). The bilateral blindness prevalence of 3.44% with 2.31% cataract blindness (72.4% of blindness) with best corrected VA<3/60) was found in the sample. Visual impairment 9.59% and severe visual impairment (including blindness) was 6.36%. Cataract surgical coverage for persons was 78.77% while for eyes it was 58.33%. Presenting Visual outcome of cataract surgeries was good in 53.87% eyes, fair in 15.18%, poor in 17.26% and was found blindness in 13.69%. But with best correction, good 61.61%, fair18.15% and poor in 20.24% of operated eyes. Pseudophakia was found in 1/3rd of cataract surgeries (30.36%) and aphakia in 2/3rd. Non-affordability, lack of cataract services and no company was the major barrier found to take up the cataract surgery in needlessly cataract blind persons. Conclusion: Treatable blindness, particularly that associated with cataract and refractive error, remains a significant problem among older adults in district Narowal and needs an effective cataract intervention with free cataract outreach activities. While continuing to increase surgical volume to reduce blindness, emphasis must also be placed on IOL surgeries and improving postoperative visual acuity outcomes.