STRATEGIC ISSUES IN PREVENTING CATARACT BLINDNESS IN DEVELOPING-COUNTRIES

Cataract blindness is a public health problem of major proportions in developing countries. intracapsular cataract extraction with aphakic s pectacles has been the standard surgical technique for restoring sight . Because of image magnification in the operated eye, however, the res ult in unilaterally blind patients is less than satisfactory. Fortunat ely, with the availability of low-cost intraocular lenses (IOL) and op hthalmologists trained in extracapsular surgery, it is now practical t o intervene successfully in the unilateral case. The need for increase d attention on the quality of the visual outcome is only one of three important strategic issues in cataract blindness control. The existing high prevalence of cataract blindness in developing countries and an increasing cataract incidence due to an aging population require subst antial increases in surgical volume. The third issue relates to cost. If significant increases in surgical volume and quality of outcomes ar e to be realized without an increased need for external funding, servi ce delivery must be made more efficient. The expansion of IOL surgery for unilateral blindness is a favourable trend in ensuring financial s ustainability of delivery systems; patients can be operated on while s till economically productive and able to pay rather than waiting for b ilateral blindness and a less favourable economic and social impact. I f the quality, volume, and cost issues are to be successfully addresse d, operational and structural changes to eye care delivery systems are necessary. These changes can be effected through training technology introduction, management of facilities, social marketing, organization al partnerships, and evaluation. With improved understanding of the cr itical factors in successful models their widespread replication will be facilitated.