cataract blindness a systems lens!
TRANSCRIPT
Cataract Blindness in India-
a health systems perspective!
Dr Sandeep Buttan MS (Ophthal), MSc CEH (ICEH, UK)
Program Development Advisor (Eye Health), Asia
Sightsavers
Outline
• Cataract Vs Cataract Blindness
• The PROBLEM
– Magnitude and trends
– Population need & Backlog
• The SOLUTION
– Cataract surgery
– Systems perspective
Cataract- History
• The first references to cataracts and their
treatment 29 AD (Ancient Rome)
• Surgical treatment Identified as early as
200 AD (Suśruta)
• Basic concept of progression and
treatment known since
• Most commonly performed surgical
procedure worldwide!
© Sightsavers
Magnitude- Prevalence of Cataract
• Age related cataract- a biological phenomena
• additional risk factors smoking, Diabetes, UV exposure etc.
Cataract Blindness - the problem?
• Cataract still remains the single largest cause of
blindness, causing more than half of all blindness in
many low and middle income countries
• Cataract Blindness:
– 30%-60% of blindness in Africa
– 60–80% in most countries in South East Asia
Magnitude (population based surveys)
• Prevalence of Blindness 8% among 50+ age
• Cataract is the commonest cause of blindness
(77.5%), low vision (58.1%) and unilateral blindness
(57.5%).
• Elderly, rural, illiterates, females higher prevalence (no
data on other vulnerable groups e.g. PWD)
Rapid Assessment of Avoidable Blindness in India 2007
Cataract Vs Cataract Blindness
CATARACT
• Gradual* opacification of
the crystalline lens.
• Age related
• Genetic
• Smoking
• Diabetes
CATARACT BLINDNESS
• Reduction in vision to the
level of 20/400 (WHO*) in
the better eye due to
Cataract
• Age (elderly)
• Gender (female)
• Poverty
• Illiteracy
• Residence (rural, Urban
slums)
Cataract Vs Cataract Blindness
CATARACT
• Biological phenomena
• Modifiable & non
modifiable risk factors
• Prevention ???
• Treatable +++
CATARACT BLINDNESS
• Social, cultural, systems
related (health care
delivery)
• AVOIDABLE BLINDNESS
The Solution: Cataract Surgery
• Cataract surgery is the only method to restore vision
• Cataract surgery is one of the most cost-effective
health interventions
• Advances in surgical technique and IOLs have made
the process extremely effective.
Population need & Backlog
• Incidence: new cases of cataract
every year
• Backlog: number of cataract cases
not receiving surgery (becoming/
remaining BLIND)
• Factors:
• Mortality
• Surgical outputs
• ? Surgical quality*
Surgical outputs need to be equal to or more than the
Incidence
Cataract Output indices
Cataract Surgical Rate
Number of cataract operations (eyes)
conducted per million population per year
• Performance indicator
• Measures quantum of cataract surgeries in
the population
• Based on secondary data
• Should be equal to or above the incidence
of Cataract
Cataract Surgical coverage
Proportion of operable cases (persons/ eyes)
actually operated at a point in time
• Impact indicator
• Measures accessibility & utilization of
services
• Needs community based survey
• Ideal 100% (85% and above)
Solution?
Surgery
Cataract Surgery No
Cataract
What is needed for a Cataract Surgery?
Surgeon
Instruments
Surgical supplies
Operation theatre
Support Infra etc.
Patients!
Is that All?
Surgeon
Instruments
Surgical supplies
Operation theatre
Support Infra etc.
Patients!
Paramedical
staff
Sterilization
Maintenance
Supply chain Utilities (Power
etc.)
Policies
Finance
Screening
There is more than what meets the eye…
There is more than what meets the eye…
Health Systems framework
“All organizations, people and actions whose primary intent is to promote,
restore or maintain Health”
Goals of ‘Health Systems’ –
the ‘Product’
• Improved health status
• Protection form Health related
financial risk (marginalized
communities)
• Responsiveness to needs
• Consumer satisfaction
• Access
• Coverage
• Quality
• Safety
Universal Coverage!
Coverage
• Population
• Service spectrum
• Financial
So what do we need to aim for?
Stronger Health
Systems
More Funding for Eye
care
More Surgeons
More Cataract surgeries
© Sightsavers
To conclude…
• Cataract (and Cataract Blindness) remains a significant public health
issue.
• Whereas Cataract itself is a biological phenomena, Cataract blindness
needs to be looked from social, cultural, financial and policy
perspective.
• Strengthening the health systems is the only approach to achieve
universal coverage for eye health.
Cataract Blindness
Age-standardised disability-adjusted life year (DALY) rates
from Cataracts by country (per 100,000 inhabitants) 2010.