SN7 SHORT NOTE 5M

Describe the community aspects of cataract and the national programme in India.

Ophthalmology · 3rd Professional

Cataract accounts for the majority of blindness in India, and cataract surgery is therefore the central activity of the national blindness control effort. The scale is unlike anything in Europe: several million operations are performed each year
The national programme for control OF blindness and visual impairment (NPCBVI) — launched in 1976 as the world’s first national programme with the goal of eliminating avoidable blindness, and fully centrally sponsored. Its components include cataract surgery with intraocular lens implantation, school eye screening and free spectacles, eye banking and corneal transplantation, treatment of glaucoma and diabetic retinopathy, and the development of eye care infrastructure at district level
The shift in strategy over time — from eye camps with intracapsular surgery and aphakic spectacles, through fixed-facility surgery with intraocular lenses, to the present emphasis on quality and visual outcome rather than on numbers alone. The indicator has changed from "cataract surgical rate" (operations per million population per year) to "cataract surgical coverage" and the proportion achieving good postoperative vision — which is the more honest measure

Barrier to uptake	Detail
Lack of awareness	Many patients and families believe that blindness is an inevitable part of ageing and that nothing can be done — the commonest barrier of all
Cost	Not only the operation but transport, the loss of a working day for the patient and the escort, and food and lodging
Lack of an escort	An elderly blind person cannot travel alone, and the escort is a wage-earner
Fear of surgery and of a poor outcome	Often based on a neighbour’s bad experience — which is why poor-quality surgery damages uptake far beyond the individual patient
Gender inequity	Women have consistently lower cataract surgical coverage than men in India despite a higher prevalence.
Distance and access	Rural residence, poor transport and the concentration of ophthalmologists in cities

Provide spectacles after surgery; uncorrected refractive error is the commonest reason a technically successful operation leaves the patient dissatisfied, and it is the cheapest thing to fix
Examine the posterior segment and explain comorbidity before operating; a patient told beforehand that the macula limits the result accepts it, and one told afterwards does not
Measure and report your outcomes, not just your numbers; the proportion seeing 6/18 or better is the measure that matters and is what sustains community confidence

All questions in The Lens and Cataract