An international study highlights economic and gender inequalities in access, as well as identifying challenges in maintaining the quality of a procedure that is highly cost-effective. Growth is below the World Health Organization target and highlights inequalities between wealthy and poorer countries.
Cataracts are currently the leading cause of preventable blindness worldwide. Although surgery is considered a safe, effective, and low-cost procedure, millions of people still live with visual impairment due to lack of access to appropriate treatment. Despite the World Health Organization (WHO) target of a 30% increase in quality and coverage of these procedures by 2030, a global study has just reported that this figure is not expected to exceed 8.4 percentage points by the target date.
In addition to the low projected estimate, the study highlights inequalities between wealthy and poorer regions, with broad access in wealthier areas and barriers such as lack of specialists, limited services, and high costs restricting access for poorer populations. It also highlights differences in access between genders, with a greater care deficit affecting women.
Published in the journal The Lancet Global Health, these are the main results of a literature review covering different regions of the world. Professor João Marcello Furtado, from the Ribeirão Preto Medical School (FMRP) of USP and a member of the research team, explains that the main motivation of the study was “to measure, in a comparable way across countries and regions, whether people who need cataract surgery are actually able to access the procedure and, in addition, whether they are achieving a good visual outcome”.
Global data
The review used data from 233 population-based surveys, covering 68 countries between 2003 and 2024. The sample mainly included adults aged 50 years or older, encompassing individuals with different degrees of visual impairment. In addition, the study brought together participants from various regions of the world, allowing for a broader and more representative analysis of inequalities in access to cataract surgery on a global scale.
Professor Furtado reports that these data were obtained from open databases such as the Global Vision Database and also through direct contact with investigators to access individual datasets. “Standardization was achieved through the application of a common definition of effective cataract surgical coverage, using uniform criteria for surgical need and for good postoperative visual outcome”, he details. In addition, the estimates were weighted by age and gender, and the authors prioritized, for each country, the most recent and most representative studies.
Persistent Inequalities
As key findings, although relative advances in global access to cataract surgery were identified, the researchers found the persistence of significant gaps that make the WHO’s 2030 target a distant goal. The projection indicates an increase of only 8.4 percentage points between 2020 and 2030, well below the proposed 30 points.
Even so, there has been an upward trend in effective coverage since the 2000s. According to the professor, this progress can be explained by a combination of factors, such as the expansion of surgical services in several countries, better organization of eye health programs, adoption of standardized monitoring methodologies, strengthening of national and regional initiatives to combat preventable blindness, and advances in professional training and surgical capacity.
Despite the observed progress, the research highlights significant inequalities between countries. In high-income nations, access to surgery is broader and more structured. In low-income regions, however, challenges persist, such as the shortage of specialists, limited ophthalmological services, and costs, which still represent a significant barrier for the population.
Quality in post-surgical care
Another point highlighted by the study is the quality of care throughout the care pathway. “It is not enough to perform more surgeries; it is necessary to perform them well and ensure refraction, glasses when needed, and management of complications”, explains the professor. In this context, part of the unsatisfactory outcomes after surgery could be avoided or treated. According to Furtado, “residual refractive error, for example, accounted for about 26.4% of visual outcomes considered inadequate, suggesting that better refraction and optical correction after surgery could measurably increase effective coverage”.
The analysis also highlights gender inequalities in access to treatment. In some countries, women have less access to cataract surgery compared to men. “The most likely explanation is structural. In many contexts, women face greater economic dependence, less autonomy to seek care, more mobility barriers, a greater burden of domestic and caregiving work, and lower priority within the family for elective procedures”.
Challenges define next steps
Finally, the professor assesses that, despite advances, progress still falls short of what is needed. “Cataract surgery is one of the most cost-effective interventions in healthcare, yet millions of people still lack access to the procedure. If the current pace is maintained, the global target for 2030 will hardly be achieved”, he states.
Furtado also highlights that expanding access must go hand in hand with quality of care. “The gap between total surgical coverage and effective surgical coverage shows that some patients reach surgery but do not achieve the expected outcome”.
The next steps of the research focus on two main fronts: improving measurement, by expanding data from underrepresented countries, and deepening the evaluation of the quality of care throughout the entire care pathway. “In practical terms, the agenda now is less about describing the problem in general, and more about identifying where, in each context, the care pathway is failing and how to correct it”.
Fonte: Jornal da USP
Nenhum comentário ainda, seja o primeiro!