Cataract Blindness in Armenia: The Results of Nationwide Rapid Assessment of Avoidable Blindness (RAAB)

This study assessed the prevalence of cataract blindness, cataract surgical coverage (CSC), effective CSC, visual outcome after cataract surgery, and barriers to cataract surgery in a population aged 50 years and older in Armenia using Rapid Assessment of Avoidable Blindness (RAAB) methodology. The study sample included 2258 individuals aged 50 years and older who were randomly selected from 11 provinces of Armenia in 2019 following the RAAB methodology. The study team randomly selected 50 clusters, 50 people in each. The RAAB survey form was used to collect information on cataract blindness, visual outcome after cataract surgery, and barriers to cataract surgery. The mean age of the participants was 65.3 (SD = 9.9) ranging from 50 to 99. The majority of participants were women (65.6%). Age- and sex-adjusted prevalence of blindness due to all causes was 1.5%; of which 36.4% was bilaterally blind due to cataract. The CSC and effective CSC at a cataract surgical threshold of  The prevalence of cataract blindness in our study was higher compared to high-income regions and lower than estimates from South/Southeast Asia. This study suggests the urgent need to update the National Strategic Plan to prevent blindness in Armenia with a focus on improving the quality and coverage of cataract surgery.</p

Absolute inequality between women and men in cataract surgical coverage (CSC_{persons <6/60}), and effective cataract surgical coverage (eCSC_{persons <6/60}) in 20 countries, 2005–2013.

<p>Absolute inequality is the difference between women and men (e.g. CSC in men–CSC in women); a positive value indicates women are worse off. Horizontal dashed lines and labels indicate the median values of all studies. Grey shading indicates the inter-quartile range (middle 50% of studies).</p

Proposed global targets for effective cataract surgical coverage (eCSC)

<p>Proposed global targets for effective cataract surgical coverage (eCSC)</p

Cataract surgical coverage (CSC) and effective cataract surgical coverage (eCSC; persons <6/60, %) in 20 countries, 2005–2013.

<p>Arranged in ascending order of relative gap between CSC and eCSC (i.e. 1 –eCSC / CSC); the gap is smallest for Argentina and largest for Yemen.</p

Proportion of operated eyes with presenting visual acuity of 6/18 or better (CSO_Good) or worse than 6/60 (CSO_Poor) plotted against observed cataract surgical coverage (CSC_{persons <6/60}, %) in 20 countries, 2005–2013.

<p>WHO Targets established in 1998.[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0172342#pone.0172342.ref031" target="_blank">31</a>].</p

Estimates of visual impairment and its causes from the National Eye Survey in Malaysia (NESII)

<div><p>Background</p><p>Population-based data on prevalence, causes of blindness and extent of ophthalmological coverage is required for efficient implementation and evaluation of ocular health programs. In view of the scarcity of prevalence data for visual impairment and blindness in Malaysia, this study aims to estimate the prevalence and causes of visual impairment (VI) in the elderly, using Rapid Assessment of Avoidable Blindness (RAAB) survey technique.</p><p>Methods</p><p>Malaysia was divided into six regions, with each region consisting of 50 clusters. Multistage cluster sampling method was used and each cluster contained 50 residents aged 50 years and above. Eligible subjects were interviewed and pertinent demographic details, barriers to cataract surgery, medical and ocular history was noted. Subjects had visual acuity assessment with tumbling ‘E’ Snellen optotypes and ocular examination with direct ophthalmoscope. The primary cause of VI was documented. Results were calculated for individual zones and weighted average was used to obtain overall prevalence for the country. Inter-regional and overall prevalence for blindness, severe VI and moderate VI were determined. Causes of VI, cataract surgical coverage and barriers to cataract surgery were assessed.</p><p>Results</p><p>A total of 15,000 subjects were examined with a response rate of 95.3%. The age and gender-adjusted prevalence of blindness, severe visual impairment and moderate visual impairment were 1.2% (95% Confidence Interval: 1.0–1.4%), 1.0% (95%CI: 0.8–1.2%) and 5.9% (5.3–6.5%) respectively. Untreated cataract (58.6%), diabetic retinopathy (10.4%) and glaucoma (6.6%) were the commonest causes of blindness. Overall, 86.3% of the causes of blindness were avoidable. Cataract surgical coverage (CSC) in persons for blindness, severe visual impairment and moderate visual impairment was 90%, 86% and 66% respectively.</p><p>Conclusion</p><p>Increased patient education and further expansion of ophthalmological services are required to reduce avoidable blindness even further in Malaysia.</p></div

Survey area population.

<p>Survey area population.</p

Population and states in Malaysia.

<p>Source: Department of Statistics, Malaysia.</p

Principal causes of blindness and visual impairment by person.

<p>Principal causes of blindness and visual impairment by person.</p

Patient perceived barriers to cataract surgery.

<p>Patient perceived barriers to cataract surgery.</p