Cataracts remain primary cause of preventable blindness
KARACHI, 20 Jul 2005 (IRIN) - Nabi Bux is typical of most of those
suffering from cataracts in Pakistan today. He has suffered from
cataracts in both eyes for over four years and the father of four
children with eight grandchildren may never see them again unless he
takes action immediately.
"I live in a rural area and have no money. That's why I haven't done
anything about it," the 75-year-old former farmer from Dadu, a city
in Pakistan's northern Sindh province, explained.
Dr Zareen Mahdi, community ophthalmologist at Karachi's Prevention
and Control of Blindness Cell is used to the problem.
"We can treat this. However, if we don't do it soon, we won't be
able to help him," she said from her office, citing poverty as the
primary constraint to those seeking cataract treatment, cataract
being the most common cause of blindness in Pakistan.
Nabi needs to raise just over
US $30 for the simple one hour
operation, a paltry sum by Western standards but a small fortune for
a man like him.
For Halima Hussain, another cataract patient, the story is much the
same. For two years she has suffered and has only a limited
perception of light remaining in her left eye. Without treatment she
is expected to develop glaucoma within two weeks.
"My husband wouldn't let me come," the 50-year-old said with tears
in her eyes. Although she lives within striking distance of the
centre, the fact that her husband earns less than a dollar a day
makes that journey impossible.
According to Dr Asad Aslam Khan, professor of ophthalmology at the
King Edward Medical College in Lahore and national coordinator for
the World Health Organization's (WHO) Programme for Preventative
Blindness in Pakistan, over 80 percent of all blindness is
avoidable, with 90 percent of all blind people worldwide living in
"There are four million blind people in Pakistan, 1.5 million in the
Punjab alone," Dr Khan said. "If proper measures are not taken, that
figure will reach three million by the year 2020."
With cataracts accounting for 66 percent of all blindness and
glaucoma 12 percent in the nation of 150 million, the need to
improve preventative care is undeniable, he stressed.
In accounting for the prevalence of blindness in Pakistan, Khan
cites a lack of human resources, coupled with a lack of training
facilities for qualified ophthalmologists.
While the World Health Organization (WHO) recommends a ratio of one
ophthalmologist per 100,000 population, Pakistan has only one eighth
of the required number, he explained.
Compounding the problem further is a lack of the necessary
infrastructure combined with little modern technology at the
district level. Poorly maintained equipment and the
absence of any
referral chain along with a lack of motivation, advocacy, awareness
or monitoring and evaluation, also play a part in the problem.
Still another cause for the country's high prevalence is that there
is no system for the prioritisation of need, whether it be sufferers
from glaucoma, cataracts or diabetes-related blindness.
"Intervention should be need-based after a situation analysis in
each district," said Dr Khan.
But resources remain scarce and a major proportion of eye care is
still being provided by NGOs such as Sight Savers International
(SSI), a UK-based group spearheading efforts to boost eye care in
"Presently, the number of cataract surgeries being performed is
about 350,000 annually. This implies that while we are meeting the
incidence, there is still a gap," Dr Haroon Awan, the NGO's country
representative said from the capital, Islamabad.
WHO recommends that the
annual cataract surgical rate (CSR) should
be about 3,000 per million population per year in 2005. Pakistan's
current CSR is 2,333 per million population per year.
Yet the government, with support from SSI, the Fred Hollows
Foundation and others, is making inroads into the issue of
preventable blindness, particularly cataracts, by offering quality
care for those who can't afford it through its centre in Karachi and
a mobile outreach programme.
"Last year, we had 45 eye camps and carried out 6,000 cataract
operations successfully," Mahdi recalled.
As a member of Pakistan's National Committee for the Prevention of
Blindness, SSI has assisted in the upgrading of secondary-level
district eye units in 16 districts of the country, including seven
in the western tribal areas, four in the North West Frontier
Province (NWFP), two in the Punjab and two in the southwestern
province of Balochistan.
Savers] has recently approved upgrading of one more
district in the Punjab. Furthermore, it supports NGO partners who
perform about 25 percent of all cataract surgery in the country,"
In a campaign entitled 'Seeing is Believing', run in partnership
with the Standard Chartered Bank, Sight Savers has recently
supported the training of ophthalmologists in small incision
cataract surgery (SICS) at different provincial centres in Karachi
"This form of surgery is known to improve the quality and outcome of
surgery and shorten the rehabilitation period after surgery," Awan
Seventy percent of the population lives in rural areas and at
present, eye care services in the government sector are available
generally only at teaching hospitals in major cities and at a
"Of the 120 districts in the country, eye care services have been
upgraded in at least 50 percent
of the eye units in the district
headquarter hospitals," eye specialist Awan noted. "The government
now has plans to upgrade the remaining district eye units and in
fact take the eye care services up to the sub district level in the
next five years."
But other difficulties remain for those needing care. These include
a fear of surgery, traditional beliefs, access and distance from eye
care facilities or the lack of an accompanying person to assist a
patient after surgery, as well as a lack of confidence in government
services - though this is changing. The cost of intraocular lenses
(IOLs) also remains too high for a large segment of the population.
Awan called on the government to redouble efforts to improve the
situation, requesting the government to waive duties and taxes on
IOLs used in cataract surgery, making them more available to the
poor. He proposed extending eye care services, including cataract
surgical services to the sub-district level and the creation of
posts for both ophthalmologists and mid-level eye care personnel in
Awan said that eye-care training should be provided to primary
health care staff, particularly community health workers, to
identify and refer persons with cataract and other causes of visual
impairment. Finally he said that there needed to be monitoring of
cataract surgical outcomes to ensure the quality of surgery is