Cataract surgical coverage effectiveness and barriers to cataract surgery in a population based eye health survey in Jhargram district West Bengal

Abstract

This study assessed cataract surgical coverage (CSC), effective cataract surgical coverage (eCSC), postoperative visual outcomes, and barriers to cataract surgery among adults residing in Jhargram district, West Bengal. A population-based cross-sectional survey using the standard Rapid Assessment of Visual Impairment (RAVI) methodology was carried out among adults aged 40 years and older. A total of 2,400 eligible individuals were enumerated and 2,292 were examined. Standardized visual-acuity and ocular examinations were performed. Postoperative visual outcomes were reported at eye level because each of the 291 participants with previous cataract surgery contributed one operated eye. CSC and eCSC were reported among adults aged 50 years and older at prespecified visual-acuity thresholds. Among 291 participants, 57.7% achieved a very good outcome (PVA ≥ 6/12) and 19.9% a good outcome (6/18). Sub-optimal (13.4%) and poor (8.9%) outcomes were less common. Surgical complications were the leading cause of poor vision (61.5%), while uncorrected refractive errors accounted for 59% of borderline outcomes. CSC increased from 33.0% at the 6/12 threshold to 75.5% at the blindness threshold (< 3/60), whereas eCSC reached only 50.4%. Higher CSC and eCSC values were observed among males than females across the assessed visual acuity thresholds. Key barriers to surgery were lack of perceived need (43.5%), fear of surgery or poor outcomes (24.7%), limited access (10.0%), and financial constraints (9.2%). The findings indicate substantial differences between cataract surgical coverage and effective coverage in this study population, as well as a substantial proportion of operated eyes with sub-optimal or poor presenting visual acuity. Differences between government, NGO, and private facilities are descriptive and should not be interpreted as causal differences in quality. Strengthening postoperative refractive correction, follow-up, awareness, and equitable access may help improve effective coverage.