Why Cataracts

Globally, 94 million people are blind or visually impaired from cataracts

Cataract is the leading cause of blindness worldwide

Cataracts can be cured with a 10 minute procedure costing as little as $25

CLEAR VISION

In a healthy eye, a clear lens focuses incoming light onto the retina, forming a sharp image. Often glasses or contacts are needed to achieve optimal vision.

PROGRESSIVE IMPAIRMENT

Over time, the natural lens inside the eye becomes cloudy. This is called a cataract. If not treated, cataracts can lead to blindness.

Blinding Cataract

In an eye with advanced cataract, incoming light is blocked or scattered, resulting in poor vision or blindness. At this point, glasses will not help - surgery is needed to replace the cloudy lens with a clear lens implant.

Patient Testimonial

Cataract Q & A

What is a cataract?

What does cataract surgery cost?

What are the impacts of sight-restoring cataract surgery?

What are the impacts of cataract blindness?

How are cataracts treated?

Who develops cataracts?

What are the causes of cataract?

A cataract is a clouding of the natural lens inside the eye. If not treated, cataracts can lead to profound blindness.

Most cataracts are age related. Other factors such as ultraviolet light exposure, malnutrition, trauma, diabetes, and genetics can also play a role.

Nearly everyone who lives long enough will develop cataracts. The factors noted above may cause someone to develop cataracts earlier in life. Congenital cataracts (cataracts at birth), early onset cataracts, and traumatic cataracts are more common in the developing world.

Cataracts are treated by removing the cloudy lens and replacing it with a clear lens. This surgery usually takes about 10 minutes. There are different cataract surgery techniques.
The technique most commonly used in developed settings is known as phacoemulsification, which utilizes a sophisticated ultrasound probe to break up the cataract inside the eye, then remove the broken down lens material through a small incision. This technique is highly effective for the mild and moderate cataracts which are typical in the developed world. However, the equipment, foldable lens implants, and consumable materials required for phacoemulsification are very expensive. Further, the phacoemulsification technique is not as well suited to address the very dense cataracts often encountered in the developing world.
The technique most commonly utilized in the developing world is called small incision sutureless cataract surgery (SICS). SICS is an elegant technique first described by Dr Michael Blumenthal and refined by pioneering surgeons in Nepal and India. This technique does not require expensive equipment and is especially well-suited for the very dense cataracts frequently encountered in the developing world. A landmark study performed in Nepal demonstrated that SICS and phacoemulsification surgery both provide excellent outcomes. It also showed that SICS can be performed for a tiny fraction of the cost of phacoemulsification.1

In rural Africa, life expectancy for the blind is ⅓ that for age-matched peers.2
Blindness and household poverty are strongly linked (15 yr longitudinal study in West Africa).3
Cataract blindness has been linked to decreased quality of life, reduced economic productivity, increased dependence on caregivers, and severe poverty.4, 5
Blindness is associated with significant levels of depression, loss of independence, and self-esteem.6
Blindness is associated with severe disruption of family relationships (50% spousal separation within 1.6 years - 5 times higher than the general population).6

Whereas phacoemulsification surgery costs about $2500 USD in developed settings, SICS surgery can be performed for a material cost of less than $25.
In addition to the material cost, which includes the surgical supplies (surgical drapes, blades, lens implant, medications, etc), there are some indirect costs associated with providing cataract surgery in the outreach setting. These include screening patients in their village, transporting them to the outreach, supporting hospital staff, feeding and sheltering them for 24 hours, and transporting them to and from their followup appointments. The indirect cost per patient is about $50.
The more efficiently cataract outreaches are performed, the lower the cost per patient. By providing efficient, high quality care, more patients can receive sight-restoring surgery.

Patients who undergo sight-restoring cataract surgery enjoy improved quality of life, increased economic productivity, decreased dependence on caregivers, and alleviation of severe poverty. These gains are sustained in the long term.5
On average, individuals who regained vision through surgery generated 1,500% of the cost of surgery in increased economic productivity during the first year following surgery.7
85% of males and 58% of females who had lost their jobs due to blindness regained those jobs following cataract surgery. Many who did not regain their jobs, resumed domestic responsibilities so that family members could return to their employment.
Three years after sight-restoring cataract surgery in a rural Ghanaian community, 94% of patients reported an increased ability to provide income for themselves and their families. One hundred percent of those who required a caregiver prior to surgery no longer required a caregiver after surgery. On average, hours spent engaging in paid work increased by 121%, significantly increasing self-reliance.8
The World Bank has called cataract surgery one of the most cost effective public health interventions available.7

References

Ruit S, Tabin G, Chang D, Bajracharya L, Kline DC, Richheimer W, Shrestha M, Paudyal G. A prospective randomized clinical trial of phacoemulsification vs manual sutureless small-incision extracapsular cataract surgery in Nepal. Am J Ophthalmol. 2007 Jan;143(1):32-38. doi:
Taylor HR, Katala S, Muñoz B, Turner V. Increase in mortality associated with blindness in rural Africa. Bull World Health Organ. 1991;69(3):335-8. PMID: 1893509; PMCID: PMC2393108.
Abubakar, Tafida & Kyari, Fatima & Abdull, Mohammed & Sivasubramaniam, Selvaraj & Gudlavalleti, Murthy & Kana, I. & Gilbert, Clare. (2015). Poverty and Blindness in Nigeria: Results from the National Survey of Blindness and Visual Impairment. Ophthalmic Epidemiol. 22. 333-41. 10.3109/09286586.2015.1077259.
Kuper H, Polack S, Eusebio C, Mathenge W, Wadud Z, Foster A. A case-control study to assess the relationship between poverty and visual impairment from cataract in Kenya, the Philippines, and Bangladesh. PLoS Med. 2008 Dec 16;5(12):e244. doi: 10.1371/journal.pmed.0050244. PMID: 19090614; PMCID: PMC2602716.
Polack S, Eusebio C, Mathenge W, Wadud Z, Rashid M, Foster A, Kuper H. The impact of cataract surgery on activities and time-use: results from a longitudinal study in Kenya, Bangladesh and the Philippines. PLoS One. 2010 Jun 1;5(6):e10913. doi: 10.1371/journal.pone.0010913. PMID: 20531957; PMCID: PMC2879361.
Bernbaum, M., Albert, A.G. & Duckro, P.N. (1993). Personal and family stress in individuals with diabetes and vision loss. Journal of Clinical Psychology, 49 (5): 670-677.
Jamison, D.T., et. al. “Impact of cataract surgery on individuals in India.” Disease Control Priorities in Developing Countries. (New York, Oxford University Press for the World Bank: 1993).
Welling, J., Newick, E., Tabin, G. (2013). The economic impact of cataract surgery in a remote Ghanaian village three years after surgical intervention. Investigative Ophthalmology & Visual Science, 54(15): e4396.