Cataract blindness in 4 regions of Guatemala - Results of a population-based survey

Objective: To assess prevalence of visual impairment resulting from cataract and cataract surgical services in 4 departments (provinces) of Guatemala to facilitate further health care planning. Design: Cross-sectional study. Participants: Ninety-eight enumeration areas were selected by systematic sampling in 4 departments in southwest Guatemala, with a combined population of 1 339 508 (2002 census). Ninety-eight clusters of 50 persons >= 50 years of age (4900 eligible persons) were selected by random walk, 1 in each selected enumeration area. A total of 4806 persons were examined (coverage, 98.1%): 1808 (37.6%) men and 2998 (62.4%) women. Mean age was 63.7 years. Methods: Each eligible participant was interviewed and underwent an assessment of visual acuity and ophthalmic examination to assess lens status. Main Outcome Measures: Visual acuity of each eye with available correction and with pinhole correction; lens status; cause of visual impairment in 1 or both eyes; reason(s) why cataract operation had not been performed; and details of previous cataract surgery. Results: Cataract is the major cause of bilateral blindness (66.1%). The adjusted prevalence of bilateral cataract blindness (best-corrected visual acuity [BCVA], <20/400) in people 50 years of age and older was 2.3% (95% confidence interval [CI], 1.8%-3.0%), or an estimated 3726 persons. The cataract surgical coverage was 49% for men and 28% for women. The adjusted prevalence of bilateral cataract and BCVA<20/200 in persons 50 years of age and older was 3.7% (95% CI, 2.9%-4.4%), or an estimated 5887 persons. In this last group, the surgical coverage was 29% (persons) and 19% (eyes). Of all operated eyes, 36% could not see 20/200. Being unaware of cataract (68%), inability to afford the procedure (12%), and fear of the procedure (10%) were mentioned most often as the reason why surgery had not been performed. Conclusions: There is a backlog in unoperated cataract in the survey area that will increase with ageing. Awareness campaigns, reducing cost, improving the outcome of cataract surgery, and expansion of surgical services may help to increase the cataract surgical rate. Women should be offered more cataract surgery. These results will enable health managers to plan effective interventions in line with Vision 2020.