Cataract services: ensuring access for everyone.

VISION 2020 states that everyone has the right to sight. This means that, regardless of status (wealth, education, gender, impairment or other factors), everyone has the right to maximise their visual potential. Evidence suggests, however, that many groups in society (for example women, those who are poor, or those who are disabled) are frequently unable to access eye care services. When they do, these disadvantaged groups experience poorer care despite their greater need. Providing services that are equitable – that are available and affordable to all – has been a priority for VISION 2020, and those organisations that support the initiative, since 1999. There is limited evidence, however, that cataract surgery is reaching these groups. A recent study conducted by the London School of Hygiene and Tropical Medicine1 asked eye hospitals throughout the world to report the preoperative visual acuity of the next 100 cataract operations they were going to perform. Even in the hospitals in the poorest countries, where the prevalence of cataract blindness (and hence the need for surgery) was high, only 40% of operations were on people who were blind from cataract. Instead, the hospitals were offering surgery to people who were not yet blind, which is hard to justify considering that there were so many people who were blind and who needed an operation more urgently. Tackling unequal access to cataract surgery for women has been a priority for VISION 2020 since its inception. Unpublished data from three ophthalmology Ad ria ne O ha ne si an /S ig ht sa ve rs Robert Lindfield Clinical Lecturer: The Disability and Eye Health Group, London, UK Robert.Lindfield@Lshtm.ac.uk