Cataract as a cause of blindness and vision impairment in Latin America: progress made and challenges beyond 2020

Abstract Purpose To provide an update of cataract as a cause of vision loss in Latin America, and analyze gender inequalities in cataract surgical coverage (CSC) and effective CSC (eCSC) in the region. Design Population-based systematic review with longitudinal comparisons. Methods We searched the LILACS and PUBMED for population-based studies reporting cataract blindness, surgical coverage, and outcomes published from January 2014 to December 2019. Information on the number of surgeries performed from the 2014-2016 period was obtained from Ministries of Health and was used for the calculation of the Cataract Surgical Rate (CSR). We performed a reanalysis of Rapid Assessment of Avoidable Blindness (RAAB) and Rapid Assessment of Cataract Surgical Services data to calculate gender inequality in CSC and eCSC by subtracting the rate in women from the rate in men. Results Cataract was the cause of between 29.8% and 77.6% of the cases of blindness in included studies; the CSR improved in ten countries. The CSC3/60 varied from 24.1% in Peru to 97.1% in Argentina, and the median absolute gender inequality CSC3/60 was -0.7%. The eCSC3/60 varied from 14.8% in Guatemala to 92.1% in Argentina, and the median absolute gender inequality eCSC3/60 was -0.8%. Conclusions Cataract remains a leading cause of blindness in Latin America. Coverage is suboptimal and surgical results are also below targets in many countries. Incentives for a better distribution of human resources, adequate training of ophthalmologists and the inclusion of vision services in universal health care coverage could reduce the burden of cataract in Latin America.