Cataract surgery--quantity and quality.

Editorials Cataract surgery—quantity and quality In this issue, we present the initial results from the second national survey of cataract surgery, which was a collabora-tive endeavour supported by the Department of Health, the Royal College of Ophthalmologists, the College of Optometrists, and the Royal College of Nursing. Great credit is due to the authors for what was clearly an enormous task, but they rightly credit all the participating centres for the vital contribution of their own data. Together with the previous 1991 survey, 1–3 we now have a detailed picture of what we are achieving in terms of the baseline characteristics of our patients and of the outcome, which is presented by Desai and colleagues in this issue of the BJO (p 893). A further paper will appear giving a fascinating modelling exercise on the national burden of visual impairment due to cataract and the levels of activity required to tackle it. 4 Thus, epidemiologists have provided the evidence for an informed debate about what if anything should be done to meet the needs of the population and deal with the ever lengthening waiting lists. This is both a national and global issue. This year, in February, " Vision 2020, the right to sight " —the World Health Organisation's global initiative for the elimination of avoidable blindness—was launched by the new director general with a commitment of high priority among the WHO's numerous campaigns. 5 Tackling cataract blindness is the first of four priority areas identified for the campaign. The issues from a global perspective were elegantly summarised by Allen Foster at last year's Cambridge symposium. 6 Armed with these insights, we are now in a position to debate our response to these challenges. We are fortunate as ophthalmologists to own an intervention that is of undoubted eVectiveness 7 and which can achieve quality of life gains of an almost unequalled scale for a single surgical procedure. 8 But it is clear that the extent of the gain is proportional to the severity of visual impairment which preceded the intervention. The rapid evolution of technology, first intraocular lenses and now phacoemulsification (5% in 1991 to 77% in 1997) which together oVer rapid rehabilitation and precise aphakic correction , has encouraged us to intervene earlier. In 1997, just under a third of eyes operated on could still see 6/12 or better. While the indication for surgery in these cases could surely …