Gender and use of cataract surgical services in developing countries.

OBJECTIVE To determine, from the existing literature, cataract surgical coverage rates by sex and the proportion of cataract blindness that could be eliminated if women and men had equal access to cataract surgical services. METHOD Methodologically sound population-based cataract surveys from developing countries were identified through a literature search. Cataract surgical coverage rates were extracted from the surveys and rates for women were compared to those for men. Peto odds ratios were calculated for each survey and a meta-analysis of the surveys was performed. FINDINGS From a literature review and meta-analysis of cataract surveys in developing countries, we found that the cataract surgical coverage rate was 1.2-1.7 times higher for males than for females. For females, the odds ratio of having surgery, compared to males, was 0.67 (95% confidence interval (CI): 0.60- 0.74). Despite their lower coverage rate, females accounted for approximately 63% of all cataract cases in the study populations, and if they received surgery at the same rates as males, the prevalence of cataract blindness would be reduced by a median of 12.5% (range 4-21%). CONCLUSION Closing the gender gap could thus significantly decrease the prevalence of cataract blindness, and gender-sensitive intervention programmes are needed to improve cataract surgical coverage among females.