Cataract surgery rates.

February 2012, Vol. 102, No. 2 SAMJ Cataract surgery rates To the Editor: Thank you for publishing the article by Lecuona and Cook on the important topic of cataract surgical rates (CSR) in the RSA.1 Indeed, the difficulty in increasing the CSR to the recommended annual target of 2 000 (to eliminate blindness from cataract) is exactly what others in Africa have experienced. Even in some very well-served districts with model programmes and high cataract surgical coverage, we find that a CSR of about 1 500 or less is all that we manage to achieve. With this in mind, we developed a model to estimate the incidence of cataract (blinding as well as visually impairing) from population-based, age-specific cataract prevalence data.2 The incidence rates can be used to predict what the CSR would need to be to eliminate blinding or visually impairing cataract. Having now applied this model to over 20 population-based surveys from Africa, we believe that the target of 2 000 to eliminate cataract blindness was simply too high. It was based on estimates of total blindness in Africa that were probably not representative because they were extrapolated from areas that had particularly high levels of blindness, sometimes from focal diseases such as trachoma and onchocerciasis. The good news is that we can and should put more emphasis on offering cataract surgery to people when most people want surgery, which is before their vision is reduced to blindness.3 Of course, it is ever more important that the quality of surgery be very high, and the authors note the potential for high-volume, high-quality surgery. The issues that they document still apply if we are to restore good vision to everyone suffering from cataract: sufficient access to theatre, good management support, better use of scarce resources, and commitment from hospitals and health managers.