India has the oldest government blindness control programme in the world, and till a few years back, cataract surgeries were the primary focus of the National Programme for Control of Blindness and Visual Impairment (NPCBVI).
The fact that cataract surgeries top the list of procedures under the newly launched Pradhan Mantri Jan Arogya Yojana (PMJAY) highlights the unmet need for cataract surgeries in India despite a government programme doing it for free since 1976.
In 2017-18 alone, 15,91,977 surgeries were performed under NBCPVI. Between September 23 —- when PMJAY was launched as the tertiary care arm of Ayushman Bharat under which 10.74 crore families will be provided annual health cover of Rs 5 lakh —- and November 24, 6,900 claims were submitted for cataract surgeries. Under PMJAY, Rs 6,500-10,500 is paid for the surgery. Under NPCB, the surgery is free.
Cataract refers to clouding of the lens of the eye causing gradual loss of vision. It is common in old age but can also be triggered by injuries to the eye. Diabetes, of which India has a very high burden (approximately 6.92 crore), is also known to hasten cataract formation.
There are an estimated 12 million (1.2 crore) blind people in India. According to government data, 62.6% of all blindness in India is a result of cataract, which means that it is reversible with timely surgery. A 2008 article in the Indian Journal of Ophthalmology predicted: “…in 2001, there were 7.75 million individuals whose blindness could be attributed to cataract and this would increase to 8.25 million by 2020. There is an increase in the total number of cataract blind in the age group above 70 years, over the period 2001-2020 as against a decrease in the other age groups. By 2020, the prevalence of cataract blindness in the population aged 70+ will be four times higher than the prevalence of cataract blindness in other age groups, while the population in this age bracket increases by 108% over the period 2001-2020.”
Data also shows that women whose health is less of a family priority often miss out on the surgery, as do the poor who cannot afford it. The fact that PMJAY currently has more private hospitals enrolled than government ones means that many of these people can now get the surgery done in the private sector.
India has a current cataract surgery rate (CSR) of 5,000 —- on the higher side of the range of 3,000-6,000 that World Health Organisation calls ideal. CSR is defined as Total number of cataract surgeries performed / Total population x 1,000,000.
However, there are wide disparities. For example, in Kannauj district of Uttar Pradesh, the cataract surgery coverage (proportion of individuals with operable cataract who manage to get the surgery) is 47.1% while that in Gujarat’s Kheda is 93.2%. Overall, cataract surgery coverage in India still remains below par at 75%.