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BackgroundCataract is the leading cause of blindness globally. Effective cataract surgical coverage (eCSC) measures the number of people in a population who have been operated on for cataract, and had a good outcome, as a proportion of all people operated on or requiring surgery. Therefore, eCSC describes service access (ie, cataract surgical coverage, [CSC]) adjusted for quality. The 74th World Health Assembly endorsed a global target for eCSC of a 30-percentage point increase by 2030. To enable monitoring of progress towards this target, we analysed Rapid Assessment of Avoidable Blindness (RAAB) survey data to establish baseline estimates of eCSC and CSC.MethodsIn this secondary analysis, we used data from 148 RAAB surveys undertaken in 55 countries (2003–21) to calculate eCSC, CSC, and the relative quality gap (% difference between eCSC and CSC). Eligible studies were any version of the RAAB survey conducted since 2000 with individual participant survey data and census population data for people aged 50 years or older in the sampling area and permission from the study's principal investigator for use of data. We compared median eCSC between WHO regions and World Bank income strata and calculated the pooled risk difference and risk ratio comparing eCSC in men and women.FindingsCountry eCSC estimates ranged from 3·8% (95% CI 2·1–5·5) in Guinea Bissau, 2010, to 70·3% (95% CI 65·8–74·9) in Hungary, 2015, and the relative quality gap from 10·8% (CSC: 65·7%, eCSC: 58·6%) in Argentina, 2013, to 73·4% (CSC: 14·3%, eCSC: 3·8%) in Guinea Bissau, 2010. Median eCSC was highest among high-income countries (60·5% [IQR 55·6–65·4]; n=2 surveys; 2011–15) and lowest among low-income countries (14·8%; [IQR 8·3–20·7]; n=14 surveys; 2005–21). eCSC was higher in men than women (148 studies pooled risk difference 3·2% [95% CI 2·3–4·1] and pooled risk ratio of 1·20 [95% CI 1·15–1·25]).InterpretationeCSC varies widely between countries, increases with greater income level, and is higher in men. In pursuit of 2030 targets, many countries, particularly in lower-resource settings, should emphasise quality improvement before increasing access to surgery. Equity must be embedded in efforts to improve access to surgery, with a focus on underserved groups.

RESUMEN Según la Organización Mundial de la Salud, la ceguera está definida como la agudeza visual inferior a 3/60 (20/400) en el mejor ojo y un campo visual menor a 10° desde el punto central de fijación. El objetivo de este trabajo fue describir las características clínico demográficas de pacientes con diagnóstico de ceguera irreversible atendidos en el Servicio de Oftalmología General de la Clínica Belén - Coronel Oviedo (Paraguay). Estudio observacional, descriptivo y retrospectivo de corte transversal. Se realizó la revisión retrospectiva de las historias clínicas de los pacientes con diagnóstico de ceguera irreversible atendidos en el Servicio de Oftalmología General de la Clínica Belén, entre el 1 de febrero 2018 y el 28 de febrero 2019. Se analizaron la edad, sexo, escolaridad, procedencia, agudeza visual, comorbilidades y etiología de la deficiencia visual. El análisis estadístico fue mediante el cálculo de frecuencias absolutas y relativas para las variables cualitativas, y el promedio y desviación estándar para las cuantitativas. Se estudiaron 78 pacientes, con predominio del sexo masculino (56,4%), edad de 71 a 95 años (43,6%) y primaria incompleta (41%). La hipertensión arterial (55,6%) fue la principal comorbilidad y glaucoma (43,6%) la etiología de ceguera más frecuente. El glaucoma fue más frecuente en varones que en mujeres (59% vs 32%) y en pacientes mayores de 50 años de edad (50%). En esta serie, los pacientes presentaron ceguera irreversible bilateral, en mayor frecuencia en varones, mayores de 50 años de edad, hipertensión como comorbilidad y glaucoma como etiología más frecuente. ABSTRACT According to the World Health Organization, blindness is defined as visual acuity less than 3/60 (20/400) in the better eye and a visual field less than 10 ° from the central fixation point. The objective was to describe the clinical demographic characteristics of patients with a diagnosis of irreversible blindness treated at the General Ophthalmology Service of the "Clínica Belén" - "Coronel Oviedo" (Paraguay). This was an observational, descriptive and retrospective cross-sectional study. A retrospective review of the medical records of patients with a diagnosis of irreversible blindness treated at the General Ophthalmology Service of the "Clínica Belén" between February 1, 2018 and February 28, 2019 was carried out. Age, sex, education, origin, visual acuity, comorbidities and etiology of visual impairment were analyzed. The statistical analysis was through the calculation of absolute and relative frequencies, as well as the average and standard deviation. Seventy eight patients were studied, with a slight predominance of males (56.4%), aged 71 to 95 years (43.6%), incomplete primary school (41%) and from "Coronel Oviedo" (25.6 %) and surroundings. Arterial hypertension (55.6%) was the main comorbidity and glaucoma (43.6%) the most frequent blindness etiology. Glaucoma was more common in male patients than female patients (59% and 32%, respectively) and in patients older than 50 years of age (50%). In this series, patients presented bilateral irreversible blindness, more frequent in men, older than 50 years of age, hypertension as comorbidity and glaucoma as the most frequent etiology.

RESUMEN El estudio del endotelio corneal proporciona una importante información clínica sobre la función y viabilidad corneal. El porcentaje de pérdida celular por la cirugía de catarata varía según la experiencia del cirujano y la técnica quirúrgica empleada. En este estudio se compara la disminución del recuento de células endoteliales por la cirugía de catarata entre dos técnicas quirúrgicas, FACO y SICS, en 50 pacientes entre 45 y 88 años de edad (edad media: 60,4 ± 10,3 años), con predominancia del sexo femenino (60%); 30 fueron operados por facoemulsificación y 20 por SICS. El recuento celular del endotelio corneal, antes y después de la intervención y la pérdida promedio de células debido a la misma, fue de 2399,7±377,7; 2188,1±416,6 y 211,6±242,0, respectivamente. El porcentaje de reducción por la cirugía fue de 8,8% en forma global, siendo significativamente mayor en los pacientes sometidos a SICS (12,5%) comparado a los operados por Faco (6,3%). Se encontraron densidades de células endoteliales en riesgo (menos de 2000 células / mm2) en el 12% de los ojos que aumentó a 28% después de la cirugía. Los resultados de este estudio son consistentes con el porcentaje de reducción de las células endoteliales informados por otros autores. ABSTRACT The study of endothelial cells provides important clinical information on corneal function and viability. The percentage of cell loss after cataract surgery varies depending on the experience of the surgeon and the surgical technique used. This study compares the decrease in endothelial cell count after cataract surgery by two surgical techniques, FACO and SICS in 50 patients between 45 and 88 years of age (mean age: 60.4 ± 10.3 years old), with a predominance of females (60%); 30 underwent cataract surgery by phacoemulsification and 20 by SICS. The cell count of the corneal endothelium, before and after the intervention and the average loss of cells, was 2399.7 ± 377.7, 2188.1 ± 416.6 and 211.6 ± 242.0, respectively. The percentage of reduction due to surgery was 8.8% overall, being significantly higher in patients undergoing SICS (12.5%) compared to those operated by Phaco (6.3%). Endothelial cell densities at risk (less than 2000 cells / mm2) were found in 12% of the patients' eyes which increased to 28% after surgery. The results of this study are consistent with the percentage of endothelial cell reduction reported by other authors.

To collect cataract surgery rates data in 19 Latin American countries over a 4-year period as data published to date have been limited.Cataract surgery rates were obtained from National Society of Ophthalmology, National VISION 2020/Prevention of Blindness Committee and Ministry of Health representatives for each country for 2005 to 2008. Economic (gross national income per capita) and other data were collected from publicly available databases. Linear and power correlations between gross national incomes and cataract surgery rates were calculated.Over the study period, most countries increased their cataract surgery rates, with the largest increases observed for Venezuela (186%), Nicaragua (183%), Costa Rica (100%), Uruguay (97%), and Peru (88%). Mean cataract surgery rates for 2005, 2006, 2007, and 2008 for the ensemble of countries were 1545, 1684, 1660, and 1822 per million population, respectively, with a growth over the study period of 17.9%, concurrent with an increase of 57 million (11.5%) in the population. A good correlation between cataract surgery rate and gross national income per capita was found (P.001).Although progress is being made in the region, the cataract surgery rates represent only one parameter. When they are examined in the context of cataract surgical coverage it is clear that substantial proportions of bilaterally blind persons are still not receiving surgery.

To estimate the burden of visual loss and blindness due to cataract in people aged 50 years and over in Paraguay.Forty clusters of 60 persons each who were 50 years and older (2400 eligible persons) were selected by systematic random sampling from the entire population of Paraguay. A total of 2136 persons were examined (89% coverage).For the population 50 years and over, the age- and gender-adjusted prevalence of bilateral blindness (VA3/60 with available correction) was 3.14% (95% CI: 2.2-4.4). The adjusted prevalence of bilateral cataract blindness (VA3/60) was 2.01% (95% CI: 1.3-3.0), making cataract the major cause of bilateral blindness in this age group (64%). The adjusted prevalence of bilateral severe visual impairment (VA6/60 with available correction) was 5.17% (95% CI: 3.9-6.7) and the adjusted prevalence of severe visual impairment due to bilateral cataract (VA6/60) was 3.09% (95% CI: 2.2-4.3). The cataract surgical coverage (persons) was 44% for bilaterally blind persons with VA3/60; 36% for persons with bilateral VA6/60; and 28% for any eye with VA6/60 due to cataract. With IOL implantation, 77% of the operated eyes could see 6/18, against 46% of the non-IOLs (p0.005), a significant better outcome.There is a need to increase the cataract surgical coverage in Paraguay. The number of eye surgeons is adequate but the accessibility of cataract surgical services in rural areas and the affordability of surgery to large sections of society are major constraints.

To report the prevalence and causes of blindness in people aged 50 years and older in Paraguay, and to compare these with the previous national survey in 1999, focusing on planning of future eye care activities.A rapid assessment of avoidable blindness (RAAB) was conducted in 2011. A total of 60 clusters of 50 residents aged 50 years and older were randomly selected and visited, and 2862 people were examined (95.4%). Survey data were analyzed with the RAAB software and compared with findings of a similar survey from 1999.The prevalence of bilateral blindness in Paraguay was 1.0% (95% confidence interval, CI, 0.6-1.6) in 2011, significantly less than the 3.1% (95% CI 2.2-4.4) in 1999. Prevalence of bilateral cataract and cataract eyes had also reduced significantly for visual acuity, VA,3/60, VA6/60 and VA6/18. Cataract surgical coverage in persons doubled to 90% for VA3/60, 78% for VA6/60 and 63% for VA6/18. Visual outcome after cataract surgery also improved to nearly the World Health Organization norm. Cataract was the main cause of blindness (43.8%), followed by severe visual impairment (40.5%). Uncorrected refractive errors were the main cause of moderate (78.0%) and the second cause of severe (18.9%) visual impairment.The reduction in blindness and visual impairment due to cataract in Paraguay between 1999 and 2011 was highly significant. Results and coverage of cataract surgical services improved substantially. The reported numbers of cataract operations may not have been complete as these do not seem to match the dramatic improvement in the cataract situation in Paraguay.

Objetivo: Determinar se a taxa de cirurgia é a principal barreira para a adesão à cirurgia de catarata no Paraguai. Métodos: Foi realizado um estudo de coorte com pacientes identificados na Avaliação Rápida da Cegueira Evitável (RAAB) de 2011, que haviam informado ser a taxa para a cirurgia a principal barreira para se submeter à cirurgia de catarata no Paraguai. Todos os pacientes com catarata operável a partir do estudo RAAB, cujos números de telefone foram registrados, foram entrevistados por telefone e foi oferecida a cirurgia gratuitamente. Aqueles pacientes que não compareceram para a cirurgia foram então re-entrevistados por telefone para confirmar as suas razões para não fazer a cirurgia. Resultados: Das 122 pessoas identificadas no estudo RAAB com barreiras para a cirurgia de catarata, 69 (56,6%) relataram a taxa cirúrgica como a principal barreira para a cirurgia; 52 (75,4%) destes indivíduos tiveram seus números de telefone registrados. Trinta e seis (69,2%) pacientes não residiam na área metropolitana de Assunção. Seis pacientes (12%) aceitaram se submeter à cirurgia gratuita, todos eles de Assunção. Dos 46 pacientes que não aceitaram a cirurgia gratuita, as duas principais razões para o não comparecimento foi o custo de transporte (n=31, 67%) e os custos de viagem de seu companheiro (n=6, 13%). Conclusão: A taxa de cirurgia de catarata per se não foi a barreira principal. Local de residência e outras despesas pessoais indiretas, como transporte e custos relacionados à companhia parecem ser mais relevantes. Embora mais estudos sejam necessários para avaliar se a redução do custo do transporte vai melhorar a adesão, os resultados sugerem que um pacote cirúrgico que inclua todos os custos deve ser oferecido aos pacientes dos programas de cirurgia de catarata a fim de aumentar a cobertura da cirurgia de catarata no Paraguai.