Cataract in central Sri Lanka: cataract surgical coverage and self-reported barriers to cataract surgery

To determine the cataract surgical coverage and investigate the barriers to cataract surgery in the Kandy District of central Sri Lanka.

A population-based, cross-sectional ophthalmic survey of the inhabitants of rural villages in central Sri Lanka was conducted; there were 1721 eligible subjects and 1375 participated (79.9% participation rate). The recorded data included age, gender, education, district, corrected visual acuity, dilated slit-lamp examination and stereoscopic fundus examination. Lens opacity was graded using the Lens Opacities Classification System III. Participants with cataract-induced visual impairment (acuity <6/18 in the better eye) were also invited to respond to a verbal questionnaire about barriers to cataract surgery.

Cataract surgical coverage per individual for visual acuity cut-offs of <6/18, <6/60 and <3/60 was 41.9%, 76.8% and 82.7%, respectively; and per eye was 34.0%, 60.3% and 65.2%, respectively. Cataract surgical coverage was higher for men than women, and two-thirds refused referral for surgery, for the following reasons: no desire to improve vision, fear of surgery and lack of awareness were the most frequently reported barriers.

Cataract surgical coverage in central Sri Lanka is higher than that in neighbouring developing regions. Surgical uptake may be improved through better community education.