[Strategies to control cataracts]

Cataracts, often associated with aging (80%), are a major cause of blindness (more than 50% of cases of blindness in Africa), and for this reason, up to 80% of cases could be predicted or prevented. The socio-economic costs (care and loss of productivity) are increased by morbidity (blindness, impaired vision, congenital, complicated or infected cataracts). The biological determinants of cataracts account for the difficulties in developing and implementing effective preventive action. These epidemiological determinants (prevalence, incidence, increase in life expectancy) account for the size of the public health problem. The surgical removal of cataracts in Africa currently only deals with about 1% of the prevalence rate or 10% of the incidence. Cataracts are, however, easy to cure, resulting in great benefits to public health. The waiting list for cataract operations is very short because of social and cultural barriers which limit the acceptability and accessibility of treatment. Rather than formalizing the dogmatic choices of surgical techniques and structures (fixed, mobile, advanced?), we should promote all phases of treatment from active screening and the selection of cases for surgery to the follow-up of interventions and their impact. We should also increase public awareness, develop a system for the transfer of information that is effective and improve the cost-effectiveness and capacity of the region to provide high quality services on a large scale. We must promote patient satisfaction at all stages of treatment: its quality, its delivery and its low cost.