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PURPOSE: Cataract surgical rate (CSR) (cataract surgeries performed per million population) is an eye health indicator that helps assess the state of eye care services. A survey in 2002 revealed a CSR of 2254. The current survey aimed to establish a new and sustainable development goal compliant baseline for the volume of cataract surgery performed by different service providers in Pakistan at district, provincial, and national levels. METHODS: The survey was commissioned by the National Committee for Eye Health under the Ministry of National Health Services, Regulations and Coordination. The methodology used for the survey included identification and mapping of all service providers by district and category and data collection from all districts in the country. RESULTS: There were more cataract surgeries performed in women than men with a male-to-female ratio of 0.95. About 98.9% of all cataract surgeries were performed with intraocular lenses, while 63.9% were performed by phacoemulsification. About 17.7% of cataract surgical services were provided in the government sector (including Forces), while nongovernmental organizations and the private sector contributed to 82.3%. Pakistan achieved a national CSR of 5307 which is almost double the CSR determined in 2002. CONCLUSION: In order to achieve a CSR of 7500+ by 2030, there is a need for at least 1,840,000 cataract surgeries to be performed annually. If there is no change in the current annual cataract surgical output, the CSR will drop to 4628 by 2030. [ABSTRACT FROM AUTHOR]

Childhood blindness and visual impairment (CBVI) are major disabilities that compromise the normal development of children. Health resources and practices to prevent CBVI are suboptimal in most countries in the Eastern Mediterranean Region (EMR). We reviewed the magnitude and the etiologies of childhood visual disabilities based on the estimates using socioeconomic proxy indicators such as gross domestic product (GDP) per capita and <5-year mortality rates. The result of these findings will facilitate novel concepts in addressing and developing services to effectively reduce CBVI in this region. The current study determined the rates of bilateral blindness (defined as Best corrected visual acuity(BCVA)) less than 3/60 in the better eye or a visual field of 10° surrounding central fixation) and functional low vision (FLV) (visual impairment for which no treatment or refractive correction can improve the vision up to >6/18 in a better eye) in children <15 years old. We used the 2011 population projections, <5-year mortality rates and GDP per capita of 23 countries (collectively grouped as EMR). Based on the GDP, we divided the countries into three groups; high, middle- and low-income nations. By applying the bilateral blindness and FLV rates to high, middle- and low-income countries from the global literature to the population of children <15 years, we estimated that there could be 238,500 children with bilateral blindness (rate 1.2/1,000) in the region. In addition, there could be approximately 417,725 children with FLV (rate of 2.1/1,000) in the region. The causes of visual disability in the three groups are also discussed based on the available data. As our estimates are based on hospital and blind school studies in the past, they could have serious limitations for projecting the present magnitude and causes of visual disabilities in children of EMR. An effective approach to eye health care and screening for children within primary health care and with the available resources are discussed. The objectives, strategies, and operating procedures for child eye-care are presented. Variables impacting proper screening are discussed. To reach the targets, we recommend urgent implementation of new approaches to low vision and rehabilitation of children. [ABSTRACT FROM AUTHOR]

State and nonstate health programs in developing countries are often influenced by priorities that are defined in the Millennium Development Goals (MDGs). In the wake of recessionary pressures, policy makers in the health sector are often seen to divert significant budgets to some specific health programs and make only token allocations for other health problems that are important but do not fall under the traditional MDG box of health priorities. This paper illustrates the economic argument for investment in one such program: The eye health program and employs a country case study of Pakistan to demonstrate that there are significant economic gains that are being foregone by not addressing the needs of the blind in poverty reduction strategies. By applying appropriate growth and discounting factors and using the average wage rate, the paper estimates the total productivity gains that are realizable over a period of 10 years if the blind population in Pakistan is rehabilitated and their carers released to participate in the mainstream economic activity. Our findings indicate that significant productivity gains accumulated over 10 years, range from 61 billion (US$ 709 million) to 421 billion (US$ 4.9 billion) depending upon whether the entire blind population or only those affected by a specific cause are rehabilitated. The per annum productivity gains of rehabilitating the entire blind population represents 0.74% of the current gross domestic product of Pakistan, which is higher than the total public spending on health. In order to reap these benefits, the subsequent absorption of the rehabilitated blind and their carers into mainstream economic activity is as important as their effective rehabilitation. [ABSTRACT FROM AUTHOR]