Cataract and its surgery in Timor-Leste

Purpose: To determine the prevalence of visually significant and unoperated blinding cataract, and the coverage, characteristics and outcome of cataract surgery in Timor-Leste. Methods: Based on the World Health Organization Rapid Assessment of Cataract Surgical Services protocol, a population-based cross-sectional survey was conducted in 2005. By two-stage cluster random sampling, 50 clusters of 30 people aged 40 years and older were selected. Each eye with a presenting visual acuity worse than 6/18 and/or a history of cataract surgery was examined. Results: Of the 1470 people enumerated, 96.2% were examined. Of the eyes examined, 11.5% were blind (presenting vision less than 6/60). Cataract caused 66.3% of this, and 40.2% of vision impairment (presenting vision less than 6/18). For those people who were blind (7.7%; presenting vision less than 6/60 in the better eye), cataract was the most frequent cause (76.1%). Cataract surgery had occurred in 2% of participants. Gender and domicile were not associated with cataract blindness or surgery. Cataract Surgical Coverage (6/60) was 16.3% for Eyes and 20.2% for Persons. Surgical outcomes were poor, falling well short of World Health Organization guidelines. Astigmatism and posterior capsule opacity were important contributors to this. Conclusions: Until census data are available, age-gender-domicile correction of sample findings cannot be calculated. In the meantime, it is estimated there are 11 500 cataract blind in Timor-Leste. Long-term, indigenous cataract surgical services need to be capable of significantly increased output. Better surgical outcomes are required to ensure scarce resources are well used. Laser capsulotomy needs to be planned for as surgical numbers increase.