Cataract and its surgery in Papua New Guinea

Purpose: To determine the prevalence of visually significant cataract, unoperated blinding cataract, and cataract surgery for those aged 50 years and over in Papua New Guinea. Also, to determine the characteristics, rate, coverage and outcome of cataract surgery, and barriers to its uptake. Methods: Using 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, 39 clusters of 30 people 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 1191 people enumerated, 98.6% were examined. The 50 years and older age-gender-adjusted prevalence of cataract-induced vision impairment (presenting acuity less than 6/18 in the better eye) was 7.4% (95% confidence interval [CI]: 6.4, 10.2, design effect [deff] = 1.3). That for cataract-caused functional blindness (presenting acuity less than 6/60 in the better eye) was 6.4% (95% CI: 5.1, 7.3, deff = 1.1). The latter was not associated with gender (P = 0.6). For the sample, Cataract Surgical Coverage at 6/60 was 34.5% for Eyes and 45.3% for Persons. The Cataract Surgical Rate for Papua New Guinea was less than 500 per million population per year. The age-gender-adjusted prevalence of those having had cataract surgery was 8.3% (95% CI: 6.6, 9.8, deff = 1.3). Vision outcomes of surgery did not meet World Health Organization guidelines. Lack of awareness was the most common reason for not seeking and undergoing surgery. Conclusion: Increasing the quantity and quality of cataract surgery need to be priorities for Papua New Guinea eye care services.