What is a Cataract Backlog Free Community?

HelpMeSee and our partner Shri Sadguru Seva Sangh Trust recently announced new Cataract Backlog Free Communities in the Banda, Hamirpur, Panna and Satna Districts of India with another in line for the Mahoba District. The achievement of these incredible milestones creates the perfect opportunity to explain the meaning of a Cataract Backlog Free Community and a Reduction in Cataract Blindness.

To begin this we need to establish some basics: 

How many people are actually blind due to cataracts?
The number of people who are legally blind due to cataracts as concluded by the World Health Organization is 20 million. This number is an estimate as no one could count the actual number of people. There is difficulty enough in finding these people for treatment let alone counting them. Using surveys and statistics WHO was able come up with this number.1

What does “legally blind” mean?
Vision and vision loss can occur various stages. Visually impaired means that “a person’s eyesight cannot be corrected to a normal level.” Legally blind is a standard at which someone with vision problems could be considered disabled.

In the U.S. a person is legally blind if they have a visual acuity of 20/200 or less with the best use of vision correction in the better eye. 20/200 means someone would have to be standing within 20 feet of an object to see it as clearly as someone with perfect vision could see it at 200 feet.

Twenty million seems like a very large number. Is it an achievable goal?
Three hundred million people died of smallpox in the 20th century.2 If we can tackle epidemics like smallpox, then eliminating blindness due to cataracts in 20 million people should be easy, right? As people are cured of an infectious disease, barring an outbreak, the likelihood that someone in the future contracts that disease is smaller. There are fewer opportunities to spread the infection.

With cataracts, the number of people treated doesn’t affect the development of new cases. The global population is aging and exposure to UV radiation is more likely, placing a larger percentage of people at risk for cataracts. If this were a waiting list the rate at which people are joining is actually increasing.

How do we handle this growing number of cataract patients and what is CSR?
While the WHO calculated that 20 million people are blind due to cataract, this number itself is around 20 years old. There are more cases occurring every day. Luckily many people are being treated and making their way to the end of these waiting lists.

The public health community wanted to come up with a figure to determine that rate at which people are being treated. Since countries vary in size, economic stability and access to healthcare Cataract Surgical Rate (CSR) their solution, is an equality yardstick measuring how countries are addressing the problem of cataract blindness. Cataract Surgical Rate is the number of cataract treatments performed per year for every 1 million people within a specific geographic area. The CSR in places like India, Africa, and Latin America is lower, so cataract patients on those waiting lists are growing faster than they can be treated creating a backlog.

For example, here are a few of the cataract surgical rates for countries around the world:  Cataract Surgical Rate chart

Can we ever completely eliminate cataract blindness?
 If we ramp up the Cataract Surgical Rate to treat more people and catch up to the point where we only have brand new cases, we have created a Cataract Backlog Free Community. Our waiting list is cleared and it’s time to go home.

But not so fast... 
Cataracts aren’t going away soon and even increasing - we may have cleared our waiting list but the front door is open and people are still coming in… at an accelerated pace. The scientific community, where accuracy is of the utmost importance, would say that we never fully eliminated the backlog. There will always be a few people waiting but in smaller numbers. We’ve created what they call a Reduction in Cataract Blindness. There were X percentage of people who had cataracts and now it has drastically been reduced to Y.

A Reduction in Cataract Blindness is great and accurate, but those focused on fundraising and marketing would rather say that we eliminated the backlog. It sounds better if the problem has gone away completely rather than only being improved. Until there is a way to prevent cataracts there will always some people in need of treatment and backlogs, but drastically smaller ones.

Infographic explaining the process through which the backlog of patients awaiting treatment can be reduced.

Mission Accomplished!
We must still take pride in our accomplishments and our Cataract Backlog Free Communities are a reflection of this. A Cataract Backlog Free Communities is sensational – A Reduction in Cataract Blindness… amazing. Both of these are laudable milestones and now we understand what they actually mean.

Do you have a question about Cataract Backlog Free Communities or a Reduction in Cataract Blindness? Please check our FAQs page for more information.

References:
1 http://www.who.int/whr/1998/en/whr98_en.pdf
2 http://www.bbc.co.uk/history/british/empire_seapower/smallpox_01.shtml