Cataract as a cause of blindness and vision impairment in Latin America: progress made and challenges beyond 2020

Authors: Reis T, Lansingh V, Ramke J, Silva JC, Resnikoff S, Furtado J

Geographical Coverage: Latin America

Sector: Cataracts

Sub-sector: Risk factors

Equity Focus: Gender

Study Population: People with cataracts

Review Type: Effectiveness review

Quantitative Synthesis Method: Narrative synthesis

Qualitative Synthesis Method: Not applicable

Background

The VISION 2020 (V2020) initiative, launched by the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB) in the late 1990s, aimed to eliminate avoidable blindness by 2020. Considerable global progress has been achieved, including in Latin America, where regional eye care strategies were implemented. The number of ophthalmologists and cataract surgeries has increased, contributing to a 28.5% reduction in the global prevalence of blindness from 1990 to 2020.

However, due to population growth and ageing, the number of blind individuals is projected to rise from 43.3 million in 2020 to 61.0 million by 2050. In Latin America, cataracts remain a major cause of blindness, with suboptimal surgical outcomes and persistent barriers to access. This study provides an update on the cataract situation in Latin America, highlighting barriers, surgical outcomes, and effective cataract surgical coverage (eCSC) by sex.

Objective

To update the status of cataract as a cause of vision loss in Latin America and to analyse gender disparities in cataract surgical coverage (CSC) and effective CSC (eCSC) within the region.

Main Findings

A total of 76 articles were identified from PubMed and 113 from LILACS. From these, five peer-reviewed papers and two additional sources were included. RAAB surveys were conducted in Bolivia, Costa Rica, Cuba, Guatemala, and Mexico, alongside a national eye health survey in Brazil. Blindness prevalence ranged from 1.0% in Mexico to 3.6% in Guatemala, with cataract consistently reported as the leading cause of blindness and severe vision impairment.

Cataract surgical rate (CSR) improved in 10 countries but declined in 6 others. Barriers to surgery—including cost and fear—were particularly noted in Guatemala and Mexico. Suboptimal outcomes were attributed to poor patient selection and postoperative complications, notably in Mexico, Bolivia, Costa Rica, Cuba, and Guatemala.

The eCSC varied substantially. In Nuevo Leon, Mexico, eCSC at 6/60 improved from 42.6% to 69.4% over eight years. Gender differences were mixed: men had higher eCSC in El Salvador, Guatemala, Honduras, Mexico, Peru, and Uruguay, while women had higher eCSC in Argentina, Bolivia, Brazil, Chile, Costa Rica, the Dominican Republic, Ecuador, and Paraguay. Some countries showed minimal differences by sex.

Methodology

The authors searched LILACS and PubMed on 1 March 2020 for literature published between January 2014 and December 2019. Articles were included if the title or abstract mentioned terms such as “cataract blindness,” “cataract surgical coverage,” “cataract surgical results,” “cataract surgical barriers,” or “blindness Latin America.” No language restrictions were applied, and studies from Latin American countries were eligible.

The RAAB repository was also searched, and study authors were contacted for additional data. Definitions of blindness, SVI, and MVI were based on presenting visual acuity. CSC and eCSC were calculated using WHO methodology, and gender inequality was assessed using disaggregated data.

Applicability/External Validity

Although the review found no overall gender inequality in CSC or eCSC, the limited geographic representation means the findings cannot be generalised to all of Latin America.

Geographic Focus

The review included studies from Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, the Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay, and Venezuela.

Summary of Quality Assessment

There is low confidence in the review’s conclusions due to several methodological limitations, such as unclear screening and data extraction procedures, a lack of risk of bias assessment, and a relatively limited search strategy.