When would one operate cataract in Africa?

There is a good retrospective study from Nigeria showing that trends to operate only the advanced stages of cataract persist in Sub-Saharan Africa. That means that a patient with cataract would typically get his cataract removed only when they are blind (i.e. 0,05 or 3/60 and beliw, HM, LP etc.). In this context it is important to remember, that MSICS technique of cataract surgery is safer in premature and matute stages of cataract, which can influence the willingness to operate among surgeons.

Ther Adv Ophthalmol. 2019 Jan-Dec; 11: 2515841419886451.
Published online 2019 Nov 13. doi: 10.1177/2515841419886451
PMCID: PMC6854760
PMID: 31763621
Preoperative visual acuity of cataract patients at a tertiary hospital in sub-Saharan Africa: a 10-year review
Mary O. Ugalahi, Obioma C. Uchendu, and Linda O. Ugalahi
Mary O. Ugalahi, Department of Ophthalmology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Ibadan, Nigeria; Department of Ophthalmology, College of Medicine, University of Ibadan and University College Hospital, 200212 Ibadan, Ibadan, Nigeria;


To determine the preoperative visual acuity of cataract patients over a 10-year period in a tertiary facility as a means of auditing the cataract surgical services.


A retrospective study of patients with age-related cataracts who had cataract surgery performed between January 2007 and December 2016 at the University College Hospital, Ibadan. Systematic random sampling and probability proportionate to size were used to recruit a representative sample. Information on sociodemographic characteristics, preoperative visual acuity, ocular and systemic comorbidities were retrieved and analysed.


Of the 499 patients studied, males were 268 (53.7%) and their mean age was 67.69 (±9.51) years. The predominant visual acuity was hand motion 184 (36.9%) and yearly mean preoperative visual acuity was in the range of 0.0037–0.04 decimal.


The mean preoperative visual acuity of patients in this facility did not change over the 10-year study period. Mean value of preoperative visual acuity remained within the range of blindness and did not improve over the decade. This could either be a reflection of visual impairment at which our patients seek care or an indication of the range of visual acuities at which surgeons are willing to offer cataract surgery in our environment. This trend has negative implications on the burden of cataract blindness as it reflects poor coverage of surgery for other levels of visual impairment due to cataract.