Visual impairment due to cataract and barriers to accessing cataract surgical services in Indian populations aged 50+ years

Purpose: We aimed to estimate prevalence of vision impairment (VI) due to cataract and its associated factors and barriers for accessing cataract surgical services in India in persons aged ≥50 years. Methods: Analysis of data collected in National Blindness and Visual Impairment Survey, India (2015–2018), was performed (n = 85135). Prevalence of cataract-associated VI was defined as cataract in at least one eye, pinhole visual acuity (PinVA) worse than threshold (6/12, 3/60) in the cataract-affected eye, and not having a more avoidable cause of VI (presenting visual acuity PVA < 6/12 in better eye) in the person. Results: The prevalence of cataract-associated VI at PinVA < 6/12 was 12.9% (95% CI: 11.8, 14.0) and 3.0% (95% CI: 2.6, 3.5) at PinVA < 3/60. The highest prevalences at PinVA < 6/12 were noted in Janjgir-Champa (19.0%), Nalbari (17.9%), and Warangal (17.9%). Females had higher prevalence at PinVA < 6/12 (univariate odds ratio [OR] 1.2) and PinVA <3/60 (univariate OR 1.5). Statistically significant gender differences (females worse off) were noted in Sikar, Ambedkar Nagar, Guna, Banda, and Thrissur at PinVA < 6/12. Prevalence increased with increasing age and decreasing literacy and varied across administrative zones on multivariate analysis. Need not felt was the major reason for not availing cataract surgical services in persons with visual impairment at PinVA < 6/12 (48.1%) and PinVA < 3/60 (27.8%) thresholds. Conclusions: The burden of cataract-associated VI at PinVA < 6/12 in India is significant. Interventions to overcome social determinants and enhance awareness about surgery are required.