Prevalence of Visual Impairment and Effective Cataract and Refractive Error Coverage Among Adults Aged ≥40 Years in the Sundarbans, Eastern India: A Population-Based Rapid Assessment of Avoidable Visual Impairment (RAAVI) Survey

ObjectivesThe primary objective was to estimate the prevalence and causes of visual impairment (VI) among adults aged 40 years and more in the Sundarbans region of South 24 Parganas, West Bengal, India.The secondary objectives were to assess cataract surgical outcomes, effective cataract surgical coverage (eCSC), effective refractive error coverage (eREC), and barriers to the uptake of cataract surgery and spectacle services. MethodsA population-based cross-sectional Rapid Assessment of Avoidable Visual Impairment (RAAVI) survey was conducted in 2024 using a multistage cluster random sampling design.Eligible participants underwent standardized assessment of visual acuity, refractive status, and ocular examination.Information on barriers to the uptake of eye care services was also collected. ResultsOf 2379 eligible individuals enumerated, 2112 were examined, yielding a response rate of 88.8%.The prevalence of blindness, distance VI, and near VI was 1.1%, 14.4%, and 51.5%, respectively.Cataract was the leading cause of VI (50.8%), followed by uncorrected refractive error/aphakia (40.9%).Other causes accounted for 7.6%, with corneal opacity and phthisis bulbi each contributing 0.3%.eCSC was 68.6% at the blindness threshold and declined to 42.8% at the <6/12 threshold.Distance and near eREC were 46.6% and 36.6%,respectively.Poor cataract surgical outcomes were observed in 7.4% of operated eyes and were mainly attributable to operative complications (68%), ocular comorbidities (16%), and long-term complications (16%).The most frequently reported barriers to cataract surgery were inability to afford treatment (27.8%), lack of perceived need (20.6%), and lack of social support (15%).For spectacle use, the commonest barrier was the perception that vision could be managed without spectacles (53.8%). ConclusionsAlthough cataract surgical services have achieved moderate coverage, improvements in surgical quality, expansion of refractive services, reduction of financial barriers, and increased community awareness are essential to enhance effective eye care coverage and reduce avoidable vision loss in this underserved population.