Assessment of Cataract Surgical Needs and Avoidable Blindness in Southern Bangladesh

Background: Cataract remains a leading cause of avoidable blindness worldwide, particularly in low- and middle-income countries. Despite advances in surgical techniques, millions, especially in rural and underserved areas, remain visually impaired due to inadequate access to cataract surgery. In Bangladesh, cataract-related blindness is a significant public health concern, particularly in the southern regions where access to specialized healthcare is limited. Objective: This study aims to assess the prevalence of cataract-induced visual impairment and blindness among adults aged ≥50 years in the southern region of Bangladesh. It further evaluates the coverage and barriers to cataract surgical services to inform targeted interventions aimed at reducing avoidable blindness. Methods: A cross-sectional study was conducted using the Rapid Assessment of Avoidable Blindness (RAAB) methodology. A total of 4,868 individuals were selected through probability-proportionate-to-size cluster sampling. Ophthalmic examinations, including visual acuity and lens status assessments, were performed following standardized protocols. Cataract surgical coverage was calculated, and the primary causes of visual impairment were identified. Data were analyzed using RAAB V.3.1 software. Results: The prevalence of bilateral severe visual impairment (visual acuity <6/60) was 1.6%, and bilateral visual impairment (<6/18) was 8.4%. Cataract was responsible for 79% of bilateral blindness cases, 78.2% of severe visual impairment, and 41.9% of visual impairment. Cataract surgical coverage for individuals with a visual acuity <3/60 was 60.9%, indicating moderate access to surgical services. The main barriers to surgery included financial constraints, lack of awareness, and fear of surgery. Conclusion: Cataract remains the primary cause of avoidable blindness in the southern region of Bangladesh, with significant gaps in surgical coverage. Addressing barriers to cataract surgery through enhanced outreach programs, financial assistance, and community education is crucial in reducing the burden of blindness. Strengthening healthcare infrastructure and increasing the availability of ophthalmic professionals can further improve access to timely cataract treatment.