Coverage of cataract surgery services in Nepal: results from a nationwide Rapid Assessment of Avoidable Blindness survey

Background/aim To assess the coverage of cataract surgery services and the outcomes of surgeries including the causes of poor outcomes in Nepal. Methods A Rapid Assessment of Avoidable Blindness survey was conducted in each of the seven provinces of Nepal and 32 565 participants aged 50 years and older were examined between 2018 and 2021. Along with causes of blindness and vision impairment, cataract surgical coverage (CSC), effective CSC (eCSC) and outcomes of cataract surgery were documented along with reasons for outcomes worse than 6/12. Cataract surgery outcomes were classified as very good (presenting visual acuity ≥6/12), good (6/18), borderline (6/24–6/60) and poor (<6/60). Results Nationally, CSC at the <6/60 cataract surgical threshold was 82.7% (95% CI 80.8% to 84.4%), similar in women (80.9% (95% CI 78.4% to 83.2%)) and men (84.7% (95% CI 82.2% to 86.8%)). Sudurpashchim province had the highest CSC <6/60 at 92.2% while Madhesh and Lumbini provinces in the Terai region had the lowest CSC <6/60, 77.6% and 75.4%. Nationally, eCSC<6/12 was 35.4% (95% CI 33.6% to 37.3%). Voluntary/non-governmental organisations accounted for almost 80% of cataract surgeries. The proportion of surgeries with a good outcome (6/18) was 81.9% in charitable hospitals and 70.7% in eye camps. Preoperative factors accounted for 60.9% of cases, and intraoperative factors accounted for 16.9% of cases with poor outcomes. Conclusion Cataract surgery services in Nepal are satisfactory. There was no gender disparity in coverage and outcomes, but outcomes can and should be improved.