The World Health Organization (WHO) is urging countries to redouble their efforts to ensure that millions of people with cataracts have access to a simple surgical procedure that can restore their sight. This operation is one of the most effective and affordable ways to prevent avoidable blindness.
The Lancet Global Health journal today publishes a new study that highlights the magnitude of the problem: almost half of the people blinded by cataracts have not yet been able to undergo the surgery they need...
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(25)00435-8/fulltext
The study, which analyzed data from 68 countries for 2023 and 2024, shows that the problem is most severe in the African Region, where three out of four people who need this procedure still do not receive the surgery. Women are disproportionately affected in all regions and have less access to care than men.
These gaps reveal long-standing structural obstacles, such as the shortage and unequal distribution of trained eye care professionals, the high costs that patients must bear directly, long waiting lists, and the limited awareness or low demand for interventions, even where these services are available.
COMMENT (NPW): The paper does not mention the traditional treatment of couching: A recent article fron the American Academy of Ophthalmology notes:
'One of the earliest surgical interventions for cataracts was a technique called couching... a traditional procedure that is still used today in parts of the world like Northern Nigeria and West Africa due to a multifactorial combination of unfamiliarity of modern procedures, fear of surgery, and preference of relying on traditional methods. In this method, a sharp needle is used to pierce the eye near the limbus until the provider can manually dislodge the cataract - typically into the vitreous chamber - and out of the visual axis.' https://eyewiki.org/History_of_Cataract_Surgery
Couching is 'dangerous and ineffective': https://www.aao.org/education/editors-choice/traditional-couching-found-...
Can HIFA members in Nigeria and west Africa confirm that this procedure is still occasionaly used?
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org