Greater Access to Cataract Surgery can Improve TT's Sustainability

The United Nations has published their commitment to achieve 17 Sustainable Development Goals (SDGs) for member states by the year 2030. These goals range from lowering poverty, improving education and equality and of course conserving our environment among others.

It is concerning though that, with less than a mere 7 years before the target date, not much has been publicised by our Health Sector about how vision impairment due to cataracts can actually put a spoke in the wheel of our development right here in Trinidad & Tobago.

Let’s look at a few questions to better understand the importance of this connection: -

Firstly, what exactly is sustainable development?

The concept of sustainable development was described by the 1987 Bruntland Commission Report as “development that meets the needs of the present, without compromising the ability of future generations to meet their own needs.” 

There are four dimensions to sustainable development – society, environment, culture and economy – which are intertwined, not separate.

What does Cataract Surgery have to do with sustainable development?

Cataracts cause a third of worldwide blindness with approximately 65.2 million people affected by moderate to severe vision loss in over 80% of cases. In a recent article published by Lancet Review it states that vision Impairment or blindness due to cataracts directly slows our ability to do the following:

·       End Poverty

·       End Hunger

·       Achieve Economic Growth, and Decent Work for all.

·       Make cities and human settlements inclusive, safe, resilient and sustainable.

So, how can we tell if cataract surgery actually contributes to sustainable development?

This relationship can be seen through several studies done. These studies, include the World Health Survey, which found that persons with vision impairment were less likely to be employed. It was also found that even if employed, persons with vision impairment would have lower salaries than those without vision impairment, thereby reducing household income. There was also additional reduction in income if there were household members who needed to stay home fulltime to care for someone with vision impairment.

Cost-effectiveness and cost-evaluation studies also showed benefits to economic productivity from cataract surgery. For example, one study showed that there was a net 13 year US$123·4 billion return on investment from a 1-year cohort of patients who had had cataract surgery, which included an increase in US national productivity of $25·4 billion.

Simply put, cataract surgery can lead to higher household income for families and result in greater economic wellbeing for a society and country.

What can we in the Health Sector do to help achieve the SDG Goals?

With more than 80% vision impairment due to cataracts being reversable, we should change our approach to cataract surgery delivery for our population. At present, our model is a bit outdated. Public Health Sector providers should begin to enlist the support of private eye care providers to boost the quantity of cataract surgeries done for those who need it.

The beauty of this approach is that it is by no means a novel concept. It’s the way to go as it’s been done across the world with life changing results.

In England, Independent sector providers are currently playing a major role in the delivery of NHS ophthalmology services, especially cataract surgery where they are undertaking almost half of NHS funded procedures.

In fact, in 2016, only 11% of NHS cataract procedures in England were delivered by Independent Sector Providers (ISPs) but by April 2021 there was almost a 50/50 split, with 46% by ISPs and 54% by NHS trusts and treatment centers. This has been transformational for reducing blindness and its negative effects. See graph below.

https://en.unesco.org/themes/education-sustainable-development/what-is-esd/sd

 We can share the burden of care within our population so that individuals, households, communities and the entire country can benefit and have a better quality of life and economic status.

Cataract Surgery improves the livelihood for almost everyone who receives it. What’s more, is that it’s one of the most cost-effective health care interventions with 99% outcomes resulting in immediate visual rehabilitation. That’s a fantastic statistic!

So far, the economic impact of Covid-19 has been grueling however, the research is showing us that increasing the number of cataract surgeries done in our country can give things a nudge in the right direction especially for our long term sustainable development.

It is all of our responsibility to make this happen. Public and Private eyecare work better if we work together. Together is better. Together we can do it.