Why Half the World's Cataract Patients Still Can't Get Surgery—and What It Costs Us All

Nearly half of all people worldwide who need cataract surgery still don't have access to it, according to a new study published in The Lancet Global Health. Cataract—the clouding of the eye's lens that causes blurred vision and can lead to blindness—affects more than 94 million people globally, yet progress in making this simple, sight-restoring procedure available is moving far too slowly.

Why Is Cataract Surgery So Important?

Cataract surgery is one of the most cost-effective medical procedures available. The operation takes just 15 minutes and provides immediate and lasting restoration of sight. For someone living with cataracts, regaining vision means regaining independence, dignity, and the ability to work and participate fully in daily life. Yet despite its simplicity and effectiveness, access remains deeply unequal across the globe.

The World Health Organization (WHO) emphasizes that "cataract surgery is one of the most powerful tools we have to restore vision and transform lives. When people regain their sight, they regain independence, dignity, and opportunity," according to Devora Kestel, Director of WHO's Department of Noncommunicable Diseases and Mental Health.

Where Are the Biggest Gaps in Access?

The disparities are striking and vary dramatically by region and gender. The African Region faces the greatest challenge, with three in four people who need cataract surgery remaining untreated. Women are disproportionately affected across all regions, consistently experiencing lower access to care than men.

These gaps reflect long-standing structural barriers that prevent people from getting the care they need:

• Workforce Shortages: There are not enough trained eye-care professionals, and those who exist are unevenly distributed, leaving rural and underserved areas without adequate services.
• Financial Barriers: High out-of-pocket costs prevent many people from affording surgery, even when it is available.
• Long Wait Times: In many regions, people must wait months or years for surgery, during which their vision continues to deteriorate.
• Limited Awareness: Many people don't know that cataract surgery exists or that it can restore their vision, so they never seek treatment.

How Fast Is Progress Really Happening?

Over the past two decades, global coverage of cataract surgery has increased by about 15%, which sounds encouraging. However, this progress is not keeping pace with the growing need. As populations age and more people develop cataracts, the overall demand for surgery continues to rise.

The latest modeling predicts that cataract surgery coverage will rise by about 8.4% during this decade. But here's the problem: the World Health Assembly has set a target of a 30% increase by 2030. At the current rate of 8.4%, the world will fall far short of that goal. Progress needs to accelerate sharply to meet this target.

What Risk Factors Make Cataracts More Likely?

While age is the primary risk factor for cataract development, several other factors can accelerate its onset. These include prolonged exposure to ultraviolet B (UV-B) radiation from the sun, tobacco use, long-term corticosteroid medication use, and diabetes. Understanding these risk factors can help people take preventive steps, though age-related cataracts remain inevitable for most people who live long enough.

What Would It Take to Close the Gap?

The WHO has identified concrete steps that countries can take to accelerate progress and ensure more people get the surgery they need. These include integrating vision screening and eye examinations into primary health care systems so cataracts are caught early, investing in essential surgical infrastructure like operating rooms and equipment, and expanding the eye-care workforce while distributing professionals more equitably to rural and underserved areas.

Targeted efforts to prioritize women and marginalized communities will be critical to reducing persistent inequities. The WHO is calling on governments, civil society, and partners to build on existing momentum, address gender and geographic inequities, and prioritize underserved populations.

The stakes are enormous. Vision impairment poses an enormous global financial burden, with an estimated annual global productivity loss of about $411 billion in purchasing power parity. This figure far outweighs the estimated $25 billion cost gap needed to address the unmet need of vision impairment. In other words, the world is losing far more money to preventable blindness than it would cost to fix the problem.

With sustained commitment and targeted investment, cataract surgery can move from being out of reach for millions to a universally accessible intervention, helping to end avoidable blindness worldwide.