Improvement in the Effective Cataract Surgical Coverage in Malaysia: Evidence of Impact from a Mobile Cataract Outreach Program

Abstract

Abstract Background Effective Cataract Surgical Coverage (eCSC) is one of the Universal Health Coverage (UHC) indicators recommended by the World Health Organization (WHO). It is calculated from a population survey and measures access and quality of eye care services in the community. We conducted simultaneous population-based eye surveys in two regions in Malaysia in 2023 to estimate eCSC and compare the results with the survey in 2014 following the implementation of a mobile cataract program. Methods The surveys were simultaneously done in Eastern and Sarawak administrative regions using the Rapid Assessment of Avoidable Blindness (RAAB) technique. It involved a multistage cluster sampling method, each cluster comprising 50 residents aged 50 years and older. Presenting visual acuity (PVA) was checked and subjects with cataract were identified. The corrected VA (Pinhole) of those who had undergone cataract surgery was measured. eCSC was calculated at all levels of cataract surgical thresholds according to the protocol. The findings were compared with the previous survey. Results Females had a significantly lower Cataract Surgical Coverage (CSC) than males for cataract surgical threshold of < 3/60 for both regions in National Eye Survey (NES) II in 2014, [Eastern female 82.0%, 95%CI (72.5, 91.5) vs male 97.8%, 95%CI (92.8, 100.0), Sarawak female 76.9%, 95%CI (66.4, 87.3) vs male 96.4%, 95%CI (91.6, 100.0%)]. Although the values for eCSC were lower than CSC during both surveys, the difference between genders was insignificant. Comparing NES II (2014) and NES III (2023) at various levels of cataract surgical threshold, eCSC improved within the range of 13.8%-19.2% and 18.6%-23.8% for Eastern and Sarawak respectively. Conclusion The improvement in eCSC could be attributed to the impact of the mobile cataract service in both regions. However, a coordinated approach is necessary to further strengthen and expand the coverage of the program to enable the country to achieve the 30% increase in eCSC as targeted by WHO.