TITLE:
Awareness of Cataract, Barriers to Cataract Surgery and Cataract Surgical Coverage among Patients Aged 50 Years and above in Bhutan
AUTHORS:
Lhacha Wangdi, Tika Maya Bajgai, Dechen Wangmo, Deki, Kuenzang Gyeltshen, Tshering Jamtsho, Sonam Choden Tshering, Gaki Dema, Karma Yeshey Wangmo
KEYWORDS:
Cataract, Blindness, Cataract Awareness, Visual Impairment, Cataract Surgical Coverage
JOURNAL NAME:
Open Journal of Ophthalmology,
Vol.16 No.4,
November
5,
2026
ABSTRACT: Introduction: Cataract continues to be one of the leading causes of blindness in Bhutan. Although regular cataract surgeries are being provided free of cost, there is still a backlog of untreated cataract in the country. Sub-optimal cataract surgical coverage could be due to unwillingness of patients to come forward, lack of awareness about cataract or due to the difficulties faced by the patients while receiving the cataract surgery. We do not know how well our people are informed about the cataract eye disorder and their challenges in availing cataract surgical services in the country. Objectives: This study was intended to assess the level of cataract awareness, challenges to cataract surgery and surgical coverage among patients aged 50 years and above. Method: Multicenter cross-sectional survey was conducted in five regional hospitals in Bhutan. Patients aged 50 years and older were enrolled in the study by a simple random sampling method. Data was collected using semi-structured questionnaires for cataract awareness and barriers to cataract surgery. Status of the visual acuity was based on the presenting visual acuity (PVA). Thorough slit lamp examination was done to assess the types of cataracts. Proportion of pseudophakic eyes were used for calculating the cataract surgical coverage. The descriptive statistics were used for describing the demographic profile and clinical characteristics of the participants. Result: A total of 380 patients were enrolled in this study, out of which 55% (n = 209) were females with mean age of 66.83 years (SD = 10.77). Although 60.79% of them had heard about cataract, the overall cataract awareness was 48.05%. An age adjusted cataract surgical coverage (CSC) was 48.61% and the effective cataract surgical coverage (eCSC) calculated as a proportion of pseudophakic eyes with PVA better than 6/12 was 41.73%. The three top most barriers to the cataract surgery were: fear of surgery 79.5% (n = 159), personal escort problems; 72.5% (n = 145) and not aware of treatment facility; 59.5% (n = 119). Conclusion: Awareness of cataract and cataract surgical coverage among cataract-prone patients was inadequate. The majority of the participants had personal escort problems, fear of eye surgery and lack of cataract treatment awareness as the biggest challenges. There is a need to scale up cataract surgical coverage in the country by addressing some of the challenges faced by the patients.