Rapid assessment of avoidable blindness (RAAB): A 15-year follow-up in Gegharkunik province of Armenia

Abstract

Purpose

This study assessed the changes in the prevalence of visual impairment (VI)/blindness, cataract surgical coverage (CSC), visual outcome after cataract surgery, and main barriers to cataract surgery among the population aged 50 years and older in Gegharkunik province of Armenia from 2003 - 4 to 2019.

Design

A cross-sectional study.

Methods

A multi-stage cluster sampling technique was used to conduct Rapid Assessment of Cataract Surgical Services (RACSS) and Rapid Assessment of Avoidable Blindness (RAAB) surveys in 2003–4 and 2019, respectively. Overall, 56 clusters (40 people in each cluster) were selected for RACSS, and 24 clusters (50 people in each cluster) for RAAB. Both surveys collected data on participants’ demographics, presenting/pinhole visual acuity (PVA/PinVA), the principal cause of VI, CSC, and barriers to cataract surgery.

Results

Overall, 1,787 people participated in RACSS and 1,099 people in RAAB. Between 2003–4 and 2019, age- and sex-adjusted prevalence of bilateral blindness decreased from 2.0 % to 1.4 % while severe VI decreased from 5.2 % to 2.2 % and moderate VI from 16.0 % to 7.3 %. Untreated cataract contributed to 71.9 % and 40.9 % of all blindness cases in 2003–4 and 2019, respectively. The CSC at the threshold <6/18 improved from 23.7 % in 2003–4 to 64.8 % in 2019. Both surveys mentioned the cost as the most common barrier to cataract surgery.

Conclusion

Despite substantial improvements, cataract remained the main cause of blindness in the province. Increasing financial coverage of cataract surgeries and improving the quality of surgeries could increase their utilization of services and help improve visual outcomes in the population.