Epidemiology of Cataract-Related Blindness in Brazil: 30 Years of Public Policy Evolution: A Review Article

Abstract

Purpose

This review evaluated the impact of various public policies on the number of cataract surgeries performed annually by the Public Health System (SUS) in Brazil and its regions. The goal was to provide insights for managers and the medical community to assess the effectiveness of strategies to prevent cataract-related blindness.

Design

Trend studies based on literature review.

Methods

This study was developed through a literature review, with a bibliographic survey conducted in databases such as PubMed, MEDLINE, Web of Science, Embase, LILACS, and SciELO.

Results

Until the early 2000s, approximately 130 000 cataract surgeries were performed annually in Brazil. In 2001, the National Cataract Campaign (CNC) was introduced, which significantly increased surgical volume by providing unrestricted federal funding. By 2003, the SUS had performed 430 000 surgeries, underscoring the critical role of funding in combating cataract blindness. However, the Ministry of Health discontinued the CNC in 2006, leading to a decline in surgeries in subsequent years. The annual surgical volume recovered to 430 000 only in 2011, following the adoption of new policies that involved directly contracting private companies through government tenders. In 2013, the SUS achieved the minimum number of surgeries required to prevent an accumulation of cataract blindness cases, conducting 530 000 procedures. By the early 2020s, parliamentary amendments directed to specific municipalities through Health Social Organizations became a primary funding source for cataract procedures. This approach proved effective, with approximately 860 000 surgeries performed in 2022 to prevent new accumulations and reduce overall cataract blindness. The COVID-19 pandemic disrupted progress, causing a 23% decline in surgeries in 2020. However, surgical rates surged with the relaxation of restrictions in 2021, exceeding prepandemic levels by 21%. By 2022, the number of cataract surgeries increased by 63% compared with the prepandemic average, fully addressing the backlog created during the health crisis.

Conclusions

The increase in surgeries was driven by unlimited federal funding, private contracts, and targeted parliamentary amendments. Despite these efforts, regional disparities persist, requiring equitable policies based on local epidemiologic data. Ensuring access to cataract surgery demands sustained public investment. The resilience of Brazil's SUS in the postpandemic era underscores the need for consistent investments to effectively address health care challenges.