农村白内障防盲手术前忠者眼病意识调查

目的了解农村白内障患者的眼病意识和眼病治疗障碍。设计前瞻性横断面调查研究。研究对象江苏省姜堰市6个月内筛查出等待手术的白内障患者251例。方法手术前对患者进行问卷调查,调查表依印度Aravind眼科医院进行白内障临床评价的眼病意识调查问卷和本地居民生活习俗而设计。主要指标眼病存在意识、眼病治疗意识、眼病治疗障碍、健康意识和错误治疗行为。结果意识到自己眼病存在时间在1年以上的患者为89．6％;知道自己眼病可以治疗的时间在1年以上为0．12％,6个月至1个月为31．9％,1个月内为65．7％;患者治疗障碍主要为:还能看见、经济困难、年纪大不要求手术、不相信手术能成功。结论在农村进行眼病卫生知识宣传教育具有必要性和紧迫性,发展经济是提高白内障手术覆盖率的根本措施, 提供价廉效优的白内障手术是目前提高白内障手术率的关键。     

农村白内障防盲手术前患者眼病意识调查

目的了解农村白内障患者的眼病意识和眼病治疗障碍.设计前瞻性横断面调查研究.研究对象江苏省姜堰市6个月内筛查出等待手术的白内障患者251例.方法手术前对患者进行问卷调查,调查表依印度Aravind眼科医院进行白内障临床评价的眼病意识调查问卷和本地居民生活习俗而设计.主要指标眼病存在意识、眼病治疗意识、眼病治疗障碍、健康意识和错误治疗行为.结果意识到自己眼病存在时间在1年以上的患者为89.6%;知道自己眼病可以治疗的时间在1年以上为0.12%,6个月至1个月为31.9%,1个月内为65.7%;患者治疗障碍主要为：还能看见、经济困难、年纪大不要求手术、不相信手术能成功.结论在农村进行眼病卫生知识宣传教育具有必要性和紧迫性,发展经济是提高白内障手术覆盖率的根本措施,提供价廉效优的白内障手术是目前提高白内障手术率的关键.（眼科,2006,15：42-45）     

Cataract and its surgery in Papua New Guinea

PURPOSE: To determine the prevalence of visually significant cataract, unoperated blinding cataract, and cataract surgery for those aged 50 years and over in Papua New Guinea. Also, to determine the characteristics, rate, coverage and outcome of cataract surgery, and barriers to its uptake. METHODS: Using the World Health Organization Rapid Assessment of Cataract Surgical Services protocol, a population-based cross-sectional survey was conducted in 2005. By two-stage cluster random sampling, 39 clusters of 30 people were selected. Each eye with a presenting visual acuity worse than 6/18 and/or a history of cataract surgery was examined. RESULTS: Of the 1191 people enumerated, 98.6% were examined. The 50 years and older age-gender-adjusted prevalence of cataract-induced vision impairment (presenting acuity less than 6/18 in the better eye) was 7.4% (95% confidence interval [CI]: 6.4, 10.2, design effect [deff] = 1.3). That for cataract-caused functional blindness (presenting acuity less than 6/60 in the better eye) was 6.4% (95% CI: 5.1, 7.3, deff = 1.1). The latter was not associated with gender (P = 0.6). For the sample, Cataract Surgical Coverage at 6/60 was 34.5% for Eyes and 45.3% for Persons. The Cataract Surgical Rate for Papua New Guinea was less than 500 per million population per year. The age-gender-adjusted prevalence of those having had cataract surgery was 8.3% (95% CI: 6.6, 9.8, deff = 1.3). Vision outcomes of surgery did not meet World Health Organization guidelines. Lack of awareness was the most common reason for not seeking and undergoing surgery. CONCLUSION: Increasing the quantity and quality of cataract surgery need to be priorities for Papua New Guinea eye care services.     

The decrease of visual acuity in cataract patients waiting for surgery

PURPOSE: To investigate the rapidity of vision loss in eyes waiting for cataract surgery and to estimate what proportion of life expectancy the extended wait for surgery comprised. METHODS: The visual acuities at the time of referral and on the day before surgery were compared in 124 patients operated on for cataract in the Vaasa Central Hospital, Finland. The expected survival of the patients after surgery was calculated individually using the Finnish life statistics. RESULTS: During the waiting time of 13 months on the average, the visual acuity in the study eye decreased from 0.68 logMAR (0.2 in decimal values) to 0.96 logMAR (0.1). The average decrease in vision was 0.27 logMAR per year varying from none to 2.07 logMAR units. 30% of the eyes experienced worsening of vision by 60% or more while 48% had no or minimal worsening (<0.2 logMAR). The rapidity of change in visual acuity was somewhat less in older patients (75 years or older), but the difference was not statistically significant. The percentage of persons with visual acuity of 0.5 or better in the better eye decreased from 66% to 41% and those with low vision (<0.3 in the better eye) increased from 8% to 21%. The mean waiting time in relation to the expected survival for all patients was 13% varying from less than 5% in 10 patients to more than 25% in 8 patients. CONCLUSION: Progression of vision loss in eyes waiting for cataract surgery varies significantly. For many patients the extended delay caused remarkable disability for a considerable part of their remaining lifetime.     

单眼先天性白内障早期手术的疗效分析

目的 观察儿童单眼先天性白内障早期手术的疗效。方法 用针吸灌注法对18例患儿手术摘除白内障，术后配镜，健眼包盖。结果 术后5例获得最好视力0．5或0．5以上(28％)，6例0．25～0．4(33％)，4例0．1～0．2(22％)，3例低于0．1(17％)，随防时间4．5～10年。结论 单眼先天性白内障的患儿，在19周前早期手术可获得较好视力0．5或0．5以上，1周岁左右儿童术后所得视力仅为0．1～0．2，早期手术是防止形觉剥夺性弱视的关键，适时屈光矫正也很重要。     

Cataract in leprosy patients: cataract surgical coverage, barriers to acceptance of surgery, and outcome of surgery in a population based survey in Korea

BACKGROUND/AIMS: Cataract is the leading cause of blindness in leprosy patients. There is no population based information on the cataract surgical coverage, barriers to use of surgical services, and outcome of surgery in these patients. We sought to determine these measures of cataract programme effectiveness in a cured leprosy population in South Korea. METHODS: The population consisted of residents of six leprosy resettlement villages in central South Korea. All residents were invited to participate in a study of eye disease and interviewed regarding use of surgical services and reasons for not using these services. RESULTS: The cataract surgical coverage in this population was 55.4% when <6/18 was used as the cut off and increased to 78.3% when the cut off was <6/60. Barriers reported by patients included being told by the doctor that the cataract was not mature and a perception by the patient that there was no need for surgery. Among patients who had aphakic surgery, 71% were still blind in the operative eye while among patients who had pseudophakic surgery, 14% were still blind (presenting vision). Blindness in pseudophakic patients could be reduced to 3% with spectacle correction. CONCLUSION: Cataract prevalence in leprosy patients will increase as life expectancy continues to increase. Leprosy control programmes will need to develop activities aimed at reducing the burden of cataract. Recommendations include establishing collaborative agreements with ophthalmological services to provide high quality IOL surgery to these patients, training of health staff to identify and refer patients in need of surgery, monitoring the uptake of cataract surgery among patients needing services, and monitoring the outcome of surgery to improve refractive outcome.     

Cost-utility analysis of cataract surgery in the second eye

OBJECTIVE: To perform a reference case cost-utility analysis of second-eye cataract surgery by using the current literature on cataract outcomes and complications. DESIGN: Computer-based econometric modeling. METHODS: Visual acuity data of patients treated and observed over a 4-month postoperative period were obtained from the U.S. National Cataract Patient Outcomes Research Team report. The results from this prospective study were combined with those of other studies that investigated the complication rates of cataract surgery to complete the cohort of patients and outcomes. These synthesized data were incorporated with time trade-off utility values, which accounted for prior successful cataract surgery in the fellow eye. Cost-utility determinations were made with decision analysis, and present value modeling was used to account for the time value of money and health state consequences. MAIN OUTCOME MEASURES: The number of quality-adjusted life-years (QALYs) gained was calculated for the study group undergoing second-eye cataract surgery, assuming that the postoperative vision in the second eye was equivalent to the vision in the first eye after surgery (20/27). This was divided into the cost of the procedure to find the number of year 2001 nominal U.S. dollars spent per QALY gained. RESULTS: Second-eye cataract surgery, as compared with unilateral pseudophakia, resulted in a mean gain of 1.31 undiscounted QALYs per patient treated. A 3% annual discount rate, dependent on the duration of benefit, was used, yielding 0.92 discounted QALYs gained over a 12-year life expectancy. The mean discounted cost of treatment for each patient totaled 2509 US dollars. The cost divided by the QALYs gained (benefit) resulted in 2727 US dollars per QALY gained for this procedure. Sensitivity analysis varying costs and utility values revealed a range from 2045 US dollars to 3649 US dollars per QALY gained. CONCLUSIONS: Second-eye cataract surgery is an extremely cost-effective procedure when compared with other interventions across medical specialties. The cost-effectiveness of second-eye surgery diminishes only slightly from the 2023 US dollars per QALY gained from first-eye cataract surgery. This suggests that patients with good vision in one eye and visual loss from cataract in the fellow eye derive substantial benefit from cataract extraction.     

Cataract in central Sri Lanka: cataract surgical coverage and self-reported barriers to cataract surgery

Purpose:  To determine the cataract surgical coverage and investigate the barriers to cataract surgery in the Kandy District of central Sri Lanka.
Methods:  A population-based, cross-sectional ophthalmic survey of the inhabitants of rural villages in central Sri Lanka was conducted; there were 1721 eligible subjects and 1375 participated (79.9% participation rate). The recorded data included age, gender, education, district, corrected visual acuity, dilated slit-lamp examination and stereoscopic fundus examination. Lens opacity was graded using the Lens Opacities Classification System III. Participants with cataract-induced visual impairment (acuity <6/18 in the better eye) were also invited to respond to a verbal questionnaire about barriers to cataract surgery.
Results:  Cataract surgical coverage per individual for visual acuity cut-offs of <6/18, <6/60 and <3/60 was 41.9%, 76.8% and 82.7%, respectively; and per eye was 34.0%, 60.3% and 65.2%, respectively. Cataract surgical coverage was higher for men than women, and two-thirds refused referral for surgery, for the following reasons: no desire to improve vision, fear of surgery and lack of awareness were the most frequently reported barriers.
Summary:  Cataract surgical coverage in central Sri Lanka is higher than that in neighbouring developing regions. Surgical uptake may be improved through better community education.     

西北地区眼科单中心1009例单眼盲患者致盲病因和手术疗效分析

目的　分析我国西北地区眼科单中心行白内障手术的单眼盲患者致盲病因和手术效果,为提高防治提供参考。方法　回顾性系列病例研究。纳入2016年7月至2020年11月陕西省眼科医院（西安市第四医院）收治的对侧眼行白内障手术的单眼盲（单眼裸眼视力＜0.05）患者1009例。采用χ²检验及logistic回归分析对患者致盲病因和白内障手术效果进行分析。结果　1009例单眼盲患者中,男465例（46.1%）,女544例（53.9%）,年龄（67.7±11.9）岁。前6种致盲病因分别为青光眼［29.7%（300例）］、视网膜脱离［15.3%（154例）］、眼外伤［14.4%（145例）］、角膜病［6.4%（65例）］、高度近视［6.1%（62例）］、白内障［5.7%（58例）］。对侧眼手术前、后视力完整者989例,术后视力提高者占90.2％（892例）,未提高者占9.8％（97例）;386例单纯白内障患者术后视力均提高,余603例术后视力提高者与未提高者间差异具有统计学意义的相关因素为眼部合并其他疾病及其治疗史(均为P<0.05),进行logistic回归分析后,有意义的独立因素包括青光眼和眼部合并其他疾病治疗史（均为P<0.05）,其中眼部合并其他疾病治疗史回归系数为-2.016,影响最大。结论　青光眼是我国西北地区行白内障手术的单眼盲患者中最常见的致盲病因,且女性多见。单眼盲对侧眼单纯白内障患者在无禁忌证时应尽早行白内障手术。眼部合并疾病尤其青光眼的及时诊治对白内障手术有积极作用。     

Audit of extracapsular cataract extraction and posterior chamber lens implantation as a routine treatment for age related cataract in east Africa

AIMS: To evaluate the outcome of extracapsular cataract extraction (ECCE) and posterior chamber intraocular lens implantation (PC-IOL) in an African eye clinic during the transition from intracapsular cataract extraction to ECCE and PC-IOL. METHODS: A retrospective survey of 461 consecutive operations for age related cataract with a mean follow up of 52.9 weeks (range 0-275) and a minimum follow up of 4 weeks in 87.9% of eyes. RESULTS: A best corrected vision of 6/18 or better was obtained in 94.3% of eyes, and an uncorrected vision of 6/18 or better in 78.2% of eyes. Six eyes (1.5%) had a best corrected vision of less than 6/60. The visual acuity at 2 months was strongly predictive of the vision at 1 year or more after surgery. Preoperative biometry and IOL power calculation increased the proportion of eyes obtaining an uncorrected vision of 6/18 or better from 73.8% to 81.3%. Four eyes developed visually significant posterior capsule opacity. CONCLUSION: ECCE and PC-IOL can give very good results in an African setting. A better visual outcome should lead to increased demand for cataract surgery, which will eventually reduce the number of cataract blind people in Africa.     

Changes in visual acuity of patients undergoing cataract surgery during the last two decades

PURPOSE: To compare preoperative visual acuities in patients who underwent cataract surgery between 1982 and 2000. METHODS: Information on visual acuity (VA), ocular disease and general disease was obtained from records relating to samples of consecutive cataract operations in 1982, 1985, 1990, 1995 and 2000 in two hospitals in the Vaasa region of Finland. RESULTS: Between 1982 and 2000, the average preoperative VA in the operated eye increased by 0.85 logMAR units (from logMAR 1.56 to logMAR 0.71) or 8.5 log lines. Corresponding decimal values are 0.03 and 0.2, respectively. In the better eye, VA increased from logMAR 0.64 to logMAR 0.37. Corresponding decimal values are 0.23 and 0.43, respectively. The incidence of cataract surgery increased from 1.0 to 7.2 operations per 1000 of the population per year over the period. For an annual increase of one operation per 1000 inhabitants, the increase in average VA before surgery is 1.3 log lines in the operated eye and 0.4 log lines in the better eye. The number of patients with visual impairment (WHO definition: VA < 0.3) before surgery fell from 47% to 15%, and the number of patients with profound visual handicaps (VA < 0.1) before surgery fell from 15% to 4%. CONCLUSION: The preoperative vision of patients undergoing cataract surgery during the last two decades has improved significantly. Preoperative VA has increased linearly in line with the incidence of surgery. Only a small proportion of the increase in incidence of cataract surgery can be explained by the increasing average age of the population.     

Gains from cataract surgery: visual function and quality of life.

AIMS: To describe the impact of cataract surgery in terms of visual function (functioning in everyday life with respect to vision dependent activities) and health related quality of life. METHODS: An observational, longitudinal study of patients undergoing cataract surgery was carried out at three district general hospitals in outer London districts of North Thames Region with follow up at 4 and 12 months postoperatively for a clinical assessment and a standardised administered interview. Patients were admitted for surgery to the first eye for age-related cataract between 1 May 1993 and 31 August 1994. Visual functioning was assessed by the VF-14, health related quality of life was assessed by the sickness impact profile (SIP), and vision related quality of life was assessed by VR-SIP (a modification of the generic SIP). RESULTS: Significant gains in all the outcome measures were demonstrated at 4 months postoperatively. No significant change (gain or loss) was observed between 4 and 12 months after surgery to the first eye. Postoperatively, the mean visual function (VF-14) scores, and health related (SIP) and vision related (VR-SIP) quality of life scores, indicated less reported trouble with vision dependent activities and better perceived quality of life, respectively. The average gains in visual function and quality of life (health and vision related) were apparent in groups with good visual outcome and poor visual outcome. Significant additional gains were seen at 1 year in patients who had second eye surgery in the interval between the postoperative assessments. CONCLUSIONS: Gains in visual functioning and quality of life (health and vision related) have been demonstrated following cataract surgery. These gains were sustained at 1 year after surgery to the first eye, with additional gains being conferred if second eye surgery had been performed. Assessment of the outcomes of cataract surgery by clinical indicators alone may underestimate the overall benefits of surgery, particularly in patients with poor visual outcome.     

Improvements in clinical and functional vision and quality of life after second eye cataract surgery.

PURPOSE: To determine whether there is a need for second eye cataract surgery or whether cataract surgery in one eye provides sufficiently adequate vision. METHODS: The vision of 43 patients was assessed using a battery of clinical vision tests, performance-based functional vision tests, and quality of life questionnaires, both before and a few months after cataract surgery. Twenty-five patients underwent second eye surgery and 18 patients underwent first-eye surgery. To determine whether cataract surgery returned vision to normal levels, a control group of 25 subjects of a similar age with normal, healthy eyes was also assessed. RESULTS: Overall, greater improvements occurred in most aspects of vision after first eye surgery than after second eye surgery. However, second eye surgery provided similar improvements in mobility orientation and self-reported night driving to those after first eye surgery, and substantially greater improvements in stereoacuity and reductions in anisometropia. CONCLUSIONS: The study provides additional evidence to support the need for second eye cataract surgery. Second eye surgery may be particularly important to improve mobility orientation and the avoidance of falls.     

Phacoemulsification cataract surgery and unplanned anterior vitrectomy--is it bad news?

PURPOSE: The aim of this study was to determine the final visual outcome of patients who undergo complicated phacoemulsification cataract surgery in which the posterior capsule is compromised and vitrectomy was required. METHODS: Data were collected for patients operated on over an 18-month period from the 1st of January till the 24th of June 1999 at the Department of Ophthalmology, Leicester Royal Infirmary. All grades of surgeons were included and patients were identified from the theatre logbook. A standard proforma was completed and the data evaluated. RESULTS: A total of 2538 phacoemulsification cataract operations were performed over this duration. Of these, 2446 (96.4%) had uncomplicated phacoemulsification cataract surgery while 92 (3.6%) required anterior vitrectomy.In order to allow for a more accurate interpretation of the visual outcome, patients were divided into two groups, depending on whether or not there was pre-existing eye disease at initial listing.Sixty-five patients did not have pre-existing eye disease. From this, notes were available for 57 patients, whereby the best-corrected visual acuity (BCVA) was obtained postoperatively.Vision of 6/12 or better was used to define acceptable postoperative vision. This group consisted of 49 patients (86%): five had visual acuities of 6/12, 26 = 6/9, one = 6/7.5 and 17 = 6/6. There were eight (14%) patients with poor visual outcome, largely represented by patients with cystoid macular oedema (8.8%). The most frequent stage of vitreous loss was during primary phacoemulsification in 46 (50%). Irrigation and aspiration, which resulted in 21 (23%) instances, followed this.The rate of posterior capsule rupture and anterior vitrectomy during phacoemulsification cataract surgery is 2% when performed by consultants, 4% by specialist registrars and staff grades and 10% by senior house officers. CONCLUSION: This study looks at the final visual outcome of patients who underwent unplanned anterior vitrectomy during routine phacoemulsification cataract surgery, in a university teaching hospital in the United Kingdom. It includes all levels of surgeons with varying experience. The rate of vitreous loss in this study for phacoemulsification cataract surgery is 3.6%. Patients who undergo complicated phacoemulsification cataract surgery do comparatively well.     

The social and family dynamics behind the uptake of cataract surgery: findings from Kilimanjaro region, Tanzania

AIMS: To describe and understand better the barriers that elderly cataract patients in Kilimanjaro region (Tanzania) experience at the family level in order to access surgery. METHODS: A phenomenological study carried out in the catchment area of a teaching hospital in Kilimanjaro Region. 60 semi-structured interviews were conducted with patients and ex-cataract patients. RESULTS: The perceived need for sight and for surgery appears partly socially constructed at the family level. It was found that women were less likely to express a need for sight for fear of being seen as a burden. Furthermore, young heads of family are more inclined to support old men than old women. The consensus is that asking children for help can be difficult. Going for cataract surgery must be seen as a social process where elderly patients might have to wait or negotiate support for weeks, months, or even years. CONCLUSIONS: Eye programmes must promote the benefits of cataract surgery to all family members, not just to the patient. A changing social climate, changing expectations of vision, and evolving cost sharing systems will have significant, sometimes contradictory, impacts on use of eye care services. Strategies for reaching those without access to financial resources need to be strengthened.     

Knowledge and beliefs about common eye diseases

Purpose: To ascertain the level of knowledge of common causes of blindness in an adult Australian population and to relate this to use of eye care services.
Methods: A population-based study of common eye diseases in an urban population aged 49 years or older was conducted. The questions were concerned with the awareness and knowledge of and the ability to describe three common eye diseases, namely cataract, glaucoma and agerelated macular degeneration (AMD).
Results: Awareness of cataract (98%) and glaucoma (93%) were high in this population, but awareness of AMD was low (20%). Among people who were aware of the target eye disease, only 29% showed some knowledge of glaucoma, 26% showed some knowledge of AMD and 20% showed some knowledge of cataract; this was also low in people who had previous eye treatment, such as cataract surgery. Knowledge was related to education level, occupational prestige and knowledge of other eye diseases. After excluding people with a previous eye disease diagnosis, those people who were aware and had some knowledge of eye disease accessed eyecare services more frequently.
Conclusions: Knowledge of common eye diseases is generally lacking. Age-related macular degeneration is the leading cause of blindness in Australia, yet only 20% of the present study population had heard of it. As there are often no early symptoms for glaucoma, community awareness of this disease and the need for screening of people at risk may allow timely diagnosis and more effective therapy before advanced visual field loss has occurred. An informed public is more likely to present earlier with visual symptoms before irreversible visual loss has occurred and is more likely to comply better with recommended therapy.     

Cataract surgical coverage and outcome in the Tibet Autonomous Region of China

BACKGROUND: A recently published, population based survey of the Tibet Autonomous Region (TAR) of China reported on low vision, blindness, and blinding conditions. This paper presents detailed findings from that survey regarding cataract, including prevalence, cataract surgical coverage, surgical outcome, and barriers to use of services. METHODS: The Tibet Eye Care Assessment (TECA) was a prevalence survey of people from randomly selected households from three of the seven provinces of the TAR (Lhoka, Nakchu, and Lingzhr), representing its three main environmental regions. The survey, conducted in 1999 and 2000, assessed visual acuity, cause of vision loss, and eye care services. RESULTS: Among the 15,900 people enumerated, 12,644 were examined (79.6%). Cataract prevalence was 5.2% and 13.8%, for the total population, and those over age 50, respectively. Cataract surgical coverage (vision <6/60) for people age 50 and older (85-90% of cataract blind) was 56% overall, 70% for men and 47% for women. The most common barriers to use of cataract surgical services were distance and cost. In the 216 eyes with cataract surgery, 60% were aphakic and 40% were pseudophakic. Pseudophakic surgery left 19% of eyes blind (<6/60) and an additional 20% of eyes with poor vision (6/24-6/60). Aphakic surgery left 24% of eyes blind and an additional 21% of eyes with poor vision. Even though more women remained blind than men, 28% versus 18% respectively, the different was not statistically significant (p = 0.25). CONCLUSIONS: Cataract surgical coverage was remarkably high despite the difficulty of providing services to such an isolated and sparse population. Cataract surgical outcome was poor for both aphakic and pseudophakic surgery. Two main priorities are improving cataract surgical quality and cataract surgical coverage, particularly for women.     

广东省斗门县农村中老年人的眼病意识调查

目的　调查农村中老年人群的眼病意识及阻碍患者接受治疗的原因。方法　采用随机整群抽样法,抽取广东省斗门县50岁及以上的中、老年人626例,对其进行眼部检查,同时对所有至少1只眼日常生活视力<0.1的视力损害者进行问卷调查。结果　535例完成问卷（85.5%）;526例眼病≥1年,其中502例（95%）意识到眼病>1年。在可治的448例眼病患者中,有118例（24.2%）患者知道眼病可以治疗,356例（73%）患者不知道或在检查当天才知道可以治疗,未治疗的原因为经济困难、恐惧手术和交通不便等。结论　进行眼病知识宣传,降低治疗费用,是扫除眼病治疗障碍的措施之一。     

Use of Cataract Services in Eastern Africa—A Study from Tanzania

Purpose: To establish the proportion of patients who are blind or have low vision prior to undergoing cataract surgery at tertiary referral centers in Tanzania. To assess which patient groups presenting for cataract surgery are more likely to be blind or visually impaired. Methods: Using pre-existing computerized audit systems we gathered data on pre-operative visual status, age, gender and presentation mode (walk-in or outreach) for 3765 patients undergoing 4258 cataract operations at 2 hospitals in Tanzania. Visual status was defined based on vision in the better eye. Results: 32% of operations were performed on blind patients, 37% on patients with low vision and 31% on normally sighted patients. Predictors of blindness at presentation were: female sex (OR 1.15; 95% CI 1.00–1.32); referral from a rural outreach program (OR 1.75; 95% CI 1.51–2.02) and older age (OR 1.02; 95% CI 1.01–1.02). Conclusions: It is not only the blind who present to cataract services in Tanzania. The demand for surgery amongst patients who or are normally sighted represents a positive move towards prevention, and not only cure of cataract blindness in Tanzania. However, it also highlights the need to target those left blind from cataract in order to deliver services to those most in need. Cataract programs targeting patients in rural areas and older patients are likely to increase the number of blind patients benefiting from cataract services.