Finding cataracts: The work starts before the operating room
When we think about cataract care, we often jump straight to surgery. In many parts of the world, age-related cataract, the clouding of the lens that leads to visual decline, is so routinely treated that some may not recognize it as a public health issue. In the UK, for instance, cataract surgery is the most performed operation. The procedure has changed dramatically over time – from removing the lens through a large incision to using ultrasound to break it up (a technique called phacoemulsification) then inserting foldable lenses tailored to each patient’s vision and a quick, sutureless recovery. It’s safe, efficient and life-changing. We’ve come a long way from 7 mm incisions and removing the lens in one piece.
However, cataracts remain the leading cause of preventable blindness in low- and middle-income countries (LMICs). Tens of millions of patients could regain vision with a single surgery. Yet the real challenge is rarely purely surgical – it’s systemic.
A major roadblock is workforce capacity: there simply aren’t enough ophthalmologists to meet the demand for this procedure. In some areas, including Sub-Saharan Africa, there may be only one eye doctor for every 1 million people, and many of these physicians are not trained surgeons. Even when surgical expertise is available, the required infrastructure often is lacking. Phacoemulsification demands reliable electricity, a functioning platform, sterilized instruments, a surgical microscope, intraocular lenses, post-operative medications and a skilled support team. These aren’t standard resources in many rural clinics or overburdened public hospitals.
Organizations like Cure Blindness and Orbis International have stepped in to bridge some of these gaps, bringing mobile surgical units, training programs and even a fully equipped airplane-turned-operating-room to areas in need. Still, one central question lingers: how do we identify patients in time? Who finds them and how are they connected to care?
That’s the question that prompted our recent review of cataract screening strategies in LMICs in PLOS Global Public Health. What we discovered is both inspiring and practical: a wave of affordable, tech-enabled tools is changing what’s possible. AI-powered smartphone apps, low-cost cameras and 3D-printed screening devices are offering accurate diagnoses, often in the hands of non-specialists working in local communities. These tools don’t just detect cataracts – they help prioritize cases, target outreach and make surgery more efficient by streamlining who gets referred and when.
However, strengthening research infrastructure is essential to support these efforts and enable rigorous evaluation of new innovations. One priority area is the continued development of affordable, user-friendly alternatives to traditional slit lamps – a multifunctional microscope used in ophthalmic diagnostics. In parallel, investments also must expand surgical capacity, raise public awareness and address cultural barriers to care. These could include establishing additional surgical centers and ophthalmology residency programs, training auxiliary personnel, implementing door-to-door screening initiatives and other community-based outreach efforts.
If we truly want cataract surgery to be accessible, the conversation cannot revolve around the OR alone.
By Elizabeth Aleksandra Merlinsky, fourth-year medical student, and Dr. Christina Weng, professor and Alice R. McPherson Retina Research Foundation Chair in Ophthalmology, Baylor College of Medicine
