Purpose: To determine cataract surgical coverage, and barriers to modern cataract surgery in Nigeria.
Methods: Multistage stratified cluster random sampling was used to identify a nationally representative sample
of 15,027 persons aged 40+ years. All underwent visual acuity testing, frequency doubling technology visual
field testing, autorefraction, and measurement of best corrected vision if <6/12 in one or both eyes. An ophthalmologist
examined the anterior segment and fundus through an undilated pupil for all participants.
Participants were examined by a second ophthalmologist using a slit lamp and dilated fundus examination
using a 90 diopter condensing lens if vision was <6/12 in one or both eyes, there were optic disc changes
suggestive of glaucoma, and 1 in 7 participants regardless of findings. All those who had undergone cataract
surgery were asked where and when this had taken place. Individuals who were severely visually impaired
or blind from unoperated cataract were asked to explain why they had not undergone surgery.
Results: A total of 13,591 participants were examined (response rate 89.9%). Prevalence of cataract surgery was
1.6% (95% confidence interval 1.4–1.8), significantly higher among those aged =70 years. Cataract surgical
coverage (persons) in Nigeria was 38.3%. Coverage was 1.7 times higher among males than females. Coverage
was only 9.1% among women in the South-South geopolitical zone. Over one third of those who were cataract
blind said they could not afford surgery (36%).
Conclusions: Cataract surgical coverage in Nigeria was among the lowest in the world. Urgent initiatives are
necessary to improve surgical output and access to surgery.