Turning The Tide On Cataract Blindness: Transforming To A High-Volume Surgical Unit As A Pragmatic Approach To Minimise Cataract Surgery Waiting Times In Resource-Limited Settings.

Cataract, the leading cause of blindness and visual impairment globally, and surgery is the most effective intervention to restore vision. Delays in accessing surgery compromise vision, adversely affecting quality of life, independence, and safety. Barriers such as economic constraints, limited accessibility, inadequate professionals, and insufficient surgical capacity exacerbate delays, contributing to preventable blindness. In low- and middle-income countries, efficiently streamlining resources can ensure accessible, affordable, and equitable cataract services. Transforming surgical services into a high-volume model eliminates unnecessary delays, improves patient outcomes, and alleviates the economic burden on the health system.

The Eye Unit of Teaching Hospital Jaffna, the only tertiary referral center in Northern Sri Lanka, operates with less than 50% of the WHO-recommended resources. Serving a predominantly rural, post-conflict population, the unit faces severe resource constraints and unequal distribution of ophthalmic services.

The high-volume surgical unit transformation was a pragmatic approach to reducing waiting times. By analysing surgical capacity, patient flow, waiting lists, staffing, resources, bottlenecks, and underused infrastructure, issues were addressed. Facilitated through public-private partnerships, key steps included rural patient screening, grouped surgical scheduling with transport, standardised referrals, a two-table workflow, local postoperative follow-up, and strict quality control to maintain surgical outcomes. This approach maximised surgical throughput while optimising resource use. It also ensured timely access to surgery for patients in remote areas, reducing the risk of vision loss from prolonged delays.

The transformed unit now delivers around 100 cataract surgeries per day at no cost, with maximised surgical output, streamlined patient flow, and optimised resource use. System-level bottlenecks were addressed, and waiting times decreased from two years to zero. This approach enabled cataract surgical coverage of 15/1,000 of the population in 2025, demonstrating that high-volume surgical models can achieve equitable access, efficiency, and quality even in resource-limited settings. Importantly, patients experienced timely vision restoration, improved quality of life, and reduced economic and social burdens associated with prolonged blindness.

It demonstrates that transforming a cataract surgical unit into a high-volume surgery unit can effectively eliminate prolonged waiting times, expand equitable access to surgery, and maintain high-quality visual outcomes in resource-limited contexts. By optimising patient flow, leveraging public-private partnerships, standardising workflows, and efficiently utilising available resources, the model addresses both system-level and patient-level barriers to care. The approach offers a scalable, pragmatic solution for low- and middle-income countries seeking to reduce avoidable blindness, enhance surgical coverage, and strengthen cataract service delivery while improving patient quality of life.