Couldn't the cataract problem be solved if there were just more trained cataract surgeons in the developing countries?
Manpower shortage is only one issue. In fact many cataract blind in developing countries do not accept surgery, even when offered. In many instances, patients diagnosed as blind from cataract and scheduled for an appointment fail to come for surgery. It has been documented in countries as diverse as Brazil, India, and Malawi that 33:-92% of the cataract blind do not accept surgery, even when offered.

What are the main reasons that more cataract blind in developing countries do not accept surgery?
Cost of surgery

For the rural poor, many of whom have no disposable income, cataract surgery may cost more than they feel they can afford. Efforts in India and elsewhere to reduce the cost of surgery or provide free surgery to the poorest patients have been effective in increasing the number of patients coming for surgery. To the poor patient, there are other costs beyond hospital expenses associated with surgery; these include transportation to the hospital, loss of salary for a guardian to accompany the patient to the hospital, and living expenses for the guardian while the patient is hospitalized. This non-surgical cost has been estimated to be one-fifth of the annual income of a rural Nepali.s In India, providing transportation expenses for the patient increased acceptance of cataract surgery. However, in some settings where cataract surgery is provided free of charge and where all expenses associated with hospital stay and transportation are provided, many patients still fail to use surgical services. There are innovative and sustainable programs in a numuer of settings to provide high-quality cataract surgery at low cost.

Distance to hospital

The majority of cataract blind live in rural areas while most ophthalmic surgeons live in large cities. For all medical conditions, it has been documented that use of Western health services is related to proximity of these services. In Malawi, it has been demonstrated that traditional healers who live far from the hospital provide more "treatments" for cataract compared to healers that live closer to the hospitals. In rural areas of Nepal, surgical coverage was highest where there was easy access to major eye centres. People use that which is most available to them first.

Cultural and social constraints

Throughout the developing world, and demonstrated in studies from India,Indonesia,Nepals and Malawi, women are much less likely to have cataract surgery than men, even though epidemiologic research has shown that women have rales of cataract almost 1 1/2 times the rates among men.". Reasons for the low coverage among women are many: women are less likeIy to be literate and have access to information about the availability or surgical services; women often do not have sufficient social support within the household to encourage them to seek care. In Mallawi, widows are more likely to have surgery than married women while married men are more likely to have surgery than widowers.