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Published: 09.06.2021
Anthea Burnett Knowledge Consultant
Jude Stern Head of Knowledge Management

With the recent World Health Assembly (WHA) adoption of the new global eye health targets on Effective Coverage of Cataract Surgery (eCSC) and Effective Refractive Error Coverage (eREC) we are revisiting key articles that may help to provide guidance on what these targets are, and how they might be measured.

The targets address the two leading causes of blindness and vision impairment, cataract and refractive error. To address the huge unmet need in eye care, all countries have committed to:

  • 40 percentage point[1] increase in effective coverage of refractive error by 2030
  • 30 percentage point increase in effective coverage of cataract surgery by 2030

The targets cement the World Health Organization’s (WHO) global strategy on vision set out in its ‘World Report on Vision’ and the World Health Assembly resolution on eye health adopted last year.

[1] A percentage point is the arithmetic difference between two percentages. For example, a change in eCSC from 40% to 50% is a 10-percentage point increase in EREC.

1. What is Effective Coverage of Cataract Surgery (eCSC)?

Key publication: Ramke, J et al. Effective cataract surgical coverage: An indicator for measuring quality-of-care in the context of Universal Health Coverage. PLoS One 12.3 (2017): e0172342.

The definition of eCSC is:

The number of people in a defined population with operated cataract and a good outcome (i.e. presenting vision 6/12 or 6/18) as a proportion of those having operable plus operated cataract.

eCSC can be determined from existing data sets, and has been presented for 20 countries using latest available RAAB data. See the key publication for details.

 2. What is Effective Refractive Error Coverage (eREC)?

Key publication: McCormick, I et al. Effective refractive error coverage: an eye health indicator to measure progress towards universal health coverage. Ophthalmic & Physiological Optics 40.1 (2020): 1. doi: 10.1111/opo.12662

This article provides the definition of eREC, using 6/12 as the threshold of a good visual outcome and makes recommendations for how to incorporate measures of eREC into population-based surveys.

3. Proposed additional indicators for monitoring eye health progress

Key publication: McCormick et al. Eye health indicators for universal health coverage: results of a global expert prioritisation process. British Journal of Ophthalmology (2021).

This work was included in the recent Lancet Global Health Commission on Global Eye Health and presents a conceptual framework for monitoring eye health as part of universal health coverage. It proposes the following seven core indicators for monitoring countries’ progress towards Universal Health Coverage (UHC) service coverage indicators:

  1. Eye health facility density and distribution
  2. Eye health worker density and distribution
  3. Coverage of national health finance pooling mechanisms that include eye care services
  4. Out-of-pocket (OOP) payments for cataract surgery
  5. Effective cataract surgical coverage
  6. Effective refractive error coverage
  7. Prevalence of Vision Impairment

There are an additional 15 indicators, that considered feasible, actionable, reliable and internationally comparable for monitoring progress towards UHC.