Sixty‑five‑year‑old Salema Beowa, a widow from Charghat upazila in Rajshahi, has spent years watching her world slowly blur into shadows as cataracts cloud her eyes. Once a dependable grandmother who cooked, cared, and kept the household steady, she now struggles with daily tasks. A recent fall in her yard left her with a painful back injury.

Her son, Amzad Hossain, is a daily wage worker whose earnings barely cover the family’s basic needs. The cost and time involved in travelling to a hospital for treatment have made surgery difficult for the family to afford. Her family has now started to question whether the surgery is worthwhile at her age.

“Who will take me to the hospital and pay for the tests? How much longer will I live anyway? I might as well carry on like this,” Salema said, her voice heavy with resignation.

Amzad recalls an earlier attempt to seek treatment for his mother, after a doctor in Puthia upazila advised cataract removal surgery.

“A government facility like the Sadar hospital would cost less, but going to Rajshahi, staying there, and bringing her back after surgery would be a challenge. And private clinics at the upazila level are far too expensive,” Amzad said.

The burden of untreated cataracts is unevenly shared, with women consistently having lower access to cataract surgery than men across developing regions, despite bearing a greater overall share of visual impairment.

World Health Organization

Salema’s experience reflects a wider national crisis: thousands continue to lose their sight not because surgery is technologically unavailable, but because poverty, distant hospitals, and socio-cultural barriers prevent them from completing the journey from diagnosis to treatment.

Data from the Bangladesh Society of Cataract and Refractive Surgeons (BSCRS) indicates that approximately 10 lakh patients are currently awaiting cataract surgery.

However, health experts caution that the national baseline itself remains dangerously outdated.

“The current backlog estimate relies on data from 2000, which projected around 7.5 lakh baseline cases, with more than 1.3 lakh new patients added to the surgical queue each year,” said Prof Dr Khayer Ahmed Chowdhury, former director of the National Institute of Opthalmology and Hospital (NIOH) and an executive member of BSCRS.

According to the World Health Organization, the burden of untreated cataracts is unevenly shared, with women consistently having lower access to cataract surgery than men across developing regions, despite bearing a greater overall share of visual impairment.

The Rapid Assessment of Avoidable Blindness -- conducted across eight districts with 21,596 participants --  found surgical coverage significantly higher among men (76.6%) than women (64.3%).

Carried out by NIOH between January 2010 and December 2012, the study found cataracts to be the leading cause of blindness, accounting for 75.8 percent of vision loss among people aged 50 and above.

A 2025 cross-sectional study of 595 cataract patients at Lions Charitable Eye Hospital in Chattogram found women were nearly twice as likely as men to report having no one to accompany them for surgery (28.1 percent vs 15.9 percent).

Women were also more than twice as likely to worry about negative surgical outcomes (34.8 percent vs 16.2 percent), contributing to significantly higher overall anxiety scores.

Furthermore, among patients facing treatment barriers, only 38.2 percent understood available treatment options -- a knowledge gap significantly wider in women at 33.3 percent than in men at 45.1 percent.

“In our country, when men fall ill, they are taken to a doctor quickly, but when women fall ill, families often delay,” Prof Khayer observed. “Women in rural households frequently continue performing domestic chores despite deteriorating vision, making their condition seem less urgent to family decision-makers until vision loss becomes absolute.”

STRETCHED SYSTEM

While BSCRS data shows Bangladesh has over 2,200 registered ophthalmologists, only around 1,200 actively perform cataract surgeries.

However, Prof Khayer estimates that only 400-500 surgeons have extensive experience with high‑volume cataract procedures. With about 10 lakh patients currently awaiting surgery, this translates into a daunting ratio of roughly 833 patients for every active cataract surgeon.

He further noted that specialised workforce distribution remains heavily skewed toward metropolitan centres.

“If an eye specialist is posted to an upazila health complex where there is no operating theatre equipment, there is little scope for them to practise,” Prof Khayer explained. “As a result, specialists naturally gravitate toward Dhaka or major divisional cities.”

Previous systemic interventions attempted to bridge this gap. Under the National Eye Care operational plan, piloted in 2017, community eye centres were set up in about 200 upazila health complexes in phases.

Three trained nurses at each facility screened patients, referring them to 13 base government medical colleges for free surgery and funded transport.

Operational continuity faced major hurdles after the 2024 political changeover, when the project was placed on a “no‑cost extension” -- meaning no new funds were allocated.

Field experiences, however, show that structural barriers can be dismantled when screening and transport are offered directly to rural communities.

For instance, under the Cure Blindness Project in Dinajpur -- implemented by Gausul Azam BNSB Eye Hospital with support from Helen Keller Intl -- around 2,400 underprivileged cataract patients across all 13 upazilas were screened, transported, operated on and provided follow-up care between mid-2025 and mid-2026.

Holding community-based eye camps in villages eliminated initial travel costs and escort arrangements for elderly patients.

Identified patients received free door-to-door transport to the base hospital, surgery, post-operative care and return transport. The initiative prioritised vulnerable demographics such as rural women aged 50 and above, persons with disabilities, and ethnic minorities.

5YR GOVT PLAN

The government has undertaken a five-year plan to clear the national backlog of 10 lakh cataract surgeries.

Speaking to The Daily Star earlier this month, State Minister for Health Dr MA Muhit said the plan will be implemented through joint resource-pooling across government, private sector and non-governmental organisations.

To reach over two lakh surgeries annually, eight to 10 premier institutes are being designated as specialised training hubs to upskill active surgeons identified from the country’s cohort of ophthalmologists.

“We are currently conducting a nationwide situation analysis to identify facility gaps,” Dr Muhit said. “We will provide equipment and trained personnel where necessary.”

Addressing the gender divide, Dr Muhit pledged that upcoming national awareness campaigns will specifically target family decision-makers to prioritise eye care for elderly women.

Additionally, a technical survey will replace decades-old baseline estimates by the year-end.

“If we succeed, Bangladesh will serve as a global model for rural eye care,” Dr Muhit said. “This is about restoring productivity and dignity to millions.”

For Salema, however, success will not be measured by numerical targets announced in the capital but by whether an impoverished woman in a remote village is finally given the means to reach an operating table.