Letter Cataract Surgical Coverage in Kurdistan, Iran Seyed-Farzad Mohammadi1, MD-FICO; Elham Ashrafi1, PhD; Saman Mohazzab-Torabi1, MD; Hanieh Delshad-Aghdam1, MS; Marzieh Katibeh2,3, MD 1Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran 2Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran 3Centers for Global Health, Department of Public Health, Aarhus University, Denmark ORCID: Seyed-Farzad Mohammadi: https://orcid.org/0000-0002-9209-3034 Hanieh Delshad-Aghdam: https://orcid.org/0000-0002-3071-6021 J Ophthalmic Vis Res 2021; 16 (4): 700–701 Dear Editor, This is an appendix of previously published paper: Rapid Assessment of Avoidable Blindness in Kurdistan, Iran.[1] Despite a widely distributed access to cataract surgery in Iran, we face populations in remote and marginal areas who have been left behind and/or are unaware of the need for surgery.[2–5] This report assesses surgical coverage and visual outcome of cataract surgery and the self- reported barriers of surgery among subjects aged 50 years or more in Kurdistan Province of Iran. Of the 3465 eligible persons who were invited to Kurdistan Rapid Assessment of Available Blindness-Diabetic Retinopathy (RAAB-DR) study, 3203 participated (response rate: 92.4%). Among the participants, 1,546 (44.6%) were males and 1,657 (55.4%) were females. The mean age of the participants was 62.7 ± 10.1 (range, 50– 99) years. Of these, 12% (384 participants) had cataract surgery. Cataract surgery coverage was 90% in males and 89% in females (P = 0.91). The corresponding coverage for rural versus urban Correspondence to: Hanieh Delshad-Aghdam, MS. Qazvin Square, Tehran 1336616351, Iran. E-mail: Delshad.np.on@gmail.com Received: 23-01-2021 Accepted: 29-03-2021 Access this article online Website: https://knepublishing.com/index.php/JOVR DOI: 10.18502/jovr.v16i4.9763 participants were 91% and 89% (P = 0.83). Among the operated patients, 84.2% underwent cataract surgery in public hospitals, 14.5% in private hospitals, 0.8% in charity hospitals, and 0.5% in eye camps. Cataract surgery was performed free or partially free of charge for 77% of participants. Cataract surgical coverage (CSC) for the presenting visual acuity (PVA) of <3/60 was 95.0% (males 95.7%, females 94.1%), for the PVA of <6/60 was 89.9% (males 91.7%, females 88.0%), and for the PVA of <6/18 was 75.4% (males 75.5%, females 75.3%). The coverage difference between the two genders was not significant. Information about barriers of surgery was obtained in 40 participants with bilateral visual acuity (VA) < 6/60 (18 males and 23 females) and 111 participants with unilateral VA < 6/60 due to cataract. “Need not felt” was reported remarkably as the commonest barrier in 75% of bilateral and 83.5% unilateral blindness or severe visual impairment (PVA < 6/60) due to cataract. It was followed by cost; 7.5% in bilateral and 8.7% in unilateral PVA < 6/60 due to cataract. None of the patients complained about “treatment denied by the provider” and “cannot This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. How to cite this article: Mohammadi S-F, Ashrafi E, Mohazzab-Torabi S, Delshad-Aghdam H, Katibeh M. Cataract Surgical Coverage in Kurdistan, Iran. J Ophthalmic Vis Res 2021;16:700–701. 700 © 2021 MOHAMMADI ET AL. THIS IS AN OPEN ACCESS ARTICLE DISTRIBUTED UNDER THE CREATIVE COMMONS ATTRIBUTION LICENSE | PUBLISHED BY KNOWLEDGE E http://crossmark.crossref.org/dialog/?doi=10.18502/jovr.v16i4.9763&domain=pdf&date_stamp=2019-07-17 https://knepublishing.com/index.php/JOVR Letter to Editor; Mohammadi et al access treatment”. “Need not felt” was comparable in both genders (P = 0.8) and rural versus urban residence (P = 0.79). Women were more likely to report “fear” as a barrier rather than men (P = 0.05). Fear and cost were more significantly reported in rural areas than in urban population (P = 0.05 and P = 0.04, respectively). Of those who underwent cataract surgery with an intraocular lens (IOL) implantation, 71.5%, 17.3%, and 11.1% had good, borderline, and poor outcomes, respectively. Poor outcomes in females and rural residents were 13.1% and 12.4%, respectively. There was no significant difference between the two genders and the place of residence in terms of rural versus urban areas in this regard. Patient’s selection (75%) was the primary reason for the poor outcome and it resulted from the concurrent eye problems (e.g., glaucoma, optic atrophy). Meanwhile, spectacles unmet need (49.2%) comprised most of the patients who had a borderline outcome. Posterior capsule opacification in 1.4% and aphakia in 1.2% were other reasons of poor outcome. Our CSC at visual acuities <3/60, <6/60, and <6/18 were 94.9%, 89.9%, and 75.4%, respectively and this rate was remarkably high for all cut-off levels. In conclusion, the current RAAB survey in Kurdistan demonstrated that CSC at PVA < 6/60 was 90% and was higher than similar studies. Of note, we did not observe a significant gender gap with respect to cataract surgery service. Different patterns of CSC barriers were observed which were not similar to low-income countries where cost and unavailable resources are the main barriers. Financial Support and Sponsorship The protocol of the current study was approved by the Iran Eye Research Network and Tehran University of Medical Sciences (#27816). Conflicts of Interest None of the authors have any proprietary interests or conflicts of interest related to this submission. REFERENCES 1. Ashrafi E, Mohammadi SF, Katibeh M, Ghaderi E, Alinia C, Nourmohammadi N, et al. Rapid assessment of avoidable blindness in Kurdistan, Iran. J Ophthalmic Vis Res 2019;14:179–184. 2. Hashemi H, Alipour F, Mehravaran S, Rezvan F, Fotouhi A, Alaedini F. Five year cataract surgical rate in Iran. Optom Vis Sci 2009;86:890–894. 3. Hashemi H, Fotouhi A, Rezvan F, Etemad K, Gilasi H, Asgari S, et al. Cataract surgical rate in Iran: 2006 to 2010. Optom Vis Sci 2014;91:1355–1359. 4. Katibeh M, Ziaei H, Rajavi Z, Hosseini S, Javadi MA. Profile of cataract surgery in Varamin Iran: a population-based study. Clin Exp Ophthalmol 2014;42:354–359. 5. Rajavi Z, Katibeh M, Ziaei H, Fardesmaeilpour N, Sehat M, Ahmadieh H, et al. Rapid assessment of avoidable blindness in Iran. Ophthalmology 2011;118:1812–1818. JOURNAL OF OPHTHALMIC AND VISION RESEARCH VOLUME 16, ISSUE 4, OCTOBER-DECEMBER 2021 701