Barriers to Cataract Surgery among Adults with Visually Impairing Cataract in Northern Togo: Results from the 2024 RAAB Survey

Purpose: To describe the sociodemographic characteristics of patients with cataract and visual impairment and to analyze the main barriers to access to cataract surgery in northern Togo. Methods: A population-based cross-sectional study using the Rapid Assessment of Avoidable Blindness (RAAB7) methodology was conducted from November to December 2024. A multistage cluster sampling design selected 4300 individuals aged ≥ 50 years across 86 clusters. Presenting visual acuity (PVA) was measured using Peek Acuity. Visually impairing cataract was defined as unoperated lens opacity causing PVA <5/10 (<6/12 equivalent) in the better eye. Prevalence estimates were calculated with 95% confidence intervals (95% CI). Associations were assessed using Chi-square tests. Results: Of 4300 eligible participants, 4290 were examined (response rate: 99.8%). The prevalence of unoperated cataract was 28.5% (95% CI: 27.2 - 29.9). The prevalence of visually impairing cataract was 23.7% (95% CI: 22.4 - 25.0). Cataract was bilateral in 73.7% of cases. Women accounted for 74.2% of patients, with a mean age of 71.0 ± 10.1 years. Moderate visual impairment was the most frequent category (49.8%). The main barriers to cataract surgery were inability to afford the procedure with 46.1% (95% CI: 43.0 - 49.2), lack of awareness of the availability of treatment with 32.4% (95% CI: 29.5 - 35.3), and poor access to eye care services with 18.0% (95% CI: 15.6 - 20.4). No significant association was found between barriers and sex (p > 0.05). Lack of perceived need was significantly associated with age (p = 2.4 × 10^？8). All barriers except fear were significantly associated with severity of visual impairment (p < 0.01). Conclusion: Financial and informational barriers remain the main obstacles to cataract surgical uptake in northern Togo. Strengthening surgical subsidies and community awareness strategies is essential to reducing avoidable blindness.