1. Dr Emmy Y. LI, MRCS Dr Chung Chai CHI, FRCS Prof. Dennis S. LAM, MD Dept. of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong The authors have no financial interest in the subject matter of this poster

2. Background  Cataract accounts for 48% of all global blindness, affecting over 18 million people worldwide  The enormous burden of cataract blindness is not due to lack of efficacious treatment. In fact, cataract surgery is one of the most cost- effective interventions in the field of health care  Instead, cataract blindness results from the sizable gap in health care delivery between affluent and poor societies Barriers to uptake of cataract surgery in developing countries include ！ a significant shortage of ophthalmologists ！ a lack of awareness about cataract and its treatment ！ a lack of trust in quality of locally available services ！ direct and indirect costs arising from surgery ！ problems with transportation

3. Background Cataract surgical rates (CSR) reported by WHO in 2006 revealed considerable variation among countries with apparently similar level of economic development

4. Purpose 1.To assess the correlation between CSR and economic development, selected social and public health indices 2.To identify possible determinants of CSR at a macro level

5. Methods  This is an ecological study of 101 countries in five continents with different levels of economic development, socio-demographic characteristics and healthcare systems

6. Methods  CSR defined as the number of cataract operations performed per million population within 1 calendar year were obtained from WHO website and OECD Health Data  GDP per capita and selected social and public health indices were collected from the CIA website

7. Methods  Correlation between CSR and GDP per capita, urbanization, Gini coefficient (a measure of income inequality), illiteracy rate, labor force in agriculture, infant mortality rate (IMR) and life expectancy at birth were studied using the non-parametric test via Spearman’s rho

8. Results Correlation with Cataract Surgical Rates Spearman’s rho correlation coefficient Economic Development GDP per capita+ 0.83 Social Development Indices Labor force in agriculture- 0.80 Illiteracy rate- 0.70 Population below poverty line- 0.70 Gini coefficient- 0.52 Unemployment rate- 0.34 Urbanization+ 0.66 Public Health Indices Infant mortality rate- 0.86 Life expectancy at birth+ 0.85 All with p values <0.01

9. Scatter Plot showing relationships between CSR and GDP per capita India is doing exceptionally good compared to its counterparts with similar level of GDP

10. Scatter Plots showing relationships between CSR and IMR & Life expectancy CSR in general correlated well with IMR and life expectancy, but at extreme ends of the scale, there might still be a wide variation of CSR in countries with similar level of performance

11.  By Univariate Analysis of Variance, interaction effect was found between GDP per capita and Gini coefficient, unemployment rate, urbanization and life expectancy at birth.  Meaning these parameters were inter-related to one another in the development of a country Results

12. Conclusion  The level of GDP per capita is highly predictive of CSR in a country  Countries with majority of its population being farmers, illiterate, living in rural areas and in poverty tend to have low CSR  High IMR and short life expectancy suggestive of suboptimal healthcare provision are associated with a low CSR.