The 2023 Rapid Assessment of Avoidable Blindness (RAAB) survey into the causes of blindness in Vanuatu found that 92 per cent of blindness in the Pacific Island nation is avoidable. This means that nine out of 10 people who are blind don’t need to be.

Between August and December 2023, we conducted a Rapid Assessment of Avoidable Blindness (RAAB) in Vanuatu to assess the prevalence and causes of blindness and vision impairment. Survey teams, including an ophthalmologist and eye nurses, travelled to all provinces in Vanuatu to examine eyes and collect data on cataract, refractive error, and diabetic retinopathy.

What did we learn?

Estimated burden of vision impairment

The age and sex adjusted prevalence of blindness was 1.7%. The prevalence of severe vision impairment was 1.7%. 92% of blindness was avoidable. This means that 9 out of 10 people who are blind in Vanuatu don’t need to be.

Cataracts as the Leading Cause

Untreated cataract was identified as the leading cause of blindness (82.4%), Severe Vision Impairment (SVI, 91%), and Moderate Vision Impairment (MVI, 66%) in Vanuatu.

Uncorrected Refractive Errors

Uncorrected refractive error was the leading cause of Early Vision Impairment (EVI) responsible for 76.9% of cases. It was the second leading cause of MVI (27.2%), highlighting the need for strengthened refractive services in Vanuatu.

Cataract Surgical Coverage (CSC)

79.2% of people blinded by cataracts have been operated on, and this is close to the 80% threshold often discussed in relation to Universal Health Coverage goals.

Visual Outcomes After Cataract Surgery

The CSC for individuals with a vision impairment threshold of <6/18 was 38.9%. This indicates that less than half of those who could benefit from cataract surgery at this level of vision impairment are receiving it.

Refractive Error Coverage (REC) and Effective Refractive Error Coverage (eREC)

Age- and sex-adjusted REC and eREC were 12.6% and 10.3% respectively. This suggests that a significant proportion of individuals with refractive errors are not receiving necessary corrective services.

Effective Cataract Surgical Coverage (eCSC)

The proportion of people who were blind from cataract, operated on (in one or both eyes) and can see better after surgery (VA 6/18) was 54.6%. The relative quality gap was 31.1%. When the quality gap is 25% or greater it is recommended that priority is given to improving the quality of cataract surgery and outcomes.

Prevalence of Diabetes and Diabetic Retinopathy (DR)

Of 4,937 consenting participants, 13.3% had known or suspected diabetes, of whom 88.9% consented to further examination: 74.5% had no DR, 21.2% had DR, and 8.0% had sightthreatening DR.

Diabetic Retinopathy (DR) Screening

Almost two-thirds (63.4%) of study participants who had diabetes were aware of their condition. Nonetheless, a significant gap exists in DR screening with 85.9% of study participants with a prior diagnosis of diabetes having never undergone an eye examination for DR.