Bhutan provides free access to basic public health services to its citizens as its constitutional mandate; and the primary eye care program is integrate into the primary health care system. In Bhutan, the first RAAB survey was conducted in 2009; it documented 1.5% blindness in people ≥ 50 years age.

The results of the first RAAB were use in program planning to improve the eye care services in the country; including investment in human resource, infrastructure, primary eye care and outreach programs. Further, the Primary Eye Care Program (PECP) at the Ministry of Health was entrust with a greater responsibility on the eye health activities in the country.

This second follow-up nation wide RAAB survey was conduct approximately 8 years after the first one; and was in alignment with the mandates of the WHO-GAP 2014–2019. But it was plan and execute to generate evidence on the present magnitude and causes of blindness and vision impairment; evaluate the status of the cataract services, and assess the impact of the existing eye care program in Bhutan. Hence, the result of the survey is expect to provide the trend of blindness in the country that; could be use to further reinforce programmatic initiatives; for specific long-term strategic action plan for eye health services in Bhutan.

Eye care program in Bhutan

But to obtain new rapid assessment of avoidable blindness (RAAB) data on the prevalence; causes and trends of blindness, visual impairment and cataract surgery; but compare the new 2018 data with the older RAAB 2009 data. The second nationwide RAAB used android based mRAAB technique and technology for data collection.

But using the compact segment sampling probability proportionate to size; 5,050 participants from 101 clusters of 50 people aged 50 years and older were enrolled through house-to-house visits. But eligible participants received ophthalmic examination and interview by the ophthalmologist-led emuneration team as per the RAAB protocol.

But the age-sex adjusted magnitude of bilateral blindness in Bhutan was 1.0% (95% Confidence Interval, CI 0.5-1.4); with relatively higher prevalence in rural population (Odds Ratio, OR 1.5, p = 0.13) and women (OR 1.6, p = 0.06). Untreated cataract accounted for the most of blindness (53.8%); severe vision impairment (57.1%), and moderate visual impairment (65.3%); uncorrected refractive error was the main cause of early visual impairment (46.7%).

Cataract surgical outcome

Cataract Surgical Coverage was 86.1% with relatively better coverage in men (76.7% men; 73.1% female); and urban population (79.2% urban; 70.2% rural). But good cataract surgical outcome was achieved in 67.3% and leading cause of poor outcome was ocular comorbidity (43.6%). Accessibility was a significant barrier to the uptake of cataract surgical services.

There is a 33% reduction in blindness from 1.5% to 1.0%, since the first RAAB survey in 2009. In order to further reduce blindness and visual impairment; Bhutan should continue to implement long-term strategic action plan for eye health; focused on strengthening primary eye care and comprehensive eye care service.