LAUSR

In 1998, on the initiative of the Brazilian Council of Ophthalmology (CBO) and the Health Ministry, with the support of medical schools, the National Cataract Campaign was established. Access to treatment was made easy with nationwide campaigns conducted for diagnosis and later for surgery (Cataract Projects). This action had the greatest impact on visual health in Brazil as the number of performed surgeries has almost doubled. By means of epidemiologic studies, the effectiveness and safety of cataract surgeries performed in university hospitals on a large scale were confirmed and Cataract Projects were improved. Nevertheless, in 2006, the Health Ministry discontinued the National Campaign due to lack of funds for all surgeries, and public hospitals were granted limited quotas for surgical procedures. This measure negatively impacted progression in the number of surgeries performed annually by reducing the use of the installed cataract surgery capability in public hospitals; thus, an additional barrier was created to limit the access of the needy population to corrective surgery: limitation of surgical offering. Despite the clinical evidence demonstrated by published epidemiologic studies that the methodology used in the National Campaign for blindness eradication by cataract surgery was successful in Brazil, the National Government and several municipalities have opted for a new strategy to deal with the problem. Currently, many public health projects for cataract surgery are implemented by means of bidding, in which private companies, some with mobile surgical units, negotiate the least value for quotas on thousands of surgeries. The analysis and interpretation of epidemiological data on total cataract surgeries performed by the public health system in Brazil from January 2000 to December 2015 demonstrated that the number of surgeries between 2010 and 2015 has increased by approximately 246%, while the amount spent annually on surgeries increased by 371% over the same period (Table 1). The number of cataract surgeries performed at the Hospital das Clínicas of the Medical School of the University of São Paulo (HCFMUSP, a reference public teaching hospital) has decreased by approximately 23%, from 2005 to 2015 (Table 2).