Ophthalmic Epidemiology

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Blindness and Visual Impairment Situation

in Indonesia Based on Rapid Assessment of
Avoidable Blindness Surveys in 15 Provinces

Lutfah Rif’Ati, Aldiana Halim, Yeni Dwi Lestari, Nila F Moeloek & Hans
Limburg

To cite this article: Lutfah Rif’Ati, Aldiana Halim, Yeni Dwi Lestari, Nila F Moeloek & Hans
Limburg (2020): Blindness and Visual Impairment Situation in Indonesia Based on Rapid
Assessment of Avoidable Blindness Surveys in 15 Provinces, Ophthalmic Epidemiology, DOI:
10.1080/09286586.2020.1853178

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Published online: 30 Dec 2020.

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OPHTHALMIC EPIDEMIOLOGY
https://doi.org/10.1080/09286586.2020.1853178

Blindness and Visual Impairment Situation in Indonesia Based on Rapid

Assessment of Avoidable Blindness Surveys in 15 Provinces
a b c
Lutfah Rif’Ati , Aldiana Halim , Yeni Dwi Lestari , Nila F Moeloekc, and Hans Limburgd
a
National Institute for Health Research and Development (NIHRD, Ministry of Health Republic of Indonesia, Jakarta, Indonesia; bResearch
Department, The Indonesian Eye Center, Cicendo Eye Hospital, Bandung, Indonesia; cOphthalmology Department, Faculty of Medicine
University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia; dHealth Information Services, Grootebroek, Netherlands

ABSTRACT ARTICLE HISTORY

Purpose: To report the latest data on blindness and visual impairment (VI) in Indonesia. Received 8 March 2020
Methods: Rapid Assessment of Avoidable Blindness (RAAB) surveys were done in 15 provinces in Revised 14 October 2020
Indonesia between 2013 and 2017. The population of the study was people aged 50 +. In each Accepted 13 November 2020
province, the required number of clusters was selected with a probability proportionately to size. KEYWORDS
A weighted average analysis for prevalence, causes of visual impairment, and cataract surgical Prevalence; avoidable
coverage (CSC) estimated the values of the country. blindness; Indonesia;
Results: The prevalence of blindness in East Java was the highest at 4.4% (95% CI: 3.1–5.6%), cataract; RAAB
followed by Nusa Tenggara Barat (NTB) at 4.0% (95% CI: 3.0–5.1%) and South Sumatra at 3.4% (95%
CI: 2.4–4.4%). In number, blindness among people aged 50+ in East Java was the highest at 371,599,
followed by West Java at 180,666 and Central Java at 176,977. Untreated cataract was the
commonest cause of blindness in all provinces (range: 71.7% to 95.5%). CSCperson<3/60 and
CSCperson<6/60 in Bali were the highest at 81.3% and 72.4%, respectively. Indonesia countrywide
prevalence of blindness was 3.0%. The total number of people with VI (PVA less than 6/18 in the
better eye) in Indonesia was 8,019,427, consisting of 1,654,595 of blindness and 6,364,832 of
moderate and severe VI.
Conclusion: The burden of blindness in Indonesia is high, and untreated cataract contributes the
most. There is an urgent need to increase cataract surgical coverage by providing better access to
cataract surgery services for all people in need.

Introduction
The geographical and demographic situation of
Indonesia poses significant challenges in implementing
an eye care program. Indonesia is the largest archipela­
gic country in the world where more than 17,000 islands,
with a lot of geographical variations, are spread through­
out the country. The Population of Indonesia at
261,890,900 is the fourth largest in the world.
However, the people are unevenly distributed, most of
which are concentrated on Java island.1 The population
aged 50 and over (aged 50+) is projected to be 69 million
in 2030, a double population compared to the popula­
tion in 2000. Also, the lifespan has been increasing from
65 years old in 2000 to 75 years old in 2030.2–5
The World Health Organization (WHO) launched an
updated global strategy for eye care in October 2019, the
World Report on Vision (WRV). According to the report,
at least 1 billion, out of 2.2 billion, visually impaired
people could have been prevented. Hence, WRV recom­
mends the member states of WHO to implement
Integrated people-centred eye care (IPCEC) in their
health system focusing on providing adequate access to
comprehensive eye care services for all people in need.
IPCEC should be part of the government health system
and run based on factual situations of visual impairment
in the communities. Data on the prevalence and causes of
blindness is essential to determine the gaps between met
and unmet needs so that the service providers can deliver
and monitor the eye care programmes effectively.6,7
Some countries in the Southeast Asia Region
(SEARO) have reported data on blindness situations,
based on the Rapid Assessment of Avoidable Blindness
(RAAB), which ranged from 0.6% to 4.6%.8 In
Indonesia, the prevalence of blindness among the gen­
eral population based on the 1993–1996 national survey
was 1.5%, and cataracts were responsible for 52%
blindness.2,9 This figures made Indonesia as the second-
highest of blindness prevalence among countries in the
world.10 However, the data of visual impairment in
Indonesia need to be updated to discover the current

CONTACT Aldiana Halim aldianahalim@icloud.com Research Department, The Indonesian Eye Center, Cicendo Eye Hospital, Bandung, West Java,
Indonesia.
© 2020 Taylor & Francis Group, LLC
2 L. RIF’ATI ET AL.
situation. Some more recent studies measured the pre­
valence of vision impairment in Indonesia, but they did
not represent the nationwide situation.,11,12
Rapid Assessment of Avoidable Blindness (RAAB)
survey estimates the prevalence and causes of visual
impairment on people aged 50 + . RAAB is a reliable
epidemiological method for assessing visual impairment
situations in certain areas.,13,14 Eye care stakeholders in
Indonesia performed RAAB surveys from 2013 to 2017
in 15 provinces to describe the nationwide visual impair­
ment situation. The purpose of this paper is to report the
visual impairment situation in Indonesia based on the
results of Indonesian RAAB 2013–2017.
Methods
The RAAB surveys in Indonesia identified the pre­
valence of avoidable blindness and visual impairment
as well as their causes among people aged 50+ at the
provincial level. We selected the provinces purpo­
sively considering the population size, the geographi­
cal representation, the local capacities of human
resources, and the security aspects. Fifteen provinces
on six islands and two island clusters were eligible
for the surveys:
● Sumatra Island: North Sumatra, West Sumatra, and
South Sumatra,
● Kalimantan Island: South Kalimantan,
● Java island: Jakarta, West Java, Central Java, and
East Java,
● Sulawesi island: South Sulawesi and North
Sulawesi,
● Island cluster of Maluku: Maluku,
● Bali island: Bali
● Island cluster of Nusa Tenggara: Nusa Tenggara
Barat (NTB) and Nusa Tenggara Timur (NTT),
● Papua island: West Papua.
All RAAB surveys in Indonesia followed the RAAB
methodology described by the International Center for
Eye Health (ICEH).13
Ethical considerations
All procedures in the RAAB survey complied with the
guidelines of The Declaration of Helsinki. The Ethical
Board of The National Institute for Health Research and
Development approved the study before its commence­
ment. All research procedures were sufficiently informed
to the participants, and their participation was entirely
voluntary.
Sample selection
The surveys used population lists, based on the 2010
national census, from the Indonesian statistical office
as a sampling frame. The smallest population unit (clus­
ter) is an area of 350 to 2000 people; it could be a village
or sub-village. Next, the RAAB software automatically
selected clusters proportionately to size.
In each cluster, the survey teams searched 50 people
aged 50+ by a compact segment sampling technique.
This sampling method used an area map of the selected
clusters to identify the survey fields. The survey team
demarcated the map and divided the survey area into
segments. Each segment contained 350 to 500 people.
The teams randomly selected a segment and visited the
households in the selected segment for a door to door
ophthalmic examination until they found 50 people
aged 50 + .
Definition of visual impairment
The definition of distance visual impairment referred to
the International Classification of Diseases (ICD) 11.
The ICD 11 classifies four distance visual impairment
based on presenting visual acuity (PVA) in the better
eye, as follows:15
1) Mild (early) visual impairment (EVI): PVA <6/
12 – 6/18;
2) Moderate visual impairment (MVI): PVA <6/18 –
6/60;
3) Severe visual impairment (SVI): PVA <6/60 – 3/60;
4) Blindness: PVA <3/60;
5) Functional low vision: best-corrected visual acuity
<6/18 to light perception in the better eye that cannot be
cured.
The term visual impairment refers to all individuals
with PVA worse than 6/18 in the better eye. So, it is the
total number of moderate and severe visual impairment
(MSVI), and blindness.16
Presenting visual acuity and ophthalmic
examinations
The survey teams measured PVA using tumbling “E”
charts of size 12, 18, and 60 at 6 m. If the participants
could not identify tumbling E size 60 correctly at 6 m,
the same E was shown at 3 m and at 1 meter. The light
perception was tested when the participants failed to
recognise the tumbling E size 60 at 1 meter.
All participants underwent a lens examination using
a torch, direct ophthalmoscope (red reflex) or handheld
slit lamp, irrespective of the PVA. Participants with
a PVA less than 6/12 underwent lens and anterior

segment examination using a torch or handheld slit
lamp to determine the causes. The dilated pupil exam­
ination using direct or indirect funduscopy was per­
formed if the PVA did not correspond to the lens
opacity or other anterior segments pathology. The
examination findings, including the primary cause of
visual impairment or blindness in each eye and the
person, were recorded in the standard survey form of
RAAB.
Survey team
In each province, the survey coordinator trained four
or five survey teams for the RAAB standard proce­
dures before they carried out fieldwork. Each team
consists of one ophthalmologist, one nurse or refrac­
tionist, and one enumerator. Inter-observer variation
tests assessed agreements among teams and must
reach Kappa≥0.6
Statistical analysis
Data entry and automatic standardised data analysis
utilised RAAB 6 software programmed in Visual
FoxPro 9.0 Crystal Reports 10. The software automati­
cally analysed unadjusted prevalence, principal cause,
prevalence adjusted for DEFF, and age- and gender-
adjusted prevalences. We used RAAB 6 software in all
the provinces, except in South Sulawesi using RAAB 5
software.
We performed a weighted average analysis to esti­
mate the nationwide visual impairment situation
(prevalences, causes of visual impairment and
Cataract Surgical Coverage). Firstly, we determined
the province weighting factors by dividing the popu­
lation aged 50+ of each province by the total popula­
tion aged 50+ of the 15 provinces together. Then, we
multiply the corresponding weighting factor with
findings of each province to determine the weighted
values of each province. The weighted average for
Indonesia is the sum of the weighted values of 15
provinces. The formula for the weighted average is as
follows:
W ¼ �ðpiaiÞ
W = weighted average; p = weight factor (proportion of
a province’s population in total population of the 15
provinces); a = the values in each province.
We also analysed the relationship between the per­
son’s CSC < 3/60 (CSCperson<3/60), as an explanatory
variable, and prevalence of blindness, as a dependent
variable, using linear regression in STATA/IC 15.1 soft­
ware. The relationship between the two variables
OPHTHALMIC EPIDEMIOLOGY 3
described in a scatter plot. A correlation coefficient,
a value between −1 and 1, represent the strength of
association between the two variables. A linear regres­
sion line is built according to the formula y = a + bx,
where x is the explanatory variable and y is the depen­
dent variable. The slope of the line is b, and a is the
intercept (the value of y when x = 0).17 So, the prevalence
of blindness can be estimated by using this formula as
follows:
�
Prevalence of blindness ¼ a þ b x CSCperson < 3=60
Results
In total 15 RAAB sites during the period of 2013–2017,
14 surveys represented provincial level, and one survey,
South Sulawesi province, only covered four districts out
of a total of 22 districts in the province.
Demographic data and response rates
The number of people aged 50+ was noticeably
higher on Java island than those on other regions.
The number of people aged 50+ in the province of
East Java is the highest at 9,428,638, followed by
Central Java at 7,922,981 and West Java at
7,677,585. In contrast, the population aged 50+ in
Maluku and West Papua is the lowest, each at
249,600 and 101,700. The total number of people
eligible for the survey in 15 provinces was 45,822,
and the survey examined 44,855 people. Response
rates were above 95% in all provinces (Table 1).
Prevalence of blindness
The age and gender-adjusted prevalence of blindness
(PVA less than 3/60 in the better eye) in East Java was
the highest at 4.4% (95% CI: 3.1–5.6%), followed by NTB
at 4.0% (95% CI: 3.0–5.1%) and South Sumatra at 3.4%
(95% CI: 2.4–4.4%). In number, blindness among people
aged 50+ in East Java was the highest at 371,599, fol­
lowed by West Java at 180,666 and Central Java at
176,977. (Table 2, Figure 1)
The prevalences of blindness in males and females in
Indonesia were 2.7% (95% CI: 1.4–4.0%) and 3.3% (95%
CI: 2.3–4.3%), respectively. The prevalence of blindness
in both genders was 3.0% (95% CI: 2.1–3.9%). The
estimated number of blindness in males was 806,343,
while in female was 848,252. The total number of blind­
ness in Indonesia was 1,654,595. (Table 2)
4 L. RIF’ATI ET AL.

Table 1. Demographic characteristics, sample sizes, and response rate.

Population
Provinces Total (n) Aged 50+ (n) Aged 50+ (%) Sample size Examined Response Rates No. of Clusters
North Sumatra 13,937,800 2,180,598 15.6 2,850 2,784 99% 57
West Sumatra 5,196,300 924,056 17.8 3,050 2,974 98% 61
South Sumatra 8,052,300 1,201,933 14.9 3,049 3,019 99% 61
Jakarta 10,177,900 1,637,595 16.1 3,050 2,998 98% 61
West Java 46,709,600 7,677,585 16.4 3,000 2,842 95% 60
Central Java 33,774,100 7,922,981 23.5 3,000 2,981 99% 60
East Java 38,847,600 9,428,638 24.3 2,842 2,822 99% 57
South Kalimantan 3,989,800 616,612 15.5 3,000 2,892 99% 60
Bali 4,152,800 733,490 17.7 3,050 3,024 98% 61
NTB 4,835,600 759,388 15.7 3,050 2,988 97% 61
NTT 5,120,100 819,679 16.0 2,846 2,763 96% 57
South Sulawesi 8,520,300 1,503,446 17.6 4,399 4,364 98% 88
North Sulawesi 2,412,100 513,200 21.3 2,950 2,918 99% 59
Maluku 1,686,500 249,600 14.8 2,800 2,742 98% 56
West Papua 871,500 101,700 11.7 2,886 2,744 95% 58
NTB: Nusa Tenggara Barat; NTT: Nusa Tenggara Timur

Prevalence of MVI and SVI to 95.2%) and MVI (range: 42.6% to 85.9%) in all 15
provinces. The proportion untreated cataract as the
The age and gender-adjusted prevalence of MVI in South
cause of blindness was the highest in West Papua at
Sulawesi was the highest at 13.3% (95% CI: 11.8–14.7%),
95.5%, followed by Maluku at 88% and South
followed by NTB at 12.0% (95% CI: 10.2–13.7%) and
Kalimantan at 87.7%. Posterior segment diseases
South Sumatra at 10.4% (95% CI: 8.5–12.3%). In number,
were also frequent as the cause of blindness in
MVI among people aged 50+ in East Java was the highest
Jakarta at 11.1% and West Java at 10.9%. Likewise,
at 836,079, followed by Central Java at 627,063 and West
glaucoma was responsible for blindness in North
Java at 471,355. (Table 2)
Sumatra at 7.4% and NTT at 8.9%. (Table 3)
The age and gender-adjusted prevalence of SVI in
Uncorrected refractive error was an important
South Sulawesi was the highest at 3.4% (95% CI: 2.8–­
cause of SVI in South Sulawesi at 33.8%, Central
4.1%), followed by East Java at 3.3% (95% CI: 2.5–4.0%)
Java at 18.4% and West Java at 10.5%. In North
and NTB at 3.1% (95% CI: 2.2–4.0%). In number, SVI
Sulawesi and NTB, the posterior segment diseases
among people aged 50+ in East Java was the highest at
were responsible for SVI at 10.9% and 18.2%, respec­
279,561, followed by Central Java at 186,278 and West
tively. Uncorrected refractive error was the second
Java at 77,539. (Table 2)
highest for MVI ranged from 10.9% to 52.6%, except
The prevalences of MVI in males and females in
in NTT and North Sulawesi. (Table 3)
Indonesia were 8.2% (95% CI: 6.1–10.4%) and 9.9%
In Indonesia, cataract was the leading causes of
(95% CI: 8.0–11.8%), respectively. The prevalence of
blindness, SVI and MVI at 81.2%, 81.4% and 64%,
MVI in both genders was 9.1% (95% CI: 7.4–10.8%).
respectively. The proportion of uncorrected refractive
The estimated number of MVI in males was
error as the causes of MVI was 23.8%. Glaucoma was
2,425,245, while in female was 2,551,293. The total
responsible for 1.8% of blindness, while the percen­
number of MVI in Indonesia was 4,976,538. (Table 2)
tage of blindness due to other posterior segment
The prevalences of SVI in males and females in
diseases was 6.1%. (Table 3)
Indonesia were 2.0% (95% CI: 1.1–2.9%) and 2.8% (95%
CI: 1.9–3.6%), respectively. The prevalence of SVI in both
genders was 2.4% (95% CI: 1.7–3.0%). The estimated
Cataract surgical coverage (CSC)
number of SVI in males was 676,565, while in female
was 711,729. The total number of in Indonesia SVI was Tables 4 and 5 describe CSC by persons and eyes. CSC
1,388,294. (Table 2) by persons for PVA less than 3/60 (CSCperson<3/60) in
Bali was the highest at 81.3%, followed by North
Sulawesi at 79.6% and Jakarta at 78.7%. The lowest
Causes of blindness, SVI and MVI
CSCperson<3/60 was in East Java at 29.6%. In all province,
Untreated cataract was the commonest cause of CSCperson<3/60 in male were higher than female.
blindness (range: 71.7% to 95.5%), SVI (range: 61% (Table 4)
 OPHTHALMIC EPIDEMIOLOGY 5

Table 2. Age and gender-adjusted prevalence of blindness and visual impairment in 15 provinces.
Male Female Total
n % 95% CI n % 95% CI n % 95% CI
North Sumatra
Blindness 13,524 1.3 0.5 - 2.0 22,076 1.9 1.0 - 2.7 35,601 1.6 0.9 - 2.2
SVI 15,504 1.5 0.7 - 2.2 25,950 2.2 1.4 - 2.9 41,453 1.8 1.2 - 2.4
MVI 78,244 7.3 5.4 - 9.3 117,180 9.8 8.0 - 11.6 195,426 8.6 7.1 - 10.2
EVI 99,468 9.3 7,3 - 11,3 163,698 13.7 11,5 - 15,9 263,166 11.6 9.9 - 133
Functional Low Vision 8,714 0.8 0.3 – 1.3 19,478 1.6 0,9 - 2,3 28,193 1.2 0.8 - 1.7
West Sumatra
Blindness 4,736 1.0 0.3 - 1.7 8,549 1.6 0.8 - 2.5 13,281 1.4 0.7 - 2.0
SVI 8,409 1.8 1.0 - 2.7 11,051 2.1 1.4 - 2.8 19,455 2.0 1.4 - 2.6
MVI 41,020 8.9 6.5 - 11.3 53,340 10.3 8.5 - 12.0 94,351 9.6 8.0 - 11.2
EVI 46,359 10.0 7.8 - 12.2 63,715 12.3 10.7 - 13.8 110,066 11.2 9.8 - 12.6
Functional Low Vision 2,414 0.5 0.1 - 0.9 4,065 0.8 0.4 - 1.1 6,479 0.7 0.4 - 0.9
South Sumatra
Blindness 16,113 2.5 1.5 - 3.4 29,145 4.4 3.0 - 5.7 45,253 3.4 2.4 - 4.4
SVI 12,281 1.9 0.9 - 2.8 19,015 2.9 1.9 - 3.8 31,292 2.4 1.7 - 3.1
MVI 57,474 8.8 6.6 - 11.0 80,285 12.1 9.7 - 14.4 137,758 10.4 8.5 - 12.3
EVI 90,250 13.8 11.6 - 15.9 86,348 13.0 10.8 - 15.1 176,593 13.4 11.7 - 15.0
Functional Low Vision 6,899 1.1 0.4 - 1.7 7,822 1.2 0.7 - 1.6 14,721 1.1 0.7 - 1.5
Jakarta
Blindness 7,331 1.2 0.2 - 2.2 16,135 2.6 1.8 - 3.3 23,464 1.9 1.3 - 2.5
SVI 10,447 1.7 0.9 - 2.5 15,008 2.4 1.6 - 3.2 25,458 2.0 1.5 - 2.6
MVI 62,234 10.0 7.7 - 12.4 62,866 10.0 8.6 - 11.4 125,104 10.0 8.6 - 11.5
EVI 62,165 10.0 7.7 - 12.4 90,233 14.4 12.4 - 16.4 152,403 12.2 10.4 - 14.0
Functional Low Vision 2,273 0.4 0.0 - 0.9 6,726 1.1 0.7 - 1.4 8,999 0.7 0.4 - 1.1
West Java
Blindness 69,058 2.1 1.1 - 3.1 111,605 3.4 2.4 - 4.4 180,666 2.8 2.0 - 3.5
SVI 27,649 0.9 0.2 - 1.5 49,889 1.5 0.9 - 2.2 77,539 1.2 0.7 - 1.7
MVI 214,133 6.6 4.3 - 8.8 257,222 7.9 6.1 - 9.7 471,355 7.2 5.7 - 8.8
EVI 222,996 6.9 5.2 - 8.5 258,452 7.9 6.4 - 9.4 481,445 7.4 6.3 - 8.5
Functional Low Vision 52,493 1.6 0.6 - 2.6 34,612 1.1 0.6 - 1.5 87,104 1.3 0.8 - 1.9
Central Java
Blindness 66,774 2.1 1.0 - 3.2 110,202 3.2 2.4 - 4.0 176,977 2.7 1.9 - 3.4
SVI 80,806 2.5 1.7 - 3.4 105,470 3.1 2.2 - 3.9 186,278 2.8 2.2 - 3.4
MVI 260,039 8.1 5.7 - 10.5 367,015 10.6 9.0 - 12.3 627,063 9.4 7.7 - 11.1
EVI 335,814 10.5 8.0 - 13.0 469,898 13.6 11.6 - 15.6 805,715 12.1 10.2 - 14.1
Functional Low Vision 21,160 0.7 0.2 - 1.1 38,046 1.1 0.5 - 1.7 59,207 0.9 0.5 - 1.3
East Java
Blindness 193,907 4.7 2.5 - 6.9 177,687 4.1 3.0 - 5.2 371,599 4.4 3.1 - 5.6
SVI 112,903 2.7 1.6 - 3.8 166,660 3.9 2.9 - 4.8 279,561 3.3 2.5 - 4.0
MVI 382,588 9.2 7.3 - 11.0 453,492 10.5 8.4 - 12.5 836,079 9.8 8.1 - 11.6
EVI 509,722 12.2 8.5 - 15.9 641,684 14.8 11.1 - 18.5 1,151,401 13.6 10.3 - 16.8
Functional Low Vision 57,353 1.4 0.7 - 2.0 54,880 1.3 0.7 - 1.9 112,231 1.3 0.9 - 1.7
South Kalimantan
Blindness 4,721 1.5 0.6 - 2.4 7,484 2.3 1.2 - 3.3 12,205 1.9 1.1 - 2.7
SVI 5,400 1.7 0.9 - 2.5 7,945 2.4 1.6 - 3.3 13,347 2.1 1.4 - 2.7
MVI 23,329 7.3 5.3 - 9.3 31,871 9.7 7.8 - 11.6 55,200 8.5 6.9 - 10.2
EVI 29,971 9.4 7.4 - 11.3 37,972 11.6 9.9 - 13.2 67,945 10.5 9.2 - 11.8
Functional Low Vision 1,416 0.4 0.0 - 0.9 1,965 0.6 0.2 - 1.0 3,381 0.5 0.3 - 0.8
Bali
Blindness 5,807 1.7 0.8 - 2.6 8,000 2.2 1.3 - 3.1 13,805 2.0 1.1 - 2.8
SVI 5,952 1.7 0.8 - 2.6 7,193 2.0 1.2 - 2.8 13,143 1.9 1.2 - 2.5
MVI 24,690 7.0 5.2 - 8.9 34,186 9.5 7.6 - 11.5 58,874 8.3 6.7 - 9.9
EVI 42,822 12.2 9.8 - 14.7 46,397 13 11.0 - 14.9 89,207 12.6 10.9 - 14.2
Functional Low Vision 5,898 1.7 1.0 - 2.4 4,734 1.3 0.6 - 2.0 10,631 1.5 1.0 - 2.0
NTB
Blindness 10,713 3.3 1.9 - 4.8 16,283 4.7 3.5 - 5.9 27,000 4.0 3.0 - 5.1
(Continued)
6 L. RIF’ATI ET AL.

Table 2. (Continued).
Male Female Total
n % 95% CI n % 95% CI n % 95% CI
SVI 7,723 2.4 1.1 - 3.7 13,283 3.8 2.9 - 4.8 21,009 3.1 2.2 - 4.0
MVI 36,614 11.4 8.8 - 14.0 43,326 12.5 10.5 - 14.5 79,945 12.0 10.2 - 13.7
EVI 32,327 10.0 7.8 - 12.3 35,821 10.4 8.8 - 11.9 68,147 10.2 8.7 - 11.7
Functional Low Vision 4,378 1.4 0.6 - 2.1 6,199 1.8 1.2 - 2.4 10,576 1.6 1.1 - 2.0
NTT
Blindness 5,577 1.4 0.6 - 2.2 10,457 2.5 1.5 - 3.4 16,035 2.0 1.3 - 2.6
SVI 7,587 1.9 1.0 - 2.8 6,027 1.4 0.8 - 2.0 13,614 1.7 1.1 - 2.2
MVI 38,484 9.8 7.5 - 12.1 34,733 8.1 6.2 - 10.1 73,220 8.9 7.1 - 10.8
EVI 30,952 7.9 5.9 - 9.9 42,954 10.1 8.3 - 11.8 73,907 9.0 7.4 - 10.6
Functional Low Vision 13,833 3.5 1.2 - 5.9 7,387 1.7 0.7 - 2.7 21,221 2.6 1.0 - 4.1
South Sulawesi
Blindness 3,667 2.4 1.6 - 3.3 4,841 2.8 2.2 - 3.4 6,875 2.6 2.1 - 3.2
SVI 4,968 3.3 2.2 - 4.4 6,155 3.6 2.7 - 4.4 11,122 3.4 2.8 - 4.1
MVI 17,772 11.7 9.9 - 13.5 25,228 14.6 12.8 - 16.4 43,006 13.3 11.8 - 14.7
EVI 779 0.5 0.1 - 0.9 2,323 1.3 1.0 - 1.7 3100 1.0 0.7 - 1.2
North Sulawesi
Blindness 4,729 1.9 0.9 - 2.8 3,733 1.4 0.9 - 2.0 8,461 1.7 1.1 - 2.2
SVI 4,614 1.8 0.9 - 2.8 5,273 2.0 1.2 - 2.8 9,885 1.9 1.3 - 2.6
MVI 17,788 7.0 5.2 - 8.8 24,527 9.4 7.7 - 11.2 42,309 8.2 6.9 - 9.5
EVI 27,259 10.8 8.6 - 12.9 46,065 17.7 15.4 - 20.1 73,323 14.3 12.3 - 16.3
Functional Low Vision 5,453 2.2 1.0 - 3.3 5,920 2.3 1.3 - 3.3 11,368 2.2 1.4 - 3.1
Maluku
Blindness 2,391 2.0 0.8 - 3.2 4,065 3.2 2.2 - 4.2 6,456 2.6 1.7 - 3.5
SVI 2,794 2.3 1.0 - 3.5 3,358 2.6 1.6 - 3.6 6,153 2.5 1.5 - 3.4
MVI 9,754 8.0 6.1 - 9.9 10,199 8.0 6.4 - 9.6 19,954 8.0 6.7 - 9.3
EVI 12,095 9.9 7.6 - 12.2 13,382 10.5 8.2 - 12.7 25,480 10.2 8.3 - 12.1
Functional Low Vision 559 0.5 0.0 - 0.9 841 0.7 0.3 - 1.0 1,400 0.6 0.3 - 0.8
West Papua
Blindness 1,214 2.2 1.3 - 3.1 1,164 2.5 1.5 - 3.5 2,379 2.3 1.7 - 3.0
SVI 672 1.2 0.6 - 1.8 729 1.6 0.9 - 2.3 1,401 1.4 0.9 - 1.9
MVI 3,707 6.7 5.0 - 8.3 3,180 6.9 5.4 - 8.4 6,886 6.8 5.5 - 8.0
EVI 4,765 8.6 6.6 - 10.6 3,924 8.5 7.0 - 10.0 8,691 8.6 7.1 - 10.0
Functional Low Vision 405 0.7 0.2 - 1.3 127 0.3 0.0 - 0.5 533 0.5 0.2 - 0.8
Indonesia
Blindness 806,343 2.7 1.4 - 4.0 848,252 3.3 2.3 - 4.3 1,654,595 3.0 2.1 - 3.9
SVI 676,565 2.0 1.1 - 2.9 711,729 2.8 1.9 - 3.6 1,388,294 2.4 1.7 - 3.0
MVI 2,425,245 8.2 6.1 - 10.4 2,551,293 9.9 8.0 - 11.8 4,976,538 9.1 7.4 - 10.8
EVI 3,016,320 10.1 7.5 – 12.6 3,187,371 12.4 10.1 – 14.7 6,232,308 11.3 9.3 – 13.3
Functional Low Vision 358,375 1.2 0.5 – 1.9 308,455 1.2 0.6 – 1.8 661,838 1.2 0.7 – 1.7
PVA: Presenting Visual Acuity; Blindness: PVA <3/60; SVI: Severe Visual Impairment (PVA <6/60 – 3/60); MVI: Moderate Visual Impairment (PVA <6/18 – 6/60); EVI:
Early Visual Impairment (PVA <6/12 – 6/18); Functional low vision: best-corrected visual acuity <6/18 to light perception in the better eye that cannot be cured;
NTB: Nusa Tenggara Barat; NTT: Nusa Tenggara Timur

The CSC by eyes for PVA less than 3/60 (CSCeye<3/60)
in Bali was also the highest 57.2%, followed by Jakarta at
56.6% and North Sulawesi at 56%. CSCeye<3/60 in NTT
was the lowest at 16.3%. CSCeye<6/60 and CSCeye<6/18 was
also highest in Bali at 50.3% and 27.9%, respectively.
(Table 4)
In all provinces, CSCperson was higher than CSCeye.
The total CSCperson<3/60 in Indonesia was 47%, while
the total CSCeye<3/60 was 28.9%. The CSCperson<3/60 in
males, at 52.8%, was higher than those in females,
at 44.1%.
Correlation between CSC by persons for PVA <3/60
and prevalence of bilateral blindness in Indonesia
The linear regression analysis showed a negative corre­
lation between Prevalence of blindness and
CSCperson<3/60 with R-squared = 0.5 (moderate correla­
tion); p-value: 0.003; a: 4.55, and b: −0.036. So, the
prevalence of bilateral blindness in Indonesia could be
estimated using the formula as follows:
Prevalence of blindness = 4.55 + (−0.036 x CSC by
persons for PVA <3/60).17 (figure 1)

Prevalence of bilateral blindness = 4.55 + (-0.036 x CSCperson<3/60)
Prevalence of bilateral blindness (%)
CSCperson<3/60 (%)
Prevalence
Figure 1. Correlation between the prevalence of blindness and CSCperson< 3/60 in Indonesia.
Cataract surgical outcome
Cataract surgical outcome achieving PVA 6/18 and bet­
ter in all provinces ranged from 50.9% to 70% of the total
cataract surgeries, while those with PVA worse than 6/60
ranged from 11.1% to 34.5%. There were still non-IOL
cataract surgeries observed in our RAAB surveys.
Percentages of non-IOL cataract surgeries higher than
5% were found in eight provinces: West Sumatra, South
Sumatra, West Java, Central Java, South Kalimantan,
South Kalimantan, NTB, South Sulawesi, and Maluku.
(Table 6)
Discussion
This study reported a serial of RAAB surveys conducted
in 15 provinces in Indonesia during the period
2013–2017. The surveys updated the data on visual
impairment situation in Indonesia. The total population
of the provinces, where RAABs were performed, repre­
sent 72% of the total population of Indonesia.1
Therefore, the findings provide a representative estimate
of visual impairment situation in the entire country. The
results of this study inform the baseline data for creating
an eye care action plan in Indonesia following the WRV
recommendations.6
Population aged 50+ on the island of Java is much
higher than in other regions in Indonesia.1 The greater
OPHTHALMIC EPIDEMIOLOGY 7
R-squared: 0.50
p-value: 0.003
Linear Prediction
high-risk population on the island correlated to a higher
number of people with visual impairment.6,18 The esti­
mated number of people with visual impairments on
Java island contributed 42% of the total nationally.
However, the provinces on Java island have adequate
health systems in terms of human resources and infra­
structure. This condition raises an opportunity to imple­
ment effective eye care on the island. Successfully eye
care programs on Java island will contribute greatly to
the reducing visual impairment of the entire country.
The Prevalence of blindness in East Java and NTB was
the highest at 4.4% and 4.0%, respectively. Although both
provinces shared similar prevalence, the burden of blind
people in East Java was thirteen-times more numerous
than in NTB. This condition is related to a much larger
population of people aged 50+ in East Java. However, the
geographical situation of NTB, which consists of several
islands, cause a more challenging situation in providing
eye care services due to the scattered population.1
The Indonesian nationwide prevalence of blindness,
at 3.0%, was the highest among the Southeast Asia
region (SEAR) countries. The number of people with
bilateral blindness in Indonesia, at 1.6 million, contrib­
uted to 13% of total blindness in the region.8 Moreover,
the prevalence of blindness in Indonesia was also higher
than those in the neighbouring countries, Malaysia
(1.2%) and Philipines (0,9%).,19,20
 8
L. RIF’ATI ET AL.

Table 3. Causes of blindness and visual impairment in 15 provinces.

North West South West Central East South South North West
Causes Sumatra Sumatra Sumatra Jakarta Java Java Java Kalimantan Bali NTB NTT Sulawesi Sulawesi Maluku Papua Indonesia
Blindness (%)
Uncorrected Refractive Error 0.0 0.0 0.7 1.4 2.2 4.8 3.1 0.0 1.2 0.6 0.0 6.0 0.0 1.3 0.0 2.7
Cataract 77.8 87.0 85.2 81.9 71.7 73.8 81.1 87.7 77.8 78.1 75.0 77.8 82.2 88.0 95.5 81.2
Pterygium 0.0 0.0 0.7 0.0 0.0 0.0 1.6 0.0 0.0 0.0 1.8 0.0 2.2 5.3 0.0 0.9
Glaucoma 7.4 0.0 0.0 0.0 2.2 1.2 4.7 3.5 2.5 3.8 8.9 2.6 0.0 0.0 0.0 1.8
Posterior Segment Disease 1.9 4.3 6.7 11.1 10.9 7.1 3.1 3.5 4.9 7.5 5.4 5.1 6.7 0.0 0.0 6.1
Severe Visual Impairment
(%)
Uncorrected Refractive Error 3.4 4.9 5.6 4.4 10.5 18.4 5.4 0.0 5.1 0.9 0.0 33.8 0.0 2.9 4.9 8.5
Cataract 84.7 83.6 88.9 77.9 73.7 80.5 89.2 95.2 83.3 88.9 71.7 61.0 63.6 88.6 85.4 81.4
Pterygium 0.0 1.6 1.1 0.0 5.3 0.0 2.2 0.0 0.0 0.9 4.3 0.0 1.8 1.4 2.4 1.9
Glaucoma 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.7 8.7 0.0 0.0 0.0 0.0 0.3
Posterior Segment Disease 8.5 6.6 1.1 7.4 0.0 0.0 0.0 1.6 1.3 3.4 10.9 1.3 18.2 0.0 0.0 1.9
Moderate Visual Impairment
(%)
Uncorrected Refractive Error 18.6 14.3 10.9 15.4 36.8 27.8 20.7 13.1 12.8 17.1 9.4 52.6 9.9 10.9 16.9 23.8
Cataract 61.3 77.0 84.0 76.3 51.2 66.7 69.6 81.1 71.3 75.3 57.7 42.6 42.6 85.9 75.1 64.0
Pterygium 2.2 1.0 0.3 0.6 1.2 0.0 0.0 0.8 0.6 0.2 2.8 0.0 1.2 0.9 1.0 0.8
Glaucoma 0.4 0.3 0.0 1.2 1.2 0.0 1.1 0.4 0.6 0.5 5.5 0.2 0.0 0.0 0.0 0.6
Posterior Segment Disease 14.9 5.6 1.6 1.5 3.7 4.2 4.0 3.1 0.9 3.7 12.6 0.7 24.4 0.5 0.5 5.0
NTB: Nusa Tenggara Barat; NTT: Nusa Tenggara Timur
 OPHTHALMIC EPIDEMIOLOGY 9

Table 4. Cataract Surgical Coverage by the person (CSCperson) in 15 provinces.

Male (%) Female (%) Both (%)
Province < 3/60 < 6/60 < 6/18 < 3/60 < 6/60 < 6/18 < 3/60 < 6/60 < 6/18
North Sumatra 76.1 67 35.6 65.8 49.4 25.8 70.2 56 29.2
West Sumatra 79.5 65 39 77.2 62.9 33.9 78.2 63.8 36.1
South Sumatra 55.4 49.7 24.5 45.4 38 18.7 49.5 42.4 20.9
Jakarta 88.0 81 44.2 70.5 60.5 36.6 78.7 69.8 40.1
West Java 69.5 65 46.4 39.9 37.9 21.6 49.7 47.5 30.9
Central Java 42.1 24.2 10.7 39.6 24.5 12.9 40.5 24.4 12
East Java 26.3 21.4 15.3 33.1 21.2 11.8 29.6 21.3 13.4
South Kalimantan 74.0 60.6 31.9 51.2 42.1 19.5 61.0 49.9 24.4
Bali 85.8 83.6 53.6 76.0 61.4 36.9 81.3 72.4 44.5
NTB 57.4 50.8 25.0 37.0 28.3 15.9 46.4 37.8 19.7
NTT 41.8 33.0 13.6 30.4 22.8 11.3 34.4 26.3 12.2
South Sulawesi 71.2 56.0 32.4 58.8 44.3 24 64.5 49.5 27.5
North Sulawesi 83.9 67.7 50.1 75.2 64.5 44.9 79.6 63.8 36.1
Maluku 57.6 45.8 30.1 41.8 31.3 18.5 50.2 38.6 24
West Papua 53.2 46.8 26.3 45.5 37.1 24.9 49.5 42.0 25.6
Indonesia 52.6 43.8 26.9 44.1 33.5 18.6 47.0 37.4 21.6
NTB: Nusa Tenggara Barat; NTT: Nusa Tenggara Timur

Table 5. Cataract Surgical Coverage by eyes (CSCeye) in 15 provinces.

Male (%) Female (%) Both (%)
Provinces < 3/60 < 6/60 < 6/18 < 3/60 < 6/60 < 6/18 < 3/60 < 6/60 < 6/18
North Sumatra 36.7 31.5 15.5 38.1 29.0 13.3 37.5 30.0 14.1
West Sumatra 48.6 40.3 21.1 54.4 44.3 22.5 51.8 42.5 21.9
South Sumatra 30.6 25.0 12.8 27.7 21.7 10.2 29.0 23.1 11.3
Jakarta 61.3 51.3 29.2 52.0 43.2 23.5 56.6 47.2 26.3
West Java 46.0 41.7 25.6 25.9 23.1 13.7 34.4 30.9 18.6
Central Java 22.6 16.0 7.7 20.4 14.5 7.0 21.3 15.1 7.3
East Java 18.9 14.1 8.9 15.9 9.8 6.2 17.4 11.8 7.4
South Kalimantan 41.4 32.1 17.7 28.6 23.2 11.2 34.2 27.1 13.9
Bali 61.6 56.2 33.9 52.7 44.7 23.0 57.2 50.3 27.9
NTB 39.3 32.7 18.3 24.6 19.9 10.9 31.1 25.5 14.1
NTT 21.0 17.8 8.8 13.1 10.4 5.6 16.3 13.3 6.9
South Sulawesi 46.7 36.2 21.3 40.3 29.4 15.8 43.3 32.5 18.2
North Sulawesi 58.2 47.1 32.7 53.9 43.2 27.6 56.0 45.1 29.9
Maluku 37.6 29.1 17.6 28.1 20.5 10.6 33.0 24.8 13.8
West Papua 35.3 30.5 17.8 27.2 23.2 12.8 31.6 27.1 15.4
Indonesia 32.8 27.0 15.6 25.9 20.0 10.8 28.9 23.0 12.8
NTB: Nusa Tenggara Barat; NTT: Nusa Tenggara Timur

The total number of people with visual impairment,
people with PVA less than 6/18 in the better eye, in
Indonesia was about 8 million. This evidence reflects
the magnitude of the problem of visual impairment in
Indonesia. Visual impairment is not only a public health
problem but also has an impact on the decline in the
people’s quality of life and economic loss of the
country.,21,22 Therefore, the prevention of blindness
program ought to be a part of the Indonesian health
system and make it as one of the priority programs.
Cataracts affect about 20 million people worldwide
and continue to be a primary cause of blindness in
many countries, especially in low-middle income
countries. Even though global prevention of blind­
ness strategies mostly focus on cataracts elimination,
the burden of bilateral blindness due to cataract
remains high.,23,24 All countries in the SEAR, and
also the current Indonesian RAAB survey, reported
a similar problem related to cataract blindness.8 The
Indonesian RAAB surveys found that cataract was
responsible for 81.2% of blindness. High volume
and high quality of cataract surgery services will
have an impact on reducing the prevalence of blind­
ness over the country. Development capacities of
human resources and infrastructures in each level of
eye care ensure the quality of cataract surgery service
deliveries.25,26
CSC is a community-based indicator to assess the
service deliveries of cataract surgeries. It evaluates the
effectiveness of the services in tackling the needs for
cataract surgeries and monitors the activities of eye
care programs. Higher CSC indicates that a larger num­
ber of people with cataract can access cataract surgery
services to restore their vision.26–28 We found that, in
Indonesia, higher CSCperson<3/60 correlated to lower pre­
valences of blindness. This fact was related to cataract as
10 L. RIF’ATI ET AL.

Table 6. Outcome by type of cataract surgery with available

correction (eyes). Table 6. (Continued).
Non-IOL IOL Total Non-IOL IOL Total
n % n % n % n % n % n %
North Sumatra West Papua
Very good: can see 6/12 0 0 30 34.5 30 34.5 Very good: can see 6/12 0 0.0 46 54.1 46 53.5
Good: can see 6/18 0 0 18 20.7 18 20.7 Good: can see 6/18 0 0.0 14 16.5 14 16.3
Borderline: can see 6/60 0 0 24 27.6 24 27.6 Borderline: can see 6/60 0 0.0 8 9.4 8 9.3
Poor: cannot see 6/60 0 0 15 17.2 15 17.2 Poor: cannot see 6/60 1 100.0 17 20.0 18 20.9
West Sumatra NTB: Nusa Tenggara Barat; NTT: Nusa Tenggara Timur
Very good: can see 6/12 3 18.8 65 51.2 68 47.6
Good: can see 6/18 2 12.5 23 18.1 25 17.5
Borderline: can see 6/60 3 18.8 21 16.5 24 16.8
Poor: cannot see 6/60 8 50.0 18 14.2 26 18.2
South Sumatra the leading causes of blindness in the country. So, it is
Very good: can see 6/12 1 11.1 40 34.2 41 32.5 reasonable that the eye care program planners should
Good: can see 6/18 2 22.2 25 21.4 27 21.4
Borderline: can see 6/60 2 22.2 27 23.1 29 23.0 focus on increasing the coverage of cataract surgeries by
Poor: cannot see 6/60 4 44.4 25 21.4 29 23.0 intensifying the case findings and high-volume cataract
Jakarta
Very good: can see 6/12 0 0.0 122 50.2 122 48.4 surgeries in their avoidable blindness elimination
Good: can see 6/18 0 0.0 45 18.5 45 17.9 programs.
Borderline: can see 6/60 1 11.1 44 18.1 45 17.9
Poor: cannot see 6/60 8 88.9 32 13.2 40 15.9
In our study, the CSCperson<3/60 were higher than
West Java CSCeye<3/60 in all provinces. It indicates that most of
Very good: can see 6/12 2 28.6 46 50.0 48 48.5 the bilateral cataract blindness had cataract surgery in
Good: can see 6/18 0 0.0 20 21.7 20 20.2
Borderline: can see 6/60 1 14.3 19 20.7 20 20.2 one eye and kept other eyes unoperated. Moreover, the
Poor: cannot see 6/60 4 57.1 7 7.6 11 11.1 country’s CSCperson<3/60 was only 47% contributing to
Central Java
Very good: can see 6/12 0 0.0 19 38.0 19 34.5 cataract backlog. All these facts represent the lack of the
Good: can see 6/18 0 0.0 9 18.0 9 16.4 provision of cataract surgery services in Indonesia. The
Borderline: can see 6/60 1 20.0 7 14.0 8 14.5
Poor: cannot see 6/60 4 80.0 15 30.0 19 34.5 Eye care program in Indonesia ought to strengthen the
East Java service delivery of cataract surgeries for all people in
Very good: can see 6/12 0 0 26 42.6 26 42.6
Good: can see 6/18 0 0 15 24.6 15 24.6
need regardless of geographical and economic condi­
Borderline: can see 6/60 0 0 8 13.1 8 13.1 tions. People in remote and rural areas must have ade­
Poor: cannot see 6/60 0 0 12 19.7 12 19.7 quate access to the services and be free from financial
South Kalimantan
Very good: can see 6/12 0 0.0 43 50.6 43 46.7 barriers.
Good: can see 6/18 0 0.0 16 18.8 16 17.4 Some countries are struggling to improve the per­
Borderline: can see 6/60 3 42.9 16 18.8 19 20.7
Poor: cannot see 6/60 4 57.1 10 11.8 14 15.2 formances of cataract surgeries in their prevention of
Bali blindness programs.28–32 Cataract surgical outcome
Very good: can see 6/12 0 0.0 111 40.8 111 39.9
Good: can see 6/18 0 0.0 55 20.2 55 19.8 measures the performance and quality of the
Borderline: can see 6/60 0 0.0 47 17.3 47 16.9 services.29,33,34 WHO recommends at least 80% of
Poor: cannot see 6/60 6 100.0 59 21.7 65 23.4
NTB
cataract surgeries achieving the good outcome (PVA
Very good: can see 6/12 0 0.0 58 47.9 58 43.0 6/18 or better) and only tolerate up to 5% of the poor
Good: can see 6/18 0 0.0 21 17.4 21 15.6 outcome (PVA < 6/60).25,34 In our RAAB survey, all
Borderline: can see 6/60 0 0.0 25 20.7 25 18.5
Poor: cannot see 6/60 14 100.0 17 14.0 31 23.0 provinces failed to meet the WHO recommendation
NTT for the good cataract surgical outcome. Moreover, we
Very good: can see 6/12 0 0.0 10 34.5 10 33.3
Good: can see 6/18 0 0.0 6 20.7 6 20.0 found the proportion of poor cataract surgical out­
Borderline: can see 6/60 0 0.0 8 27.6 8 26.7 come greater than 10% in all provinces. These results
Poor: cannot see 6/60 1 100.0 5 17.2 6 20.0
South Sulawesi are an additional contribution to the high prevalence
Good: can see 6/18 2 11.1 169 64.5 171 62.4 of blindness in Indonesia. There is an urgent need to
Borderline: can see 6/60 2 11.1 50 19.0 52 19.0
Poor: cannot see 6/60 14 77.7 43 16.4 51 18.6
intensify the excellent outcome of high-volume catar­
North Sulawesi act surgeries in Indonesia. The health system in
Very good: can see 6/12 0 0.0 66 42.9 66 41.0 Indonesia ought to develop a training system to
Good: can see 6/18 1 14.3 37 24.0 38 23.6
Borderline: can see 6/60 0 0.0 33 21.4 33 20.5 increase the skills of the cataract surgeons and pro­
Poor: cannot see 6/60 6 85.7 18 11.7 24 14.9 vide the standard equipment and infrastructures for
Maluku
Very good: can see 6/12 0 0.0 49 52.1 49 49.0 the provision of cataract surgeries.
Good: can see 6/18 0 0.0 21 22.3 21 21.0 In Indonesia, there are still blind people caused by
Borderline: can see 6/60 2 33.3 7 7.4 9 9.0
Poor: cannot see 6/60 4 66.7 17 18.1 21 21.0 causes of permanent blindness, such as glaucoma and
(Continued) posterior segment diseases. Even though it is a small

proportion compared to other causes of blindness, the
affected people need visual assistance and social support
for the rest of their lives. The permanently blind people
require extra effort for their community participation.35,36
Therefore, the government must provide rehabilitation
and inclusive programs for them to maintain their capa­
cities and productivities.
The Indonesian Ministry of Health, along with the
other eye care stakeholders, created a strategic plan to
reduce the problems of visual impairment in the country.
The action plan, The roadmap of a visual impairment
control program in Indonesia 2017–2030, is comprehen­
sive and integrated national guidelines that include var­
ious efforts and collaboration in combating visual
impairment problems in Indonesia. The target is a 25%
reduction in the prevalence of blindness by 2030. The
visual impairment control programs focus on the
strengthening referral pathway for cataract surgeries ser­
vices. Each level of eye care has specific roles as follows:
visual impairment identification by key informants at the
community level, cause of blindness determination by
health workers at primary level, and high-volume cataract
surgeries by ophthalmologists at the district hospital. All
the efforts aim to increase the access for the people to
cataract surgery services, so hopefully, the total prevalence
of visual impairment in Indonesia will decrease signifi­
cantly. Besides, the strategic plan also includes the pro­
grams for people permanently blind by providing visual
rehabilitation and supports services.18
Conclusions
The burden of visual impairment in Indonesia is high,
and cataract contributes mostly to visual impairment.
The government and eye care stakeholder must have
a strong commitment to increasing the cataract surgical
coverage by providing accessible cataract surgery ser­
vices for the people in need.
Acknowledgments
We thank all elements of RAAB surveys in South Sulawesi,
NTB and West Java for initiating the surveys in Indonesia.
Their initiative to conduct a population-based survey trig­
gers other RAAB surveys in Indonesia. We acknowledge the
outstanding contribution of all individuals from different
institutions and organisation in Indonesia who dedicated
their valuable time to ensure the surveys completed. We
thank The National Institute for Health Research and
Development of The Indonesian Ministry of Health for
organising the survey fieldworks. Our gratitude also for all
The Indonesian Ophthalmologist Association (IOA) mem­
bers in North Sumatra, West Sumatra, South Sumatra,
South Kalimantan, DKI Jakarta, West Java, Central Java,
OPHTHALMIC EPIDEMIOLOGY 11
East Java, NTB, NTT, Bali, South Sulawesi, North
Sulawesi, Maluku, and West Papua who dedicated their
valuable time in the surveys. Finally, we thank all fieldwork
personnel for their priceless contribution in the survey,
even though they had to deal with a challenging geographi­
cal situation.
ORCID
Lutfah Rif’Ati http://orcid.org/0000-0003-3014-1835
Aldiana Halim http://orcid.org/0000-0003-3062-8133
Yeni Dwi Lestari http://orcid.org/0000-0003-2418-6076
Declaration of Interest
None of the authors have any proprietary interests or conflicts
of interest related to this submission.
Financial supports
● RAAB survey in South Sulawesi province was financially
supported by Lions Club International and Indonesian
Ophthalmology Association (IOA) South Sulawesi Branch.
● RAAB survey in West Java province was financially sup­
ported by Cicendo Eye Hospital, CBM Indonesia and
Indonesian Ophthalmology Association (IOA) West Java
Branch.
● RAAB survey in Nusa Tenggara Barat (NTB) province was
financially supported Fred Hollows Foundation (FHF) and
Ministry of Health Office of NTB province.
● Other 13 RAAB surveys were financially supported by
National Institute for Health Research and Development
(NIHRD), The Indonesian Ministry of Health.
This manuscript has not been published anywhere pre­
viously and that it is not simultaneously being submitted and
considered for any other publication.
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