Emerging Barriers to Accessing Cataract Surgery in a Low- and Middle-Income Country: A Hospital-Based Cross-Sectional Study from Bangladesh

PurposeTo assess the key barriers that limit access to cataract surgery services in the lower-middle-income country, Bangladesh, with a high cataract burden. MethodsA cross-sectional preoperative survey was conducted among 595 cataract patients attending hospital outpatient services (n = 222) and community outreach camps (n = 373) in Lions Charitable Eye Hospital from May to August 2025. Data were collected using systematic sampling through an interviewer-administered questionnaire. Socio-demographic characteristics, awareness of cataracts and treatment, and barriers to surgery were assessed. Regression analyses were performed to evaluate the associations between patient characteristics and the reported barriers. ResultsThe study included 595 cataract patients (mean age 62 years; 50% women). Most of them presented with bilateral cataracts (74%). Camp patients were more often rural and less educated (p < 0.001). Although most patients reporting barriers had heard of cataract (72.4%), fewer knew about treatment options (38.2%), with knowledge strongly linked to education (p < 0.01). The leading barriers were affordability (430, 72.3%), insufficient time due to work or family responsibilities (165, 27.7%), worry about surgical outcomes (161, 27.1%), fear of the procedure (154, 25.9%), transportation (138, 23.2%), and lack of escort (131, 22%). Women frequently cited fear and lack of escort (p < 0.001) as barriers. Lower education and income were associated with more barriers, while prior surgery was found to reduce them (Adj. R{superscript 2} = 0.138). Cataract-related visual impairment significantly limited daily functioning, particularly household work (47.9%) and mobility (45.4%). ConclusionFinancial, socio-cultural, and accessibility barriers limit uptake of cataract surgery in Bangladesh. The existing disparities in access to cataract surgery can be addressed through health promotion, medical staff training, and enhanced patient counseling.