level of 6/18 (20/60) varies significantly from about 1200 to about 4500 surgeries per year per million people. This variation may relate to genetic or cultural differences. Nigeria As of 2011, 0.78% of the population of Nigeria are blind. More than 43% of these are blind from cataracts and another 9% from aphakia and complications from couching performed by itinerant practitioners. There are about 2.8 ophthalmologists per million population in Nigeria, but the cataract surgical rate is only 300 per million per year, as opposed to the WHO recommendation of 3000 per million per year. Reasons cited for this situation include inadequate blindness prevention programs, lack of political will, shortage of funding, and failure of the government to take responsibility for training and services. Teaching hospitals do not have enough patient surgical load to support training. South Africa Facilities vary from government hospitals where subsidised operations for the disadvantaged may be charged at rates that cover the consumables, to private clinics where state of the art equipment is used and charged at premium rates. Waiting times in government hospitals may be up to two years, but are much shorter at private clinics. An innovation increasing efficient use of facilities is used in some hospitals where two patients are operated on for cataracts in the theatre at the same time. There are also charitable organisations which provide pro bono cataract surgery in rural areas using mobile clinics. As of 2023 the cataract surgery rate in South Africa is less than half of the estimated requirement of at least 2000 per million population per year needed to eliminate cataract blindness. Problems identified by Lecuona and Cook in 2011 include inadequate human resources available to the public sector to provide care for the indigent population. The main barrier to increasing the rate of surgery in South Africa is inadequate surgery capacity. A higher annual rate of cataract surgeries by individual surgeons would improve cost effectiveness and personal skills, and also contribute towards a overall reduction of risk. Special populations Congenital cataracts Congenital cataracts are a lens opacity which is present at birth. Congenital cataracts occur in a broad range of severity: some lens opacities do not progress and are visually insignificant, others can produce profound visual impairment. Congenital cataracts may be unilateral or bilateral. They can be classified by morphology, presumed or defined genetic cause, presence of specific metabolic disorders, or associated ocular