90 percent of all blind and visually impaired people live in low- and middle-income countries (LMICs) with cataracts as the major cause, and research differs on whether blindness is a gender-based risk with greater prevalence among women. Three types of surgery, the only treatment choice for visually disabling cataract and a most cost-effective intervention, offer advantages over other visual disabilities: (1) it is one-time with excellent visual rehabilitation; (2) visual acuity returns to normal in about one month allowing patients to resume productive pursuits; and (3) patients usually seek care early in the course of the disease. The lack of availability of ophthalmologists and their disproportional distribution presents a major issue. Although philanthropy can be an initial source of support, programs need to devise ways to become self-sustaining to continue to be efficient. Demographic projections suggest that a significant increase in cataracts as the global population ages.