Universal screening: To do or not to do

[1] on the seroprevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) among patients undergoing cataract surgery published in this issue of the journal is a welcome change because it raises several issues related to preoperative universal screening and the risk of disease transmission from patient to patient and from patient to HCW. Despite a large known pool of HIV, HBV, and HCV infection and the risk of transmission to HCWs or other patients, routine universal serological screening for these infections is not recommended in India under the National Program for Control of Blindness or elsewhere by other professional bodies such as the American Academy of Ophthalmology or the National Institute for Clinical Excellence, UK. The lack of evidence of direct disease transmission from infected patients to other patients or HCWs during intraocular surgeries, along with the variable sensitivity and specificity of the screening tests, the presence of a window period before seroconversion, the narrow focus of only safeguarding the HCW interest and not case detection and treatment of hitherto undiagnosed patients, and the costs of conducting these tests in resource-scarce settings are some of the reasons why universal screening does not find universal acceptance.