Bulgaria faces a marked shortage of ophthalmic resources. There are over 600 ophthalmologists for this Balkan nation of 8.9 million, giving Bulgaria a ratio of ophthalmologists to overall population that is similar to that of the United States; however, less than 20% of these ophthalmologists perform surgery. No formal residency or fellowship training programs exist in the country. Ophthalmic textbooks and journals are written predominantly in Russian and are in short supply. Pharmaceutical supplies are extremely limited. The leading cause of blindness in Bulgaria is cataracts that have not been treated surgically. Most cataracts are removed with intracapsular extraction. However, in the major cities, extracapsular cataract extraction with implantation of intraocular lenses is available.