The individual and household impacts of cataract surgery on older blind adults in ethiopia

Cataract Surgery Visual Outcome and Associated Factors Among Adults Attended Jimma University Medical Center, Jimma, Southwest Ethiopia

Background

Cataract is the leading cause of blindness and the second leading cause of visual impairment worldwide, accounting for 51% and 33% of all cases, respectively, in low- and medium-income countries bearing a disproportionately high burden. Hence, this study aimed to assess the visual outcome of age-related cataract surgery and identify factors associated with patients' postoperative visual outcomes in Jimma University Medical Center, Southwest Ethiopia.

Methods

An institution-based cross-sectional study design was conducted among 386 cataract surgery patients from January 1, 2016, to December 30, 2017. The study participants were selected using a systematic random sampling technique. Data were collected by reviewing the selected patients' medical records using a pre-tested checklist, entered into EpiData version 3.1, and exported to SPSS 20 for analysis. Proportions, summary statistics, and tables were used for presentations of the findings. Binary logistic regression was carried out to identify independent predictors of visual outcome. Findings were presented with adjusted odds ratios and their 95% confidence interval. A p-value <0.05 was used to declare a statistically significant association.

Results

About 231 individuals (59.8%) had poor visual results following cataract surgery. Furthermore, age >70 (AOR = 3.64; 95% CI [1.35-9.82]), preoperative ocular co-morbidities (AOR = 2.34; [1.32-4.15]), incision-based cataract surgery (AOR = 7.11; [3.16-16.02]), compared phacoemulsification operated by resident surgeons (AOR = 2.19; [1.23-3.89]), presence of intraoperative complication (AOR = 3.41; [1.47-7.92]), lens remnant (AOR = 2.91; [1.11-4.92]), ocular inflammation (OR = 2.56; [1.34-4.92]), and striate keratopathy/corneal edema (AOR = 1.91; [1.07-3.44]) were significantly associated with poor visual outcome.

Conclusion

The visual outcome following cataract surgery fall below WHO recommendation. In this study, age, ocular co-morbidities, surgical method, surgeon status, intraoperative complication, SK, and ocular inflammation associated with post-operative Uveitis and anterior chamber reaction were associated with a poor visual outcome.

Impact on caregivers of patients with eye diseases: systematic review and meta-analysis

OBJECTIVE

The burden on caregivers of patients with eye disease is exacerbated by competing priorities and their own advancing age. The objective of this paper is to identify and characterize the burden of caregiving for patients with eye diseases.

DESIGN

Systematic review and meta-analysis.

METHODS

A comprehensive review of the literature was conducted accessing the main databases up to March 25, 2021: Medline (Ovid), Embase, CINAHL, Cochrane Library, PsycINFO, and PubMed. Studies included referred to the burden experienced by caregivers of adults with any eye disease. Review studies, editorials, commentaries, opinion studies, and single case reports were excluded as well as studies that described only the quality of life and (or) burdens of the care recipient. Two independent reviewers carried 2-level screening. Risk of bias assessment was determined according to the Modified Downs and Black Checklist. Demographic data and measures of burden were extracted and tabulated.

RESULTS

In total, 2421 articles were identified after duplicate removal; 17 progressed to data extraction after full-text screening, and 7 were included in the meta-analysis. Overall, caregiving was associated with significant burden (65%; 95% CI, 12%-17%). Meta-analysis indicated significant severe burden (24%; 95% CI, 3%-45%), moderate burden (18%; 95% CI, 9%-28%), and mild burden (34%; 95% CI, 7%-61%) on caregivers of visually impaired patients.

CONCLUSIONS

Awareness of the psychosocial impact and risk of severe burden experienced by caregivers of eye disease patients is required to aid health care providers to develop proactive interventions for both providers and recipients of care.

Update of a Simple Model to Calculate the Annual Global Productivity Loss Due to Blindness and Moderate and Severe Vision Impairment

PURPOSE

To develop a simple but more precise model to calculate potential annual productivity losses due to blindness and moderate and severe vision impairment (MSVI) at the national, regional, and global level.

METHODS

Productivity loss was defined as the loss of minimum wage/Gross National Income per capita (GNI) incurred by people aged 50-64 years with blindness or MSVI, who were not able to work or worked with reduced earnings in 2020. We developed a global list of minimum wage data from on-line sources. All other model data were sourced from international, standardised, and open-access databases. For blindness, the total productivity loss (not working) incurred by 64%-90% of the affected population was summed up with partial productivity loss, defined as 10%-36% of the affected population earning one-third of that of the sighted population. For MSVI, the total productivity loss for 30%-55% of the affected population was summed with the partial productivity loss, defined as 45%-70% of the affected population having 35% reduced earnings. The costs of blindness and MSVI were summed to obtain the cost of combined vision loss.

RESULTS

The global cost of vision loss based on minimum wage was US$160-US$216.32 billion for 2020. The global cost of vision loss using GNI was US$449.36-US$584.66 billion.

CONCLUSIONS

A parsimonious model that considers minimum wage and GNI potentially lost due to blindness and MSVI can be used for eye care programming planning and advocacy at the national, regional, and global level.

Advancing the Sustainable Development Goals through improving eye health: a scoping review

UN member states have committed to achieving the Sustainable Development Goals (SDGs) by 2030. This Review examines the published evidence on how improving eye health can contribute to advancing the SDGs (beyond SDG 3). We identified 29 studies that showed direct benefits from providing eye health services on SDGs related to one or more of poverty (SDGs 1, 2, and 8), education (SDG 4), equality (SDGs 5 and 10), and sustainable cities (SDG 11). The eye health services included cataract surgery, free cataract screening, provision of spectacles, trichiasis surgery, rehabilitation services, and rural community eye health volunteers. These findings provide a comprehensive perspective on the direct links between eye health services and advancing the SDGs. In addition, eye health services likely have indirect effects on multiple SDGs, mediated through one of the direct effects. Finally, there are additional plausible links to other SDGs, for which evidence has not yet been established.

Economic impact of surgery on households and individuals in low income countries: A systematic review

BACKGROUND

Surgical disease in Low Income Countries (LIC) is common, and overall provision of surgical care is poor. A key component of surgical health systems as part of universal health coverage (UHC) is financial risk protection (FRP) - the need to protect individuals from financial hardship due to accessing healthcare. We performed a systematic review to amalgamate current understanding of the economic impact of surgery on the individual and household. Our study was registered on Research registry (www.researchregistry.com).

METHODS

We searched Pubmed and Medline for articles addressing economic aspects of surgical disease/care in low income countries. Data analysis was descriptive in light of a wide range of methodologies and reporting measures. Quality assessment and risk of bias analysis was performed using study design specific Joanna-Briggs Institute checklists. This study has been reported in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) Guidelines.

RESULTS

31 full text papers were identified for inclusion; 22 descriptive cross-sectional studies, 4 qualitative studies and 5 economic analysis studies of varying quality. Direct medical, direct non-medical and indirect costs were variably reported but were substantial, resulting in catastrophic expenditure. Costs had far reaching economic impacts on individuals and households, who used entire savings, took out loans, reduced essential expenditure and removed children from school to meet costs.

CONCLUSION

Seeking healthcare for surgical disease is economically devastating for individuals and households in LICs. Policies directed at strengthening surgical health systems must seek ways to reduce financial hardship on individuals and households from both direct and indirect costs and these should be monitored and measured using defined instruments from the patient perspective.