1
|
Marmamula S, Saha R, Khanna RC. Effective Cataract Surgical Coverage in Four Large Districts in Telangana, India - Results from Rapid Assessment of Visual Impairment Study. Ophthalmic Epidemiol 2024:1-7. [PMID: 38569085 DOI: 10.1080/09286586.2024.2336498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE To report cataract surgical coverage (CSC) and effective Cataract Surgical Coverage (eCSC) from four districts in Telangana, India. METHODS Individuals aged ≥40 years were recruited from Adilabad, Mahbubnagar, Warangal and Khammam districts using two stage cluster sampling methodology. All participants had detailed eye examinations including visual acuity assessment using a standard Snellen chart at a distance of six meters, anterior segment examination and fundus imaging by trained professionals. CSC and eCSC were calculated for persons using a 6/12 visual acuity cut-off. RESULTS Of 12,150 individuals enumerated from four districts 11,238 (92.5%) were examined. The mean (standard deviation) age of the participants was 54.1 (±11.2) years (range: 40 to 102 years) and 54.6% (n = 6137) were women. Overall, the CSC (%) was 54.2%. It ranged from a highest of 59% in Khammam followed by 57.5% in Adilabad, 51.7% in Warangal, and a least of 49.7% in Mahbubnagar district. Overall, the eCSC (%) was 39.9%. It ranged from a highest of 46.1% in Adilabad followed by 43.2% in Khammam, 36.2% in Warangal district and a least of 35.8% in the Mahbubnagar district. CONCLUSIONS CSC and eCSC varied across the districts. A significant gap between CSC and eCSC is noted suggestive of challenges with quality of services. District-wise planning of cataract surgical services with a focus on quality care is recommended to improve coverage and contribute towards achieving the goal of universal eye health coverage in the Telangana State in India.
Collapse
Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
- Wellcome Trust/Department of Biotechnology India Alliance, L V Prasad Eye Institute, Hyderabad, India
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Ranindita Saha
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| |
Collapse
|
2
|
Cho WKT, Hwang DG. Sociodemographic Disparities in Preoperative Visual Acuity and Cataract Surgery Utilization in the San Francisco Bay Area. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01914-4. [PMID: 38329693 DOI: 10.1007/s40615-024-01914-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/23/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE We examined whether cataract surgery utilization and preoperative visual acuity were associated with patient-specific factors, including ocular findings and comorbidities, general biomedical factors, and/or sociodemographic factors. DESIGN Retrospective, cross-sectional study. SUBJECTS, PARTICIPANTS, AND/OR CONTROLS We reviewed the electronic health records of patients from 2012 to 2022 who were examined and followed for at least 2 years by an eye care provider at University of California San Francisco Health (UCSF Health) and who had cataract in at least one eye associated with best-corrected visual acuity of 20/25 or worse. Data include ocular factors (e.g., best-corrected visual acuity, lens opacity grade, diagnoses of glaucoma, and/or age-related macular degeneration), biomedical comorbidities, and sociodemographic factors including race/ethnicity, health insurance coverage, primary language spoken, and social vulnerability index. METHODS Logistic and multivariate regression analyses. MAIN OUTCOME MEASURES We examined cataract surgery utilization and preoperative best-corrected visual acuity. RESULTS Compared to White and Asian patients, Black patients had the lowest rates of cataract surgery utilization and the poorest mean preoperative visual acuities, with Hispanic patients following in second place in both categories. However, when the analysis controlled for sociodemographic and biomedical factors, Medicaid insurance and speaking Chinese as a primary language emerged as significant associations. In addition, higher cataract surgery utilization rates were associated with worse preoperative best-corrected visual acuity, a concurrent diagnosis of glaucoma, and a concurrent diagnosis of macular degeneration. Worse preoperative visual acuity was associated with Spanish or Chinese language preference, Medicaid status, and glaucoma diagnosis; poorer preoperative visual acuity was only weakly correlated with increased social vulnerability. CONCLUSIONS After adjusting for other biomedical and sociodemographic variables, having Medicaid insurance and being a non-English speaker were the factors most notably associated with reduced cataract surgery utilization and poorer preoperative visual acuity. Health insurance and language barriers, as well as other biomedical and sociodemographic factors, may explain a large proportion of the racial disparities in both cataract surgery utilization and preoperative visual acuity observed among Black and Hispanic patients. Chinese-speaking patients with limited English proficiency are a vulnerable subgroup that exhibits lower rates of cataract surgery utilization and higher degrees of visual loss prior to undergoing cataract surgery compared to other Asian patients.
Collapse
Affiliation(s)
- Wendy K Tam Cho
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA.
- Departments of Political Science, Statistics, Mathematics, Computer Science, and Asian-American Studies, University of Illinois, Urbana-Champaign, Urbana, IL, USA.
- The College of Law, University of Illinois, Urbana-Champaign, Urbana, IL, USA.
- The National Center for Supercomputing Applications, University of Illinois, Urbana-Champaign, Urbana, IL, USA.
| | - David G Hwang
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
3
|
Bizuneh ZY, Gessesse GW, Anbesse DH. Barriers to Cataract Surgery Utilization Among Cataract Patients Attending Surgical Outreach Sites in Ethiopia: A Dual Center Study. CLINICAL OPTOMETRY 2021; 13:263-269. [PMID: 34512065 PMCID: PMC8427071 DOI: 10.2147/opto.s324267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Cataract is the leading cause of avoidable blindness globally and in Africa. Various barriers limit access of cataract blind individuals to cataract surgery. This study aimed to determine the barriers to cataract surgery utilization among cataract blind patients presenting to campaign sites in Ethiopia. METHODS An institution-based cross-sectional design study was conducted to select 209 patients. The study was conducted from July to August 2020. A structured questionnaire was used to collect socio-demographic data and barriers for not having cataract surgery. Physical examination such as visual acuity, slit lamp bio microscopy and direct ophthalmoscopy was done for all participants. Epi Info 7 was used for data entry and Statistical Package for Social Science/SPSS version 23 was used for analysis after data were exported. Descriptive methods were employed for analysis. RESULTS A total of 209 subjects were recruited in the study with a mean age of 64.2 (±14.6) years, with a range of 32-99 years. From the total study subjects, 53% were males and 40.2% were over 66 years old. Upon presentation to the campaign site, 33% of study subjects had visual acuity of operable eye under blindness category and half of the study subjects (50.2%) had mature cataract. The most reported barriers were waiting until cataract becomes mature (18.7%), fear of surgery complications (16.7%), far from eye health institution (16.4%) and lack of income/cost for surgery (11.5%). CONCLUSION Recognizing the severity and the blindness burden of cataract in Ethiopia, creating public awareness, establishing eye health institutions, increasing the number of eye health professionals, increasing the quantity and the quality of cataract campaigns to alleviate these barriers are of paramount importance at the country level.
Collapse
Affiliation(s)
- Zewdu Yenegeta Bizuneh
- Department of Ophthalmology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Girum W Gessesse
- Department of Ophthalmology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Dereje Hayilu Anbesse
- Department of Ophthalmology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| |
Collapse
|
4
|
Shen W, Cun Q, Zhong H, Pan CW, Li J, Chen Q. Ethnic variation in prevalence, self-reported barriers and outcome of cataract surgery in a rural population in southwestern China: the Yunnan minority eye study. BMC Public Health 2020; 20:893. [PMID: 32517668 PMCID: PMC7285510 DOI: 10.1186/s12889-020-09009-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 05/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As a part of the Yunnan Minority Eye Studies, the purpose of this study was to determine the prevalence, barriers and visual acuity outcomes of cataract surgery in a multiethnic adult population in rural areas of southwestern China. METHODS A population-based cross-sectional survey was conducted with participants of Bai, Yi, and Han ethnicity aged ≥50 years in Yunnan. A detailed eye examination was performed. Information on the date, setting, type, and complications of cataract surgery were recorded in the examination of cataract-operated eyes. RESULTS Of 6546 subjects (2133 Bai ethnicity, 2208 Yi ethnicity and 2205 Han ethnicity), the prevalence of cataract surgery was 6.0%, with 4.6% in Bai, 7.0% in Yi, and 6.4% in Han ethnicity. Cataract Surgical coverage (CSC) among those with presenting visual acuity (PVA) < 20/200 in both eyes because of cataract was 53.3%, with 52.8% in Bai, 64.4% in Yi, and 45.3% in Han ethnicity. CSC was associated with Yi ethnicity, younger age, and higher education level, while unoperated cataract was associated with Han ethnicity, older age, and illiterate. The main barrier to cataract surgery was lack of awareness and knowledge, cost, and fear. Among the 525 cataract-operated eyes, PVA and best-corrected visual acuity (BCVA) of 20/63 or better was 44.5 and 67.2%, respectively, with 48.1 and 65.9% in Bai, 47.8 and 75.4% in Yi, 39.1 and 59.9% in Han ethnicity. Han ethnicity, aphakia, earlier year of surgery, lower-level surgical hospital and illiterate were associated with postoperative visual impairment defined by PVA, while Han ethnicity, aphakia, and illiterate were associated with that defined by BCVA. The principal causes of postoperative visual impairment were retinal disorders (26.8%), posterior capsule opacification (25.1%), refractive error(22.7%), and glaucoma (9.3%). CONCLUSIONS Han ethnicity had a lower CSC and relatively poor visual outcomes compared with ethnic minorities. Further effective effort to remove barriers and provide sight restoration is warranted.
Collapse
Affiliation(s)
- Wei Shen
- Department of Ophthalmology, the Fourth Affiliated Hospital of Kunming Medical University (the Second People's Hospital of Yunnan Province), Yunnan Eye Institute, Key Laboratory of Yunnan Province for the Prevention and Treatment of Ophthalmology, Kunming, 650032, People's Republic of China
| | - Qing Cun
- Department of Ophthalmology, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hua Zhong
- Department of Ophthalmology, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chen-Wei Pan
- School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Jun Li
- Department of Ophthalmology, the Fourth Affiliated Hospital of Kunming Medical University (the Second People's Hospital of Yunnan Province), Yunnan Eye Institute, Key Laboratory of Yunnan Province for the Prevention and Treatment of Ophthalmology, Kunming, 650032, People's Republic of China
| | - Qin Chen
- Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210000, People's Republic of China.
| |
Collapse
|
5
|
Amritanand A, Jasper S, Paul P, Kuriakose T. Facilitating factors in overcoming barriers to cataract surgical services among the bilaterally cataract blind in Southern India: A cross-sectional study. Indian J Ophthalmol 2018; 66:963-968. [PMID: 29941740 PMCID: PMC6032741 DOI: 10.4103/ijo.ijo_216_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To effectively address cataract blindness, increasing sight-restoring surgeries among the bilaterally blind are essential. To improve uptake of surgical services among this group, evidence regarding the problems of access is vital. Barriers in accessing eye care services have previously been reported but not specific to bilaterally cataract blind patients. Further, there is a gap in knowledge regarding factors facilitating access to eye care. Our aims were to (1) report proportion of bilaterally cataract blind patients undergoing surgery and sight restoration rate (SRR) and (2) analyze barriers and factors enabling access to eye care services among bilaterally cataract blind patients. Methods Retrospective analysis of interview and clinical data of bilaterally cataract blind patients undergoing surgery through outreach services at the base hospital, from June 2015 to May 2016, was performed. Demographic data, vision, postoperative visual outcomes, barriers, and facilitating factors in accessing cataract surgical services were obtained. Results Bilateral cataract blindness was present in 196/3178 (6.2%, 95% confidence interval 5.4-7.06) patients. SRR was 6.5%. Fear of surgery (24.2%) and lack of family support/escort (22.9%) were the most common barriers. Neighbors and acquaintances (28.6%), general health workers (20.2%), and persons who had undergone cataract surgery (19.6%) were the most common facilitating factors. Conclusion Proportion of bilaterally cataract blind people undergoing surgery and consequently SRR were low. The most common barriers were at the individual level while facilitating factors at the community level were instrumental in promoting uptake of services. Interventions involving community-based support for the blind may be useful in overcoming barriers to eye care.
Collapse
Affiliation(s)
- Anika Amritanand
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Smitha Jasper
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Padma Paul
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Thomas Kuriakose
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| |
Collapse
|
6
|
Phaswana-Mafuya N, Peltzer K, Crampin A, Ahame E, Sokhela Z. Prevalence of Self-Reported Diagnosed Cataract and Associated Risk Factors among Elderly South Africans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121523. [PMID: 29211038 PMCID: PMC5750941 DOI: 10.3390/ijerph14121523] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 11/24/2022]
Abstract
This paper estimates the prevalence of self-reported cataract and associated risk factors among individuals aged ≥50 years in South Africa. Data from a nationally-representative cross-sectional Study on Global AGEing and Adult Health (SAGE) (N = 3646) conducted in South Africa from 2007–2008 was analyzed. The primary outcome was self-reported cataract, and exposures included socio-demographics, self-reported co-morbidities, and behavioral factors. Linearized multivariate logistic regression models were used. The weighted prevalence of self-reported diagnosed cataract was 4.4% (95%CI: 3.4–5.8). Prevalence was greater among individuals with advancing age (10.2%), higher quality of life (QoL) (5.9%), education (5.2%), and wealth (5.8%) than their counterparts. Prevalence was also higher among individuals with depression (17.5%), diabetes (13.3%), hypertension (9.1%), and stroke (8.4%) compared to those without these conditions, with the exception of obesity (4.2%). In the final multivariate model, the odds of self-reported cataract were: 4.14 times higher among people ≥70 years than 50 to 59 year olds (95%CI: 2.28–7.50); 2.48 times higher in urban than rural residents (95%CI: 1.25–4.92); 5.16, 2.99, and 1.97 times higher for individuals with depression (95%CI: 1.92–13.86), hypertension (95%CI: 1.60–5.59), and diabetes (95%CI: 1.07–3.61), compared to those without these conditions.
Collapse
Affiliation(s)
- Nancy Phaswana-Mafuya
- Office of the Deputy Vice Chancellor: Research and Innovation, North West University, Potchefstroom 2520, South Africa.
- HIV/AIDS/STI/TB Research Programme, Human Sciences Research Council, Pretoria 0002, South Africa.
| | - Karl Peltzer
- HIV/AIDS/STI/TB Research Programme, Human Sciences Research Council, Pretoria 0002, South Africa.
- Department of Research & Innovation, University of Limpopo, Turfloop 0727, South Africa.
| | - Amelia Crampin
- London School of Hygiene and Tropical Medicine, University of London, London WC1E 7HT, UK.
| | - Edmund Ahame
- HIV/AIDS/STI/TB Research Programme, Human Sciences Research Council, Pretoria 0002, South Africa.
- Office of the Deputy Vice Chancellor for Research and Engagement, Nelson Mandela University, Port Elizabeth 6001, South Africa.
| | - Zinhle Sokhela
- HIV/AIDS/STI/TB Research Programme, Human Sciences Research Council, Pretoria 0002, South Africa.
| |
Collapse
|
7
|
LeBrun DG, Talwar D, Pham TA, Banskota B, Spiegel DA. Predictors of healthcare seeking delays among children with chronic musculoskeletal disorders in Nepal. J Epidemiol Glob Health 2017; 7:299-304. [PMID: 29110873 PMCID: PMC7384576 DOI: 10.1016/j.jegh.2017.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 08/14/2017] [Accepted: 10/02/2017] [Indexed: 11/10/2022] Open
Abstract
Background: Healthcare seeking behaviors among children with musculoskeletal disorders are poorly understood. We sought to analyze healthcare seeking delays among children with chronic musculoskeletal conditions in Nepal and identify predictors of clinically significant delays. Methods: A cross-sectional study was conducted at a large pediatric musculoskeletal rehabilitation center in Nepal. Baseline sociodemographic data and healthcare seeking behaviors were assessed via interviews with 75 randomly selected caregivers. Delays of at least 3 months between disease recognition and presentation to a health worker were considered clinically significant. Predictors of significant delay were assessed via multivariable logistic regression. Results: Clubfoot was the most common condition seen in the study sample (N = 33; 37%). Mean and median presentation delays were 33 months and 14 months, respectively. Sixty-seven percent of children were delayed at least 3 months and 40% were delayed at least 2 years. Caregiver occupation in agriculture or unskilled labor was associated with an increased risk of delayed presentation (adjusted OR = 4.05; 95% CI: 1.36–12.09). Conclusions: Children with chronic musculoskeletal disorders in Nepal face significant delays in accessing healthcare. This poses a major clinical problem as the delayed diagnosis and treatment of childhood musculoskeletal disorders can complicate management options and decrease long-term quality of life.
Collapse
Affiliation(s)
- Drake G LeBrun
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Divya Talwar
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Tuyetnhi A Pham
- The Wharton School, University of Pennsylvania, Philadelphia, PA, USA.
| | - Bibek Banskota
- Department of Orthopaedics, Hospital and Rehabilitation Centre for Disabled Children, Banepa, Nepal.
| | - David A Spiegel
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Orthopaedics, Hospital and Rehabilitation Centre for Disabled Children, Banepa, Nepal.
| |
Collapse
|
8
|
Pant HB, Bandyopadhyay S, John N, Chandran A, Gudlavalleti MVS. Differential cataract blindness by sex in India: Evidence from two large national surveys. Indian J Ophthalmol 2017; 65:160-164. [PMID: 28345574 PMCID: PMC5381297 DOI: 10.4103/ijo.ijo_28_15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIMS Women suffer disproportionately more from cataract blindness compared to males in low- and middle-income countries. Two large population-based surveys have been undertaken in India at an interval of 7 years and data from these surveys provided an opportunity to assess the trends in gender differentials in cataract blindness. MATERIALS AND METHODS Data were extracted from the surveys to discern sex differences in cataract blindness. Multivariate analysis was performed to adjust for confounders and their impact on gender differences in cataract blindness. Blindness was defined as presenting vision <20/400 in the better eye, and a cataract blind person was defined as a blind person where the principal cause of loss of vision was cataract. RESULTS Prevalence of cataract blindness was higher in females compared to males in both surveys. The odds of cataract blindness for females did not change over time as observed in the surveys (1999-2001 and 2006-2007). Adjusted odds ratio from logistic regression analysis revealed that females continued to be at a higher risk of cataract blindness. CONCLUSIONS Sex differences continued in India in relation to cataract blindness despite the gains made by the national program.
Collapse
Affiliation(s)
- Hira B Pant
- Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Souvik Bandyopadhyay
- Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Neena John
- Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Anil Chandran
- Department of Demography, University of Kerala, Thiruvananthapuram, Kerala, India
| | | |
Collapse
|
9
|
Holmes W, Shajehan R, Kitnasamy S, Abeywickrama C, Arsath Y, Gnanaraj F, Inbaraj S, Jayakody G, Durrant K, Luchters S. Impact of vision impairment and self-reported barriers to vision care: The views of elders in Nuwara Eliya district, Sri Lanka. Glob Public Health 2016; 13:642-655. [PMID: 27760492 DOI: 10.1080/17441692.2016.1241816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The growing burden of vision impairment (VI) among older people is a development challenge in Asian countries. This study aimed to understand older people's views and experiences about the impact of VI and barriers to eye care to inform policies to address this challenge. We conducted 12 focus group discussions in 2013 with retired Tamil and Sinhala elders in Nuwara Eliya district, Sri Lanka (n = 107). Data were analysed thematically. Older people described the broad impacts VI has on their lives. They worry about becoming dependent. VI restricts their ability to contribute to their families and communities, access information, socialise, maintain their health, and earn. Barriers to eye care services include transport difficulties, costs of treatment, fear, lack of knowledge, waiting times, and health staff attitudes. Older people experience and fear the impacts of VI on their health and well-being. Eye health promotion and care services need strengthening and integration with the primary health care system to address the backlog and growing need among older people in an equitable way. Older people should be consulted about how to overcome the economic, social, and cultural barriers to access to eye care and to minimise the impact of VI. ABBREVIATIONS FGDs: focus group discussions; GBD: global burden of disease; NCDs: non-communicable diseases; VI: vision impairment.
Collapse
Affiliation(s)
- W Holmes
- a Centre for International Health , Burnet Institute , Melbourne , Victoria , Australia
| | - R Shajehan
- b PALM Foundation , Nuwara Eliya , Sri Lanka
| | - S Kitnasamy
- b PALM Foundation , Nuwara Eliya , Sri Lanka
| | | | - Y Arsath
- c Berendina , Colombo , Sri Lanka
| | | | - S Inbaraj
- d Plantation Human Development Trust , Colombo , Sri Lanka
| | - G Jayakody
- e Central Province Health Department , Kandy , Sri Lanka
| | - K Durrant
- a Centre for International Health , Burnet Institute , Melbourne , Victoria , Australia
| | - S Luchters
- a Centre for International Health , Burnet Institute , Melbourne , Victoria , Australia.,f Department of Obstetrics and Gynaecology , International Centre for Reproductive Health, Ghent University , Belgium.,g Department of Epidemiology and Preventive Medicine , School of Public Health and Preventive Medicine, Monash University , Victoria , Australia
| |
Collapse
|
10
|
Newman-Casey PA, Ravilla S, Haripriya A, Palanichamy V, Pillai M, Balakrishnan V, Robin AL. The Effect of Counseling on Cataract Patient Knowledge, Decisional Conflict, and Satisfaction. Ophthalmic Epidemiol 2016; 22:387-93. [PMID: 26653261 DOI: 10.3109/09286586.2015.1066016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Cataract is the leading cause of non-refractive preventable blindness, and comprehensive strategies to increase cataract surgery rates are imperative, including high-quality supportive patient education. We evaluated the effectiveness of non-physician pre-surgical counselors teaching patients about cataract and cataract surgery in improving patient knowledge, decisional conflict, and satisfaction. METHODS A survey was given before and after 61 newly-diagnosed cataract patients underwent pre-surgical counseling at the Aravind Eye Hospital, Madurai, India. The survey measured change in cataract knowledge and decisional conflict, a measure of anxiety surrounding the decision to undergo surgery, along with patient satisfaction. Multiple regression was used to identify factors that influenced change in knowledge. RESULTS Both patient knowledge scores and decisional conflict scores improved following counseling (mean difference +2.0, p = 0.004 and +8.4, p < 0.0001, respectively). Multiple regression analysis identified female sex (β = 2.5, p < 0.001) and being illiterate (β = 1.7, p = 0.04) as important predictors of increased knowledge post-counseling. CONCLUSION Counseling both improved knowledge and reduced decisional conflict about cataract surgery, particularly among patients who had traditionally had more limited access to healthcare such as women and illiterate patients. Increased use of high quality counseling might help to further reduce the global burden of cataract and other forms of blindness.
Collapse
Affiliation(s)
- Paula Anne Newman-Casey
- a Department of Ophthalmology and Visual Sciences , University of Michigan , Ann Arbor , MI , USA
| | | | | | | | | | | | - Alan L Robin
- a Department of Ophthalmology and Visual Sciences , University of Michigan , Ann Arbor , MI , USA .,d Departments of International Health and Ophthalmology , Johns Hopkins University , Baltimore , MD , USA , and.,e Department of Ophthalmology , University of Maryland , Baltimore , MD , USA
| |
Collapse
|
11
|
Virendrakumar B, Jolley E, Gordon I, Bascaran C, Schmidt E. Availability of evidence on cataract in low/middle-income settings: a review of reviews using evidence gap maps approach. Br J Ophthalmol 2016; 100:1455-1460. [PMID: 27267446 PMCID: PMC5155310 DOI: 10.1136/bjophthalmol-2015-308156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 03/23/2016] [Accepted: 04/10/2016] [Indexed: 11/23/2022]
Abstract
Background Despite high-quality evidence being essential for planning and delivering eye health programmes, evidence on what works is relatively scarce. To address this need, we developed eye health Evidence Gap Maps (EGMs) with the first one focusing on cataract. These maps summarise, critically appraise and present evidence in a user-friendly format. This paper presents experiences of developing the cataract gap map and discusses the challenges and benefits of the process. Methods Following a comprehensive search of relevant databases, we sifted and extracted data from all relevant reviews on cataract. Critical appraisal was conducted by two reviewers independently using Supported the Use of Research Evidence checklist and a summary quality assessment was shared with the authors for comments. Results A total of 52 reviews were included in the map. The majority of the reviews addressed quality of clinical care (20) and types of treatment (18). Overall, 30 reviews provided strong evidence in response to the research question, 14 reviews showed weak or no evidence and in 14 reviews the results were inconclusive. 14 reviews were regarded as high quality, 12 were medium quality and 26 were graded as low quality. To verify the validity of the Supporting the Use for Research Evidence (SURE) checklist, studies were also appraised using the Scottish Intercollegiate Guidelines Network (SIGN) tool. Based on the κ statistics test, results showed excellent agreement between the two checklists (K=0.79). Discussion EGMs support policy makers and programme managers to make informed decisions and enable researchers to prioritise future work based on the most evident gaps on knowledge.
Collapse
Affiliation(s)
| | - Emma Jolley
- Research department, Sightsavers, Haywards Heath, UK
| | - Iris Gordon
- Cochrane Eyes and Vision Group, International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Cova Bascaran
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Elena Schmidt
- Research department, Sightsavers, Haywards Heath, UK
| |
Collapse
|
12
|
Mitsuhiro MH, Berezovsky A, Belfort R, Ellwein LB, Salomao SR. Uptake, Barriers and Outcomes in the Follow-up of Patients Referred for Free-of-Cost Cataract Surgery in the Sao Paulo Eye Study. Ophthalmic Epidemiol 2014; 22:253-9. [PMID: 25310584 DOI: 10.3109/09286586.2014.966849] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To determine uptake, barriers and outcomes in the follow-up of patients referred for free-of-charge, expedited cataract surgery in the Sao Paulo Eye Study (SPES). METHODS SPES was a population-based study of urban, low-middle income residents aged ≥50 years. Presenting visual acuity (PVA), best-corrected visual acuity, refraction, and slit-lamp examination were performed in 3677 participants. For subjects with cataract as a principal cause of best-corrected visual acuity ≤20/40, surgery was offered free of charge. Two years after the baseline study, surgery uptake, barriers to surgery, and visual outcomes were analyzed. RESULTS Among 210 (5.71%) participants who had a cataract surgery indication at baseline, 164 (78.1%) were successfully contacted and 55 (33.5%) reported being operated on for cataract, with 51 agreeing to be re-examined. In a multiple logistic regression model, age, sex, schooling, previous cataract surgery, and PVA at baseline were not significantly associated with surgery uptake. Co-existing health conditions (20.4%), fear of surgery (12.2%) and fear of losing eyesight (11.6%) were the most frequent barriers to cataract surgery adherence. Among the 69 eyes operated on in the interval between baseline and follow-up, PVA ≥20/63 was observed in 50 (72.6%, 95% confidence interval, CI, 62.2-82.3%), PVA <20/63-20/200 in 11 (15.8%, 95% CI 8.9-22.9%) and PVA <20/200 in 8 (11.6%, 95% CI 5.3-17.9%). CONCLUSIONS Quality of surgery is an increasing determinant of uptake rates. Although free-of-charge and expedited cataract surgery was offered, surgical outcomes might have influenced the low uptake. Aside from cataract surgery campaigns, improvement of surgeon skills, accurate biometry, treatment of ocular comorbidities, postoperative follow-up and eye-care education are needed.
Collapse
Affiliation(s)
- Marcia H Mitsuhiro
- Departamento de Oftalmologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo , Sao Paulo, SP , Brasil and
| | | | | | | | | |
Collapse
|
13
|
Zhang XJ, Jhanji V, Leung CKS, Li EY, Liu Y, Zheng C, Musch DC, Chang DF, Liang YB, Lam DSC. Barriers for Poor Cataract Surgery Uptake among Patients with Operable Cataract in a Program of Outreach Screening and Low-cost Surgery in Rural China. Ophthalmic Epidemiol 2014; 21:153-60. [DOI: 10.3109/09286586.2014.903981] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong
Hong KongChina
| | - Vishal Jhanji
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong
Hong KongChina
- Centre for Eye Research Australia, University of Melbourne
VictoriaAustralia
| | | | - Emmy Y. Li
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong
Hong KongChina
- Project Vision Charity Foundation Limited
Hong KongChina
- Hong Kong Eye Hospital
Hong KongChina
| | - Yingpeng Liu
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong
Hong KongChina
- Project Vision Charity Foundation Limited
Hong KongChina
| | - Chongren Zheng
- Project Vision Charity Foundation Limited
Hong KongChina
| | - David C. Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School
Ann Arbor, MIUSA
| | - David F. Chang
- The University of California
San Francisco, Los Altos, CAUSA
| | - Yuan Bo Liang
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong
Hong KongChina
| | - Dennis S. C. Lam
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong
Hong KongChina
- Project Vision Charity Foundation Limited
Hong KongChina
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University
GuangzhouChina
| |
Collapse
|
14
|
Abstract
Lens opacification or cataract reduces vision in over 80 million people worldwide and blinds 18 million. These numbers will increase dramatically as both the size of the elderly demographic and the number of those with carbohydrate metabolism-related problems increase. Preventative measures for cataract are critical because the availability of cataract surgery in much of the world is insufficient. Epidemiologic literature suggests that the risk of cataract can be diminished by diets that are optimized for vitamin C, lutein/zeaxanthin, B vitamins, omega-3 fatty acids, multivitamins, and carbohydrates: recommended levels of micronutrients are salutary. The limited data from intervention trials provide some support for observational studies with regard to nuclear - but not other types of - cataracts. Presented here are the beneficial levels of nutrients in diets or blood and the total number of participants surveyed in epidemiologic studies since a previous review in 2007.
Collapse
Affiliation(s)
- Karen A Weikel
- Laboratory for Nutrition and Vision Research, JM-USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, USA
| | | | | | | |
Collapse
|
15
|
Katibeh M, Ziaei H, Rajavi Z, Hosseini S, Javadi MA. Profile of cataract surgery in Varamin Iran: a population-based study. Clin Exp Ophthalmol 2013; 42:354-9. [PMID: 23927430 DOI: 10.1111/ceo.12185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 07/26/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cataract is the most popular cause of blindness. This study addresses some aspects of cataract surgery in an Iranian population. DESIGN A cross-sectional study. PARTICIPANTS 3000 adults over 50 in Varamin district. METHODS Cataract surgical coverage was defined as the proportion of (pseudo) aphakic eyes of all operable and operated eyes with cataract. If there was obvious lens opacity in either or both eyes in combination with best corrected visual acuity less than 6/18, the person was asked why the operation for cataract was not done to find out about barriers of cataract surgery. Outcomes of cataract surgery were categorized as good, intermediate and poor using presenting visual acuity which were defined as visual acuity ≥ 6/18, 6/60 ≤ visual acuity < 6/18 and visual acuity < 6/60, respectively. MAIN OUTCOME MEASURES Cataract surgical coverage, barriers and outcomes of cataract surgery. RESULTS Out of 5638 examined eyes, 526 eyes (9.3%) had history of cataract surgery. 156 subjects (45.7%) had a unilateral and 185 subjects (54.2%) had bilateral operated eyes. Cataract surgical coverage was 66.4% in visually impaired eyes (visual acuity < 6/18), 90.4% in blind eyes (visual acuity < 3/60), 80.5% in visually impaired persons and 97.6% in blind persons. Cataract surgery in the majority of eyes (71.9%) had a good visual outcome. The main barrier of cataract surgery was unawareness of treatment. CONCLUSION Overall, the cataract services in the studied population were acceptable, although it should be improved, to achieve vision 2020 objectives.
Collapse
Affiliation(s)
- Marzieh Katibeh
- Ophthalmic Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | | | | |
Collapse
|
16
|
Prevalence and outcomes of cataract surgery in adult rural Chinese populations of the Bai nationality in Dali: the Yunnan minority eye study. PLoS One 2013; 8:e60236. [PMID: 23577095 PMCID: PMC3618447 DOI: 10.1371/journal.pone.0060236] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 02/23/2013] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To investigate the prevalence and visual acuity (VA) outcomes of cataract surgery in adults of the Bai Nationality populations in rural China. METHODS We conducted a population-based cross-sectional survey (from randomly selected block groups) of Chinese Bai Nationality aged ≥50 years in southwestern China. Presenting visual acuity (PVA), best corrected visual acuity (BCVA) were recorded and a detailed eye examination was carried out. For all aphakic and pseudophakic subjects identified, information on the date, setting, type, and complications of cataract surgery were recorded. In eyes with VA <20/63, the principal cause of visual impairment was identified. RESULTS Of 2133 (77.8% of 2742) subjects, 99 people (129 eyes) had undergone cataract surgery. The prevalence of cataract surgery was 4.6%. Surgical coverage among those with PVA <20/200 in both eyes because of cataract was 52.8%. Unoperated cataract was associated with older age. The main barrier to cataract surgery was lack of awareness and knowledge, cost, and fear. Among the 129 cataract-operated eyes, 22.5% had PVA of ≥20/32, 25.6% had PVA of 20/40 to 20/63, 23.3% had PVA <20/63 to 20/200, and 28.7% had PVA<20/200. With BCVA, the percentages were 42.6%, 23.3%, 10.9%, and 23.3%, respectively. Aphakia (odds ratio [OR], 8.49; P<0.001) and no education (OR, 10.18; P = 0.001) or less education (OR, 6.49; P = 0.014) were significantly associated with postoperative visual impairment defined by PVA, while aphakia (OR, 8.49; P<0.001) and female gender (OR, 4.19; P = 0.004) were significantly associated with postoperative visual impairment by BCVA. The main causes of postoperative visual impairment were refractive error, retinal disorders and glaucoma. CONCLUSIONS Half of those with bilateral visual impairment or blindness because of cataract remain in need of cataract surgery in Bai population. Surgical uptake and visual outcomes should be further improved in the future.
Collapse
|
17
|
Visual impairment among weaving communities in Prakasam district in South India. PLoS One 2013; 8:e55924. [PMID: 23409090 PMCID: PMC3567039 DOI: 10.1371/journal.pone.0055924] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 01/03/2013] [Indexed: 11/12/2022] Open
Abstract
Purpose To assess the prevalence and causes of visual impairment in weaving communities in Prakasam district in South India state of Andhra Pradesh. Methods Using Rapid Assessment of Visual Impairment (RAVI) methodology, a population based cross-sectional study was conducted. A two-stage sampling strategy was used to select 3000 participants aged ≥40 years. Visual Acuity (VA) was assessed using a tumbling E chart and ocular examinations were performed by trained Para medical ophthalmic personnel. A questionnaire was used to collect personal and demographic information. Blindness and moderate Visual Impairment (VI) was defined as presenting VA <6/60 and <6/18 to 6/60 respectively. VI included blindness and moderate VI. Results 2848 of 3000 enumerated subjects (94.0%) participated. 39% were in 40–49 years age group and 11.8% were aged ≥70 years, 55% were women and nearly half of them had no formal education. 400 (14%; 95% CI: 12.8–15.3) subjects had VI, including blindness in 131 (4.6%; 95% CI: 3.8–5.4) and moderate VI in 269 (9.4%; 95% CI: 8.3–10.5) individuals. On applying multiple logistic regression, VI was significantly associated with older age and no formal education. Though the odds of having VI were higher in females, it was of borderline statistical significance (p = 0.06). Refractive error was the leading cause of all VI followed by cataract (56%). However, refractive errors were the leading cause of moderate VI (73.2%) and cataract was the leading cause of blindness (62.6%). ‘Cannot afford the cost of services’ was the leading barrier for utilization of eye care services (47%). Conclusions There is a significant burden of VI in weaving communities in Andhra Pradesh, India most of which is avoidable. With this information as baseline, services need to be streamlined to address this burden.
Collapse
|
18
|
Zhang XJ, Liang YB, Liu YP, Jhanji V, Musch DC, Peng Y, Zheng CR, Zhang HX, Chen P, Tang X, Lam DS. Implementation of a Free Cataract Surgery Program in Rural China. Ophthalmology 2013; 120:260-5. [DOI: 10.1016/j.ophtha.2012.07.087] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 07/27/2012] [Accepted: 07/31/2012] [Indexed: 11/30/2022] Open
|
19
|
Rajak SN, Habtamu E, Weiss HA, Bedri A, Zerihun M, Gebre T, Gilbert CE, Emerson PM, Burton MJ. Why do people not attend for treatment for trachomatous trichiasis in Ethiopia? A study of barriers to surgery. PLoS Negl Trop Dis 2012; 6:e1766. [PMID: 22953007 PMCID: PMC3429389 DOI: 10.1371/journal.pntd.0001766] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 06/22/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Trachomatous trichiasis (TT) surgery is provided free or subsidised in most trachoma endemic settings. However, only 18-66% of TT patients attend for surgery. This study analyses barriers to attendance among TT patients in Ethiopia, the country with the highest prevalence of TT in the world. METHODOLOGY/PRINCIPAL FINDINGS Participants with previously un-operated TT were recruited at 17 surgical outreach campaigns in Amhara Region, Ethiopia. An interview was conducted to ascertain why they had not attended for surgery previously. A trachoma eye examination was performed by an ophthalmologist. 2591 consecutive individuals were interviewed. The most frequently cited barriers to previous attendance for surgery were lack of time (45.3%), financial constraints (42.9%) and lack of an escort (35.5% in females, 19.6% in males). Women were more likely to report a fear of surgery (7.7% vs 3.2%, p<0.001) or be unaware of how to access services (4.5% vs 1.0% p<0.001); men were more frequently asymptomatic (19.6% vs 10.1%, p<0.001). Women were also less likely to have been previously offered TT surgery than men (OR = 0.70, 95%CI 0.53-0.94). CONCLUSIONS/SIGNIFICANCE The major barriers to accessing surgery from the patients' perspective are the direct and indirect costs of surgery. These can to a large extent be reduced or overcome through the provision of free or low cost surgery at the community level. TRIAL REGISTRATION ClinicalTrials.gov NCT00522860 and NCT00522912.
Collapse
Affiliation(s)
- Saul N. Rajak
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Esmael Habtamu
- The Carter Center, Bahir Dar, Ethiopia
- The Carter Center, Atlanta, Georgia, United States of America
| | - Helen A. Weiss
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Amir Bedri
- Light For The World, Addis Ababa, Ethiopia
| | - Mulat Zerihun
- The Carter Center, Bahir Dar, Ethiopia
- The Carter Center, Atlanta, Georgia, United States of America
| | - Teshome Gebre
- The Carter Center, Bahir Dar, Ethiopia
- The Carter Center, Atlanta, Georgia, United States of America
| | - Clare E. Gilbert
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Paul M. Emerson
- The Carter Center, Bahir Dar, Ethiopia
- The Carter Center, Atlanta, Georgia, United States of America
| | - Matthew J. Burton
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
20
|
Hashemi H, Khabazkhoob M, Emamian MH, Shariati M, Fotouhi A. Visual impairment in the 40- to 64-year-old population of Shahroud, Iran. Eye (Lond) 2012; 26:1071-7. [PMID: 22595906 DOI: 10.1038/eye.2012.94] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine the prevalence of visual impairment by age and gender in Shahroud. METHODS Using random cluster sampling, 6311 Shahroud inhabitants who were between 40 and 64 years old were invited for ophthalmological examinations. Visual acuity worse than 0.5 LogMAR (20/60) and 1.3 LogMAR (20/400) in the better eye was regarded as low vision and blindness, respectively. The cause of blindness was determined by an ophthalmologist and in a person with more than one cause, the most correctable cause was regarded as the main cause. RESULTS This study was conducted on 5190 participants (response rate: 82.2%). On the basis of presenting visual acuity, the prevalence of low vision and blindness was found to be 1.8% (95% confidence interval (CI): 1.4-2.10) and 0.5% (95% CI: 0.3-0.7), respectively. Based on corrected vision, these values were 0.5% (95% CI: 0.3-0.7) and 0.3% (95% CI: 0.1-0.4), respectively. Visual impairment increased with age in women (P<0.001). Uncorrected refractive errors (63.9%), cataract (20.2%), and amblyopia (5.9%) were the most common causes of visual impairment based on presenting vision. Based on corrected vision, however, cataract (42.5%), amblyopia (12.5%), and retinitis pigmentosa (7.5%) were the most common causes of visual impairment. CONCLUSION Although the prevalence of visual impairment in the city of Shahroud was determined to be lower than two previous studies in the country, correction of refractive errors and cataract could minimize the rate of visual impairment in this population as they were shown to comprise 85% of the causes of visual impairment. The elderly women need to receive more attention.
Collapse
Affiliation(s)
- H Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | | | | | | | | |
Collapse
|
21
|
Abubakar T, Gudlavalleti MVS, Sivasubramaniam S, Gilbert CE, Abdull MM, Imam AU. Coverage of Hospital-based Cataract Surgery and Barriers to the Uptake of Surgery among Cataract Blind Persons in Nigeria: The Nigeria National Blindness and Visual Impairment Survey. Ophthalmic Epidemiol 2012; 19:58-66. [DOI: 10.3109/09286586.2011.643271] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
22
|
Nesbitt RC, Mackey S, Kuper H, Muhit M, Murthy GVS. Predictors of referral uptake in children with disabilities in Bangladesh--exploring barriers as a first step to improving referral provision. Disabil Rehabil 2011; 34:1089-95. [PMID: 22136387 DOI: 10.3109/09638288.2011.634943] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Making services available to children with disabilities in low- and middle-income countries does not guarantee their use. This study aims to identify factors associated with the uptake of referrals in order to investigate barriers to service use. METHODS Children with impairments identified in two districts of Bangladesh were invited to attend screening camps where their condition was confirmed; they were provided with referrals for rehabilitation and treatment services. Predictors of referral uptake were identified using logistic regression. RESULTS Overall referral uptake was 47%, 32% in Sirajganj and 61% in Natore. There was no association between age or gender and referral uptake. Factors predictive of referral uptake were higher income in Sirajganj (OR=2.6 95%CI 1.4-5.0), and the districts combined (OR=1.6 95%CI 1.1-2.1); maternal literacy in Natore (OR=1.6 95%CI 1.0-2.5); and epilepsy in all three models (Sirajganj: OR=2.6 95%CI 1.7-4.0; Natore: OR=13.5 95%CI 6.5-28.3; Combined: OR=4.6 95%CI 3.3-6.5). Physical impairment was associated with increased odds of uptake in Sirajganj and in the combined model (OR=2.7 95%CI 1.8-4.1; OR=3.34 95%CI 2.2-5.2). CONCLUSIONS Even when some logistical and financial assistance is available, children with impairment from low-income families may require additional support to take up referrals. There may be greater willingness to accept treatment that is locally provided, such as medication for epilepsy or therapy at village level.
Collapse
Affiliation(s)
- R C Nesbitt
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Camden, London, United Kingdom.
| | | | | | | | | |
Collapse
|
23
|
Abstract
PURPOSE OF REVIEW To review the previous year's literature related to cataract surgery in developing countries and to provide fast, up-to-date information to the scientific world. RECENT FINDINGS Cataract is the leading cause of blindness, especially in developing countries. The prevalence of cataract increases with the aging population. Although cataract surgery is the most cost-effective intervention, its delivery in developing countries has many issues and challenges. A paradigm shift has occurred in the surgical techniques used for delivering cataract services and the outcomes have been positive in some countries compared to the scenario a decade ago. However, in some parts of Africa, it still continues to be a challenge. Apart from this, the issues related to ongoing supply of consumables and human resources continue to be a challenge in these countries. SUMMARY Although manual small incision cataract surgery is the most cost-effective intervention, there are other issues related to the delivery of services in developing countries. We need to plan a comprehensive strategy to deliver the services in developing countries if we want to achieve our goal of VISION 2020.
Collapse
|
24
|
Abstract
PURPOSE OF REVIEW To review the previous year's literature related to prevalence of blindness in general, blindness due to cataract, cataract surgical coverage (CSC) and cataract surgical rates (CSRs). RECENT FINDINGS Cataracts are the major cause of blindness and visual impairment in developing countries and contributes to more than 90% of the total disability adjusted life years. This review shows that coverage continues to be a problem in many countries, especially for the female population, those residing in rural areas and those who are illiterate. Although CSR is an indicator of the availability and acceptability of services, for measuring the impact of the program, we should look at combining CSR with CSC. This strategy would also enable us achieve our goal of eliminating avoidable blindness due to cataracts by the year 2020. SUMMARY Cataracts still continue- to be a major cause of blindness globally and with the rapidly aging population, it is a challenge to tackle. We need to plan a comprehensive strategy addressing issues related to availability, affordability, accessibility and acceptability of eye-care services.
Collapse
|
25
|
Bibliography. Cataract surgery and lens implantation. Current world literature. Curr Opin Ophthalmol 2011; 22:68-72. [PMID: 21900756 DOI: 10.1097/icu.0b013e328341ec20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
26
|
|