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Feng J, Jan C, Peng Y, He M, An L, Zhan L, Shi W, Peng X, Shang W, Li W, Xu X, Yao L. Retrospective analysis of cataract surgery outcomes in China from 2009 to 2018: from a national registry system data. BMJ Open 2023; 13:e070989. [PMID: 37019483 PMCID: PMC10083822 DOI: 10.1136/bmjopen-2022-070989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
OBJECTIVE To evaluate patients' benefits after cataract surgery and to form recommendations for Chinese national health policy decision makers and administration departments based on the quality of cataract treatments. METHOD An observational study based on real-world data source from the National Cataract Recovery Surgery Information Registration and Reporting System. RESULTS A total of 14 157 463 original records were reported from 1 July 2009 to 31 December 2018. The factors that influenced the 3-day postsurgical best-corrected visual acuity (BCVA), the primary outcome, were analysed by logistic regression analysis. We found that a history of hypertension (OR=0.916) or diabetes (OR=0.912), presurgical pupil abnormality (OR=0.571) and high intraocular pressure (OR=0.578) were harmful to the postsurgical BCVA improvement (BCVA ≥6/20), while male sex (OR=1.113), better presurgical BCVA level (OR=5.996 for ≥6/12-<6/7.5 and OR=2.610 for >6/60-<6/12 taken ≤6/60 as reference), age-related cataract (OR=1.825) and intraocular lens implantation (OR=1.886) were statistically beneficial to the postsurgical BCVA improvement. Compared with extracapsular cataract extraction (ECCE) with large incision, the ECCE with small incision (OR value=1.810) and the phacoemulsification (OR=1.420) significantly improved the benefit probability. CONCLUSION ECCE with small incision has comparable effects on postsurgical BCVA improvement of phacoemulsification. Therefore, ECCE could be an alternative cataract surgical treatment in economically underdeveloped areas in China, provided the surgeons are adequately trained.
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Affiliation(s)
- Jingjing Feng
- Department of Nursing Administration and Rehabilitation Research, National Institute of Hospital Administration, Beijing, China
| | - Catherine Jan
- Lost Child's Vision Project, Sydney, New South Wales, Australia
- Centre for Eye Research Australia, Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Yaguang Peng
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Beijing, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
| | - Lei An
- Department of Nursing Administration and Rehabilitation Research, National Institute of Hospital Administration, Beijing, China
| | - Leilei Zhan
- Department of Nursing Administration and Rehabilitation Research, National Institute of Hospital Administration, Beijing, China
| | - Wei Shi
- Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xiaoxia Peng
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Beijing, China
| | - Wenhan Shang
- Department of Nursing Administration and Rehabilitation Research, National Institute of Hospital Administration, Beijing, China
| | - Wei Li
- Department of Nursing Administration and Rehabilitation Research, National Institute of Hospital Administration, Beijing, China
| | - Xiao Xu
- Department of Healthcare Service and Safety Research, National Institute of Hospital Administration, Beijing, China
| | - Li Yao
- Department of Nursing Administration and Rehabilitation Research, National Institute of Hospital Administration, Beijing, China
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Li C, Zhu B, Zhang J, Guan P, Zhang G, Yu H, Yang X, Liu L. Epidemiology, health policy and public health implications of visual impairment and age-related eye diseases in mainland China. Front Public Health 2022; 10:966006. [PMID: 36438305 PMCID: PMC9682104 DOI: 10.3389/fpubh.2022.966006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/26/2022] [Indexed: 11/10/2022] Open
Abstract
The prevalence of visual impairment (VI) and age-related eye diseases has increased dramatically with the growing aging population in mainland China. However, there is limited comprehensive evidence on the progress of ophthalmic epidemiological research in mainland China to enhance our awareness of the prevention of eye diseases to inform public health policy. Here, we conducted a literature review of the population-based epidemiology of VI and age-related eye diseases in mainland China from the 1st of January 1946 to the 20th of October 2021. No language restrictions were applied. There was significant demographic and geographic variation in the epidemic of VI and age-related eye diseases. There are several factors known to be correlated to VI and age-related eye diseases, including age, gender, family history, lifestyle, biological factors, and environmental exposures; however, evidence relating to genetic predisposition remains unclear. In addition, posterior segment eye diseases, including age-related macular degeneration and diabetic retinopathy, are amongst the major causes of irreversible visual impairments in the senile Chinese population. There remains a significant prevention gap, with only a few individuals showing awareness and achieving optimal medical care with regards to age-related eye diseases. Multiple challenges and obstacles need to be overcome, including the accelerated aging of the Chinese population, the lack of structured care delivery in many underdeveloped regions, and unequal access to care. Despite the progress to date, there are few well-conducted multi-center population-based studies following a single protocol in mainland China, which findings can hopefully provide valuable cues for governmental decision-making and assist in addressing and halting the incidence of VI and age-related eye diseases in China.
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Affiliation(s)
- Cong Li
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,School of Medicine, South China University of Technology, Guangzhou, China
| | - Bo Zhu
- Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Jie Zhang
- Department of Retina, Weifang Eye Hospital, Weifang, China
| | - Peng Guan
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
| | - Guisen Zhang
- Department of Retina, Inner Mongolia Chaoju Eye Hospital, Hohhot, China
| | - Honghua Yu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,*Correspondence: Honghua Yu
| | - Xiaohong Yang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,Xiaohong Yang
| | - Lei Liu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,Lei Liu
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Jiachu D, Jin L, Jiang F, Luo L, Zheng H, Ji D, Yang J, Yongcuo N, Huang W, Yi J, Bright T, Yip JL, Xiao B. Prevalence and service assessment of cataract in Tibetan areas of Sichuan Province, China: population-based study. BMJ Open 2019; 9:e031337. [PMID: 31685508 PMCID: PMC6858214 DOI: 10.1136/bmjopen-2019-031337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To assess the prevalence of visual impairment (VI) and blindness (BL) due to cataract and cataract surgical outcomes in remote dispersed and high-altitude Tibetan areas of China. DESIGN AND SETTING A cross-sectional study was conducted among people aged 50 and above in Tibetan Autonomous Prefecture of Kandze (TAPK), China, in 2017. The Rapid Assessment of Avoidable Blindness protocol was followed. PARTICIPANTS Of 5000 eligible participants, 4764 were examined (response rate 95.3%). PRIMARY AND SECONDARY OUTCOME MEASURES Cataract VI was defined as lens opacity at visual acuity (VA) levels of <3/60 (Blindness (BL)), ≥3/60 and <6/60 (severe visual impairment (SVI)), ≥6/60 and <6/18 (moderate visual impairment (MVI)), ≥6/18 and <6/12 (early visual impairment (EVI)). RESULTS The estimated prevalence of cataract BL was 0.61% (95% CI 0.42 to 0.87). With best corrected VA, the estimated prevalence of SVI from cataract was 0.86% (95% CI 0.63 to 1.17); MVI was 2.39% (95% CI 2.00 to 2.87) and EVI was 5.21% (95% CI 4.61 to 5.87). Women in TAPK had a significantly higher prevalence of cataract BL (0.82%, 95% CI 0.54 to 2.15) than men (0.34%, 95% CI 0.16 to 0.70). Women had lower cataract surgical coverage (CSC) by eyes (60.8%, 95% CI 55.5 to 65.8) compared with men (70.1%; 95% CI 63.7 to 75.7). The prevalence of cataract BL was higher among Tibetan (2.28%; 95% CI 1.98 to 2.62) than Han Chinese (1.01%%; 95% CI 0.54% to 1.87%). Overall CSC by person with BL (by better eye) was 82.0% (95% CI 75.2 to 87.6). Among cataract-operated participants, 71.2% had VA equal to or better than 6/18. CONCLUSIONS The study detected a low prevalence of VI and BL due to cataract with high CSC in the study area compared with many other places in China. Further actions should be taken to improve cataract surgical outcome.
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Affiliation(s)
- Danba Jiachu
- Kham Eye Centre, Kandze Prefecture People's Hospital, Kangding, China
| | - Ling Jin
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Feng Jiang
- Kham Eye Centre, Kandze Prefecture People's Hospital, Kangding, China
| | - Li Luo
- Kham Eye Centre, Kandze Prefecture People's Hospital, Kangding, China
| | - Hong Zheng
- Kham Eye Centre, Kandze Prefecture People's Hospital, Kangding, China
| | - Duo Ji
- Kham Eye Centre, Kandze Prefecture People's Hospital, Kangding, China
| | - Jing Yang
- Kham Eye Centre, Kandze Prefecture People's Hospital, Kangding, China
| | - Nima Yongcuo
- Kham Eye Centre, Kandze Prefecture People's Hospital, Kangding, China
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Opthalmic Centre, Sun Yat-sen University, Guangzhou City, China
| | - Jinglin Yi
- Nanchang University Affiliated Eye Hospital, Nanchang University, Nanchang, China
| | - Tess Bright
- International Centre for Evidence in Disablility, London School of Hygiene & Tropical Medicine, London, UK
| | - Jennifer Ly Yip
- International Centre for Evidence in Disablility, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Baixiang Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Opthalmic Centre, Sun Yat-sen University, Guangzhou City, China
- Nanchang University Affiliated Eye Hospital, Nanchang City, China
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Kulkarni S, Kondalkar S, Mactaggart I, Shamanna BR, Lodhi A, Mendke R, Kharat J, Kapse R, Dole K, Deshpande M. Generating evidence for planning eye care service delivery in an urban underprivileged population setting in Pune, Western India. BMJ Open Ophthalmol 2019; 4:e000202. [PMID: 31414051 PMCID: PMC6668608 DOI: 10.1136/bmjophth-2018-000202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose To estimate prevalence of blindness, diabetic retinopathy and causes of blindness through rapid assessment of avoidable blindness (RAAB) survey in Pune, India to develop an evidence base for planning urban eye care services. Methods ‘Rapid assessment of avoidable blindness and diabetic retinopathy’ methodology was used. Compact segment sampling was used in each of the 60 selected electoral wards identified through cluster selection module of the RAAB software using probability proportionate to size method. Persons >50 years of age were enumerated from selected segments to achieve cumulative target of 60/day by two teams. Participants underwent presenting and pinhole visual acuity (VA) testing in each eye. A torch light examination and direct ophthalmoscopy established cause of visual impairment/blindness if present. Data were entered into and analysed using RAAB software. Results The response rate was 89.5% (3221/3600), and 55.3% were women. Results of only RAAB module are presented in this paper. Age-standardised and sex-standardised prevalence of blindness was 1.3% (95% CI 0.9 to 1.8). Cataract was the most common cause of blindness (45.7%) followed by overall posterior segment disorders (39.1%). Cataract surgical outcome was good (VA>6/18) or very good (VA>6/12) in 805/1190 (67.6%) cases. Cataract surgical coverage was 96.7%. ‘Need not felt’ (36.6%) and ‘cost’ (31.7%) were the most common barriers for cataract surgery. Conclusion Prevalence of blindness is showing declining trend in urban India. Cataract remains a major cause of blindness followed by posterior segment disorders. Social marketing, and referral linkages between community and service providers were planned after this survey.
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Affiliation(s)
- Sucheta Kulkarni
- Department of community ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, India
| | - Shridevi Kondalkar
- Department of community ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, India
| | - Islay Mactaggart
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - B R Shamanna
- School of Medical Sciences, University of Hyderabad, Hyderabad, India
| | - Azher Lodhi
- Department of community ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, India
| | - Rohit Mendke
- Department of community ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, India
| | - Jitesh Kharat
- Department of community ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, India
| | - Rajesh Kapse
- Department of community ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, India
| | - Kuldeep Dole
- Department of community ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, India
| | - Madan Deshpande
- Department of community ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, India
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Zhao J, Mariotti SP, Resnikoff S, Wang Y, Yu S, He M, Fan Y, Zou H, Zhang W, Jia Y, Wang L, Guan H, Xu X, Zhan L, An L, Ye Q, Wang N. Assessment of trachoma in suspected endemic areas within 16 provinces in mainland China. PLoS Negl Trop Dis 2019; 13:e0007130. [PMID: 30689647 PMCID: PMC6366720 DOI: 10.1371/journal.pntd.0007130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 02/07/2019] [Accepted: 01/04/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND China used to be among the countries with a high prevalence of trachoma. At the launch of The Global Elimination of Trachoma (GET) 2020 campaign by the World Health Organization (WHO) in 1996, China was placed on the list of countries endemic for trachoma based on historical data. However, empirical observation and routinely collected eye care data were suggesting that trachoma was no longer a public health problem. To determine whether the GET 2020 goals had been met in P. R. China, we conducted a targeted assessment with national scope. METHODOLOGY/PRINCIPAL FINDING Province assessment teams, trained in WHO Trachoma Rapid Assessment (TRA) methodology and in WHO simplified trachoma grading system, carried out assessments in 16 provinces (among them, 2 provinces conducted pilot assessment). Based on the published literature, including national and international reports, suspected trachoma-endemic areas within each province were identified. Within these areas, trachomatous inflammation- follicular (TF) assessments were carried out in at least 50 grade-one children in primary schools serving villages with the lowest socio-economic development. Trachomatous trichiasis (TT) and corneal opacity (CO) assessments were conducted among persons aged 15 and over in villages within the catchment area of the selected schools. Of 8,259 children examined in 128 primary schools in 97 suspected trachoma endemic areas, only 16 cases of conjunctivitis were graded as TF. 38 cases with TT were found among the 339,013 examined residents in villages surrounding the schools. Among these 97 suspected trachoma endemic areas in only three was the prevalence of TT more than 0.2%. CONCLUSIONS/SIGNIFICANCE This large study suggested that trachoma was not a public health problem in 16 provinces that had been previously suspected to be endemic. These findings will facilitate planning for elimination of trachoma from PR China.
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Affiliation(s)
- Jialiang Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Silvio Paolo Mariotti
- Non Communicable Diseases and Mental Health, World Health Organization, Geneva, Switzerland
| | - Serge Resnikoff
- Brien Holden Vision Institute and SOVS, University of New South Wales, Sydney, Australia
| | - Yuqin Wang
- Pharmacy Department, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Shicheng Yu
- Health Statistics Department, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mingguang He
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
| | - Yingchuan Fan
- Department of Ophthalmology, Sichuan Provincial People’s Hospital, Chengdu, China
| | - Haidong Zou
- Department of Ophthalmology, Shanghai First People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Wenfang Zhang
- Department of Ophthalmology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Yading Jia
- Department of Ophthalmology, Shanxi Eye Hospital, Taiyuan, China
| | - Lihua Wang
- Department of Ophthalmology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
| | - Huaijin Guan
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, China
| | - Xiao Xu
- Rehabilitation Administration Department, National Institute of Hospital Administration, National Health and Family Planning Commission, Beijing, China
| | - Leilei Zhan
- Rehabilitation Administration Department, National Institute of Hospital Administration, National Health and Family Planning Commission, Beijing, China
| | - Lei An
- Rehabilitation Administration Department, National Institute of Hospital Administration, National Health and Family Planning Commission, Beijing, China
| | - Quanfu Ye
- Rehabilitation Administration Department, National Institute of Hospital Administration, National Health and Family Planning Commission, Beijing, China
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing, China
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Jiachu D, Jiang F, Luo L, Zheng H, Duo J, Yang J, Nima Y, Ling J, Xiao B, Bassett K. Blindness and eye disease in a Tibetan region of China: findings from a Rapid Assessment of Avoidable Blindness survey. BMJ Open Ophthalmol 2018; 3:e000209. [PMID: 30539152 PMCID: PMC6257377 DOI: 10.1136/bmjophth-2018-000209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/06/2018] [Accepted: 10/16/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction The only population-based survey of blindness and visual impairment of a Tibetan population was conducted in the Tibet Autonomous Region in 1999. Methods and analysis The Rapid Assessment of Avoidable Blindness methodology was used to conduct a survey of Kandze Tibetan Autonomous Prefecture, Sichuan Province of China in the Fall 2017. Using the 2010 census, 100 clusters of 50 participants aged 50 years or older were randomly sampled using probability proportionate to size. Results Among the 5000 people enumerated, 4763 were examined (95.3% response). The age-adjusted and sex-adjusted prevalence of blindness, severe visual impairment, moderate visual impairment and early visual impairment (EVI) were 1.6% (95% CI: 1.08 to 2.38)), 0.9% (95% CI:0.7 to 1.5), 5.1% (95% CI:4.4 to 5.7), and 7.45% (95% CI:6.67 to 8.2), respectively. The prevalence of blindness among Tibetans was significantly higher than that among Han Chinese (2.2% (95% CI:1.8 to 2.6) and 0.6 (95% CI:0.2 to 1.7), respectively, p<0.05). Women bore a significant excess burden of EVI compared with men (8.5% (95% CI:7.5 to 9.6) and 6.1% (95% CI:5.1 to 7.2), respectively, p<0.05). Cataract was the primary cause of blindness (39.4%) followed by macular degeneration (10.6%) and corneal opacity (5.3%). Conclusion Blindness and visual impairment in Kandze Tibetan Autonomous Prefecture is substantially less than an earlier study of a Tibetan region and now resembles other regions of China. About 58% of blindness and 67% of SVIwere avoidable, primarily by providing cataract services. Eighty-three percent of EVI was avoidable by providing refractice services throughout the region.
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Affiliation(s)
- Danba Jiachu
- Kham Eye Centre, Kandze Prefecture People`s Hospital, Dartsedo, China
| | - Feng Jiang
- Kham Eye Centre, Kandze Prefecture People`s Hospital, Dartsedo, China
| | - Li Luo
- Kham Eye Centre, Kandze Prefecture People`s Hospital, Dartsedo, China
| | - Hong Zheng
- Kham Eye Centre, Kandze Prefecture People`s Hospital, Dartsedo, China
| | - Ji Duo
- Kham Eye Centre, Kandze Prefecture People`s Hospital, Dartsedo, China
| | - Jing Yang
- Kham Eye Centre, Kandze Prefecture People`s Hospital, Dartsedo, China
| | - Yongcuo Nima
- Kham Eye Centre, Kandze Prefecture People`s Hospital, Dartsedo, China
| | - Jin Ling
- Department of Preventive Ophthalmology, Zhongshan Ophthalmic Center of Sun Yat-sen University, Guangzhou, China
| | - Baixiang Xiao
- Department of Preventive Ophthalmology, Zhongshan Ophthalmic Center of Sun Yat-sen University, Guangzhou, China
| | - Ken Bassett
- British Columbia Center for Epidemiology & International Ophthalmology and Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
- Seva Canada, Vancouver, Canada
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Szabó D, Sándor GL, Tóth G, Pék A, Lukács R, Szalai I, Tóth GZ, Papp A, Nagy ZZ, Limburg H, Németh J. Visual impairment and blindness in Hungary. Acta Ophthalmol 2018; 96:168-173. [PMID: 28834193 DOI: 10.1111/aos.13542] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 06/26/2017] [Indexed: 02/05/2023]
Abstract
AIM The aim of this study was to estimate the prevalence and causes of blindness, severe visual impairment (SVI), moderate visual impairment (MVI), and early visual impairment (EVI) and its causes in an established market economy of Europe. DESIGN A cross-sectional population-based survey. METHODS A sample size of 3675 was calculated using the standard Rapid Assessment of Avoidable Blindness (RAAB) software in Hungary. A total of 105 clusters of 35 people aged 50 years or older were randomly selected with probability proportionate to size by the Hungarian Central Statistical Office. Households within the clusters were selected using compact segment sampling. Visual acuity (VA) was assessed with a Snellen tumbling E-chart with or without a pinhole in the households. RESULTS The adjusted prevalences of bilateral blindness, SVI, MVI and EVI were 0.9% (95% CI: 0.6-1.2), 0.5% (95% CI: 0.2-0.7), 5.1% (95% CI: 4.3-5.9) and 6.9% (95% CI: 5.9-7.9), respectively. The major causes of blindness in Hungary were age-related macular degeneration (AMD; 27.3%) and other posterior segment diseases (27.3%), cataract (21.2%) and glaucoma (12.1%). Cataract was the main cause of SVI, MVI and EVI. Cataract surgical coverage (CSC) was 90.7%. Of all bilateral blindness in Hungary, 45.5% was considered avoidable. CONCLUSION This study proved that RAAB methodology can be successfully conducted in industrialized countries, which often lack reliable epidemiologic data. The prevalence of blindness was relatively low, with AMD and other posterior segment diseases being the leading causes, and cataract is still a significant cause of visual impairment.
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Affiliation(s)
- Dorottya Szabó
- Department of Ophthalmology; Semmelweis University; Budapest Hungary
| | | | - Gábor Tóth
- Department of Ophthalmology; Semmelweis University; Budapest Hungary
| | - Anita Pék
- Department of Ophthalmology; Semmelweis University; Budapest Hungary
- Department of Ophthalmology; Petz Aladár Hospital; Győr Hungary
| | - Regina Lukács
- Department of Ophthalmology; Semmelweis University; Budapest Hungary
- Department of Ophthalmology; Flór Ferenc Hospital; Budapest Hungary
| | - Irén Szalai
- Department of Ophthalmology; Semmelweis University; Budapest Hungary
| | | | - András Papp
- Department of Ophthalmology; Semmelweis University; Budapest Hungary
| | - Zoltán Zsolt Nagy
- Department of Ophthalmology; Semmelweis University; Budapest Hungary
| | - Hans Limburg
- Health Information Services; Grootebroek The Netherlands
| | - János Németh
- Department of Ophthalmology; Semmelweis University; Budapest Hungary
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Zhang G, Tham YC, Gong H, Ren F, Morige J, Dai W, Cheng CY, Zhang H, Liu L. Blindness, low vision and cataract surgery outcome among adults in Hohhot of Inner Mongolia: a Rapid Assessment of Avoidable Blindness (RAAB) study. Br J Ophthalmol 2018; 102:1653-1657. [PMID: 29439090 DOI: 10.1136/bjophthalmol-2017-311633] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/04/2018] [Accepted: 01/29/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND To determine the prevalence and causes of visual impairment (VI), and to describe the characteristics of cataract surgery coverage and related barriers among adults aged ≥50 years residing in Hohhot, Inner Mongolia. METHODS A population-based cross-sectional study was performed. Presenting visual acuity (PVA) was measured using the Rapid Assessment of Avoidable Blindness (RAAB) methodology. All VI cases were defined using the WHO definition, based on the PVA of the better-seeing eye. Details on history of cataract surgery and barriers to cataract surgery were also obtained using a standardised questionnaire. RESULTS Of 4500 eligible individuals, 3985 (88.6% response rate) were examined. The age-standardised prevalence of moderate VI (PVA <6/18 to ≥6/60) was 5.4% (95% CI 4.6% to 6.3%), and severe VI (PVA <6/60 to ≥3/60) was 0.9% (95% CI 0.6% to 1.3%). The age-standardised prevalence of blindness (PVA <3/60) was 1.2% (95% CI 0.8% to 1.6%). Uncorrected refractive error (40.1%) and cataract (37.9%) were the leading causes of overall VI. Cataract (34.9%) was the leading cause of blindness. Among individuals with blindness, cataract surgical coverage was 80.7%. Among individuals with blindness due to cataract, the main barriers to cataract surgery were lack of awareness (38.1%). CONCLUSIONS The age-standardised prevalence rate of blindness in Hohhot was lower compared with other RAAB studies in China. Cataract was the leading cause of blindness. These findings provide useful information for the planning of public healthcare services in Inner Mongolia.
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Affiliation(s)
- Guisen Zhang
- Department of Ophthalmology, Hohhot Chao Ju Eye Hospital, Hohhot, China
| | - Yih-Chung Tham
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore
| | - Hui Gong
- Department of Ophthalmology, Hohhot Chao Ju Eye Hospital, Hohhot, China
| | - Fengmei Ren
- Department of Ophthalmology, Hohhot Chao Ju Eye Hospital, Hohhot, China
| | - Jilitu Morige
- Department of Ophthalmology, Hohhot Chao Ju Eye Hospital, Hohhot, China
| | - Wei Dai
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore
| | - Ching-Yu Cheng
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore
| | - Han Zhang
- Department of Ophthalmology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Lei Liu
- Department of Ophthalmology, The First Affiliated Hospital, China Medical University, Shenyang, China
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Li Y, Huang W, Qiqige A, Zhang H, Jin L, Ti P, Yip J, Xiao B. Prevalence and causes of blindness, visual impairment among different ethnical minority groups in Xinjiang Uygur autonomous region, China. BMC Ophthalmol 2018. [PMID: 29433477 DOI: 10.1186/s12886‐018‐0705‐6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this cross-sectional study is to ascertain the prevalence and causes of blindness, visual impairment, uptake of cataract surgery among different ethnic groups in Xinjiang Uygur Autonomous Region, China. METHODS Four thousand one hundred fifty people at 50 years and above from different minority ethnic groups were randomly selected for an eye examination. The four trained eye teams collected data using tumbling E visual chart, torch, portable slit lamp and direct ophthalmoscope in 2015. The World Health Organization's definition of blindness and visual impairment (VI) was used to classify patients in each ethnic group. Data were analyzed by different minority groups and were compared with Han Chinese. RESULTS 3977 (95.8%) out of 4150 people were examined. The prevalence of blindness from the study population was 1.7% (95% confidence interval: 1.3-2.2%).There was no significant difference in prevalence of blindness between Han Chinese and people of Khazak and other minority ethnic groups, nor, between male and female. Cataract was the leading course (65.5%) of blindness and uncorrected refractive error was the most common cause of VI (36.3%) followed by myopic retinopathy. The most common barrier to cataract surgery was lack of awareness of service availability. CONCLUSIONS This study documented a low blindness prevalence among people aged 50 years and over comparing to prevalence identified through studies of other regions in China. It still indicates blindness and un-operated cataract as the significant public health issue, with no evidence of eye health inequalities, but some inequities in accessing to cataract surgery amongst ethnic minority groups in Xinjiang.
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Affiliation(s)
- Yanping Li
- The Affiliated Eye Hospital of Nanchang University, Nanchang City, China
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, #54 South Xianlie Road, Guangzhou City, Guangdong Province, 510060, China
| | - Aoyun Qiqige
- Tacheng District People's Hospital, Tacheng City, Xinjiang Uygur Autonomous Region, China
| | - Hongwei Zhang
- Altay District People's Hospital, Altay City, Xinjiang Uygur Autonomous Region, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, #54 South Xianlie Road, Guangzhou City, Guangdong Province, 510060, China
| | - Pula Ti
- Xinjiang Regional Hospital, Urumqi, China
| | - Jennifer Yip
- International Center for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Baixiang Xiao
- The Affiliated Eye Hospital of Nanchang University, Nanchang City, China. .,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, #54 South Xianlie Road, Guangzhou City, Guangdong Province, 510060, China.
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Li Y, Huang W, Qiqige A, Zhang H, Jin L, Ti P, Yip J, Xiao B. Prevalence and causes of blindness, visual impairment among different ethnical minority groups in Xinjiang Uygur autonomous region, China. BMC Ophthalmol 2018; 18:41. [PMID: 29433477 PMCID: PMC5809952 DOI: 10.1186/s12886-018-0705-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/02/2018] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this cross-sectional study is to ascertain the prevalence and causes of blindness, visual impairment, uptake of cataract surgery among different ethnic groups in Xinjiang Uygur Autonomous Region, China. Methods Four thousand one hundred fifty people at 50 years and above from different minority ethnic groups were randomly selected for an eye examination. The four trained eye teams collected data using tumbling E visual chart, torch, portable slit lamp and direct ophthalmoscope in 2015. The World Health Organization’s definition of blindness and visual impairment (VI) was used to classify patients in each ethnic group. Data were analyzed by different minority groups and were compared with Han Chinese. Results 3977 (95.8%) out of 4150 people were examined. The prevalence of blindness from the study population was 1.7% (95% confidence interval: 1.3–2.2%).There was no significant difference in prevalence of blindness between Han Chinese and people of Khazak and other minority ethnic groups, nor, between male and female. Cataract was the leading course (65.5%) of blindness and uncorrected refractive error was the most common cause of VI (36.3%) followed by myopic retinopathy. The most common barrier to cataract surgery was lack of awareness of service availability. Conclusions This study documented a low blindness prevalence among people aged 50 years and over comparing to prevalence identified through studies of other regions in China. It still indicates blindness and un-operated cataract as the significant public health issue, with no evidence of eye health inequalities, but some inequities in accessing to cataract surgery amongst ethnic minority groups in Xinjiang.
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Affiliation(s)
- Yanping Li
- The Affiliated Eye Hospital of Nanchang University, Nanchang City, China
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, #54 South Xianlie Road, Guangzhou City, Guangdong Province, 510060, China
| | - Aoyun Qiqige
- Tacheng District People's Hospital, Tacheng City, Xinjiang Uygur Autonomous Region, China
| | - Hongwei Zhang
- Altay District People's Hospital, Altay City, Xinjiang Uygur Autonomous Region, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, #54 South Xianlie Road, Guangzhou City, Guangdong Province, 510060, China
| | - Pula Ti
- Xinjiang Regional Hospital, Urumqi, China
| | - Jennifer Yip
- International Center for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Baixiang Xiao
- The Affiliated Eye Hospital of Nanchang University, Nanchang City, China. .,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, #54 South Xianlie Road, Guangzhou City, Guangdong Province, 510060, China.
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Zhao J, Xu X, Ellwein LB, Cai N, Guan H, He M, Liu P, Lv J, Sheng X, Yang P, Yi J, Yang M, Zhang R, Ding X, Du L, Li F, Lu H, Shao W, Wang J, Yuan Y, Zhou R, Zhuang W, An L. Prevalence of Vision Impairment in Older Adults in Rural China in 2014 and Comparisons With the 2006 China Nine-Province Survey. Am J Ophthalmol 2018; 185:81-93. [PMID: 29102607 DOI: 10.1016/j.ajo.2017.10.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 10/18/2017] [Accepted: 10/23/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE To estimate the prevalence of vision impairment and blindness in 2014 among older adults in rural China with comparisons with the 2006 Nine-Province Survey. DESIGN Population-based, cross-sectional study. METHODS Geographical cluster sampling was used in randomly selecting residents from a rural county or semi-rural district within 9 provinces: Beijing, Jiangsu, Guangdong, Heilongjiang, Jiangxi, Hebei, Ningxia, Chongqing, and Yunnan. Persons 50 years of age or older were enumerated through household visits and invited to examination sites for visual acuity testing and examination. Vision impairment and blindness in 2014 was compared with data from the 2006 survey. RESULTS Among 51 310 examined persons, the prevalence of presenting vision impairment (<20/63 to ≥20/400) in the better-seeing eye ranged from 6.05% to 15.3% across the 9 study sites, with presenting blindness (<20/400) ranging from 0.66% to 5.35%. With best-corrected visual acuity, the prevalence of vision impairment ranged from 1.96% to 8.74%, and blindness from 0.47% to 5.01%. Vision impairment was associated with older age, female sex, and little or no education. The overall prevalence of presenting vision impairment and blindness decreased during the 2006-2014 interval by 6.31% and 29.0%, respectively; and by 16.1% and 38.0%, respectively, after standardization of 2006 prevalence rates to the 2014 population. CONCLUSIONS Substantial progress has been made in the reduction of vision impairment in rural China. Nevertheless, vision impairment remains an important public health problem with substantial geographic disparities and with older age, female sex, and illiteracy as risk factors.
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Zhang X, Li EY, Leung CKS, Musch DC, Tang X, Zheng C, He M, Chang DF, Lam DSC. Prevalence of visual impairment and outcomes of cataract surgery in Chaonan, South China. PLoS One 2017; 12:e0180769. [PMID: 28797099 PMCID: PMC5552304 DOI: 10.1371/journal.pone.0180769] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/21/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose To estimate the prevalence and causes of blindness and visual impairment (VI), and report the outcomes of cataract surgery in Chaonan Region, Guangdong Province, southern China Design Cross-sectional population-based survey Participants A total of 3484 participants including 1397 men (40.1%) and 2087 women (59.9%) aged ≥50 years were examined (94.2% response rate). Method A two-stage cluster sampling procedure was used to select 3700 participants aged ≥50 years from 74 clusters of Chaonan Region. Participants were examined according to the Rapid Assessment of Avoidable Blindness (RAAB) method. Blindness and visual impairment (VI) were defined by the World Health Organization criteria. Participants with visual acuity (VA) < 6/18 in either eye were examined by ophthalmologists. The primary causes of blindness and VI were reported with reference to the participant’s better eye. Main outcome measures Prevalence and main causes of blindness, severe visual impairment (SVI), VI and the outcomes of cataract surgery Results The standardized prevalence rates of blindness, SVI, and VI were 2.4% (95% confidence interval [CI], 1.9–2.9%), 1.0% (95% CI, 0.7–1.4%), and 6.4% (95% CI, 5.6%– 7.1%), respectively. The principal cause of blindness and SVI was cataract, accounting for 67.1% and 67.6% respectively, and the principal cause of VI was refractive error (46.9%). One hundred and fifty five out of 3484 (4.4%) people (211 eyes) had cataract surgery. Of the 211 eyes that had cataract surgery, 96.7% were pseudophakic. 67.2% of the 211 operated eyes had a presenting visual acuity (PVA) of 6/18 or better. Conclusions The prevalence of blindness, SVI, and VI was high among rural residents in Chaonan. Cataract remained the leading cause of avoidable blindness. Outcomes of cataract surgery performed in rural private clinics were suboptimal. Quality-control initiatives such as hands-on training program should be introduced to improve cataract surgery outcomes.
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Affiliation(s)
- Xiujuan Zhang
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China
- Tianjin Eye Hospital, Tianjin, China
| | - Emmy Y. Li
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China
- Project Vision Charitable Foundation, Hong Kong, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong, China
| | | | - David C. Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Xin Tang
- Tianjin Eye Hospital, Tianjin, China
| | | | - Mingguang He
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, China
| | - David F. Chang
- The University of California, San Francisco, California, United States of America
| | - Dennis Shun-Chiu Lam
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China
- Project Vision Charitable Foundation, Hong Kong, China
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, China
- * E-mail:
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The Correlation of Age and Postoperative Visual Acuity for Age-Related Cataract. BIOMED RESEARCH INTERNATIONAL 2016; 2016:7147543. [PMID: 26881225 PMCID: PMC4736385 DOI: 10.1155/2016/7147543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/22/2015] [Accepted: 12/10/2015] [Indexed: 11/28/2022]
Abstract
Purpose. Clinically, what is the best time for age-related cataract (ARC) patients to receive surgeries and get the most benefits is important. We explored the relationship between age and presenting postoperative visual acuity (POVA) in patients from rural China. Methods. Three Lifeline Express Hospital Eye-Train missions of Peking University People's Hospital were chosen. At the first day after surgery, 3452 ARC eyes with the presenting POVA ≥ 6/60 were enrolled. The relationship between age and POVA was analyzed statistically. Results. In these three missions, there were more female patients than males; the ratio of females to males was 1.71. The average age of females was older than males. Overall, the percentages of patients with good visual outcomes (≥6/18) were significantly decreased with aging. Different regions had variations, but the trends were the same. There was weak linear correlation between age and POVA. The correlations of females were stronger than males in Yuncheng and Sanmenxia and weaker than males in Zhoukou. Conclusion. The good visual outcomes of presenting POVA were significantly decreased with aging and there were weak linear correlations between age and POVA in rural China. The linear correlation might be influenced by the difference of gender and region.
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Abstract
BACKGROUND Age-related cataract accounts for more than 40% of cases of blindness in the world with the majority of people who are blind from cataract living in lower income countries. With the increased number of people with cataract, it is important to review the evidence on the effectiveness of day care cataract surgery. OBJECTIVES To provide authoritative, reliable evidence regarding the safety, feasibility, effectiveness and cost-effectiveness of day case cataract extraction by comparing clinical outcomes, cost-effectiveness, patient satisfaction or a combination of these in cataract operations performed in day care versus in-patient units. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2015, Issue 7), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to August 2015), EMBASE (January 1980 to August 2015), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to August 2015), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 17 August 2015. SELECTION CRITERIA We included randomised controlled trials comparing day care and in-patient surgery for age-related cataract. The primary outcome was the achievement of a satisfactory visual acuity six weeks after the operation. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. We contacted study authors for additional information. We collected adverse effects information from the trials. MAIN RESULTS We included two trials. One study was conducted in the USA in 1981 (250 people randomised and completed trial) and one study conducted in Spain in 2001 (1034 randomised, 935 completed trial). Both trials used extracapsular cataract extraction techniques that are not commonly used in higher income countries now. Most of the data in this review came from the larger trial, which we judged to be at low risk of bias.The mean change in visual acuity (in Snellen lines) of the operated eye four months postoperatively was similar in people given day care surgery (mean 4.1 lines standard deviation (SD) 2.3, 464 participants) compared to people treated as in-patients (mean 4.1 lines, SD 2.2, 471 participants) (P value = 0.74). No data were available from either study on intra-operative complications.Wound leakage, intraocular pressure (IOP) and corneal oedema were reported in the first day postoperatively and at four months after surgery. There was an increased risk of high IOP in the day care group in the first day after surgery (risk ratio (RR) 3.33, 95% confidence intervals (CI) 1.21 to 9.16, 935 participants) but not at four months (RR 0.61, 95% CI 0.14 to 2.55, 935 participants). The findings for the other outcomes were inconclusive with wide CIs. There were two cases of endophthalmitis observed at four months in the day care group and none in the in-patient group. The smaller study stated that there were no infections or severe hyphaemas.In a subset of participants evaluated for quality of life (VF14 questionnaire) similar change in quality of life before and four months after surgery was observed (mean change in VF14 score: day care group 25.2, SD 21.2, 150 participants; in-patient group: 23.5, SD 25.7, 155 participants; P value = 0.30). Subjective assessment of patient satisfaction in the smaller study suggested that participants preferred to recuperate at home, were more comfortable in their familiar surroundings and enjoyed the family support that they received at home. Costs were 20% more for the in-patient group and this was attributed to higher costs for overnight stay. AUTHORS' CONCLUSIONS This review provides evidence that there is cost saving with day care cataract surgery compared to in-patient cataract surgery. Although effects on visual acuity and quality of life appeared similar, the evidence with respect to postoperative complications was inconclusive because the effect estimates were imprecise. Given the wide-spread adoption of day care cataract surgery, future research in cataract clinical pathways should focus on evidence provided by high quality clinical databases (registers), which would enable clinicians and healthcare planners to agree clinical and social indications for in-patient care and so make better use of resources.
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Affiliation(s)
- David Lawrence
- London School of Hygiene & Tropical MedicineKeppel StreetLondonUKWC1E 7HT
| | | | - Esther J van Zuuren
- Leiden University Medical CenterDepartment of DermatologyPO Box 9600B1‐QLeidenNetherlands2300 RC
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Patil S, Gogate P, Vora S, Ainapure S, Hingane RN, Kulkarni AN, Shammanna BR. Prevalence, causes of blindness, visual impairment and cataract surgical services in Sindhudurg district on the western coastal strip of India. Indian J Ophthalmol 2015; 62:240-5. [PMID: 24618491 PMCID: PMC4005244 DOI: 10.4103/0301-4738.128633] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Konkan coast of India is geographically distinct and its pattern of blindness has never been mapped. Aim: To study the prevalence and causes of blindness and cataract surgical services in Sindhudurg district of West Coast. Subjects: Individual aged > 50 years. Materials and Methods: Rapid assessment of avoidable blindness used to map blindness pattern in the district. Statistical analysis: SPSS version 19. Results: Amongst those examined 1415 (51.7%) had visual acuity (VA) >20/60, 924 (33.8%, confidence interval (C.I) 30.5%-36.8%) had VA 20/200-<20/60(visual impairment), 266 (9.7%, C.I. 6.1%-13.3%) had VA < 20/200-20/400 (severe visual impairment) and 132 (4.8%, C. I. 1.1%-8.5%) had VA < 20/400 (blindness by WHO standards). There was no significant gender difference in prevalence of blindness, but blindness and visual impairment was more in older and rural residing individuals. Amongst those with presenting vision < 20/200 in better eye, 309 (82.4%) had cataract, 36 (9.7%) had corneal scars, 13 (3.5%) had diabetic retinopathyand 3 (0.8%) had glaucoma. Cataract surgical coverage for the district was only 30.5%; 32% for males and 28.4% for females. Unable to afford, lack of knowledge and lack of access to services were the commonest barriers responsible for cataract patients not seeking care. Amongst those who had undergone cataract surgery, only 50% had visual acuity ≥ 20/60.46.9% of the population had spectacles for near, but only 53.3% of the population had presenting near vision < N10. Conclusion: Cataract, refractive errors and diabetes were significant causes of visual impairment and blindness.
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Affiliation(s)
| | - Parikshit Gogate
- Lions NAB Eye Hospital, Miraj; Dr. Gogate's Eye Clinic, Pune, Maharashtra, India
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Prevalence and Causes of Visual Impairment in a Chinese Adult Population: The Taizhou Eye Study. Ophthalmology 2015; 122:1480-8. [PMID: 25986897 DOI: 10.1016/j.ophtha.2015.03.022] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 03/18/2015] [Accepted: 03/19/2015] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To study the current prevalence and causes of low vision and blindness in an adult Chinese population. DESIGN Population-based, cross-sectional study. PARTICIPANTS We used a random cluster sampling method and evaluated 10 234 eligible subjects ≥45 years old (response rate, 78.1%) in the Taizhou Eye Study. METHODS Examinations were performed from July 2012 through December 2013. Participants underwent a detailed examination, including uncorrected visual acuity, best-corrected visual acuity (BCVA), intraocular pressure, axial length, slit-lamp, and fundus examinations to evaluate the prevalence and primary causes of visual impairment (VI). MAIN OUTCOME MEASURES We defined low vision and blindness according to the World Health Organization (WHO) criteria (low vision: BCVA, <20/63-≥20/400; blindness: BCVA, <20/400 in the better eye) and United States criteria (low vision: BCVA, <20/40-≥20/200; blindness: BCVA, <20/200 in the better eye). RESULTS Using the WHO BCVA criteria, the standardized prevalence of bilateral low vision and blindness were 5.1% and 1.0%, respectively. Using the United States BCVA criteria, the standardized prevalence were 12.8% and 1.5%, respectively. Using the WHO criteria, the primary causes of bilateral low vision and blindness were cataract (59.1% and 48.5%, respectively), myopic macular degeneration (17.6% and 17.2%, respectively), and age-related macular degeneration (11.6% and 10.1%, respectively). The primary causes of monocular low vision were cataract (55.6%), age-related macular degeneration (12.6%), and myopic macular degeneration (8.9%), whereas those of monocular blindness were cataract (46.8%), atrophy of eyeball or prosthetic eye (10.2%), and cornea opacity (7.3%). A further analysis revealed that in adults 45-59 years old, myopic macular degeneration (59.6% and 27.2%, respectively) and cataract (13.8% and 23.4%, respectively) were the leading causes of bilateral and monocular VI. In adults ≥60 years old, cataract (66.8% and 61.2%, respectively) and age-related macular degeneration (12.6% and 11.8%, respectively) were the primary causes of bilateral and monocular VI. CONCLUSIONS The prevalence of low vision and blindness in Chinese adults remains a severe public health problem. In the Taizhou Eye Study, cataract was the leading cause of low vision and blindness. Myopic macular degeneration and cataract were the primary causes of VI in adults 45-59 years and ≥60 years old, respectively.
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Prevalence of Blindness and Outcomes of Cataract Surgery in Hainan Province in South China. Ophthalmology 2013; 120:2176-83. [DOI: 10.1016/j.ophtha.2013.04.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 04/03/2013] [Accepted: 04/03/2013] [Indexed: 11/20/2022] Open
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Lindfield R, Vishwanath K, Ngounou F, Khanna RC. The challenges in improving outcome of cataract surgery in low and middle income countries. Indian J Ophthalmol 2013; 60:464-9. [PMID: 22944761 PMCID: PMC3491277 DOI: 10.4103/0301-4738.100552] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cataract is the leading cause of blindness globally and surgery is the only known measure to deal with it effectively. Providing high quality cataract surgical services is critical if patients with cataract are to have their sight restored. A key focus of surgery is the outcome of the procedure. In cataract surgery this is measured predominantly, using visual acuity. Population- and hospital-based studies have revealed that the visual outcome of cataract surgery in many low and middle income settings is frequently sub-optimal, often failing to reach the recommended standards set by the World Health Organization (WHO). Another way of measuring outcome of cataract surgery is to ask patients for their views on whether surgery has changed the functioning of their eyes and their quality of life. There are different tools available to capture patient views and now, these patient-reported outcomes are becoming more widely used. This paper discusses the visual outcome of cataract surgery and frames the outcome of surgery within the context of the surgical service, suggesting that the process and outcome of care cannot be separated. It also discusses the components of patient-reported outcome tools and describes some available tools in more detail. Finally, it describes a hierarchy of challenges that need to be addressed before a high quality cataract surgical service can be achieved.
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Affiliation(s)
- Robert Lindfield
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Ko F, Frick KD, Tzu J, He M, Congdon N. Willingness to pay for potential enhancements to a low-cost cataract surgical package in rural southern China. Acta Ophthalmol 2012; 90:e54-60. [PMID: 21801337 DOI: 10.1111/j.1755-3768.2011.02207.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess determinants of patients' willingness to pay (WTP) for potential components of a multi-tiered cataract surgical package offered by a non-governmental organization (NGO) in rural China. DESIGN Cross-sectional study. METHODS Demographic and clinical data were collected from 505 patients presenting for cataract screening or surgery in Yangjiang, China. Willingness to pay for potential enhancements to the current surgery package was assessed using a bidding format with random payment cards. RESULTS Among 426 subjects (84.4%) completing interviews, the mean age was 73.9 ± 7.3 years, 67.6% were women and 73% (n = 310) would pay for at least one offering, with 33-38% WTP for each item. Among those who would pay, the mean WTP for food was US$1.68 ± 0.13, transportation US$3.24 ± 0.25, senior surgeon US$50.0 ± 3.36 and US$89.4 ± 4.19 for an imported intra-ocular lens (IOL). The estimated total recovery from these enhancements under various assumptions would be US$20-50 (compared to the current programme price of US$65). In multivariate models, WTP for the senior surgeon increased with knowledge of a person previously operated for cataract (OR = 2.13, 95% CI 1.42-3.18, p < 0.001). Willingness to pay for the imported IOL increased with knowledge of a previously operated person (OR = 1.85, 95% CI 1.24-2.75, p < 0.01) and decreased with age >75 years (OR = 0.61, 0.40-0.93, p < 0.05). CONCLUSIONS Opportunities exist to increase cataract programme revenues through multi-tiered offerings in this setting, allowing greater subsidization of low-income patients. Personal familiarity with cataract surgery is important in determining WTP.
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Affiliation(s)
- Fang Ko
- Wilmer Eye Institute, Baltimore, Maryland, USA
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Fedorowicz Z, Lawrence D, Gutierrez P, van Zuuren EJ. Day care versus in-patient surgery for age-related cataract. Cochrane Database Syst Rev 2011:CD004242. [PMID: 21735397 DOI: 10.1002/14651858.cd004242.pub4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Age-related cataract accounts for more than 40% of cases of blindness in the world with the majority of people who are blind from cataract found in the developing world. With the increased number of people with cataract there is an urgent need for cataract surgery to be made available as a day care procedure. OBJECTIVES To provide reliable evidence for the safety, feasibility, effectiveness and cost-effectiveness of cataract extraction performed as day care versus in-patient procedure. SEARCH STRATEGY We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 5), MEDLINE (January 1950 to May 2011), EMBASE (January 1980 to May 2011), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to May 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (www.clinicaltrials.gov). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 23 May 2011. SELECTION CRITERIA We included randomised controlled trials comparing day care and in-patient surgery for age-related cataract. The primary outcome was the achievement of a satisfactory visual acuity six weeks after the operation. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. Adverse effects information was collected from the trials. MAIN RESULTS We included two trials (conducted in Spain and USA), involving 1284 people. One trial reported statistically significant differences in early postoperative complication rates in the day care group, with an increased risk of increased intraocular pressure, which had no clinical relevance to visual outcomes four months postoperatively. The mean change in visual acuity (Snellen lines) of the operated eye four months postoperatively was 4.1 (standard deviation (SD) 2.3) for the day care group and 4.1 (SD 2.2) for the in-patient group and not statistically significant. The four-month postoperative mean change in quality of life score measured using the VF14 showed minimal differences between the two groups. Costs were 20% more for the in-patient group and this was attributed to higher costs for overnight stay. One study only reported hotel costs for the non-hospitalised participants making aggregation of data on costs impossible. AUTHORS' CONCLUSIONS This review provides some evidence that there is a cost saving but no significant difference in outcome or risk of postoperative complications between day care and in-patient cataract surgery. This is based on one detailed and methodologically sound trial conducted in the developed world. The success, safety and cost-effectiveness of cataract surgery as a day care procedure appear to be acceptable. Future research may well focus on evidence provided by high quality clinical databases and registers which would enable clinicians and healthcare planners to agree clinical and social indications for in-patient care and so make better use of resources, by selecting day case surgery unless these criteria are met.
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Affiliation(s)
- Zbys Fedorowicz
- UKCC (Bahrain Branch), Ministry of Health, Bahrain, Box 25438, Awali, Bahrain
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Kempen JH. The Need for a Revised Approach to Epidemiological Monitoring of the Prevalence of Visual Impairment. Ophthalmic Epidemiol 2011; 18:99-102. [DOI: 10.3109/09286586.2011.588908] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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