Cataract and its surgery in Fiji

Abstract

To characterize cataract and its surgery among adults aged ≥40 years in Fiji. Population-based cross-sectional survey using multistage cluster random sampling. 1381 (= 73.0% participation); eight provinces on Viti Levu. Interview-based questionnaire; visual acuity measured; autorefraction; dilated ocular examination. Prevalence; predictors; surgical outcomes. Being Indian (P = 0.001), elderly (P < 0.001), and previous/current smoker (P = 0.036) were predictive of at least one unoperated vision-impairing or operated cataract. Gender (P = 0.062) and diabetes (P = 0.384) were not. Unoperated cataract (predominantly nucleosclerosis) was the second most frequent (25.0%) cause of low vision (<6/18, ≥6/60) and commonest (71.1%) of blindness (<6/60). Ethnicity-gender-age-domicile adjusted and extrapolating to the Fiji population aged ≥40 years, prevalence of cataract-induced low vision and blindness were each 1.7% (95% confidence interval [CI] 1.0-2.4%). At least one eye of 4.6% and both of 1.8% participants had surgery (86.4% extracapsular). Gender (P = 0.213), age (P = 0.472) and rural/urban domicile (P = 0.895) were not predictors of surgery among those who required it in at least one eye. After intraocular lens surgery: 50.7% had pupillary posterior capsular opacification; mean spherical equivalent was -1.37 ± 1.95D (range, -6.38 to +2.25D); mean cylindrical error was 2.31 ± 1.75D (range, 0.0 to 8.75D); ≥N8 for 39.5%; ≥6/18 for 56.6%; <6/60 for 19.7%, with 2.6% no light perception. Ethnicity-gender-age-domicile adjusted and extrapolating to the Fiji population aged ≥40 years, Cataract Surgical Coverage (Person) was 47.5% (95%CI 29.2-65.8%) at <6/18, and 65.2% (95%CI 37.8-92.6%) at <6/60. Fiji cataract services and outcomes compare favourably with those of neighbouring Papua New Guinea and Timor Leste.