Abstract
Despite significant evidence around barriers hindering timely access to cataract surgery in low- and middle-income countries (LMICs), little is known about the strategies necessary to overcome them and the factors associated with improved access. Despite significant evidence that certain groups, women for example, experience disproportionate difficulties in access, little is known about how to improve the situation for them. Two reviews were conducted recently: Ramke et al., 2018 reported experimental and quasi-experimental evaluations of interventions to improve access of cataract surgical services, and Mercer et al., 2019 investigated interventions to improve gender equity. The aim of this systematic review was to collate, appraise and synthesise evidence from studies on factors associated with uptake of cataract surgery and strategies to improve the uptake in LMICs. We performed a literature search of five electronic databases, google scholar and a detailed reference review. The review identified several strategies that have been suggested to improve uptake of cataract surgery including surgical awareness campaigns; use of successfully operated persons as champions; removal of patient direct and indirect costs; regular community outreach; and ensuring high quality surgeries. Our findings provide the basis for the development of a targeted combination of interventions to improve access and ensure interventions which address barriers are included in planning cataract surgical services. Future research should seek to examine the effectiveness of these strategies and identify other relevant factors associated with intervention effects.
Highlights
Cataract occurs when the normal clear lens of the eye becomes cloudy leading to gradual, progressive loss of vision often in both eyes [1]
This systematic review aimed to synthesise all available evidence on the uptake of cataract surgeries in low and middle-income countries (LMICs), including reported uptake rates, factors influencing the uptake and interventions reported to improve it
The review builds on two other systematic reviews [23] and [24], which investigated interventions to improve equity in eye care
Summary
Cataract occurs when the normal clear lens of the eye becomes cloudy leading to gradual, progressive loss of vision often in both eyes [1]. Cataract is a major cause of visual impairment. Factors associated with the uptake of cataract surgery and interventions to improve uptake globally, affecting 20 million people who are blind [1, 2] and another 65 million who have moderate or severe visual impairment. People from poorer households, and those living in low and middle-income countries (LMICs) are disproportionately affected by visual loss from cataract [3,4,5]. Despite technical advances in the management of cataract, the volume of cataract surgeries in many LMICs remains low. This can be attributed to a combination of supply-side (provider) and demand-side (patient) factors. Demand-side factors may include insufficient community awareness, fear of surgery, cultural beliefs and inability to travel to healthcare facilities [11, 12]
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