Abstract
BackgroundCataract is the leading cause of blindness in developing countries and identification of the barriers to accessing treatment is essential for developing appropriate public healthcare interventions. To evaluate the barriers to cataract surgery after diagnosis and assess the postoperative outcomes in Sao Paolo State, Brazil.MethodsThis prospective study evaluated cataract patients from 13 counties in São Paulo State in 2014. Cataract was diagnosed in the community by a mobile ophthalmic unit and patients were referred to a hospital for management. Gender, age, distance to the hospital and local municipal health structure were evaluated as possible barriers. Data were analyzed for postoperative outcomes and the impact on blindness and visual impairment.ResultsSix hundred patients were diagnosed with cataract with a mean age of 68.8±10.3 years and 374 (62.3%) were females. Two hundred and fifty-four (42.3%) patients presented to the referral hospital. One hundred forty-four (56.7%) underwent surgery, 56 (22.0%) decided not to undergo surgery, 40 (15.7%) required only YAG-Laser and 14 (5.5%) required a spectacle prescription only. Visual acuity increased statistically significantly from 1.07±0.73 logMAR at presentation to 0.25±0.41 logMAR at the final visit after intraocular lens implantation (p=0.000). There was a statistically significantly decrease from 17 (11.8%) blind patients and 55 (38.2%) visually impaired patients at presentation to 2 (1.4%) and 5 (3.5%) patients respectively after treatment (p=0.000).ConclusionLess than half of the individuals with cataract presented to the hospital for surgery. Among the patients who underwent treatment, there was an overall decrease in the number of blind individuals and visually impaired individuals. The barriers to cataract surgery were older age, greater distance to the hospital, municipalities with fewer inhabitants and less ophthalmic services.
Highlights
Cataract is the leading cause of blindness in developing countries and identification of the barriers to accessing treatment is essential for developing appropriate public healthcare interventions
The present study evaluates the barriers to cataract surgery and presents some suggestions to increase the uptake of cataract surgery
A cross-sectional prospective survey was performed in the southwest region of São Paulo State, Brazil, involving patients who were screened at a Ophthalmic Mobile Unit (OMU) in 2014
Summary
Cataract is the leading cause of blindness in developing countries and identification of the barriers to accessing treatment is essential for developing appropriate public healthcare interventions. Cataract surgery is a leading cause of blindness in developing countries [1]. Brazil has a universal public health system (Sistema Único de Saúde – SUS) that provides surgery without cost to those in need [5]. Cataract remains the major cause of blindness in Brazil [6, 7]. Appropriate public healthcare strategies can be developed to eliminate cataract as a source of blindness using data from studies of barriers to cataract surgery in de Almeida Ferreira et al BMC Ophthalmology (2017) 17:259 regions of Brazil. The present study evaluates the barriers to cataract surgery and presents some suggestions to increase the uptake of cataract surgery
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